Dysphagia in patients undergoing esophageal atresia surgery: Assessment using a functional scale. / Disfagia en pacientes intervenidos de atresia de esófago: valoración con una escala funcional.

INTRODUCTION: Dysphagia is defined as difficulty swallowing. Up to 84% of patients undergoing esophageal atresia surgery have dysphagia beyond the neonatal period. MATERIALS AND METHODS: A retrospective study of patients undergoing esophageal atresia surgery from 2005 to 2021 was carried out. The Functional Oral Intake Scale (FOIS) was used to assess dysphagia in 4 age groups (< 1 year old, 1-4 years old, 5-11 years old, and > 11 years old). FOIS scores < 7 or symptoms of choking, impaction, or food aversion were regarded as dysphagia. RESULTS: 63 patients were analyzed. 74% (47/63) had dysphagia during follow-up. Prevalence was 50% in patients < 1 year old (FOIS mean 4.32), 77% in patients aged 1-4 (FOIS mean 5.61), 45% in patients aged 5-11 (FOIS mean 5.87), and 38% in patients > 11 years old (FOIS mean 6.8). The most frequent causes of dysphagia were stenosis, which occurred in 38% of the patients (n=24), and gastroesophageal reflux (n=18), which was present in 28% of the patients. Both conditions were associated with significantly lower mean FOIS scores (p< 0.05) in the patients under 11 years of age. Differences (p< 0.05) were found in the dysphagia-associated perinatal factors in the various age groups, with longer ventilation assistance times, parenteral nutrition, and hospital stays. CONCLUSIONS: Dysphagia is an extremely frequent symptom at any given age in patients undergoing esophageal atresia surgery. A standardized, cross-disciplinary follow-up is key to improve quality of life.

INTRODUCCION: La disfagia se define como dificultad en el proceso de alimentación. Hasta un 84% de pacientes intervenidos de atresia de esófago tienen disfagia más allá del periodo neonatal. MATERIAL Y METODOS: Estudio retrospectivo de serie de casos intervenidos por atresia de esófago 2005-2021. Se utilizó la escala FOIS (Functional Oral Intake Scale) para cuantificar la disfagia en 4 grupos de edad (menores de 1 año, 1-4 años, 5-11 años y mayores de 11 años). Se consideró disfagia cualquier valor de FOIS < 7 o síntomas de atragantamiento, impactación o aversión alimentaria. RESULTADOS: Se obtuvieron datos de 63 pacientes. El 74% (47/63) presentó disfagia durante el seguimiento. La prevalencia fue del 50% < 1 año (media FOIS 4.32), 77% 1-4 años (media FOIS 5.61), 45% 5-11 años (media FOIS 5.87) y 38% > 11 años (media FOIS 6.8). Las causas más frecuentes de disfagia fueron la estenosis, que presentó un 38% de los pacientes (n= 24) y el reflujo gastroesofágico (n= 18), que presentó a su vez un 28% de los pacientes. Ambas condiciones se asociaron con unos valores medios de FOIS significativamente menores (p< 0,05) en los pacientes menores de 11 años. Se encontraron diferencias (p< 0,05) en factores perinatales asociados a disfagia en los distintos periodos de edad, a destacar mayor tiempo medio de: asistencia ventilatoria, nutrición parenteral e ingreso hospitalario. CONCLUSIONES: La disfagia es un síntoma extremadamente frecuente a cualquier edad en los pacientes intervenidos de atresia de esófago. Un seguimiento estandarizado y multidisciplinar es esencial para mejorar la calidad de vida de estos pacientes.

What urethrogram sees and a surgeon does not. / Lo que una uretrografía ve y un cirujano no.

