Patient satisfaction and quality of life following laparoscopic Nissen fundoplication.

BACKGROUND: Today, antireflux surgery has an established position in the management of gastroesophageal reflux disease. Some case series have shown good short-term results, but there is still little information regarding long-term results. Studies have recently focused on evaluating residual symptomatology and its impact on quality of life. OBJECTIVES: To determine the postoperative quality of life and degree of satisfaction in patients that underwent laparoscopic Nissen fundoplication. PATIENTS AND METHODS: A total of 100 patients (59 women and 41 men) were studied after having undergone laparoscopic Nissen fundoplication. The variables analyzed were level of satisfaction, gastrointestinal quality of life index (GIQLI), residual symptoms, and the Visick scale. RESULTS: No variation was found in relation to sex; 49 men and 51 women participated in the study. The mean age was 49 years. The degree of satisfaction encountered was: satisfactory in 81 patients, moderate in 3, and bad in 2 patients. More than 90% of the patients would undergo the surgery again or recommend it. The Carlsson score showed improvement at the end of the study (p<0.05). In relation to the GIQLI, a median of 100.61 points±21.624 was obtained. Abdominal bloating, regurgitation, and early satiety were the most frequent residual symptoms. The effect on lifestyle measured by the Visick scale was excellent. CONCLUSIONS: The level of satisfaction and quality of life obtained were comparable with reported standards; and the residual symptoms after antireflux surgery were easily controlled.

H-reflex and clinical examination in the diagnosis of diabetic polyneuropathy.

OBJECTIVES: To determine among adult patients with type-2 diabetes mellitus the proportion diagnosed with diabetic polyneuropathy (DPN) by clinical evaluation and by the Hoffmann reflex (H-reflex). In addition, the predictive value of the H-reflex in the diagnosis of DPN was evaluated. METHODS: Studies were carried out on 150 adult patients referred for neuropathy screening. Diagnostic criteria for DPN were at least two abnormalities in clinical neurophysiological examinations and electrophysiological testing (H-reflex and nerve conduction velocity). Logistic regression analysis was performed to identify unique contributions of study characteristics to positive versus negative outcomes. RESULTS: H-reflex was absent in 39.3% (59/150) and latency was prolonged in 43.3% (65/150) of patients. Ulnar nerve motor branch nerve conduction showed prolonged latency in 9.3% (14/150) of patients. Logistic regression analysis indicated that the H-reflex was significantly associated with positive outcomes. CONCLUSION: The H-reflex could have a predictive value in DPN, providing more quantitative information regarding diagnosis than conventional nerve conduction studies.

Effects of chronic caffeine administration on blood glucose levels and on glucose tolerance in healthy and diabetic rats.

OBJECTIVE: To analyse the effect of chronic caffeine use on risk reduction and prognosis of diabetes mellitus. METHODS: In this 60-day study, five groups of 11 healthy male Wistar rats were selected to receive one of four doses (37.5, 56.2, 75.0 or 93.0 mg/kg per day) of caffeine orally or no caffeine (control). The effect of caffeine on glycaemia and glucose tolerance was evaluated. After 15 days, each group was treated with 60 mg/kg of streptozotocine to induce diabetes mellitus, and glycaemia and glucose tolerance were assessed for a further 45 days. RESULTS: In nondiabetic rats, caffeine had no effect on blood glucose. Compared with controls, the fasting blood glucose levels declined significantly in two caffeine-treated groups (93.0 mg/kg per day and 56.2 mg/kg per day) during the first 15 days following diabetes induction. Glucose tolerance was significantly improved 120 min after glucose loading in all caffeine-treated groups. The mean ± SE half-maximal effective concentration of caffeine was 35.79 ± 2.44 mg/dl. CONCLUSIONS: Blood glucose levels decreased, and glucose tolerance improved, in diabetic rats administered increasing doses of caffeine.

Cervical human papillomavirus infection in Mexican women with systemic lupus erythematosus or rheumatoid arthritis.

