Incidence and characterization of the anterior resection syndrome through the use of the LARS scale (low anterior resection score).

INTRODUCTION: Recently a score (LARS) has been internationally validates that quantifies the anterior resection syndrome (ARS). The objective of this study is to know the incidence and severity of the ARS using LARS and its correlation with selected variables or risk factors. METHODS: All operated patients with anterior resection for rectal cancer between October 2007 and February 2014, with curative intention and at least one year of functionality, were sent a LARS questionnaire. The variables studied were: Age sex, time elapsed since surgery, type of surgical approach, type of anastomosis, derivative ileostomy, postoperative pelvic complication, and radiotherapy regimen. RESULTS: Out of 195 patients, 136 (70%) responded, and 132 responded properly. A total of 47% of the patients presented "severe" LARS and 34% did not develop quantifiable ARS. Quality of life was worse in the highest LARS scores (P=.002). In the univariate analysis, total mesorectal excision, long radiotherapy regimen and derivative stoma were associated to "severe" LARS and the use of a reservoir was associated with minor LARS. In multivariate analysis only the type of resection (P<.001) and the use of a reservoir (P=.002) were individual factors related to LARS. CONCLUSIONS: Half of the operated patients presented high LARS score and only a third did not provide a quantifiable ARS. The overall perception of quality of life was significantly worse in patients with more severe LARS. The absence of the rectum (total mesorectal excision) and the type of anastomosis were the main factors associated with the LARS score.

Perineostomy: the last oportunity.

OBJECTIVE: To review the technique and outcome of perineal urethrostomy or urethral perineostomy and to identify factors related to the procedure failure. MATERIAL AND METHODS: We studied 17 patients who underwent perineal urethrostomy between 2009-2013 in a single hospital. Success was defined as no need for additional surgical treatment or urethral dilatation. We reviewed the clinical data related to age, weight, previous urethral surgery, diabetes, hypertension, ischemic cardiopathy, lichen sclerosus and other causes and studied their association with the procedure failure (univariate analysis). We completed the analysis with a multivariate test based on binary regression. RESULTS: The average follow-up was 39.41 months. From all the causes, we found Lichen Sclerosus in 35 %, idiopathic etiology in 29 % and prior hypospadia repair in 18 %. Postoperative failure occurred in 3 patients, with a final success of 82.4 %. The binary regression model showed as independent risk factors ischemic cardiopathy (OR: 2.34), and the presence of Lichen Sclerosis (OR: 3.21). CONCLUSIONS: The success rate with the perineal urethrostomy technique shows it to be a valid option above all when we preserve the urethral blood supply and plate. Lichen sclerosus and ischemic vascular problems are risk factors to re-stenosis.

Total pelvic exenteration for the treatment of advanced primary or recurrent pelvic neoplasia.

INTRODUCTION: Complete resection with clear margins in locally advanced pelvic visceral tumors, primary or recurrent, occasionally requires total pelvic exenteration (TPE). METHODS: We reviewed the results of EFA in 34 consecutive patients operated on between June 2006 and December 2013. RESULTS: Median age was 62 (40-82) years; 24 (70%) were male. The tumor origin most frequent was advanced primary rectal tumor (APRT), with 19 cases (55.9%) and most common type of exenteration was supraelevator (61.8%). R0 resection was achieved in 24 (70.6%) patients and in 16 (85%) of the APRT. Fifteen (79%) patients had pT4 APRT, and 4 (20%) pN +. Reconstruction of the bowel and bladder was performed with two stomas in 17 cases (50%), colorectal anastomosis and Bricker in 11 (32.3%) and wet double barreled colostomy in 6 (17.6%). There was no postoperative mortality; 23 (67,5%) patients had complications, and 5 (14.6%) required a postoperative reoperation to solve them. Median follow-up was 23 (13-45) months. Overall survival (OS) and disease free survival (DFS) at 2 years were 67% and 58% respectively, and the median OS and DFS was 59 months (95% CI 26-110) and 39 months (95% CI 14-64), respectively. The DFS of R0 was significantly better (p=0.003) than R1. CONCLUSIONS: TPE is a potentially curative procedure for advanced pelvic visceral malignancies with similar morbi-mortality than other extended excisional surgery.

[Interposition of the small intestine between the colon and the rectum as a way of achieving a pelvic anastomosis without pressure]. / Interposición de intestino delgado entre el colon y el recto como forma de lograr una anastomosis pélvica sin tensión.