INTRODUCTION: Urethrorrhagia is an infrequent sign in childhood. It should be distinguished from hematuria, since they have a different etiology. CLINICAL CASE: 11-year-old male patient with significant urethrorrhagia. Urinary sediment analysis: red blood cells++. Pelvic ultrasonography: fusiform anechoic image in the corpus spongiosum of the penile root. Retrograde urethrogram: normal anterior urethra, extraluminal contrast passage in the ventral aspect of the bulbar urethra. Cystoscopy: no pathological findings in the urethra or the bladder. Control retrograde urethrogram: cystic dilatation of Cowper's gland duct; Maizels' type 3 perforated syringocele. DISCUSSION: Cowper's syringocele is a rare pathology. It can occur at any stage of childhood in the form of urinary infection, obstructive voiding symptoms, or urethrorrhagia. Urethrogram is key for diagnostic purposes, since most Cowper's syringoceles are detected following urethrogram or cystoscopy. Cases with functional repercussions for the urinary system require surgical treatment. Otherwise, a wait-and-see approach is feasible.

INTRODUCCION: La uretrorragia es un signo infrecuente en la infancia que debe distinguirse de la hematuria dada la diferente etiología de las mismas. CASO CLINICO: Varón de 11 años con uretrorragia franca. Sedimento urinario: hematíes++. Ecografía pélvica: imagen anecoica fusiforme en cuerpo esponjoso de raíz peneana. Uretrografía retrógrada: uretra anterior normal, paso de contraste extraluminal ventral en uretra bulbar. Cistoscopia: sin hallazgos patológicos en uretra ni vejiga. Uretrografía retrógrada de control: dilatación quística del conducto de las glándulas de Cowper; siringocele perforado tipo 3 de Maizels. COMENTARIOS: El siringocele de Cowper es una patología infrecuente que puede debutar en cualquier momento de la infancia como infección urinaria, síntomas miccionales obstructivos o uretrorragia. La uretrografía es fundamental en su diagnóstico ya que la mayoría se objetivan por este medio o cistoscopia. Los casos con repercusión funcional del sistema urinario requieren tratamiento quirúrgico. En caso contrario podrá realizarse actitud expectante.

Testicular volume in adult patients undergoing cryptorchidism surgery in childhood, and impact on paternity. / Volumen testicular en pacientes adultos operados de criptorquidia en edad infantil y su efecto sobre la paternidad.

OBJECTIVE: To determine the impact of orchiopexy on testicular volume. To determine whether age at surgery impacts testicular volume. To determine whether paternity is associated with testicular volume. METHODS: Patients born between 1961 and 1985 who had undergone cryptorchidism surgery at the Pediatric Surgery Department of Miguel Servet University Hospital were included. Testis location and macroscopic appearance data were collected. Control testicular ultrasonographies and paternity surveys were carried out. Initially, the study was descriptive, and subsequently, inferential. RESULTS: Ultrasonography was performed in 216 testicular units a mean of 14.9 years following surgery, whereas the paternity survey was conducted among 157 respondents a mean of 41.9 years following surgery. There were significant differences (p = 0.0038) in testicular volume distribution according to epididymal dissociation. There was a linear correlation between older age at surgery and lower testicular volume, but without statistical significance. Significant differences (p < 0.0001) in testicular volume according to groups - operated and non-operated -, as well as between unilateral and bilateral cases, were found. No differences in paternity rates according to testicular volume were noted. CONCLUSION: Operated testes have lower volumes than normally descended testes. Older age at surgery may contribute to lower final volumes. Testes with full epididymal-testicular dissociation have lower total volumes. No relation between testicular volume and paternity rates was found. Further long-term studies are required.

OBJETIVOS: Determinar el efecto de la orquidopexia sobre el volumen testicular. Determinar si la edad de intervención afecta el volumen testicular. Determinar si la paternidad se asocia al volumen testicular. METODOS: Pacientes nacidos entre los años 1961 y 1985, intervenidos de criptorquidia por el Servicio de Cirugía Pediátrica del Hospital Universitario Miguel Servet, tomando datos de la localización del teste y aspecto macroscópico. Se realizan ecografías testiculares de control y encuestas de paternidad. Realizamos un estudio inicial descriptivo y posteriormente inferencial. RESULTADOS: La ecografía se realizó con una media de 14,9 años postoperatorios en 216 unidades testiculares y la encuesta de paternidad con una media 41,9 años postoperatorios a 157 participantes. Existen diferencias significativas (p = 0,0038) en la distribución del volumen testicular según disyunción del epidídimo. Hay correlación lineal entre mayor edad de tratamiento quirúrgico y menor volumen testicular sin llegar a significancia estadística. Se observan diferencias significativas (p < 0,0001) en el volumen testicular según grupos de operados y no operados, como también entre los unilaterales y los bilaterales. No se observan diferencias en índices de paternidad según volumen testicular. CONCLUSION: El teste intervenido presenta un volumen testicular menor que el teste de descenso normal. Una mayor edad de tratamiento quirúrgico puede contribuir a un menor volumen final del teste. Los testículos con disyunción epidídimo testicular completa, tienen menor volumen total. No observamos relación entre el volumen testicular y índices de paternidad. Más estudios a largo plazo son necesarios.