Cervical human papillomavirus (HPV+) infection is associated with an increased risk of cervical dysplasia. Although the frequency of HPV+ in systemic lupus erythematosus (SLE) has been investigated in some races its prevalence in Hispanic women is still unknown. This cross-sectional study evaluated the prevalence of cervical HPV+ in Mexican women with SLE (n = 34) or rheumatoid arthritis (RA) (n = 43) and in healthy controls (n = 146). These women were interviewed about risk factors for sexually transmitted infections and cervical cytology analysis was performed. HPV+ viral types were identified using PCR: HPV+ was observed in 14.7% of SLE, 27.9% of RA and 30.8% of controls. High-risk HPV types were observed in 11.7% of women with SLE, 27.9% of women with RA, and in 26% of the controls. High-risk viral types 58, 35 and 18 were the most frequently identified in SLE. Two women with SLE had a high-grade squamous intraepithelial lesion and one had cervical cancer. An association was observed between methotrexate utilization, longer duration of therapy with prednisone, and HPV+ in RA or SLE. Thus, there is a high prevalence of cervical HPV infection in Mexican women with SLE or RA, and physicians must be vigilant in preventing the development of cervical dysplasia.

Forskolin compared with beclomethasone for prevention of asthma attacks: a single-blind clinical trial.

This single-blind study compared the efficacy of oral forskolin versus inhaled beclomethasone for mild or moderately persistent adult asthma. Patients were randomly assigned to receive forskolin (one 10-mg capsule orally per day; n = 30) or beclomethasone (two 50 microg inhalations every 12 h; n = 30) for 2 months. No statistically significant improvement occurred in any lung function parameter in the forskolin-treated patients. Subjects in the beclomethasone-treated group presented a slight but statistically significant improvement in percentage forced expiratory volume in 1 s (FEV(1)), percentage forced expiratory flow in the middle (25 - 75%) expiratory phase (FEF(25 - 75%)) and percentage forced vital capacity (FVC) after 2 months of treatment, though the improvement in absolute values for FEV(1), FEF(25 - 75%), FVC and FEV(1):FVC did not reach statistical significance. There was no statistically significant difference between the forskolin and beclomethasone treatment groups for any lung function parameter at baseline or after treatment. None of the beclomethasone-treated patients had an asthma attack and one forskolin-treated patient had a mild asthma attack during the 2-month study period. More studies are needed in adult asthma patients to confirm whether forskolin may be a useful preventive treatment for mild or moderately persistent adult asthma.

Prevalence of childhood sexual abuse among Mexican adolescents.

BACKGROUND: To determine the characteristics and prevalence of previous child sexual abuse among a group of Mexican junior high school students. METHODS: A total of 1067 adolescents of both genders were selected to fill out a survey about child sexual abuse. RESULTS: The prevalence of child sexual abuse was 18.7% (n = 200). It was more frequent in girls (58%) than in boys (42%). Sexual abuse involved physical contact in 75% of those cases reporting abuse. The aggressors were neighbours (50.3%), relatives (36.8%) and strangers (13.9%). Abuse was committed through deception in 90% of the cases and involved physical mistreatment in 10% of the cases. Of the victims, 14.4% had spoken about the problem and 3.7% had taken legal action. And 9.6% of those surveyed stated that they required psychological counselling. CONCLUSIONS: In the population studied, the prevalency of child sexual abuse was greater than that reported in Mexico City (4.3-8.4%), although it was similar to that found in the Spanish child population (15-23%). The risk of sexual abuse is greater for girls and the principal aggressors are male neighbours, family friends and relatives; the abuse is committed in the home of the aggressor or the victim and very few cases are reported to the authorities.

Reduction of peritoneal adhesion to polypropylene mesh with the application of fibrin glue.

