Risk factors associated with postoperative morbidity and mortality in D2 radical gastrectomy for gastric cancer.

INTRODUCTION AND AIMS: Surgery is the main treatment for gastric cancer. D2 radical gastrectomy is associated with a variable postoperative morbidity and mortality rate worldwide. The aim of the present study was to identify the risk factors associated with the postoperative morbidity and mortality of D2 radical gastrectomy, with curative intent, for gastric cancer. MATERIALS AND METHODS: A retrospective case series was conducted, in which the medical records were reviewed of patients with gastric cancer that underwent D2 radical gastrectomy, within the time frame of January 2014 and December 2018. Univariate and multivariate analyses were carried out to identify the risk factors related to postoperative morbidity and mortality within 90 days. RESULTS: The percentages of postoperative morbidity and mortality in 691 patients were 23.3% and 3.3%, respectively. In the multivariate analysis, age ≥70 years (OR = 1.85, 95% CI: 1.25-2.76), ASA III-IV (OR = 2.06, 95% CI: 1.28-3.34), total gastrectomy (OR = 1.96, 95% CI:1.19-3.23), and pancreatosplenectomy (OR = 5.41, 95% CI: 1.42-20.61) were associated with greater postoperative morbidity, and age ≥70 years (OR = 4.92, 95% CI:1.78-13.65), lower BMI (OR = 0.81, 95% CI: 0.71-0.92), and hypoalbuminemia (OR = 0.91, 95% CI: 0.85-0.98) were associated with greater mortality in distal and total D2 radical gastrectomy. CONCLUSIONS: D2 radical gastrectomy for gastric cancer was shown to be a safe treatment, with low postoperative morbidity and mortality rates. Age ≥70 years, ASA III-IV, total gastrectomy, and pancreatosplenectomy were factors associated with a higher complication rate. Age ≥70 years, lower BMI, and hypoalbuminemia were mortality predictors in distal and total radical gastrectomy.

[Comparison of treatment with plates for distal tibia fractures]. / Comparación del tratamiento con placas en fractura de tibia distal.

INTRODUCTION: Currently the surgical treatment of fractures of extraarticular distal tibia is controversial for the multiple techniques and materials of osteosynthesis, the Minimally Invasive Percutaneous Techniques (MIPO) allow us to preserve the periosteal circulation, crucial point in the natural processes of convalescence of the patient, so this technique takes relevance in our study. OBJECTIVE: To observe that this approach to fractures of the distal tibia has fewer complications and better functional result than fixation with open technique. MATERIAL AND METHODS: A longitudinal, ambispective and analytical study was conducted in the period from July 2018 to September 2019 in patients with closed fracture of the extraarticular distal tibia in patients over 18 years of age without previously diagnosed musculoskeletal comorbidities, the calculation was performed with the WinPEPI program (Programs for Epidemiologists for Windows) version 11.43 based on the study by Paul Toogooda et al (2018) with a confidence interval of 95% a minimum total of 20 patients for each group. Measures of central tendency, correlations between technique and variable were used. RESULTS: Two groups of 20 patients were analyzed comparing MIPO vs conventional technique in a period of 6 months postsurgical evaluating risk of infection, wound dehiscence, radiographic bone consolidation, joint functionality and demographic data; showing positive statistical superiority for MIPO technique. CONCLUSION: Relevant data were obtained in favor of MIPO with bone consolidation and higher functional score at six months.

