"Fully endoscopic preperitoneal ascending suprapubic approach for minimally invasive repair of anterior and lateral abdominal wall hernias".

PURPOSE: The aim of this work is to describe the rational, feasibility and clinical and Quality-of-life improvement results of a fully endoscopic preperitoneal repair for midline and lateral abdominal wall hernias, starting from the space of Retzius in a "bottom-to-up" approach. METHODS: An observational prospective data-collected and quality of life study is performed in selected patients with less than 10 cm. in diameter midline and lateral abdominal wall hernias. A suprapubic upward e-TEP technique from a previously dissected Retzius space, is performed in all cases. The surgical goal is to perform a total free-tension abdominal wall reconstruction followed by a prosthetic hernioplasty. Clinical Data is classified in preoperative, intraoperative, and postoperative variables, including a quality-of-life clinical evaluation based on an improvement of HerQLes score. RESULTS: A total of 30 patients underwent this approach from September 2017 to October 2022 in a single-surgeon practice. A total restoration of the previous abdominal wall anatomy and a prosthetic repair were achieved in all cases. The mean operative time was 142.53 min, with a significant shorter time in lateral hernias approach. Minor complications (Clavien-Dindo I) were collected in 10% of the patients. Major complications (Clavien-Dindo IIIb) occurred in 6.66% of the patients. The mean pain at discharge was 1.83 VAS, with a significant lower pain in M-eTEP approach for lateral hernias. The mean hospital stay was 42.4 h. No seroma, hematoma, chronic pain, or recurrence was observed in the mean follow-up (20.33 months). A clinical and quality of life improvement was found in 92.9% of the patients, measured by a minimal clinical important difference (MCID) between preoperative and postoperative HerQLes score. CONCLUSION: Despite being a technically demanding approach, the results obtained by this approach are compatible in safety and feasibility with other minimally invasive preperitoneal hernia repair techniques, in addition to obtaining a significant improvement in the quality of life of patients.

Clinical and genetic factors involved in Porto-sinusoidal vascular disorder after oxaliplatin exposure.

BACKGROUND AND AIMS: Oxaliplatin (OX) has been described as a potential etiologic agent for porto-sinusoidal vascular disorder (PSVD). Our aim was to describe the natural history of PSVD due to OX in colon cancer (CRC) and identify risk factors for its development. METHODS: We made a multicenter retrospective case-control (ratio 1:3) study with patients diagnosed of PSVD-OX. Baseline data, end of treatment, years of follow-up and diagnosis of PSVD were collected and compared to controls (without PSVD). Besides, 16 different SNPs were selected from bibliography and analyzed by genotyping in the case group to identify potential genetic risk factors. RESULTS: 41 cases were identified, with a median time to PSVD diagnosis after the end of OX of 34 months. Spleen diameter was the strongest predictor of PSVD during treatment (OR 43.94 (14.48-133.336); p < 0.0001). Additionally, thrombocytopenia (<150 × 10^9) at one year was a significant disease risk marker (OR 9.35; 95% CI: 3.71-23.58; p = 0.001). We could not establish any significant association between the selected SNPs and PSVD diagnosis. CONCLUSION: The increase of spleen diameter is the strongest predictor of PSVD in patients treated with OX for CRC. These patients could be candidates for a specific follow-up of portal hypertension-related complications.

How a single perioperative delirium case can make the difference.

This report describes how postoperative delirium in an elderly man during COVID-19 pandemic led to a serious event involving a central venous catheter. Delirium is a common cause of perioperative morbidity and mortality, and is characterised by an alteration in consciousness and perception and a reduced ability to focus, sustain or shift attention. The event was analysed by a multidisciplinary committee which developed a risk stratification delirium protocol in order to prevent similar events in the future.

Flavor and TASTE attributes and nutritional insights of maize tortillas from landraces of Mexican races.