PURPOSE: The purpose of our study was to evaluate the possibility of the reduction of peritoneal adhesions to a polypropylene mesh with fibrin glue. METHODS: Forty Wistar rats were assigned to two treatment groups: Group 1) hernioplasty with polypropylene mesh plus fibrin glue sealant, and Group 2) hernioplasty with polypropylene mesh without fibrin glue sealant. The variables evaluated were: presence and density of adhesion, organs or abdominal structures adhered to the polypropylene mesh, inflammatory tissular reaction and cell recount. RESULTS: Group 1 presented a statistically lower adhesion percentage than Group 2 (40% versus 100%, P = 0.0003). The mean areas of mesh patch surfaces covered with adhesions were statistically different between Groups 1 and 2 (0.67 +/- 0.65 cm2 versus 1.60 +/- 0.51 cm2; P = 0.00001). Twelve rats presented with adhesions in Group 1; eleven were adhesions to the epiploon and one to the colon. In Group 2 there were 16 adhesions to the epiploon, 2 to the colon, 1 to the small intestine and 1 to the stomach. Tissular reaction comparison showed a significant difference (21 +/- 4.9 versus 17 +/- 4.1; P = 0.006). CONCLUSIONS: Fibrin glue sealant significantly reduced the frequency and severity of intra-abdominal adhesions.

Subcutaneous histamine versus topiramate in migraine prophylaxis: a double-blind study.

BACKGROUND: Histamine has a selective affinity for H3 receptors and it may specifically inhibit the neurogenic edema response involved in migraine pathophysiology. OBJECTIVE: To evaluate the therapeutic potential of subcutaneous administration of histamine in migraine prophylaxis, compared with oral administration of topiramate. METHODS: Ninety patients with migraine were selected in a 12-week double-blind controlled clinical trial to evaluate the efficacy of subcutaneous administration of histamine (1-10 ng twice a week) compared with oral administration of topiramate (100 mg daily dose). The variables studied were: headache intensity, frequency, duration, analgesic intake and Migraine Disability Assessment. RESULTS: The data collected during the 12 weeks of treatment revealed that headache symptoms improved in both the histamine and topiramate groups, which was evident within the first month after the initiation of treatment, with statistically significant (p < 0.001) reductions in headache frequency (50%), Migraine Disability Assessment score (75%), intensity of pain (51%), duration of migraine attacks (45%), as well as in the use of rescue medication (52%). CONCLUSION: The present study provides evidence of the efficacy of subcutaneously applied histamine and orally administered topiramate in migraine prophylaxis. Subcutaneously applied histamine may represent a novel and effective therapeutic alternative in resistant migraine patients.

Direct trocar insertion without pneumoperitoneum and the Veress needle in laparoscopic cholecystectomy : a comparative study.

PURPOSE: The purpose of this study is to compare the safety and complications of direct trocar insertion without pneumoperitoneum (DTI) with Veress needle (VN) in laparoscopic cholecystectomy (LC). METHODS: We studied 84 patients admitted to our hospital for LC, in a random simple blind design, 42 patients were assigned to DTI and 42 to VN. The variables analysed were : procedure complications, laparoscope insertion time and duration of surgery. RESULTS: Complication percentages between the groups were significantly different (DTI 2.3% versus VN 23.8%, p = 0.009). The duration of surgery between the two groups was also significantly different (DTI 56+/-31 versus VN 71+/-28 minutes, p < 0.02). Finally, laparoscope insertion time between the two techniques was significantly different (DTI 1.5+/-0.5 versus VN 3.0+/-0.4 minutes p < 0.001). CONCLUSIONS: Our results show DTI to be a safe, efficient, rapid and easily-learned alternative technique, reducing the number of procedure-related complications.

Forskolin versus sodium cromoglycate for prevention of asthma attacks: a single-blinded clinical trial.

To determine the efficacy of forskolin in preventing asthma attacks, we performed a single-blinded clinical study in children and adult out-patients at a public hospital in Mexico. Forty patients of either sex with mild persistent or moderate persistent asthma were assigned randomly to 6 months of treatment with forskolin at 10 mg/day orally (capsules) or with two inhalations of sodium cromoglycate every 8 h, i.e. three times a day. The number of patients who had asthma attacks during the treatment period was significantly lower among those receiving forskolin (8/20, 40%) than among those receiving sodium cromoglycate (17/20, 85%). Values of forced expiratory volume in 1 s and forced expiratory flow, mid-phase, A similar in the two groups during the treatment period. We conclude that forskolin is more effective than sod cromoglycate in preventing asthma attacks in patients with mild persistent or moderate persistent asthma.