INTRODUCCIÓN: Actualmente el tratamiento quirúrgico de fracturas de tibia distal extraarticular es controversial por las múltiples técnicas y materiales de osteosíntesis, las técnicas Mínimo Invasivo Percutánea (MIPO) nos permiten preservar la circulación perióstica, punto crucial en los procesos naturales de convalecencia del paciente, por ello esta técnica es de gran relevancia en nuestro estudio. OBJETIVO: Observar que este abordaje de fracturas de tibia distal tiene menos complicaciones y mejor resultado funcional que la fijación con técnica abierta. MATERIAL Y MÉTODOS: Se realizó un estudio de tipo longitudinal, ambispectivo y analítico en el período de Julio de 2018 a Septiembre de 2019 en pacientes adultos con fractura cerrada de tibia distal extraarticular sin comorbilidades, el cálculo se realizó con el programa WinPEPI (Programs for Epidemiologists for Windows) versión 11.43 basado en el estudio de Paul Toogooda, con un intervalo de confianza de 95% se obtuvo un total mínimo de 20 pacientes por cada grupo. Se usaron medidas de tendencia central, correlaciones entre técnica y variable. RESULTADOS: Se analizaron dos grupos de 20 pacientes comparando la técnica MIPO vs. la convencional en un período de seis meses postquirúrgico evaluando riesgo de infección, dehiscencia de herida, consolidación ósea radiográfica, funcionalidad articular y datos demográficos, mostrando superioridad estadística positiva para la técnica MIPO. CONCLUSIONES: Se obtuvieron datos relevantes a favor de MIPO con consolidación ósea y mayor puntaje funcional articular a los seis meses.

Risk factors associated with postoperative morbidity and mortality in D2 radical gastrectomy for gastric cancer. / Factores de riesgo asociados con morbilidad y mortalidad postoperatoria en gastrectomía radical D2 por cáncer gástrico.

INTRODUCTION AND AIMS: Surgery is the main treatment for gastric cancer. D2 radical gastrectomy is associated with a variable postoperative morbidity and mortality rate worldwide. The aim of the present study was to identify the risk factors associated with the postoperative morbidity and mortality of D2 radical gastrectomy, with curative intent, for gastric cancer. MATERIALS AND METHODS: A retrospective case series was conducted, in which the medical records were reviewed of patients with gastric cancer that underwent D2 radical gastrectomy, within the time frame of January 2014 and December 2018. Univariate and multivariate analyses were carried out to identify the risk factors related to postoperative morbidity and mortality within 90 days. RESULTS: The percentages of postoperative morbidity and mortality in 691 patients were 23.3% and 3.3%, respectively. In the multivariate analysis, age ≥ 70 years (OR=1.85, 95% CI: 1.25-2.76), ASA III-IV (OR=2.06, 95% CI: 1.28-3.34), total gastrectomy (OR=1.96, 95% CI:1.19-3.23), and pancreatosplenectomy (OR=5.41, 95% CI: 1.42-20.61) were associated with greater postoperative morbidity, and age≥70 years (OR=4.92, 95% CI:1.78-13.65), lower BMI (OR=0.81, 95% CI: 0.71-0.92), and hypoalbuminemia (OR=0.91, 95% CI: 0.85-0.98) were associated with greater mortality in distal and total D2 radical gastrectomy. CONCLUSIONS: D2 radical gastrectomy for gastric cancer was shown to be a safe treatment, with low postoperative morbidity and mortality rates. Age≥70 years, ASA III-IV, total gastrectomy, and pancreatosplenectomy were factors associated with a higher complication rate. Age≥70 years, lower BMI, and hypoalbuminemia were mortality predictors in distal and total radical gastrectomy.

Enfermedad de Bowen: Reporte de un caso / Bowen's disease: A case report

La enfermedad de Bowen es un carcinoma in situ de células escamosas, que puede progresar a un carcinoma epidermoide invasor, por lo que se requiere un diagnóstico y tratamiento adecuados. Se presenta el caso de una mujer de 74 años, con enfermedad de Bowen en el tórax posterior, una localización poco frecuente, la que fuera tratada con crioterapia.

Bowen's disease is an squamous cells carcinoma in situ of that can progress to an invasive squamous cell carcinoma, so an adequate diagnosis and treatment are required. We present the case of a 74-year-old woman with Bowen's disease in the posterior thorax, a rare location, which was treated with cryotherapy.