What's up with my neck? Ultrasound and surgical findings in cervical midline tumors. / ¿Qué tengo en el cuello? Hallazgos ecográficos y quirúrgicos en tumoraciones de línea media cervical.

OBJECTIVE: Evaluate ultrasound (US) sensitivity and specificity in suspected thyroglossal duct cysts (TGDC) undergoing surgery in our hospital, and their correlation with surgical findings. MATERIAL AND METHODS: Retrospective study of 150 patients undergoing surgery for midline neck mass suggestive of TGDC (2008-2018). We analyzed epidemiological variables and compared the correlation between diagnostic ultrasound imaging and surgical findings, considering previous episodes of local infection. RESULTS: Mean age at surgery was 3.96 years (0.75-12.58 years). Of the 150 patients, 81 were male and 69 were female. Following ultrasound examination, 110 were suspected to have TGDC, and diagnosis was confirmed after surgery in 80 cases. Of the remaining 40 cases without TGDC-compatible US examination, TGDC was confirmed in 15 cases. The rest were diagnosed with dermoid cyst (49), lymphadenopathy (4), and vascular malformation (2). US sensitivity was 84%, while specificity was 45%, with a positive predictive value of 73%, and a negative predictive value of 62%. In 62.1% (59) of TGDCs, a previous infection episode had been described, with 16.7% of cases requiring surgical drainage. 13.6% had recurrence after Sistrunk technique. There was no statistically significant relationship between previous infection episodes and postsurgical recurrence, or between surgical or spontaneous drainage and cyst recurrence. CONCLUSIONS: Even though US role in eutopic thyroid gland identification cannot be doubted, it provides with low specificity in the study of midline neck masses. Therefore, the physician's opinion should be prioritized.

OBJETIVO: Evaluar la sensibilidad y especificidad de la ecografía en las sospechas de quistes del conducto tirogloso (QCT) intervenidas en nuestro centro y su correlación con los hallazgos quirúrgicos. MATERIAL Y METODOS: Estudio retrospectivo de 150 pacientes intervenidos por nódulo en línea media cervical sugestivo de QCT (2008-2018). Recogida de variables epidemiológicas y comparación de la correlación de imagen ecográfica con hallazgos quirúrgicos, considerando la presencia de episodios de sobreinfección previos. RESULTADOS: La edad media de intervención fue de 3,96 años (0,75-12,58 años), siendo 69 mujeres y 81 hombres. De 150 pacientes, 110 presentaron ecografía compatible con QCT, confirmándose el diagnóstico por anatomía patológica en 80 casos. De los 40 pacientes con ecografía no compatible, en 15 se confirmó diagnóstico de QCT. En 95 pacientes del total se identificó QCT. El resto fueron diagnosticados de quiste dermoide (49), adenopatía (4) y malformación vascular (2). La sensibilidad ecográfica fue del 84% y la especificidad del 45%, el valor predictivo positivo del 73% y valor predictivo negativo del 62%. El 62,1% (59) de los QCT tuvo episodio de sobreinfección, precisando drenaje quirúrgico 16,7%. El 13,6% presentó recidiva tras técnica de Sistrunk. No se encontró relación estadísticamente significativa entre episodios previos de infección y recidiva postquirúrgica, ni entre drenaje (espontáneo o quirúrgico) y recidiva del quiste. CONCLUSIONES: A pesar de la importancia de la ecografía para valorar tiroides eutópico en sospechas de QCT, su resultado en el estudio de quistes cervicales tiene baja especificidad, debiendo primar el criterio del facultativo.