Maize tortilla is the best-recognized food product of Mexican gastronomy. Artisanal maize tortillas (AMT) are prepared with native maize varieties and a traditional process. The aims of this study were to identify sensory attributes, texture, and color in AMT that allow them to be differentiated from commercial tortillas, and to determine the chemical and mineral composition of both types of tortillas. Six landraces related to four Mexican maize races were used. Two commercial tortillas were included as references (tortillería and supermarket). Tortillas were subjected to sensory analysis by the modified Flash technique, texture and color were measured objectively and chemical and mineral analysis of all tortillas were evaluated. Lime taste and lime smell attributes were relevant to differentiate AMT from commercial tortillas; aftertaste and fracturability attributes were highly associated to supermarket tortillas. The fracturability attribute of tortillas is consider undesirable for taco preparation. Five of the six AMT were characterized by the presence of a layer, a characteristic that is associated with traditional tortilla made by Mexican consumer. Regarding chemical composition, supermarket tortillas exhibited the highest dietary fiber content (17.09%), but showed 30% more Na than AMT, with the exception of tortillas from Purepecha native variety. Besides, supermarket tortilla had 48.9% less Ca than AMT. The sensory attributes relevant to differentiate native maize tortillas from the commercial maize tortilla references were appearance, smell, and taste, while textural and color attributes played a lesser role.

Enfermedades vasculares del hígado. Guías Clínicas de la Sociedad Catalana de Digestología y de la Asociación Española para el Estudio del Hígado / Vascular diseases of the liver. Clinical Guidelines from the Catalan Society of Digestology and the Spanish Association for the Study of the Liver

Las enfermedades vasculares hepáticas, a pesar de su relativamente baja prevalencia, representan un problema de salud importante en el campo de las enfermedades hepáticas. Una característica común a muchas de estas enfermedades es que pueden causar hipertensión portal, con la elevada morbimortalidad que ello conlleva. Con frecuencia estas enfermedades se diagnostican en pacientes jóvenes y el retraso en su diagnóstico y/o un tratamiento inadecuado pueden reducir de forma importante la esperanza de vida. El presente artículo revisa la evidencia actual en el síndrome de Budd-Chiari, la trombosis venosa portal en pacientes no cirróticos, la hipertensión portal idiopática, el síndrome de obstrucción sinusoidal, las malformaciones vasculares hepáticas en la telangiectasia hemorrágica hereditaria, la trombosis portal en la cirrosis, otras patologías vasculares menos frecuentes como las fístulas arterioportales, así como un apartado sobre el diagnóstico por imagen de las enfermedades vasculares hepáticas y su tratamiento desde el punto de vista hematológico (estudio de la diátesis trombótica y tratamiento anticoagulante). Las recomendaciones se han realizado de acuerdo a los estudios publicados extraídos de Pubmed. La calidad de la evidencia y la intensidad de las recomendaciones fueron graduadas de acuerdo al sistema Grading of Recommendations Assessment Development and Evaluation (GRADE). Cuando no existían evidencias suficientes, las recomendaciones se basaron en la opinión del comité que redactó la guía.

Despite their relatively low prevalence, vascular diseases of the liver represent a significant health problem in the field of liver disease. A common characteristic shared by many such diseases is their propensity to cause portal hypertension together with increased morbidity and mortality. These diseases are often diagnosed in young patients and their delayed diagnosis and/or inappropriate treatment can greatly reduce life expectancy. This article reviews the current body of evidence concerning Budd-Chiari syndrome, non-cirrhotic portal vein thrombosis, idiopathic portal hypertension, sinusoidal obstruction syndrome, hepatic vascular malformations in hereditary haemorrhagic telangiectasia, cirrhotic portal vein thrombosis and other rarer vascular diseases including arterioportal fistulas. It also includes a section on the diagnostic imaging of vascular diseases of the liver and their treatment from a haematological standpoint (study of thrombotic diathesis and anticoagulation therapy). All recommendations are based on published studies extracted from PubMed. The quality of evidence and strength of recommendations were rated in accordance with the GRADE system (Grading of Recommendations, Assessment Development and Evaluation). In the absence of sufficient evidence, recommendations were based on the opinion of the committee that produced the guide.

[Development of integrated support software for drug validation]. / Desarrollo de un software integrado de ayuda a la validación farmacéutica.

