A rare case of a strangulated Littre's hernia with Meckel's diverticulum duplication. Case report and literature review.

INTRODUCTION: The Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract present in approximately 1-4% of the population; the MD duplication is exceedingly rare with only a few reports of it. Here we present the firs case of a strangulated Littre's hernia with MD duplication. PRESENTATION OF CASE: A 30-year-old male presented to the emergency room with clinical signs of small bowel obstruction, at physical examination, a right incarcerated inguinal hernia with erythema was found. We did a laparotomy, and two MD were found, one in the sac with ischemia, and the other 90cm from the Bahuins valve. A diverticulectomy of the ischemic diverticulum was done, and the other MD was left in place; the inguinal region was repaired with a Lichtenstein technique. DISCUSSION: The complications of the MD are 3-4 times more frequent in men, been an intestinal obstruction, hemorrhage, diverticulitis, ulceration, and perforation. A Littrés hernia is when the MD is found in the sac; this is seen in the inguinal region in 50% of the cases. The management of a Littre's hernia is the resection of the MD; it could be done by an intestinal resection or by a diverticulectomy accordingly to the Park criteria. CONCLUSION: As to our knowledge, this is the first case of an incarcerated Littre's hernia with duplication of a Meckel's diverticulum.

Terapia cognitivo-conductual en las psicosis crónicas / Cognitive-behavioral therapy for chronic psychosis

En los últimos años, la terapia cognitivo-conductual (TCC) ha comenzado a utilizarse como una intervención en las psicosis crónicas, generalmente como complemento al tratamiento farmacológico. Este hecho ha motivado la realización de estudios controlados que analizan la eficacia de este tipo de intervenciones. Así, esta revisión bibliográfica tuvo como objetivo analizar aquellos estudios más relevantes hasta la fecha. Se incluyeron aquellos trabajos con un diseño controlado y aleatorio, y que garantizaban los requisitos de fiabilidad y validez. Los estudios muestran resultados esperanzadores, en cuanto que avalan la eficacia de la TCC como medida de tratamiento. Sin embargo, todavía se hace necesario un mayor número de investigaciones que avalen estos datos (AU)

Cognitive-behavioral therapy (CBT) has been used in recent years as an intervention for chronic psychoses, generally as a complement to the pharmacological treatment. This fact has motivated controlled studies that analyze the efficiency of this type of interventions. That is why this bibliographical review has aimed to analyze the most relevant studies up-to-date. Those works having a controlled and random design, that assured the requirements of reliability and validity, were included. The studies show encouraging results, because they support the efficiency of CBT as a measurement of treatment. Nevertheless, more investigations that support this information are still required (AU)

Prevención en salud bucodental del paciente diabético: el papel del odontólogo en el equipo de atención primaria para el paciente diabético / Prevention in bucodental' s health of the diabetic patient: the paper of the odontology in the team of primary attention for the diabetic patient

Los pacientes diabéticos, por su especial situación, tienen especial predisposición a ciertas patologías como la periodontitis, la caries, infecciones, liquen y otras patologías. Pero esta situación no se traduce en un mayor conocimiento, por parte de los pacientes, de esta asociación y no poseen, en general conductas de salud bucodental como una higiene bucal adecuada, programas de revisión, etc; incluso algunos no comunican su condición de diabéticos a su odontólogo. La realización de una encuesta sobre salud bucodental en los pacientes diabéticos pertenecientes al Ambulatorio José Marvá del área V de la Comunidad de Madrid, evidencia la carencia de promoción en salud bucodental en esta población. Sólo la mitad de ellos (63 por ciento) han sido informados de esa facilidad para padecer patologías bucodentales y solo la mitad (62 por ciento) de ellos se cepilla de manera habitual, como ejemplo de conducta de salud bucodental. Como conclusión, es evidente la necesidad de incluir dentro de los subprogramas de educación para la salud del diabético, la educación en salud bucodental (AU)

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International Multicenter Study of Head Injury in Children. ISHIP Group.

With the object of evaluating different epidemiological factors in the acute phase of head injury (HI) in the pediatric age group in five countries (Argentina, Brazil, France, Hong-Kong and Spain), we carried out a prospective and descriptive study, in which we analyzed the clinical and radiological risk factors versus management and outcome 7-30 days after trauma. We included all children seen in the emergency department and hospitalized who were aged between 0 and 15 years and had sustained HI. Data were compiled from the clinical records and analyzed for neurological evaluation with the Glasgow Coma Scale (GCS) and the Glasgow Paediatric Coma Score (GPCS), and also by means of dynamics, symptoms, skull X-rays, CT scans. The total of 2478 patients enrolled in the study was made up of 60.9% boys and 39.1 % girls. Age distribution was as follows: 55.2% aged 0-4 years; 28.3% aged 5-9 years, and 16.4% aged 10-15 years. Most (75.3%, or 1768) of these patients completed follow-up. The total sample included 1058 children (42.7%) who required hospitalization. Skull fractures were identified in 11.8% (298) of the cases, and 6.4% (158) of CT scans were pathologic. Minor HI accounted for 56.4% of these children, moderate HI for 38.9%, and severe HI for the remaining 4.7%. The lethality rate was 1.6%. Our preliminary data reveal that it is very important for new guidelines on the treatment of minor HI to be prepared, because patients with minor HI had undergone the most skull X-rays and also most frequently been admitted to hospital for unnecessarily long periods of time, though the incidence of brain damage (1.6%) was lowest in this group of the study population. We intend to carry out a full analysis of the various risk factors at the end of the study.

[Primary Mycobacterium avium respiratory infection in nonimmunocompromised children]. / Primoinfección respiratoria por Mycobacterium avium en niños no inmunocomprometidos.

Mycobacterium avium is a common pathogen in barnyards, where it infects poultry and pigs. In human beings M. avium is most often found to cause disease in immunocompromised individuals, although it is also described fairly often as affecting patients with tuberculosis or chronic obstructive pulmonary disease; in recent years lung infections by M. avium have even been reported in elderly women with no underlying disease. Respiratory infection by this mycobacterium is unusual, however, in healthy children. We describe the case of a previously healthy 2-year-old boy with pneumonia whose course was complicated. After 6 months of treatment with various broad spectrum antibiotics there was no clinically or radiologically observable improvement. Other underlying diseases were ruled out, including infection by germs that cause atypical pneumonia. When all tests were negative, we investigated the possibility of primary infection by an atypical mycobacterium. A skin test was positive for M. avium. Acid-alcohol resistant bacilli were isolated from lung biopsy samples and the presence of tuberculoid granulomas were confirmed. Our patient then responded favorably after tuberculostatic treatment with 3 drugs (isoniazid, rifampicin and pyrazinamide).