Aircraft soot from conventional fuels and biofuels during ground idle and climb-out conditions: Electron microscopy and X-ray micro-spectroscopy.

Aircraft soot has a significant impact on global and local air pollution and is of particular concern for the population working at airports and living nearby. The morphology and chemistry of soot are related to its reactivity and depend mainly on engine operating conditions and fuel-type. We investigated the morphology (by transmission electron microscopy) and chemistry (by X-ray micro-spectroscopy) of soot from the exhaust of a CFM 56-7B26 turbofan engine, currently the most common engine in aviation fleet, operated in the test cell of SR Technics, Zurich airport. Standard kerosene (Jet A-1) and a biofuel blend (Jet A-1 with 32% HEFA) were used at ground idle and climb-out engine thrust, as these conditions highly influence air quality at airport areas. The results indicate that soot reactivity decreases from ground idle to climb-out conditions for both fuel types. Nearly one third of the primary soot particles generated by the blended fuel at climb-out engine thrust bear an outer amorphous shell implying higher reactivity. This characteristic referring to soot reactivity needs to be taken into account when evaluating the advantage of HEFA blending at high engine thrust. The soot type that is most prone to react with its surrounding is generated by Jet A-1 fuel at ground idle. Biofuel blending slightly lowers soot reactivity at ground idle but does the opposite at climb-out conditions. As far as soot reactivity is concerned, biofuels can prove beneficial for airports where ground idle is a common situation; the benefit of biofuels for climb-out conditions is uncertain.

Role of equilibrative adenosine transporters and adenosine receptors as modulators of the human placental endothelium in gestational diabetes mellitus.

Gestational diabetes mellitus (GDM) is a diseases that alters human placenta macro and microvascular reactivity as a result of endothelial dysfunction. The human placenta is a highly vascularized organ which lacks innervation, so blood flux is governed by locally released vasoactive molecules, including the endogenous nucleoside adenosine and the free radical nitric oxide (NO). Altered adenosine metabolism and uptake by the endothelium leads to increased NO synthesis which then turns-off the expression of genes coding for a family of nucleoside membrane transporters belonging to equilibrative nucleoside transporters, particularly isoforms 1 (hENT1) and 2 (hENT2). This mechanism leads to increased extracellular adenosine and, as a consequence, activation of adenosine receptors to further sustain a tonic activation of NO synthesis. This is a phenomenon that seems operative in the placental macro and microvascular endothelium in GDM. We here summarize the findings available in the literature regarding these mechanisms in the human feto-placental circulation. This phenomenon is altered in the feto-placental vasculature, which could be crucial for understanding GDM deleterious effects in fetal growth and development.

Liver transplantation using University of Wisconsin or Celsior preserving solutions in the portal vein and Euro-Collins in the aorta.

INTRODUCTION: Orthotopic liver transplantation (OLT) is today the gold standard treatment of the end-stage liver disease. Different solutions are used for graft preservation. Our objective was to compare the results of cadaveric donor OLT, preserved with the University of Wisconsin (UW) or Celsior solutions in the portal vein and Euro-Collins in the aorta. METHODS: We evaluated retrospectively 72 OLT recipients, including 36 with UW solution (group UW) and 36 with Celsior (group CS). Donors were perfused in situ with 1000 mL UW or Celsior in the portal vein of and 3000 mL of Euro-Collins in the aortia and on the back table managed with 500 mL UW or Celsior in the portal vein, 250 mL in the hepatic artery, and 250 mL in the biliary duct. We evaluated the following variables: donor characteristics, recipient features, intraoperative details, reperfusion injury, and steatosis via a biopsy after reperfusion. We noted grafts with primary nonfunction (PNF), initial poor function (IPF), rejection episodes, biliary duct complications, hepatic artery complications, re-OLT, and recipient death in the first year after OLT. RESULTS: The average age was 33.6 years in the UW group versus 41 years in the CS group (P = .048). There was a longer duration of surgery in the UW group (P = .001). The other recipient characteristics, ischemia-reperfusion injury, steatosis, PNF, IPF, rejection, re-OLT, and recipient survival were not different. Stenosis of the biliary duct occured in 3 (8.3%) cases in the UW group and 8 (22.2%) in the CS (P = .19) with hepatic artery thrombosis in 4 (11.1%) CS versus none in the UW group (P = .11). CONCLUSION: Cadaveric donor OLT showed similar results with organs preserved with UW or Celsior in the portal vein and Euro-Collins in the aorta.

