Pancreatitis aguda por migración de sonda de gastrostomía percutánea / Acute pancreatitis secondary to migration of percutaneous gastrostomy tube

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Addressing the need for access to culturally and linguistically appropriate HIV/AIDS prevention for Latinos.

This article reports a comprehensive national needs assessment of Latinos' access to HIV/AIDS prevention and education services in 14 cities throughout the United States and Puerto Rico. Interviews and focus groups were conducted with Latinos who were HIV-positive and at risk for HIV infection. The study explored risk behaviors, access to health care services, and exposure to HIV prevention messages. Differences in predictors of risk behaviors were noted by sex. For women, increased age, being married, foreign-born, and a U.S. resident, and having tested for HIV previously, were associated with reduced HIV/AIDS risk. Thematic analysis of qualitative findings revealed limited awareness of risk factors, and a need for culturally and linguistically appropriate, family-centered HIV/AIDS education incorporating Latino values. Findings were incorporated into culturally relevant brochures featuring vignettes and quotes. Brochures were distributed and evaluated by 71 community-based organizations (CBOs) in the U.S. and Latin America. Evaluators responded positively to the brochures, and Latino-serving organizations in 48 states now use them for HIV/AIDS prevention outreach and education.

Access to care for chronic pain: racial and ethnic differences.

UNLABELLED: Access to medical care is a major national issue, and several surveys suggest that racial and ethnic differences influence access to care for chronic pain problems. To evaluate the influence of race and ethnicity on access to treatment for chronic pain, a cross-sectional telephone survey was performed in a nationally representative sample of 454 white, 447 African-American, and 434 Hispanic subjects with pain for > or =3 months. Questions explored demographics, pain and its treatment, and perceived access to care. A composite "access" variable combined actual consultation with perceived access. Hispanics were younger, least likely to be insured, and had the least education and lowest income; 61% spoke Spanish at home. Hispanics were significantly less likely to have consulted a primary care practitioner for pain (70%) than whites (84%) or African-Americans (85%). A lower likelihood of consultation also was associated with speaking Spanish, being male, being relatively young (18-34 years old) or single, having limited education, and not being employed. Low "access" to care was associated with being Hispanic and speaking Spanish, being younger or male, having low income or limited education, being employed, and agreeing that financial concerns prevented pain treatment. High "access" was associated with being white or African-American; being older or female or living in a suburban area; having insurance, higher income, or college education; and being unemployed. In multivariate models, low "access" was associated with Hispanic ethnicity and agreement that financial concerns prevented pain treatment. High "access" was associated with more severe pain, having insurance or an income of US 25,000 dollars to US 74,000 dollars, and agreeing that "A doctor or other health care provider is the first person I would go to to discuss my pain." These data suggest that race/ethnicity, other demographic characteristics, and socioeconomic factors influence access to pain care. Hispanic ethnicity predicts limited access. PERSPECTIVE: The influence of race and ethnicity on access to health care is a major issue in the United States. A national telephone survey suggests that race and ethnicity, along with other demographic and socioeconomic factors, influence access to care for chronic pain.

Population-based survey of pain in the United States: differences among white, African American, and Hispanic subjects.

UNLABELLED: A cross-sectional telephone survey was conducted in nationally representative probability sample of non-Hispanic white subjects, non-Hispanic African American subjects, and Hispanic subjects of any race to explore relationships between chronic pain and race or ethnicity. Approximately one third in each group reported "frequent or persistent pain" for 3 months or longer during the past year, and approximately one third of the 454 white subjects, 447 African American subjects, and 434 Hispanic subjects in the final sample experienced "disabling pain" (defined as both high severity and high functional interference). White subjects had pain longer but with lesser intensity than the other groups, and pain-related life interference did not vary. Significantly fewer Hispanic subjects (68%) than white subjects (82%) or African American subjects (85%) had visited a physician for pain, and African American subjects (81%) were more likely than white subjects (75%) or Hispanic subjects (63%) to have used prescription medications. Disabling pain was positively associated with female sex (odds ratio [OR], 1.45), income of $25,000 or less (OR, 1.71), less than a high school education (OR, 1.72), and divorce (OR, 1.69) and was negatively associated with younger age (18-34 years; OR, 0.68), income between $25,000 and $74,999 (OR, 0.64) or $75,000 or more (OR, 0.37), being employed (OR, 0.48), suburban residence (OR, 0.64), and having a college (OR, 0.51) or graduate (OR, 0.32) degree. Multivariate logistic regression found that income of $25,000 or less (OR, 2.54), less than a high school education (OR, 1.59), and being unemployed (OR, 1.50) remained significant when other factors were controlled. Neither race nor ethnicity predicted disabling pain, but the minorities had more characteristics identified as predictors. The data suggest that race and ethnicity contribute to clinical diversity, but socioeconomic disadvantage is the more important predictor of disabling pain. PERSPECTIVE: Race and ethnicity influence the presentation and treatment of chronic pain. This study evaluated community-dwelling white, African American, and Hispanic subjects by using a sophisticated telephone survey methodology. Pain was highly prevalent across groups, and there were racial and ethnic differences in pain experience and treatment preferences. Race and ethnicity were not independently associated with severe pain, but both minorities were more likely to possess the socioeconomic and educational characteristics that were associated.