PURPOSE: There are some circumstances in which the descending colon does not reach the pelvis to complete a colorectal anastomosis without tension. Re-establishing intestinal continuity by interposing small bowel as a bridge between the colon and the rectum could be an acceptable surgical alternative. METHODS: We describe the interposition of one or two segments of small bowel as a way of restoring continuity of the colon and rectum in three patients in whom it was not possible to perform a colorectal anastomosis without tension due to ischaemic colon, synchronous cancer or difficulty in accessing the supramesocolic space, respectively. RESULTS: Intestinal continuity was re-established in all patients with no significant morbidity and good intestinal function. CONCLUSION: The interposition of small bowel segments between the colon and the rectum should be considered a valid surgical option when it is not possible to achieve a well-perfused, tension-free pelvic colorectal anastomosis.

[Surgical approach to the locoregional recurrence of cancer of the rectum]. / Abordaje quirúrgico de la recidiva locorregional del cáncer de recto.

A literature review has been made on the pelvic recurrence of rectal cancer using the MedLine, Ovid, EMBASE, Cochrane and Cinahl data bases. Assessment of the locoregional recurrence must be made using imaging tests in order to rule out the presence of metastasis, as well as for locating its exact location within the pelvis. As the only curative treatment should be complete resection of the recurrence with negative margins, a pre-operative CT, NMR, endorectal ultrasound and PET-CT must be performed to determine its resectability. For a potential cure, radical resections must be made, with the technique varying according to whether the location is central (axial), posterior (presacral) or lateral, as well as treatment directed at the primary tumour. Neoadjuvant treatments, brachiterapy and intra-operative radiotherapy improve the local control results and survival in these patients.

Midluteal matrix metalloproteinase and tissue-inhibiting metalloproteinase plasma levels after embryo transfer.

This study demonstrates significant differences in the midluteal concentrations of active matrix metalloproteinase (MMP)-1, MMP-2, and total MMP-3 between patients who conceived and those who did not after day 3 ET.

La Voluntad Política en la Salud Pública cubana / Political willingness in the Cuban public health

Se aborda el tema Voluntad Política teniendo como paradigma al conductor de la Revolución cubana, Fidel Castro Ruz. Se realizó una búsqueda de los términos Voluntad, Política y Voluntad Política. Se hace un recuento de cómo se inició esa voluntad partiendo de un análisis de la situación de salud antes del triunfo de la Revolución y como en el decursar de la lucha de liberación y después del triunfo, esa voluntad se transformó en Voluntad Política presente en todas las acciones de salud hasta nuestros días. La Voluntad Política ha estado impulsada en lo interno por Fidel y su influencia hacia lo externo en las acciones de gobiernos progresistas en la región de las Américas, a los cuales se les combate en la actualidad en una ofensiva con vista a la implantación de políticas neoliberales contradictorias con la voluntad de los pueblos.Se le reconoce a Fidel su ejemplo, su enseñanza y su dedicación a la Salud Publica cubana(AU)

The topic called political willingness was dealt with in this paper, taking the leader of the Cuban Revolution Fidel Castro Ruz as paradigm. The terms willingness, politics and political willingness were searched for. An account was made of how this type of willingness emerged, on the basis of the analysis of the health situation before the Revolution, and how this willingness changed into political willingness in the course of the liberation struggle and after the triumph of the revolution. It is present in all the health actions put into practice up to our times, encouraged by Fidel at domestic level, and its external influence over the actions undertaken by progressive governments in the Americas, which are now fought in an offensive to implement neoliberal policies going against the peoples´ willingness. Fidel´s example, teachings and devotion to the Cuban public health were acknowledged(AU)

Robotic-assisted laparoscopic ovarian tissue transplantation.

OBJECTIVE: To describe a technique for frozen-banked ovarian tissue transplantation using robotic-assisted laparoscopy. DESIGN: Case study. SETTING: Academic tertiary care center. PATIENT(S): A 38-year-old patient in remission for non-Hodgkin lymphoma, whose ovarian tissue had been frozen for 3 years. INTERVENTION(S): Robotic-assisted laparoscopic transplantation of thawed ovarian cortical tissue to the remaining ovary and peritoneum. MAIN OUTCOME MEASURE(S): Resumption of spontaneous menses, follicular development, and ovulation as demonstrated by ultrasound, and serum E(2) and P levels. RESULT(S): The patient experienced cyclic spontaneous menstruation 6 months after the transplantation. Ovulation was confirmed by ultrasound and serum E(2) and P levels at month 11 after surgery. CONCLUSION(S): Robotic-assisted laparoscopic surgery may be a good, minimally invasive alternative for the ovarian tissue transplantation procedure to restore ovarian function.