Histopathologic characteristics of incidental hepatocellular carcinoma after liver transplantation.

INTRODUCTION: Liver transplantation for patients with hepatocellular carcinoma (HCC) is an accepted therapeutic modality, depending on the size and number of nodules. Since a high incidence of incidental HCC at transplantation has been reported, our aim was to evaluate the histopathologic characteristics of these patients. PATIENTS AND METHODS: This retrospective analysis from March 1998 to June 2009 included liver transplantation patients without increased alpha-fetoprotein or nodules on imaging methods. We included patients with HCC on anatomopathologic exam, excluding those presenting with HCC on the presurgery evaluation through clinical, laboratory and imaging methods. RESULTS: Among the 277 transplanted subjects, 27 showed incidental HCC. The alpha-fetoprotein average level was 8.52 mg/dL (1.6-28.2). One patient presented with adenomatosis and focus of HCC. Histopathologic analyses showed: mean tumor size was 0.9 cm (range = 0.4-3.5); average number of tumors in each explanted liver 1.85 (range = 1-7) nodules; and three (11.1%), microvascular invasion (11.1%). The TNM staging showed 17 (63%) stage I and 6 (22%) stage II. The Edmondson and Steiner classification showed 19 (70%) subjects in degree II. CONCLUSION: The histopathologic presentation of incidental HCC after liver transplantation showed tumors in early stage with microvascular invasion in some cases.

Prevalence, treatment, and outcomes of the hepatic artery stenosis after liver transplantation.

INTRODUCTION: Hepatic artery stenosis (HAS) after liver transplantation can lead to altered hepatic function and/or thrombosis, there by increasing morbidity and mortality. The prevalence of HAS in the literatures varies from 4% to 11%. OBJECTIVE: We sought to describe the prevalence and treatment of hepatic artery stenosis. METHODS: We performed a descriptive retrospective analysis of 253 liver transplantations from March 1998 to May 2007, including patients with suspected HAS owing to increased hepatic enzymes, altered Doppler ultrasound (us) and hepatic biopsy. The confirmation of HAS was achieved through areriography. RESULTS: Nine patients were identified to have HAS, a 3.5% prevalence. Among the HAS patients, seven were male and two female. Their average age was 35.5 years (range, 65 to 53). The average time between the diagnosis and transplantation was 14.2 months (range, 9 to 68). The increase in hepatic enzymes among this group averaged: aspartate aminotransferase 131 U/L (range, 26 to 412) and alanine aminotransferase 192 U/L (range, 35 to 511). Doppler US showed alteration in the resistance level index. All patients underwent areriography; only one could not be treated owing to severe hepatic artery spasm, which also occurred during another attempt weeks after the first one. Among the eight patients, six were treated with stents and two with angioplastis. All treated patients displayed improvements in parameters. Four patients treated with stents required retreatment: two underwent angioplasty and two, a thrombolytic. One graft rethrombosed but evolved in compensated fashion with recanalization by collaterals. There has been no graft loss or mortality in this population. The average time of posttreatment follow-up was 31.28 (range, 9 to 68) months. CONCLUSION: The prevalence of HAS in our unit was within that reported in the literature. Treatment with a stent or angioplasty proved to be efficient to control this complication, considering that hepatic function recovered and that there was neither graft nor patient loss.

Adenovirus transmission in a nursing home: analysis of an epidemic outbreak of keratoconjunctivitis.