Liquen amiloideo: diagnóstico diferencial de pápulas agminadas en piernas / Lichen amyloid as differential diagnosis of grouped papules in the legs

El liquen amiloideo es un tipo de amiloidosis cutánea primaria localizada, de etiología desconocida. Generalmente afecta a adultos, siendo más frecuente en ciertos grupos étnicos. Clínicamente se manifiesta por pápulas pruriginosas, frecuentemente localizadas en miembros inferiores. Presentamos el caso de una mujer de 50 años, con un historial de dos años caracterizado por pápulas agminadas en piernas, que tras la realización de una biopsia se diagnosticó liquen amiloideo.

Amyloid lichen is a type of localized primary cutaneous amyloidosis of unknown etiology. It usually affects adults being more frequent in certain ethnic groups. Clinically it is manifested by pruritic papules frequently located in lower limbs. We present the case of a 50-year-old woman, with a two-year history characterized by papules agminated in the legs that diagnosed amyloid lichen after biopsy.

Dopaminergic activation anticipates daily nursing in the rabbit.

Maternal care is a motivated behavior and in the rabbit it is restricted to the spontaneous return of the mother to nurse her pups for just a few minutes once a day. Previously we have reported neural activation of brain areas and neuroendocrine cells after nursing. However, this daily spontaneous return suggests that the mother is in a high motivational state to nurse her pups. Here we hypothesized that during anticipation of nursing there is an activation of dopaminergic neurons of the mesolimbic system and in their target areas. Then we explored, by the expression of FOS protein, possible activation of the mesolimbic system as well as dopaminergic cells of the A10 cell group before and after nursing and in control does. Additionally, we measured FOS expression in the preoptic area and lateral septum. We found a significant increase of FOS before nursing, and a further increase after nursing, in the mesolimbic system and dopaminergic cells as well as in the preoptic area and lateral septum. Interestingly, the medial prefrontal area shows an intense activation during anticipation of nursing, which remains after nursing. We conclude that the activation of the mesolimbic system before nursing is related to the high locomotor behavior prior to the next nursing bout and support the proposal that the mother is in a high motivational state at the time of returning to the nest. The additional activation after nursing can be related to the neuroendocrine and neural consequences of the milk ejection reflex by suckling.

Efecto de Microemulsiones de Aceites Esenciales Sobre el Eritrocito Humano y Bacterias Patógenas / Effect of Microemulsions of Essential Oils on Human Erythrocyte and Pathogens Bacteria

RESUMEN: El objetivo del presente trabajo fue evaluar el efecto de las microemulsiones de aceite esencial de romero (AER) y árbol de té (AET) sobre el eritrocito humano y microorganismos patógenos. Para ello, se elaboraron microemulsiones de AER y AET al 8.0% (v/v), 5.0% (v/v) y 2.5% (v/v). Las microemulsiones fueron probadas sobre el eritrocito humano para determinar el porcentaje de hemólisis, el porcentaje de inhibición de hemólisis y su actividad antibacterial contra E. coli O157:H7 y S. aureus. Las microemulsiones con AER no presentaron actividad hemolítica significativa, caso contrario con las microemulsiones de AET al 8.0% (≈70%) y 5.0% (33%) que presentaron mayor actividad hemolítica. Las microemulsiones de AER protegieron significativamente al eritrocito contra la presencia de radicales libres, en comparación con aquellas de AET (p< 0.05). Además, las emulsiones de AET al 8.0% mostraron efectos antibacterianos contra E. coli O157:H7 y S. aureus mientras que AER al 8.0% solo mostraron efecto contra E. coli O157:H7. La limitante del estudio fue que no utilizamos células nucleadas para establecer si los aceites esenciales dañan el material nuclear. Sin embargo, observamos que el tipo y la cantidad de aceite utilizado pueden tener implicaciones serias sobre la membrana eritrocitaria. Se concluye que las microemulsiones de AER presentaron mejor efecto protector eritrocitario, mientras que las microemulsiones de AET presentaron mejor actividad antibacterial contra las bacterias estudiadas, pero con mayor efecto tóxico sobre el eritrocito.