Sistema computadorizado de localización por angiografía estereotáxica transoperatoria como guía en abordajes / Computerized localization System by transoperatory stereotactic angiography as a guide in microsurgical approaches

La técnica de localización estereotáxica dirigida por angiografía cerebral, también llamada angiografía estereotáxica, consiste en la obtención de imágenes no paralelas del árbol vascular cerebral realizando una angiografía con la colaboración de un marco estereotáxico y localizadores adecuados. El sistema computadorizado de localización de un marco estereotáxico y localizadores adecuados. El sistema computadorizado de localización por angiografía estereotáxica (ANGIOWIN), diseñado en el Centro Internacional de Restauración Neurológica es un "software" médico para la localización de estructuras vasculares del cerebro. Puede ser utilizado como complemento en abordajes microquirúrgicos guiados por imagen (TAC y RM) y asistido por computadora, tales como resecciones de malformaciones arteriovenosas (MAV), fístulas durales (carótido-cavernosas), tumores cerebrales con patrón vascular definido y cierre de aneurismas micóticos periféricos o asociados a hematoma perilesional. La metodología de trabajo consiste en obtener dos imágenes angiográficas cerebrales utilizando la técnica de Sustracción Digital durante el transoperatorio de abordajes microquirúrgicos. Una vez obtenidas, estas son transferidas a una computadora personal donde el sistema calcula la matriz de transformación que relaciona las coordenadas estereotáxicas (3D) de un blanco con suposición en el plano de la imagen (2D). Hecho esto el cirujano puede obtener las coordenadas estereotáxicas de cualquier blanco angiográfico de interés quirúrgico como pueden ser las arterias aferentes de una MAV. De esta forma, el sistema contribuye a mejorar el trabajo microquirúrgico, facilitando el reconocimiento espacial de estructuras vasculares de interés. Esto evita una mayor manipulación y daño al tejido cerebral circundante, lo cual repercute en una reducción del riesgo de complicaciones y en una disminución del tiempo quirúrgico. En este trabajo se presentan las principales características, posibilidades y ventajas del sistema así como la metodología de trabajo(AU)

Oxido nítrico en gastroenterologia / Nitric oxide in gastroenterology

La identiicación del llamado mensajero humoral lábil EDRF (endothelium derived relaxing factor), con el Oxido Nítrico, de elaboración in situ en el tracto digestivo, al igual que en multitud de otros organos, abre la posibilidad de contar en el futuro con agentes farmacológicos capaces de estimular o bloquear su producción localmente. Teoriamente sera posible manejar afecciones como la Achalasia, la injuria celular por endotoxinas, alteraciones del flujo arterial visceral, el control del estado circulatorio hiperdnamico en la cirrosis descompensada, la sintesis proteica y la filtración glomerular en laascitis del cirrótico. Este gas es considerado como mensajero mediador, neurotrasmisor y regulador de la fisiología en estado normal y patológico. Las perspectivas son promisoras. Por ahora la información procede de experimentación animal

Lipoma del cuerpo calloso / Lipoa of the corpus collosum

Referimos un nuevo caso de lipoma del cuerpo calloso cuyo diagnóstico se realiza por los estudios neurorradiológicos. Se señala la utilidad de la radiografía simple del cráneo que orienta el diagnóstico. Se describen las alteraciones angiográficas que son típicas de la afección y se enumeran las alteraciones de la TAC por lo que se evidencia que este estudio es el más útil y práctico y permite garantizar la identificación del proceso con un método de diagnóstico no invasivo. El lipoma del cuerpo calloso es una afección de presentación poco frecuente, cuyo diagnóstico se efectúa atendiendo a los hallazgos neurorradiológicos. Hay algo más de 100 ejemplos referidos en la literatura . Nosotros comunicamos el caso de un nuevo paciente y discutimos las características de la entidad (AU)

Lipoma del cuerpo calloso / Lipoma of the corpus collosum

Referimos un nuevo caso de lipoma del cuerpo calloso cuyo diagnóstico se realiza por los estudios neurorradiológicos. Se señala la utilidad de la radiografía simple del cráneo que orienta el diagnóstico. Se describen las alteraciones angiográficas que son típicas de la afección y se enumeran las alteraciones de la TAC por lo que se evidencia que este estudio es el más útil y práctico y permite garantizar la identificación del proceso con un método de diagnóstico no invasivo. El lipoma del cuerpo calloso es una afección de presentación poco frecuente, cuyo diagnóstico se efectúa atendiendo a los hallazgos neurorradiológicos. Hay algo más de 100 ejemplos referidos en la literatura . Nosotros comunicamos el caso de un nuevo paciente y discutimos las características de la entidad