Electrophysiological abnormalities in type 2 diabetic patients with reduced levels of insulin-like growth factor I.

This cross-sectional study investigated electrophysiological abnormalities in type 2 diabetics with normal and reduced insulin-like growth factor I (IGF-I) levels. Sixty patients and 20 non-diabetic controls were included in the study. The fasting serum glucose was measured and IGF-I levels were determined by radioimmunoassay in all patients. Nerve conduction tests were performed in all the study participants on the ulnar nerve and lower extremities. Compared with the controls, all the patients showed a reduction in the peak amplitude of the motor response, 58% showed a reduction in the motor conduction velocity and 55% showed a reduction in the sensory conduction velocity. There was no statistically significant correlation between the electrophysiological changes and the glucose or IGF-I levels. In conclusion, there does not appear to be a correlation between serum glucose or IGF-I levels and electrophysiological abnormalities in patients with type 2 diabetes mellitus.

[Subcutaneous histamine in migraine prophylaxis. Initial effects and long-term outcome]. / Histamina subcutánea en profilaxis de migraña. Efectos iniciales y seguimiento a largo plazo.

INTRODUCTION: Histamine may prove to be effective in migraine prophylaxis, as an specific treatment aimed to limit excessive inflammatory responses involved in the pathophysiology of migraine. METHODS: One hundred and ten migraine patients were selected. The variables analyzed were: a) frequency; b) intensity; c) duration, and d) number of analgesic tablets. Treatment consisted of a regimen of subcutaneous histamine (10 ng/ml of Evan's solution) twice a week, with an administration volume of 1 ng (0.1 ml) of histamine, which was consecutively increased until reaching 10 ng (1 ml); during twelve month. At the end of treatment, the patients remained under observation for 8 years. A Friedman repeated measures ANOVA on ranks test was used to evaluate the statistical significance of differences between basal values and values found. RESULTS: The statistical analysis showed significant differences between basal values and values found for the 3, 6 and 12 months of treatment with histamine (p < 0.0001). The beginning of the 4th week there was a significant decrease in the magnitude of all variables studied (p < 0.0001). During the first and second year after treatment there were no headache attacks. In the third year migraine appeared again same to basal values. CONCLUSIONS: The present study provides evidence of the safety and efficacy of histamine, applied subcutaneously at doses of 1 to 10 ng twice a week, bringing about a new therapeutic alternative and laying the clinical and pharmacological groundwork for the use of histaminergic H3-agonists in migraine prophylaxis.

Correlation between serum leptin levels and insulin sensitivity in diffuse toxic goiter.

OBJECTIVE: The aim of this survey was to assess the correlation between leptin and insulin sensitivity (IS) in cases of diffuse toxic goiter. DESIGN, PATIENTS, MEASUREMENTS: This is a descriptive study on patients with diffuse toxic goiter (DTG) assessing their body mass index (BMI), serum leptin concentrations, circulating insulin (area under the curve (AuC) of insulin), average insulin level, thyroid hormones, thyroid stimulating hormone (TSH), glycemia and IS (using a hyperinsulinemic-euglycemic clamp and the homeostasis model for assessment of insulin resistance (HOMA-IR) before and after euthyroidism induced with metimazol. RESULTS: The average patient age was 35 years old (range 31-40 years), height was 157 cm (range 151-160 cm), glycemia was 4.3 +/- 0.3 mmol/L and TSH 0.1 +/- 0.1 microU/mL. Average leptin level was 11.3 +/- 2.8 ng/dL, the average insulin level was 10.13 +/- 3.7 mIU/mL and the AuC for insulin was 50.6 +/- 18 microIU x min/mL. No correlation was found between leptin and BMI, thyroid hormones and glycemia. While controlling for the BMI effect, a correlation was found between leptin and TSH (r = -0.77, p = 0.042), as well as between leptin and insulinemia (r = 0.93, r2 = 0.86, p = 0.001) independently from the state of thyroid function. There was a tendency for a high correlation between leptin and the insulin AuC (hyperthyroidism: r = 0.89, p = 0.056; euthyroidism: r = 0.99, p = 0.056). A negative correlation was found between IS and the insulin AuC (rho = -0.58, p = 0.18). There was a high tendency for correlation between leptin and IS when the BMI effect (HOMA-IR: r = 0.70, p = 0.12; PHE: r = -0.55, p = 0.26) was taken into consideration. CONCLUSIONS: There is a high tendency for a negative correlation between leptin and IS when the BMI effect is controlled. There is a high tendency for a positive correlation between leptin and insulin and TSH.