OBJECTIVE: To describe the development of a tool to automate detection of adverse drug-related events (ADRE) in all patients in a hospital. METHOD: We selected the ADRE that we wished to detect (administering drugs to patients with kidney failure and/or by enteral feeding tube) We designed software to record, process and integrate analytical results from SELENE(®) clinical history programme, treatment prescribed using Farmatools(®), and the information included in the tables we designed. RESULTS: The programme allows us to automatically detect patients likely to experience the ADRE we defined, and recommends a modified treatment to the pharmacist. This new tool enables us to search for all patients who might have a specific ADRE. CONCLUSIONS: The software we designed may be a useful drug validation tool.

First Report of Pantoea agglomerans Causing Leaf Blight and Vascular Wilt in Maize and Sorghum in Mexico.

Zea mays and Sorghum bicolor are important crops for animal and human nutrition worldwide. In the Central Highland Valley of Mexico, both crops are extremely important, and research is aimed toward increasing yield, disease resistance, and crop adaptation from 1,900- to 2,700-m elevation. In a 3-year field breeding experiment (2004 to 2006), leaf blight and vascular wilt symptoms were frequently observed in contiguous plots of maize and sorghum crops in Montecillo, Mexico and maize plots in Tecamac, Mexico. To identify and characterize the causal agent of these symptoms, isolations were conducted on leaves from areas where healthy and diseased tissues converged. Leaf sections of 1 cm2 from both crops were disinfested, placed on casamino acid-peptone-glucose (CPG) medium, and incubated at 28°C. After 48 h, only yellow colonies were observed and 12 isolates were selected for further characterization. Physiological and biochemical tests indicated that the isolates were nonfluorescent on King's B medium, and API 50 CHE (bioMérieux, Marcy l'Etoile, France) revealed that they were negative for gelatin hydrolysis, indole production, acid production from raffinose and positive for utilization of glycerol, D-glucose, mannitol, arbutine, esculine, salicine, cellobiose, maltose, melibiose, D-fucose, and D-arabitol; all characteristics of Pantoea agglomerans. Further identification of these isolates was accomplished by DNA analysis. For DNA analysis, 1.4-kbp fragments of the 16S rRNA gene were amplified with primer set 8F/1492R (3) and sequenced with U514F/800R universal primers (2). Five sequences were obtained and deposited in GenBank (Accession Nos. EF050806 to EF050810). A phylogenetic tree was constructed using the UPGMA method (mega version 3.1). Results of the phylogenetic analysis grouped the species P. ananatis, P. stewartti, and P. agglomerans into three clusters. The five unknown sequences were grouped into the P. agglomerans cluster. There was a 98 to 99% similarity of the five 16S rRNA gene sequences with P. agglomerans strain type ATCC 27155. Pathogenicity of the 12 isolates was confirmed by injecting 108 CFU mL-1 of inoculum into stems of 3-week-old maize cv. Triunfo and sorghum cold tolerant hybrid (A1×B5)×R1 seedlings in the greenhouse at 28°C and 80% relative humidity. Also, seedlings were inoculated with water, nonpathogenic isolates of P. agglomerans from maize (GM13, and HLA1), and not inoculated as negative controls. Three replications were included for each isolate and control. All test strains developed water-soaked lesions on juvenile leaves at 8 days postinoculation and were followed by chlorotic to straw-colored leaf streaks and then leaf blight symptoms at 3 weeks postinoculation. All negative control seedlings did not develop symptoms. In addition, the 12 isolates were infiltrated at 107 CFU mL-1 into tobacco leaves that displayed a hypersensitive response at 4 days, indicating the presence of the type III secretion system (1). Isolates were reisolated, and the 16S rRNA gene fragments were 100% similar to their original isolate sequences. P. agglomerans has been reported to affect other crops, including chinese taro in Brazil (2007), onion in the United States (2006) and South Africa (1981), and pearl millet in Zimbabwe (1997); however, to our knowledge, this is the first report of P. agglomerans associated with leaf blight and vascular wilt symptoms in maize and sorghum in the Central Highland Valley of Mexico. References: (1) J. Alfano and A. Collmer. Annu. Rev. Phytopathol 42:385, 2004. (2) Y. Anzai et al. Int. J. Syst. Evol. Microbiol. 50:1563, 2000. (3) M. Sasoh et al. Appl. Environ. Microbiol. 72:1825, 2006.