Perineostomy: the last oportunity

Objective To review the technique and outcome of perineal urethrostomy or urethral perineostomy and to identify factors related to the procedure failure. Material and methods We studied 17 patients who underwent perineal urethrostomy between 2009-2013 in a single hospital. Success was defined as no need for additional surgical treatment or urethral dilatation. We reviewed the clinical data related to age, weight, previous urethral surgery, diabetes, hypertension, ischemic cardiopathy, lichen sclerosus and other causes and studied their association with the procedure failure (univariate analysis). We completed the analysis with a multivariate test based on binary regression. Results The average follow-up was 39.41 months. From all the causes, we found Lichen Sclerosus in 35%, idiopathic etiology in 29% and prior hypospadia repair in 18%. Postoperative failure occurred in 3 patients, with a final success of 82.4%. The binary regression model showed as independent risk factors ischemic cardiopathy (OR: 2.34), and the presence of Lichen Sclerosis (OR: 3.21). Conclusions The success rate with the perineal urethrostomy technique shows it to be a valid option above all when we preserve the urethral blood supply and plate. Lichen sclerosus and ischemic vascular problems are risk factors to re-stenosis. .

Synthesis of 2-nitro- and 2,2'-dinitrobiphenyls by means of the suzuki cross-coupling reaction.

[Reaction: see text]. Mechanistic investigations and protocols for the synthesis of 2-nitrobiphenyls and 2,2'-dinitrobiphenyls are disclosed. It is revealed that obstacles appear during the transmetalation step when the phenylboronic acid is substituted with a nitro group in the 2-position, whereas when substituted in the 3- or 4-positions, the reaction follows similar patterns as found in the electrophilic substitution of nitrobenzenes, an observation that may be attributed to the elimination step of the catalytic cycle.

Evaluación de algunos factores que pudieron influir en el incremento de la fiebre porcina clásica en el Estado de México, México, durante 1997 / Evaluation of some factors influencing the increment of classical swine fever in athe State of Mexico during 1997

El área de control de la fiebre porcina clásica se encuentra localizada en la parte central y sur de México. Se continúa con la vacunación de los animales y se han seguido presentando casos de la enfermedad. El número de brotes se incrementó durante 1997, siendo 87 por ciento en explotaciones de traspatio. Con el propósito de determinar algunos de los factores que contribuyeron al incremento de los brotes en 1997, se hicieron encuestas en 424 explotaciones de traspatio de cuatro municipios, cuatro mercados o tianguis de animales, cuatro rastros municipales y 16 granjas de ciclo completo de la zona poniente del Estado de México, México, que se encuentra dentro del área de control. En las explotaciones de traspatio, en promedio, 25 por ciento de los cerdos fueron vacunados y en el muestreo serológico 43 por ciento tenían anticuerpos. En promedio 37 por ciento de los cerdos eran vendidos y remplazados cada tres meses. De las granjas de ciclo completo, en 12 por ciento no vacunaban a los animales. En los tianguis, un promedio de 40 por ciento de los cerdos comercializados provenían de la zona en erradicación y 60 por ciento de la zona en control. En los cuatro rastros encuestados, los veterinarios oficiales informaron el decomiso de animales con lesiones sugerentes de fiebre porcina clásica. Se concluyó que los factores que contribuyeron al incremento del número de brotes en 1997 en la población de traspatio, fueron el elevado número de animales susceptibles que estaban entrando al área de control y eran mezclados con otros cerdos en los tianguis, su gran movilidad y bajo nivel de inmunidad, y cerdos enfermos y virémicos eran mandados al rastro por lo que los vehículos y choferes se pudieron contaminar en los rastros y acarrear el virus a las explotaciones porcinas.

La reforma universitaria de 1962 en la Facultad de Ciencias Médicas de la Universidad de La Habana / The 1962th university reform in the Faculty of Medical Sciences from Havana university

Se exponen brevemente los antecedentes históricos en Cuba y América de la Reforma Universitaria de 1962. Se relacionan los hechos más importantes que entorpecieron el proceso de dicha reforma y la participación destacada del estudiantado universitario en su culminación en la Facultad de Ciencias Médicas de la Universidad de La Habana. Por último, se da a conocer la proyección social y humanística que dio la reforma al médico y estomatólogo cubanos en el período revolucionario socialista

The historical antecedents in Cuba and the Americas of the University Reform of 1962 are briefly explained. The most important events that hinder the process of this reform and the outstanding participation of the university students in its culmination at the Faculty of Medical Sciences of Havana University are dealt with. Finally, it is made known the social and humanistic projection given to the Cuban physcians and stomatologists by the reform in the socialist revolutionary period.