Therapy with intermittent pulse cyclophosphamide for pulmonary hypertension associated with systemic lupus erythematosus.

The aim of this study was to compare the efficacy of intravenous cyclophosphamide (IVCYC) versus oral enalapril in mild or moderate pulmonary hypertension (PH) in systemic lupus erythematosus (SLE). Thirty-four patients with SLE who had systolic pulmonary artery pressure (SPAP) > 30 mmHg by Doppler echocardiography were randomized to receive IVCYC (0.5 g/mt2 body surface area, monthly), or oral enalapril (10 mg/day) for six months. The primary outcome was the significant decrease in SPAP. An additional outcome measure included the improvement in the heart functional class (NYHA). Sixteen patients received cyclophosphamide and 18 enalapril. IVCYC decreased the median values of SPAP from 41 to 28 mmHg (P < 0.001), and enalapril from 35 to 27 mmHg (P = 0.02). IVCYC reduced more than twice as much SPAP than enalapril (P = 0.04). In those patients with SPAP > or = 35 mmHg, cyclophosphamide decreased from 43 to 27 mmHg (P = 0.003), but enalapril was not effective (P = 0.14). The NYHA functional class improved only in those with cyclophosphamide (P = 0.021). Also IVCYC had a higher frequency of side effects including infections (RR = 1.6; 95% CI, 1.001-2.47), and gastrointestinal side effects (RR = 14.6; 95% CI, 2.15-99.68). We concluded that IVCYC was effective in mild and moderate PH associated with SLE. Further research is needed to evaluate its long-term efficacy.

Frequency of, indications for and clinical epidemiological characteristics of first time cesarean section, compared with repeated cesarean section.

UNLABELLED: The aim of this study was to determine the frequency of, indications for and clinical epidemiological characteristics in patients having their first cesarean section (FCS) and then to compare the data with that found in patients with repeated cesarean section (RCS). PATIENTS AND METHODS: A cross-sectional study was carried out. 493 pregnant patients who gave birth by cesarean section or vaginal delivery were seen. Some of the variables analyzed were: age, prenatal care consultations, gyneco-obstetric antecedents, cesarean section indication and neonate weight. Statistical analysis included ANOVA, chi(2) and OR, with a 95% CI. Significance was p<0.05. RESULTS: 66% of the patients had vaginal births (VB) and 33.4% had cesarean sections, with a FCS frequency of 61%. The three most frequent indications for FCS were dystocias and cephalopelvic disproportion (45%), fetal distress (12.8%), and pelvic presentation (9.9%). Meanwhile, those for RCS were previous cesarean section (51%), dystocias (20%) and pelvic presentation (6.2%). The variables significantly associated with FCS were: first pregnancy, antecedent of labor room induction and a neonate weight above 3500 g. The remaining variables were not associated with FCS. Percentages of nulliparity, secondgravidity and multigravidity were greater in RCS patients. CONCLUSION: The frequency of FCS is still high in Mexico. Adequate following of programs to diminish the percentage of FCS and increase the number of VB, would significantly reduce the prevalence of cesarean section.

Measurement of Ca(2+) currents in intact slow skeletal muscle fibers of the frog by the three-microelectrode technique.

The recording of currents passing through calcium channels in intact skeletal muscle fibers presents several difficulties. However, use of the three-microelectrode voltage-clamp technique at the end of the fiber provided us with a good approximation of current values in such fibers. Using this technique, we were able to measure the calcium-channel current in slow skeletal muscle fibers of the frog (Rana pipiens) and to quantify the effects of denervation on this current.