ABSTRACT: The aim of the study was to evaluate the effect of microemulsions of rosemary (AER) and tea tree (AET) essential oils on human erythrocyte and pathogen bacteria. Microemulsions of each oil were prepared at 8.0% (v/v), 5.0% (v/v) and 2.5% (v/v), and they were tested on human erythrocyte to determine the hemolysis percentage, hemolysis inhibition percentage and the antibacterial capacity against E. coli O157:H7 and S. aureus. All AER microemulsions showed no significant hemolytic activity. On the contrary, AET microemulsions showed hemolytic effect but those in concentrations of 8.0% (≈70 %) and 5.0% (33%) showed the highest effect. In addition, AER microemulsions showed protective effect against free radicals in comparison with the AET microemulsions (p< 0.05). On the other hand, the AET microemulsion at 8.0% showed antibacterial effect against E. coli O157:H7 and S. aureus, and the AER at 8.0% showed antibacterial effect against E. coli O157:H7. The limitation of this study was that nucleated cells were not used to observe the damage of the essential oils on nuclear material. However, the observed damage of erythrocyte's membrane is depending on type and amount of used oil. Therefore, it can be concluded that the AER microemulsions showed better protective effect of erythrocytes, while AET microemulsions showed better antibacterial effect against the tested bacteria, although with toxic effect on the erythrocytes.

Aerial pesticide application causes DNA damage in pilots from Sinaloa, Mexico.

The use of pesticides in agricultural production originates residues in the environment where they are applied. Pesticide aerial application is a frequent source of exposure to pesticides by persons dedicated to agricultural practices and those living in neighboring communities of sprayed fields. The aim of the study was to assess the genotoxic effects of pesticides in workers occupationally exposed to these chemicals during their aerial application to agricultural fields of Sinaloa, Mexico. The study involved 30 pilots of airplanes used to apply pesticides via aerial application and 30 unexposed controls. Damage was evaluated through the micronucleus assay and by other nuclear abnormalities in epithelial cells of oral mucosa. The highest frequency ratios (FR) equal to 269.5 corresponded to binucleated cells followed by 54.2, corresponding to cells with pyknotic nuclei, 45.2 of cells with chromatin condensation, 3.7 of cells with broken-egg, 3.6 of cells with micronucleus, and 2.0 of karyolytic cells. Age, worked time, smoking, and alcohol consumption did not have significant influence on nuclear abnormalities in the pilots studied. Pesticide exposure was the main factor for nuclear abnormality results and DNA damage. Marked genotoxic damage was developed even in younger pilots with 2 years of short working period, caused by their daily occupational exposure to pesticides.

Levels of organochlorine pesticides residues in human adipose tissue, data from Tabasco, Mexico.

The objective of this study was to determine the levels of organochlorine pesticides HCB, α-ß-γ-HCH, p,p'-DDE, o,p'-DDT and p,p'-DDT in 150 adipose tissue of inhabitants of Tabasco, Mexico. The following pesticides were detected: p,p'-DDE in 100% of samples at mean 1.034 mg/kg; p,p'-DDT in 96.7% at mean 0.116 mg/kg; o,p'-DDT in 78.7% at mean 0.022 mg/kg and ß-HCH in 58.0% at mean 0.049 mg/kg. The pooled sample was divided according to sex of donors (75 female and 75 male). Significantly higher levels of all organochlorine pesticides in females were found. The sample was divided into three age's ranges (15-28, 29-45 and 46-84 years). The mean and median levels of ß-HCH, p,p'-DDE and Σ-DDT increase significantly (p < 0.05) from the first to the second and third group. The presence of organochlorine pesticide residues in Tabasco inhabitants is still observed, indicating sources of exposure to the pesticides.

Effect of dehydration on raspberries: polyphenol and anthocyanin retention, antioxidant capacity, and antiadipogenic activity.