BACKGROUND: An epidemic outbreak of keratoconjunctivitis occurred in a nursing home in Madrid from August to December 2005. OBJECTIVE: This article reports the outbreak, the infection control measures taken, and risk factors for keratoconjunctivitis. METHODS: A cohort study was conducted on the nursing home staff and residents. Specific attack rates and relative risks with their 95% confidence intervals were estimated. A multivariate analysis (logistic regression) was performed proving odds ratios (OR) of becoming ill. Conjunctival swab samples were taken and tested for viral infection. More stringent infection control measures were implemented following the occurrence of the initial cases. RESULTS: Forty-six cases were identified in the nursing home (infection rates of 30.5% in residents and 8.3% in workers). Total duration of the outbreak was 120 days. Corneal ulcer occurred in 3 cases. The factors appearing as independent risk factors were age (OR = 5.7 in people aged >or=90 years compared to those aged <80 years), cognitive impairment (OR = 2.64) and nursing home floor (OR = 2.74 for the first floor, where the outbreak started). Adenoviral DNA was amplified in 10 samples, and 8 of them could be typed as adenovirus serotype 8. CONCLUSIONS: Early adoption of adequate hygiene measures is essential to control these outbreaks. In nursing homes with a high number of people with cognitive impairment, an additional effort should be made when the first cases occur to provide such people an increased and improved care and monitoring.

Colangioresonancia (CPRM) vs ultrasonido (US) focalizado en pacientes con ictericia o sospecha de obstrucción de la vía biliar: resultados preliminares / Magnetic resonance cholangiopancreatography (MRCP) versus ultrasound (US) focused in patients with ictericia or suspicion of bile duct obstruction: preliminary results

Introducción. Existe controversia en el algoritmo de estudio de obstrucción de la vía biliar (VB). La colangiopacreatografía endoscópica retrógrada (ERCP) ha sido el examen de referencia. La colangioresonancia (CPRM) es un examen no invasivo con buena correlación entre observadores al evaluar la VB, pero aún cuestionada en nuestro medio por su mayor costo. El US convencional focalizado detecta dilatación de VB y disminuye los costos del algoritmo de estudio, seleccionando los pacientes que debieran referirse a otros métodos de estudio más costosos o invasivos (CPRM-ERCP). Objetivo. Comparar la validez, valores predictivos y cambios de probabilidad post-test de CPRM y US focalizado a la VB, en el estudio de pacientes con ictericia o sospecha de obstrucción biliar. Materiales y métodos. Se realizó un ensayo clínico pareado ciego. La muestra la constituyeron pacientes con sospecha de patología obstructiva de la VB a los cuales se les solicitó CPRM entre Enero-Julio 2003. Se les realizó US 24 hr antes o después de la CPRM por ecografistas de diferente experiencia. La CPRM se realizó con protocolos estándar, se registró el uso de Gadolinio y secuencias adicionales. El estándar dorado lo constituyeron la cirugía, la ERCP, seguimiento de al menos 30 días y revisión de informes de Anatomía Patológica. Se clasificó el riesgo de obstrucción de la VB en alto, moderado o bajo. Análisis. Se construyeron tablas de contingencia de 2x2 para estimar los valores del test: Sensibilidad (S), Especificidad (E), Valores predictivos positivo (VPP) y negativo (VPN), Likelihood ratios (LR) y probabilidades pre y post test. Resultados. Muestra constituida por 76 pacientes de los cuales 64 han completado el seguimiento. En el grupo de Alto riesgo en 21 pacientes se comprobó obstrucción, en 1 de los de moderado, en ninguno de los de bajo riesgo y en 2 de los no clasificados. La prevalencia de obstrucción (probabilidad pre-test) fue de 24/64 (37.5 por ciento). El US encontró dilatación d

[Burned out testicular tumor]. / Tumor testicular fundido "Burned out".

OBJECTIVE: Extragonadal germ cell tumor is a rare condition. The present study reports an additional case of this uncommon disease. METHODS/RESULTS: A 24-year-old male with retroperitoneal disease and a testicular lesion detected by ultrasonography is described. Histopathological analysis of the orchiectomy specimen disclosed a 'burned out' tumor. The anatomopathological features of this tumor type are discussed. CONCLUSION: Extragonadal germ cell tumor is a rare condition. It derives from the germ cells that exist in the gonad and is located in every anatomical region but the gonad itself. Ultrasonography must be performed if an extragonadal germ cell tumor is suspected.