[A severe episode in a patient with recurrent disseminated acute encephalitis due to vaccination against hepatitis B. For or against vaccination?]. / Brote grave en paciente con encefalitis aguda diseminada recurrente por vacuna contra LA hepatitis B: A favor o en contra de la Vacunación?

INTRODUCTION: Several reports of new cases of CNS demyelination or reactivation of MS after hepatitis B vaccination have raised the possibility of a causal relationship. Conversely, some authors have concluded that the risk of developing a demyelinating CNS event after a hepatitis B vaccination is unknown. PATIENTS AND METHODS: We have observed a 40 year old man, with diabetes mellitus (DM) type 1 and a previous history of recurrent acute demyelinating encephalomyelitis (rADEM). The patient had experienced three episodes of neurological dysfunction and he fulfilled the criteria for definite clinical MS but MRI showed demyelinating lesions in the pons and cerebellum without MRI criteria of MS. CSF analysis showed oligoclonal banding. The patient had been clinically stable during the last 6 years. Yearly MRI during this period had not shown any new disease activity. He was admitted in our MS Clinic due to dizziness, nausea, vomiting and diplopia, 6 weeks after the first of the two injections for hepatitis B vaccine after participating in the national programme of vaccination in DM type 1 patients. Clinical examination showed intranuclear ophtalmoplegia, visual loss in the left eye and worsening of the previous cerebellar and pyramidal signs. MRI showed an increase in the old lesions with high intensity signals on T2 weighted sequences with post gadolinium enhancement on T1 weighted sequences located in the brainstem and mesencephalon. The patient s diabetes mellitus deteriorated with ketoacidosis that needed increased doses of insulin. His condition worsened and he developed partial motor seizures. He improved 15 days later but he still had involvement of the cerebellar and pyramidal systems and occasional dizziness. CONCLUSIONS: As pointed out by some authors and in view of this observation, it would seem reasonable, as a precautionary measure, to avoid hepatitis B vaccination in patients with a personal or family history of symptoms suggestive of a demyelinating disease of the CNS.

Growth hormone effects in intestinal adaptation after massive bowel resection in the suckling rat.

BACKGROUND: Massive small bowel resection provokes intestinal malabsorption that leads to diminished growth in the suckling rat. Growth hormone is one of the several factors that can enhance the adaptive response of the intestines in the adult rat; however, whether it also enhances postresection intestinal adaptation in the suckling rat, thus reducing the adverse effects of resection on growth, is still unclear. METHODS: Seventy-four 30-day-old suckling Wistar rats underwent 80% midgut bowel resection, laparotomy (sham operation), or no surgery. They were treated with either growth hormone or saline for 15 days and studied 15 or 45 days after surgery. Body weight was monitored and samples of bone and intestinal mucosa were obtained at the end of the study period for analysis. RESULTS: Resected rats lost body and bone weight regardless of growth hormone administration. Bowel resection provoked significant increases in the proliferation and size of the intestinal mucosa. Growth hormone significantly, but just barely, increased crypt height and mucosal mass at day 15 after surgery, but not at day 45. Lengthening of the intestines was the main effect of growth hormone. CONCLUSIONS: The relatively small adaptive response of intestines to growth hormone is insufficient to promote body growth after intestinal resection in the suckling rat. This response is lower than that in older rats and may reflect an age-related differential response to growth hormone.

Pancreatic neuroendocrine tumors. Report of nine cases.

BACKGROUND/AIMS: Tumors of the endocrine pancreas are infrequent, and their malignant behavior is assessed only in the presence of lymph node or hepatic metastases. We present 9 new cases from the past 11 years. METHODOLOGY: We reviewed the clinical records of 9 patients diagnosed of pancreatic neuroendocrine tumors, analyzing age, sex, past medical history, symptoms, clinical presentation, laboratory tests, imaging studies, operative findings, pathological diagnosis, mortality, morbidity and hospital stay. RESULTS: There were 5 women and 4 men, with a mean age of 48.7 years. In 4 patients the tumor presented with hypoglycemia. Malignant behavior was observed in 2 cases. We discuss the origin and classification of these tumors, as well as the best diagnostic and therapeutic approaches. CONCLUSIONS: Endocrine tumors of the pancreas affect middle aged men and women, presenting with specific signs or symptoms in less than half of the cases. In small tumors preoperative or intraoperative localization may be difficult. Most of the lesions are localized in the tail of the pancreas, and malignant behavior is seen in less than 25% of the cases.