Fresh and dried raspberries prepared by freeze drying (FD), microwave-vacuum (MIVAC), hot-air drying (HAD), and a combination of hot-air drying and microwave-vacuum (HAD/MIVAC) drying methods were evaluated for polyphenol retention, total polyphenol and anthocyanin contents, total antioxidant capacity, and antiadipogenic activity (the inhibition of fat cell development). Ellagic acid and quercetin were present in the largest concentrations in fresh and dehydrated raspberries. Dehydration led to a loss of polyphenols and anthocyanins and antioxidant capacity. Polyphenols (aglycone form) were retained in the greatest amount: 20% (freeze dried) to 30% (HAD/MIVAC) (fresh = 100%). A total of 30% of polyphenols (glycoside form) were retained in raspberries dried by the HAD/MIVAC methods with 5% of retention observed for raspberries dried by FD, HAD, or MIVAC. FD and MIVAC resulted in higher retention of anthocyanins (aglycone form) than other drying methods. It was also observed that antioxidant activity was reduced by dehydration. Adipogenesis was inhibited by polyphenolic glycosides (30%) and aglycones (30% to 40%) in fresh and HAD/MIVAC raspberries. Extracts from dried raspberries by HAD/MIVAC methods were relatively more effective at inhibiting adipogenesis compared to HAD and FD dried raspberries.

Programa piloto para pacientes beneficiarios de Fonasa, que padecen esclerosis multiple: tratamiento con inmunomoduladores en el sistema público de salud de Chile: Informe del primer año, 10 de julio 2008-30 de Junio 2009 / Pilot national treatment program for multiple sclerosis patients belonging to the public health care system of Chile (FONASA) with immunomodulating disease-modifying therapies: first year report from July 2008 to June 2009

Multiple Sclerosis (MS) is a chronic disease of the central nervous system. It is manifested in the young adult who presents at the beginning alternation between transient neurological dysfunction and normality, followed by a progressive level of disability. MS affects the quality of life in the young adults in their full productive and creative age limiting not only in their personal lives but also affects to the whole society in terms of "dreams and life projects". Besides, this illness also influences the family group who has to assume progressively the help and care for the patient. In healthcare aspect MS implies intensive and progressive resources. In Chile, although we don't have epidemiological studies that indicate which is the MS prevalence it exist a projection that states 14 per 100.000 inhabitants. Considering a population of 16.5 million of inhabitants our expectative of patients with MS is of 2310 cases in our country. The MS immunomodulating injectable disease-modifying therapies are of high cost and were not available in a regular way in the state health care system of Chile (FONASA) that attends the 70 percent of the population; the other 30 percent has different private health insurances. In 2008 the ministry of health decided to initiate and pilot (exploratory) program which had a great meaning and impact concerning to start offering immunomodulating therapies to relapsing remitting MS, for patients belonging to FONASA system. The pilot program was thought with a double mission, on the one hand to achieve that a very limited group of MS patients belonging to FONASA system (80 cases) from all over the country had access to immunomodulating injectable disease-modifying therapies of high cost in a regular way. The second objective was to obtain clinical and epidemiological information which let us to evaluate the clinical and administrative obstacles generated by the incorporation of this treatment in the public health...

Introducción El presente documento corresponde al informe del primer año de trabajo operativo del "Programa piloto de tratamiento con inmunomoduladores, para pacientes beneficiarios de Fonasa1, que padecen esclerosis múltiple (EM)", elaborado por el equipo del centro de referencia nacional, para este programa, con sede en el Servicio de Neurología del Complejo Asistencial Barros Luco (CABL) del SSMS2. Dado su origen no incluye antecedentes del proceso de gestión ni toma de decisiones del nivel Minsal3 o Fonasa. Este trabajo, no es ni aspira ser: un ensayo clínico, una guía de práctica clínica, una revisión bibliográfica, ni una puesta al día sobre el tratamiento de la Esclerosis Múltiple (EM), es simplemente el informe anual de un centro de referencia, para una tarea específica, a la autoridad ministerial competente. El informe incluye algunos antecedentes generales y referencias presentadas como "notas al pie", sólo para contextualizar la información presentada4. La EM es una enfermedad crónica del SNC, de origen incierto, inmunológicamente mediada, bien definida en sus características inmunopatogénicas, patológicas, imagenológicas y clínicas. Se expresa en el adulto joven, quien presenta inicialmente alternancia entre disfunción neurológica transitoria y normalidad y cuya progresión determina múltiples efectos discapacitantes. La EM afecta la calidad de vida de adultos jóvenes en plena edad productiva y creativa limitando tanto los "sueños y proyectos de vida" como el desarrollo laboral, social y afectivo. Además trasciende al grupo familiar, cuando deben asumir la asistencia del paciente. En lo sanitario, la EM, genera uso intensivo y progresivo de recursos. Las terapias inmunomoduladores para la EM, que tienen la posibilidad de detener o reducir la evolución de la modalidad recurrente remitente de la EM, no se encontraban disponibles en forma regular en el sector público de salud de nuestro país, por esto el presente programa piloto...