Cobertura de artículos y revistas mexicanas en la base de datos Bibliomex Salud / Coverage of Mexican manuscripts and journals in a Mexican biomedical data base

Objetivo. Evaluar la cobertura de artículos y revistas médicas mexicanas durante los 10 años de existencia de la base de datos mexicana Bibliomex Salud. Material y métodos. Se analizó si los artículos publicados por la Revista de Investigación Clínica (RIC) fueron registrados por Bibliomex: la ausencia de un manuscrito RIC en Bibliomex se consideró una falla por omisión. Se recuperó la identidad de las revistas mexicanas capturadas en dicho lapso. Del total de 744 manuscritos, se excluyeron 99 (22 extranjeros, 25 no referenciables y 52 inicialmente no capturados por Bibliomex). El remanente de 645 manuscritos se clasificó de acuerdo con el año en que comenzaron a registrarse: originales desde el inicio, cartas a los editores a partir de 1990, editoriales y respuestas a cartas a partir de 1993. Resultados. Bibliomex inició con 21 revistas mexicanas y actualmente captura más de 50 (12 durante los 10 años, y 27 en los últimos cinco a nueve años); tuvo 8 por ciento de omisiones en originales (46/597) y cartas (3/36) y 25 por ciento en editoriales y respuestas (3/12). Conclusiones: a) Ha mejorado sensiblemente la cobertura de Bibliomex en la segunda mitad de su vida tanto en manuscritos como en revistas: b) el uso de la información publicada por Bibliomex podría mejorarse con dos modificaciones de su proceso operativo; c) Bibliomex parece ser actualmente una base de datos adecuada para recabar información de producción biomédica mexicana que pudiera publicar periódicamente algún organismo interesado

Objetive. To evaluate the coverage of Mexican journals and manuscripts of biomedical research in a Mexican data base (Bibliomex Salud) during its 10 years of existence (1985-1994). Material and methods. All the manuscripts published by a single Mexican journal Revista de Investigación Clínica (RIG) were searched for in Bibliomex: the absence of a RIC manuscript in Bibliomex was considered a failure. Also, the number and identity of the Mexican journals included in Bibliomex was also noted. From a total of 744 manuscripts 99 were excluded (22 non-Mexican, 25 non-indexable, and 52 initially not indexed by Bibliomex). The remainder (645) were classified according to starting year of indexing: originals since the first year; letters to the editor since 1990; and editorials and authors' replies since 1993. Results. Bibliomex started out with 21 Mexican journals and now has more than 50 (12 indexed during the 10 years, 27 for the last 5-9 years, and 16 for the last 1-4 years). Regarding manuscripts, Bibliomex had an 8% failure rate in originals (46/597) and letters (3/36), and 25% in editorials and authors' replies (3/12). Conclusions. a) The coverage of Bibliomex has improved in its second half of life in the number of both journals and manuscripts indexed; b) the retrieval of information could be improved by two changes in the procedures of Bibliomex; c) Bibliomex seems to be a database which could be used to analyze Mexican research production at several levels (institutional, regional, and national).

Retroperitoneal approach used exclusively with epidural anesthesia for infrarenal aortic disease.