Sobre la confección de un programa de desarrollo de las especialidades médicas / On the making of a programme for the development of medical especialities

Se crea una comisión nacional, a nivel ministerial, con la participación de todas las areas del Ministerio de Salud Pública que labora, a tiempo completo, con la participación activa de los grupos nacionales de especialidades médicas, en la confección de un proyecto de programa de desarrollo para cada una de las especialidades médicas. Este proyecto se analiza y discute con la participación de los mejores talentos de la especialidad y los representantes de las demás especialidades médicas bajo la guía de la dirección del Ministerio y la presencia de altos funcionarios del Gobierno, lo que permite arribar a una concepción integral del desarrollo de la especialidad que se plasma en un libro que se confecciona al respecto

Carcinoma in situ de la vejiga: desafío diagnóstico y terapéutico / Carcinoma in situ of urinary bladder: a diagnostic and therapeutical challenge

Se presenta una revisión de 10 años de los casos de carcinoma in situ de la vejiga. De 446 biopsias quirúrgicas obtenidas, 263 correspondieron a carciona de la vejiga y, de ellas, 10 eran de carcinoma in situ. El tratamiento de estos casos plantea grandes dificultades a causa de lo tardío de su diagnóstico. La citología exfoliativa es de gran valor para el estudio de estos casos, aunque requiere la búsqueda intencionada de este trastorno patológico. Los carcinomas de este tipo son muy agresivos, y su pronóstico es malo a corto plazo.

Utilización de los policlínicos en la atención médica especializada de los trabajadores en horarios vespertinos y nocturnos / Use of polyclinics in specialized medical care for workers in the afternoon and evening hours

Se llevó a cabo un pilotaje en 4 municipios de Ciudad de la Habana para analizar las doficultades en la atención médica al trabajador, para lo cual se realizaron 200 entrevistas y revisiones documentales en algunas unidades en diferentes provincias del país. Se concluyó que es factible ejecutar la atención especializada al trabajador y se recomendó la ampliación de este servicio al resto del país, dado los beneficios socioeconómicos: presentación de la salud de los trabajadores, descongestión hospitalaria, ejecución extralaboral y utilización en gran medida de los recursos existentes

Aneurismas de arteria renal. Reporte de un caso / Renal artery aneurysm. One case report

Se ha estimado que los aneurismas de arteria renal representan el 22 por ciento de todos los aneurismas viscerales, sin embargo a nivel de población general su incidencia varía del 0.3 al 1 por ciento. El 20 por ciento puede ser bilateral; y del 55 al 75 por ciento cursan con hipertención arterial secundaria a estenosis renal segmentaria coexistente o a compresión extrínseca provocada por el mismo aneurisma. Se trata de femenino de 41 años de edad, hipertensa de cinco años de evolución de difícil control con manejo médico, con fenómeno de Raynaud incompleto asociado de predominio en extremidades superiores. Perfíl inmunológico completo negativo, gammagrama renal y urografía excretora normal. Se realizó angiografía por sustracción digitálica reportando aneurisma de arteria renal derecha tipo sacular no calcificado de 2.5 x 3.5 cm. Se realizó determinación de reninas con reporte anormal. Se decidió manejo quirúrgico con abordaje transabdominal con incisión transversa con maniobra de Kocher ampliada, resección directa del saco aneurismático y reconstrucción realizando plastia con vena safena autóloga, con sutura continua de monofilamento 7/0 y magnificación óptica del campo a 3x. No hubo complicaciones transoperatorias, y la presión arterial se normalizó. Se realizó Dúplex de control a la semana de postoperatorio con índice de resistencia de .87 en arteria renal y de .57 en vena renal con velocidad de flujo normal. No se apreciaron trastornos estructurales residuales, y el seguimiento actualmente a 6 meses es clínicamente satisfactoria. Conclusión: Los aneurismas de arteria renal son raros, pueden presentar complicaciones graves y cuando se asocian a hipertensión arterial esencial o renovascular, su manejo quirúrgico es factible hacerlo de forma primaria con buenos resultados