[Screening of cervix uteri cancer in female health workers. Comparative analysis of insured individuals]. / Tamizaje de cáncer cervicouterino en trabajadoras de la salud. Un análisis comparativo con derechohabientes.

OBJECTIVE: To compare epidemiological characteristics and proportion of participation in a cervical cancer screening program in both, health-care professionals and insured on a health institute's women (Group A and Group B respectively). MATERIAL AND METHODS: Through questionnaires applied to both healthcare professionals and insured on a health institute's women (n = 96 for each group) randomly selected, a cross-sectional study was performed. To analyze the results, Yates' correction for continuity, was used. RESULTS: The characteristics from A and B groups were respectively: age 35 +/- 10 vs. 41 +/- 5 years (p < 0.001), years of scholarship: 8.3 +/- 5 vs. 12.0 +/- 1 (p < 0.001), frequency of screening test in the last two years: 1.2 +/- 0.4 vs. 1.0 +/- 0.1 (p < 0.001), time elapsed from the last test: 13.6 +/- 15 vs. 12.2 +/- 13 months (p = 0.52), attendance to screening test 55 (57%) vs. 72 (75%), (p < 0.001). Reasons for not attendance to screening test were indolence 13 (14%) vs. 13 (14%) and not enough time 7 (7%) vs. 2 (2%) by both groups, A and B, respectively. CONCLUSIONS: The proportion of attendance to cervical cancer screening is higher in health-care professionals than in insured on a health institute's women. The causes for not attendance to screening are the same in both groups.

[Levodopa in hemifacial spasm. A therapeutic alternative]. / Levo dopa en espasmo hemifacial. Una alternativa terapéutica.

OBJECTIVE: After reviewing the existing literature on the subject, a therapeutic, symptomatic alternative in the treatment of hemifacial spasm is proposed. MATERIAL AND METHOD: Three patients, all with a 5-year history of hemifacial spasm, were given one 25/250-mg tablet of Levodopa/carbidopa every 12 h. In a cross-over study, the patients were their own controls. The initial treatment phase lasted 1 month, at the end of which treatment was suspended. For an equal amount of time, the patients were given a placebo, after which they were again given Levodopa. RESULTS: After a 2-week period of treatment with Levodopa, the symptomatic aspect of the spasm disappeared in the patients. Upon replacing the drug with the placebo, the spasm reappeared. The patients have since been receiving the treatment with Levodopa, one tablet every 12 h, for a period of 4 years and the reduction of the hemifacial spasm has oscillated at 75%. CONCLUSION: We suggest the use of Levodopa/carbidopa in the treatment of hemifacial spasm as a therapeutic alternative. This treatment is within the patients' economic reach and more importantly allows them to once again lead normal lives.

[Risk factors for cesarean section: epidemiologic approach]. / Factores de riesgo para cesárea: un enfoque epidemiológico.

The increase in frequency of cesareans that has been noted through 70's, not diminished--like it was expected--perinatal morbidity and mortality. The most important indications to cesarean are distocias, previous cesarean and fetal stress. In 1998 frequency of cesarean deliveries in our hospital was 35% of the pregnancy attended. The claim of this study was to determine risks factors to cesarean in our hospital. A case-control study was performed, selecting 165 cases (cesareans) and 328 controls (via vaginal). It was determined OR of the risks factors and atribuible fraction. Data were analyzed by X2. The most important indications to cesarean delivery were: distocias (39%, n = 64); previous cesarean (23%, n = 41) and fetal stress (11%, n = 21). There was not significative differences in age, height and rupture membrane time in both groups. History of cesarean delivery gave major risk to another surgical intervention (OR = 12.7, p = < 0.0001, atribuible fraction 92%). Nuliparous (OR = 6.6, p < 0.00000, atribuible fraction 85%), second gestation (OR = 1.8, p = 0.002) or history of abortion (OR = 1.8, p = 0.04) were factors mainly associated to cesarean delivery. We concluded that the precise 'medications of this surgical intervention specially in nuliparous or previous cesarean delivery cases must be replanteated to diminish its elevated frequency.