Acute emphysematous cholecystitis. Report of twenty cases.

BACKGROUND/AIMS: Our aim is to present our experience with acute emphysematous cholecystitis (AEC), a severe variety of acute cholecystitis characterized by early gangrene and perforation of the gallbladder. METHODOLOGY: We reviewed the clinical records of 20 patients with AEC, analyzing age, sex, past medical history, symptoms, laboratory tests, X-rays, ultrasounds, operative and microbiological findings, morbidity and mortality. RESULTS: Our study included 13 men and 7 women (mean age 59 years). Associated factors were diabetes mellitus (11 cases) and gallstones (6 cases, 3 of them with common bile duct stones). Clinical symptom presentation included: right hypochondrial pain and fever in all cases, vomiting in 9, septic shock in 3, jaundice in 7, and peritonitis in 8. Hyperbilirubinemia was present in 7 cases. Plain abdominal X-rays or ultrasounds led to diagnosis in 95% of the cases. Surgical findings were AEC in all cases, pericholecystic abscess in 8, gallbladder necrosis in 7 and bile peritonitis in 3. C perfringens, E coli and B fragilis were the most frequent pathogens. Mortality rate was 25%, and morbidity 50%. CONCLUSIONS: AEC predominantly affects elderly diabetic men. Abdominal X-rays or ultrasounds are good diagnostic techniques, and emergency surgery is needed due to the high incidence of gangrene and perforation Despite all the efforts made, morbidity and mortality are still high.

Malignant stromal tumors of the stomach.

BACKGROUND/AIMS: The purpose of this paper is to expose our experience in malignant stromal tumors of the stomach. METHODOLOGY: We present 16 cases of malignant stromal tumors of the stomach, operated on in our hospital from 1977 to 1995. Age, sex, symptoms and signs, standard laboratory tests, diagnostic methods, location, size, infiltration of other organs, proliferating activity, treatment and survival rate are analyzed. Immune staining was performed using the avidin-biotin-peroxidase method, with the S-100 1/8000 and muscular actin 1/50 antiserum. All patients underwent surgical treatment, and neither chemotherapy nor radiotherapy were used. RESULTS: Thirteen patients died 5 to 78 months after surgery, and the other 3 are alive and free of disease 74, 48 and 38 months after resection, respectively. Five year survival rate was 37.5%. The most important prognostic factors were tumor size, infiltration of neighboring organs and high mitotic index. CONCLUSION: All the clinical data, survival rates and prognostic factors are similar to other published cases. Surgery is the first step in the treatment of these tumors, as the role of other therapeutic options is not well known yet.

Neumonitis por radiación en pacientes con cáncer de mama tratados con radioterapia / Radiation neumonitis in patients with breast cancer treated with radiotherapy

La neumonitis por radiación es un síndrome acompañado de cambios radiológicos bien definidos a nivel pulmonar. Su presentación e intensidad están ralacionadas con diferentes factores. La frecuencia con que se presenta por irradiación a la mama y sus zonas linfoportadoras es variable. Para conocer la frecuencia y relación que guarda con el antecedente de patología pulmonar previa y asociación a tratamiento secuencial de radioterapia y quimioterapia se estudiaron 62 pacientes con cáncer de mama que recibieron radioterapia al tórax, con seguimiento radiológico mínimo de 52 semanas. En el 29 por ciento de las pacientes (18/62) se presentó el síndrome de neumonitis por radiacipon y el 45 por ciento (28/62) evolucionó a fibrosis pulmonar, con todas las pacientes asintomáticas al cierre del estudio. La patología pulmonar previa fue un factor de riesgo estadísticamente significativo (p=0.04) para el desarrollo de neumonitis y fibrosis pulmonar. Esto no se demostró con la asociación de radioterapia y quimioterapia.