BACKGROUND: The retroperitoneal approach for elective infrarenal aortic procedures is an attractive alternative to the standard transperitoneal approach. In an effort to limit the number of extraneous influences on patient outcome, this approach was performed using epidural anesthesia without the use of endotracheal intubation or general anesthesia. METHODS: From June 1991 through July 1993, 62 consecutive patients with aorto-occlusive or aorto-iliac disease underwent infrarenal aortic repair using the retroperitoneal approach. Epidural anesthesia was used exclusively in all cases. Patients were evaluated for age, sex, comorbid conditions, morbidity, operating time, blood loss, ileus, and length of hospital stay. RESULTS: There were 29 aortobiiliac bypasses, 18 aortobifemoral bypasses, and 15 aortic tube grafts. Three patients had an associated renal artery procedure performed. There were 48 men and 14 women. The average age was 74.2 years (range 30 to 88). Comorbid conditions including smoking (69%), coronary artery disease (61%), hypertension (61%), prior myocardial infarction (43%), chronic obstructive pulmonary disease (35%), prior surgery (27%), diabetes mellitus (24%), and a history of cancer (8%) were identified. The average length of surgery was 2 hours and 10 minutes (range 1 hour 20 minutes to 3 hours 15 minutes). The average blood loss was 510 mL (range 200 to 4,000). A nasogastric tube was not used in any patient perioperatively, and oral feeding was started on average by postoperative day 2. The average intensive care unit stay was 1.3 days (range 1 to 7). A mortality rate of 1.6%, and major complication rate of 11% were found. None were of pulmonary nature, which may be ascribed to the absence of endotracheal intubation or general anesthesia. A minor complication rate of 19% was achieved under the presented method. The average hospital stay was 7.7 days (range 5 to 15). CONCLUSION: No large series using the retroperitoneal approach exclusively under epidural anesthesia has been reported. Recent literature on the retroperitoneal approach makes use of general anesthesia with/without epidural anesthesia. This review supports our contention that the procedure of choice for elective infrarenal aortic surgery is the retroperitoneal approach utilizing epidural anesthesia in the absence of endotracheal intubation and general anesthesia. There is a decrease in the physiologic disturbances associated with general anesthesia, notably pulmonary and gastrointestinal, when only epidural anesthesia is used. This translated into a low complication rate, improved patient comfort, early hospital discharge, and subsequent lower costs.

Imágenes ecotomográficas de úlcera gastro-duodenal / Echotomographic images of gastroduodenal ulcer

The ultrasonographic study of gastroduodenal lesions has received little attention. We report results of ultrasound examination in 39 patients with gastric ulcer and 14 patients with duodenal ulcers, all endoscopically confirmed. We describe six varieties of ultrasonographic images that change with front or side views of the crater, according to the contents of the crater (liquid, sediment of air-mucus) and according to its localization (proximal or distal to the transducer). The importance of gastroduodenal segment exploration during ultrasound examination is emphasized

Effects of magnesium, high energy phosphates, piracetam and thiamin on erythrocyte transketolase.

Erythrocyte transketolase activity coefficient (ETK-AC) and affinity for coenzyme (Km TPP) were assessed in 50 patients with transketolase abnormalities such as fibromyalgia or senile dementia of Alzheimer's type, before and after magnesium (Mg), thiamin+pyridoxine (B1,B6), high energy phosphates (HEP) (phosphocreatinine of adenosine triphosphate), and piracetam. Compared to 12 untreated patients, ETK-AC was significantly decreased with B1,B6 (P < 0.05, n = 10); Km-TPP was significantly decreased with HEP (P < 0.05, n = 20) and piracetam (P < 0.01, n = 5). In nine other patients treated with HEP + B1,B6 + magnesium, ETK-AC and Km TPP were both significantly decreased.

Laparoscopic gastrostomy versus percutaneous endoscopic gastrostomy. A comparison.

A retrospective study was carried out at our institution to compare patients who underwent percutaneous endoscopic gastrostomy (PEG) to those who underwent laparoscopic gastrostomy (LG). There were 17 patients who had a PEG with a mean age of 81 years (43-97 years). The procedure time, including complete esophago-gastroduodenoscopy, averaged 28 min. There were four deaths (23%) in a 30-day period, but none of these were directly related to the procedure. The LG group consisted of 14 patients with a mean age of 66 years (20-94 years). Mean duration of the procedure was 18 minutes. Thirty-day mortality rate was 35% (five patients) with one death (7%) directly related to the tube. Indications for gastrostomy were similar in both groups, being predominantly inability to eat and/or recurrent aspiration. However, LG was done because of 4 technical failures, 5 patients with tumors of the head and neck, 2 patients with esophageal obstruction and radiation stenosis precluding safe PEG, and 1 patient with hiatal hernia; 2 LGs were performed at the surgeon's preference. Outcomes for LG and PEG were comparable. LG is a suitable, safe alternative to PEG in selected patients who cannot undergo gastroscopy and should be considered the procedure of choice in patients with head and neck tumors or intrathoracic pathology that prevents PEG.