Primary hepatosplenic large B-cell lymphoma: a rare aggressive tumor.

Diffuse large B-cell lymphoma is the most common form of lymphoma. It usually begins in the lymph nodes; up to 40% may have an extranodal presentation. According to a definition of primary extranodal lymphoma with presentation only in extranodal sites, there are reports of large B-cell lymphomas limited to liver or spleen as separate entities, and to date there have been only three documented cases of primary hepatosplenic presentation. This paper reports a fourth case. Due to a review of the literature and the clinical course of the case reported, we conclude that primary hepatosplenic large B-cell lymphoma has been found predominantly in females older than 60 years. The patients reported had <2 months of evolution prior to diagnosis, prominent B symptoms, splenomegaly in three and hepatomegaly in two, none with lymph node involvement. All had thrombocytopenia and abnormal liver function tests; three had anemia and elevated serum lactic dehydrogenase levels, two with hemophagocytosis in bone marrow. Because of the previously mentioned data, it can be stated that primary hepatosplenic lymphoma is an uncommon and aggressive form of disease that requires immediate recognition and treatment.

Reconstrucción después de pancreatoduodenectomía proximal mediante anastomosis pancreatoyeyunal simplificada. Resultados operatorios en 198 pacientes / Reconstruction following proximal pancreatoduodenectomy by simplified pancreatojejunal anastomosis. Operation results in 198 patients

Introducción: La dehiscencia de la anastomosis pancreatoyeyunal es la complicación más temida de la pancreatoduodenectomía proximal (PDP) y puede ocasionar la muerte del paciente. Objetivo: Presentamos nuestra experiencia acumulada en 198 PDPs reconstruídos utilizando la técnica simplificada de la anastomosis pancreatoyeyunal. Técnica Operatoria: Consiste en realizar una sutura en bolsa de tabaco alrededor del borde libre del yeyuno para introducir 4cm de muñon pancreático guiado por dos suturas transfixiantes entre el páncreas y el intestino, cerrar el yeyuno sobre el páncreas ajustando la sutura en bolsa de tabaco y colocar 4 puntos separados para "anclar" la anastomosis. Se descomprime las anastomosis pancreática y biliar mediante yeyunostomía. Material y métodos: Estudio prospectivo de 198 pacientes consecutivos que tuvieron PDP en el Instituto de Enfermedades Neoplásicas en el periodo 1995-2005. Resultados: La morbilidad post operatoria global fue 38.4 por ciento (76 de 198 pacientes). Trece pacientes (6.6 por ciento) presentaron dehiscencia de anastomosis pancreatoyeyunal. La mortalidad post operatoria a 30 días y la mortalidad hospitalaria fue 2 por ciento y 3.5 por ciento, respectivamente. Conclusión: Nuestra técnica modificada de anastomosis pancreatoyeyunal es simple, aplicable a todo tipo de páncreas y sobretodo segura, logrando reducir de manera importante la incidencia de dehiscencia de la anastomosis pancreatoyeyunal, la morbilidad y la mortalidad post operatorias.

