[Characterisation of thromboembolic risk in a mexican population with non-valvular atrial fibrillation and its effect on anticoagulation (MAYA Study)]. / Caracterización del riesgo tromboembólico en una población mexicana con fibrilación auricular (FA) no-valvular y su efecto en la indicación de anticoagulación (estudio MAYA).

OBJECTIVE: To evaluate the risk of stroke and bleeding using the CHA2DS2-VASc and HAS-BLED scores in Mexican patients with atrial fibrillation and to analyze whether the risk score obtained determined treatment decisions regarding antithrombotic therapy. METHODS: This is an observational, retrospective study in Mexican patients recently diagnosed with atrial fibrillation. The risk of stroke was assessed using the CHA2DS2-VASc scores. The bleeding risk was evaluated using the HAS-BLED score. The frequency of use of antithrombotic therapy was calculated according to the results of the score risk assessment. RESULTS: A total of 350 patients with non-valvular atrial fibrillation were analyzed. A 92.9% of patients had a high risk (score ≥ 2) of stroke according to the CHA2DS2-VASc score and only 17.2% were treated with anticoagulants. A high proportion of patients with atrial fibrillation (72.5%) showed both a high risk of stroke and a high risk of bleeding based on HAS-BLED score. CONCLUSIONS: In this group of patients with atrial fibrillation, from Northeast Mexico, there is a remarkably underutilization of anticoagulation despite the high risk of stroke of these patients.

[Spontaneous cholecystocutaneous fistula]. / Fístula colecistocutánea espontánea.

BACKGROUND: Spontaneous cholecystocutaneous fistula is defined as a gallbladder communication with the external environment through the abdominal wall rupture; the first reports were written in the seventeenth century by Thilesus. During the past 50 years 25 cases have been reported. CLINICAL CASE: We report a case of a 30-year-old woman presented with a five-year history of biliary colic, six months prior to medical assessment presents outlet of biliary material and gallstones spontaneously in the right upper quadrant. Fistulogram was performed without evidence of obstruction, subsequently cholecystectomy and resection of the fistula was performed. DISCUSSION: The biliary fistulas are an abnormal communication from the gallbladder into another surface, is a rare condition in our day as it only occurs in 10% of patients with gallbladder lithiasis; while spontaneous cholecystocutaneous fistula clinic is more than evident. It is imperative perform studies like ultrasound, tomography, and fistulogram. The mainstay of treatment is cholecystectomy, resection of the fistula and repair of abdominal wall defect. CONCLUSION: The incidence of cholecystocutaneous fistula today is minimal and it seems that the current trend is to become an entity anecdotal, the approach subcostal abdominal examination remains as the first choice. The laparoscopic approach is an option reserved for the experienced surgeon.

[Pancreatic pseudocyst. Case report and literature review]. / Pseudoquiste pancreático. Revisión y reporte de caso.

BACKGROUND: The most frequent etiology of pancreatic pseudocyst is acute pancreatitis and exacerbations of chronic pancreatitis, presenting spontaneous resolution in 50% of the cases. Treatment is indicated in symptomatic or complicated persistent pseudocysts. The OBJECTIVE of this article is to present a case and management options of pancreatic pseudocyst defined as a collection of fluid in the omental bursa. CLINICAL CASE: We present the case of a 59-year-old female patient with a history of laparoscopic cholecystectomy and necrotizing pancreatitis. She presented abdominal pain, early satiety, and nausea during the previous 2 months. Presence of pancreatic pseudocysts of 92 and 62 mm was demonstrated by computed tomography. The patient was submitted to a laparoscopic cyst-gastric anastomosis. CONCLUSIONS: Laparoscopic cyst-gastric anastomosis is the ideal treatment for pancreatic pseudocyst management because it offers continuous drainage, low rate of recurrence and few complications, exceeding the RESULTS of endoscopic management and imaging-guided drainage along with the benefits of a minimally invasive procedure.

ANTECEDENTES: la etiología más frecuente del quiste pancreático es la pancreatitis aguda y las agudizaciones de pancreatitis crónica; el 50% de los casos se alivia espontáneamente. El tratamiento se indica en pseudoquistes persistentes, sintomáticos o complicados. OBJETIVO: comunicar un caso y las opciones de tratamiento del pseudoquiste pancreático, definido como una colección de líquido en la transcavidad de los epiplones. Caso clínico: paciente femenina de 59 años de edad, con ANTECEDENTES de colecistectomía laparoscópica, pancreatitis necrotizante y en los últimos dos meses dolor abdominal, saciedad temprana y náuseas. La tomografía reveló un pseudoquiste pancreático de 92 y 62 mm, razón por la que se efectuó una cistogastroanastomosis laparoscópica. CONCLUSIONES: la cistograstroanastomosis laparoscópica es el tratamiento ideal para el tratamiento del pseudoquiste pancreático porque ofrece: drenaje continuo, bajo índice de recidiva y pocas complicaciones que superan al tratamiento endoscópico y al drenaje guiado por imagenología, junto con las ventajas de mínima invasión.