Introduction: Pancreatojejunal anastomosis dehiscence is the most feared complication of proximal pancreatoduodenectomies and it is the cause of other complications, including death. OBJECTIVE: We present our cumulative experience gathered with 198 proximal pancreatoduodenectomies reconstructed by using the simplified pancreatojejunal anastomosis technique.OPERATION TECHNIQUE: It consists of performing a tobacco-pouch suture around the free edge of the jejunum in order to introduce 4 cm of the pancreatic stump guided by two transfixing sutures between the pancreas and the intestine, closing the jejunum over the pancreas tighteningthe tobacco-pouch suture and making four separate stitches to ìanchorî the anastomosis. The pancreatic and bile anastomoses are decompressed by jejunostomy. MATERIAL AND METHOD: Prospective study in 198 consecutive patients who had proximal pancreatoduodenectomies at the Institute for Neoplastic Diseases during the 1995 - 2005 period. RESULTS: Overall post-operative morbidity was 38.4 per cent (76 out of 198 patients). Thirteen patients (6.6 per cent) showed pancreatojejunal anastomosis dehiscence. Post-operative mortality after 30 days and hospital mortality were 2 per cent and 3.5 per cent, respectively. CONCLUSIONS: Our modified pancreatojejunal anastomosis technique is simple, applicable to alltypes of pancreata and, most importantly, safe. It greatly reduces incidences of pancreatojejunal anastomosis dehiscence as well as post-operative morbidity and mortality.

Is dementia reversible in patients with neurocysticercosis?

OBJECTIVE: To determine the correlates and outcome of dementia in patients with neurocysticercosis (NCC). METHODS: Ninety consecutive patients with untreated NCC underwent a cognitive assessment (Mini-mental State Examination, Neurobehavioral Cognitive Status Examination, and IQCODE) and were classified as having or not having dementia according to DSM-IV criteria. Imaging and cerebrospinal fluid examination data were recorded. The cognitive measures were repeated six months after treatment with albendazole and steroids. RESULTS: At the initial evaluation 15.5% (n = 14) of the patients were classified as having dementia. Dementia was associated with older age, lower education level, increased number of parasitic lesions in the brain (mostly in the frontal, temporal, and parietal lobes). After six months, 21.5% of the patients from the dementia group continued to have a full dementia disorder and 78.5% no longer fulfilled the DSM-IV criteria for dementia, although some of these patients still showed mild cognitive decline. CONCLUSIONS: The results of this study suggest that dementia occurs frequently in patients with untreated NCC, and it is reversible in most cases.

[Non-convulsive epileptic status associated with Lafora disease: two case reports]. / Estado epiléptico no convulsivo asociado a enfermedad de Lafora: presentación de dos casos.

INTRODUCTION: Lafora s disease is a type of progressive myoclonic epilepsy with poor prognosis, is characterized by myoclonic crisis, tonic clonic seizures, absence or partial complex seizures and other neurological manifestations with a progressive course and a poor response to the treatment. It has not been considered as a cause of epileptic status. CASE REPORTS: Two women without important past medical history with normal psychomotor development before their suffering, with manifestations of 2 years of evolution the first one and 8 years on the second case characterized by myoclonic generalized, partial complex seizures and progressive deterioration of the mental functions that joined to our institution in a non convulsive epileptic status and they featured with a different evolution. The first patient with favorable control of the event with a single medication and functionality recover later, the second one with torpid evolution complicated with an epileptic status convulsive widespread condition and a prolonged permanency in the unit of intensive therapy. In both patients the diagnosis of Lafora s disease was established based in the findings of the skin axilar biopsy. DISCUSSION AND CONCLUSION: We believe that Lafora s disease must be suspected as a probable cause of non convulsive epileptic status in patients with myoclonic epilepsy associated with other neurological manifestations and a refractary response to the medical treatment. The evolution and clinical response will depend on the evolutionary stage of the disease.

Test-retest reliability of the alcohol and drug use disorder sections of the schedules for clinical assessment in neuropsychiatry (SCAN).

This report presents the results of a test-retest reliability study of the alcohol and drug dependence, as well as harmful use/abuse were investigated in Ankara, Turkey and Farmington, Connecticut (US). Reliabilities for the past year, prior to past year, and lifetime diagnosis of alcohol and drug use disorders were evaluated using ICD-IO, DSM-III-R and DSM-IV criteria. The results indicate that SCAN alcohol and drug diagnosis have good to excellent levels of reliability for dependence across different substances, different diagnostic systems, and different cultural groups. Diagnostic classification of alcohol and drug abuse/harmful use was considerably less reliable. Implications of the findings are discussed.

Effect of insuflated Nafarelin (D-Nal-6-GnRH) upon uterine leiomyomata.

A nasal spray containing the GnRH analog Nafarelin (D-Nal-6-GnRH) was used to treat 20 patients of reproductive age with clinical and ultrasonographic diagnosis of uterine leiomyomata. Nafarelin showed a high index of efficacy (approximately 65%) in decreasing the volume of myomas. The collateral effects observed were scarce; among these were predominant a decrease of libido and vasomotor symptoms. Although bone pain was not referred, the impact upon osteodensity was not assessed. The effect upon pituitary gonadotropin production as well as that of sexual steroids by GnRH was practically null, and one patient became pregnant. Nonetheless, those symptoms associated with the use of Nafarelin were apparently due to a moderate hypoestrogenism, despite not being substantiated in the laboratory studies. With such disparity, we assume it was given by the route of administration of nasal Nafarelin, which is known to have erratic effects due to limitations in its absorption. Thus, far from being a disadvantage it could be useful in regimes of long term therapy (1-2 years) to avoid the impact of estrogen shortage upon bone turnover. We conclude that Nafarelin through insuflation was highly effective for decreasing the size of uterine leiomyomata.

[Multifactorial analysis of patients with endometriosis in an institutional program of assisted reproduction]. / Análisis multifactorial de pacientes con endometriosis en un programa institucional de reproducción asistida.

It is a retrospective and transverse study with an analysis of results from patients submitted to intrauterine insemination (IIU), intratubal gamete transfer (GIFT) and in vitro fertilization and embryo transfer (FIVTE), at the Clinic of Assisted Reproduction, Instituto Nacional de Perinatología in Mexico City. From 134 cycles of patients submitted to IIU, 113 corresponded to women with diagnosis of sterility from non determined cause, and 21 to cases with endometriosis, and at least one permeable tube. From the first group, 22 pregnancies were obtained, for a monthly fertility rate of 19.4%; and from the second one, 12 pregnancies with a fertility rate of 56%. This, which is very high , may be explained by the relatively small number of cases in the second group, or else, by the influence of a previous medical treatment for endometriosis; the square Chi analysis shows a P less than 0.01 in the two groups. In the GIFT and FIVTE cases, from which 35 cycles were analyzed, per each procedure, there were 10 pregnancies, 9 for GIFT and one for FIVTE; the amount is very limited in order to obtain conclusions, but it seems that there is a proportional tendency in GIFT to less amount of pregnancies in women with endometriosis. The analysis of hormonal follow up did not show differences in the groups, and the averages may be useful to determine, early, the cancellation, or not, of an stimulation cycle. Finally, in FIVTE cases there is a diminution of fertilization index in women with endometriosis (53%), as compared with the cases without disease (80%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Pseudocyesis: clinical and hormonal evaluation]. / Pseudociesis: evaluación clínica y hormonal.

Hormonal and clinical evaluation was performed in eleven females with diagnosis of pseudocyesis. Plasma levels of pituitary gonadotropins (FSH-LH), progesterone, estradiol and thyroid hormones (T3, T4, TSH) under basal conditions were measured through radioimmunoassay. Diagnosis of pseudocyesis was made according to the following criteria: a) secondary amenorrhea (greater than 12 weeks); b) two or more symptoms of gestation; c) conviction of being pregnant; d) negative HCG or pelvic ultrasound study. The circulation levels of gonadotropins were within normal limits. Progesterone exhibited a ovulatory pattern and thyroid hormones were normal for every instance. Once case had slight hyperprolactinemia (26.0 ng/ml) with impaired gonadotropin production and ovulatory progesterone. All patients had galactorrhea. The psychological study disclosed a tendency toward depression. Our findings partially confirmed previous observations, differing basically on that we observed normal hormonal trend.