Situs inversus totalis and abdominal aortic aneurysm: Surgical repair of an extremely uncommon association.

INTRODUCTION: Situs inversus totalis (SIT) is an uncommon congenital syndrome, which refers to a reversal mirror-image of the normal thoracoabdominal organs position. The coexistence of SIT and abdominal aortic aneurysm has been seldom previously reported. PRESENTATION OF THE CASE: We report a case of a 69-year-old man with SIT and infrarenal abdominal aortic aneurysm (AAA) that underwent open repair with a straight graft through a minilaparatomy without evisceration. DISCUSSION: There is no consensus on which should be the optimum approach in cases of open surgical repair of AAA due to the limited number of cases described. The fact of intestinal scrolling to the left abdomen, unlike usual, is due to the anatomical arrangement of the root of the mesentery which is directed obliquely from duodenojejunal on the left side of the vertebra L2 to the ileocecal junction and right sacroiliac joint. CONCLUSION: A minilaparotomy without evisceration and with intestinal scrolling to left hemiabdomen, can be very useful and beneficial on those cases of congenital anatomical abnormalities that may add difficulty during the surgical procedure.

Early hepatitis C virus changes and sustained response in patients with chronic hepatitis C treated with peginterferon alpha-2b and ribavirin.

BACKGROUND: Interferon-based therapy induces changes in viral dynamics in chronic hepatitis C (CHC) patients. AIMS: The aim of this study was to assess early hepatitis C virus (HCV)-RNA changes and evaluate its predictive value to achieve sustained viral response (SVR) in patients with CHC treated with peginterferon alpha-2b weekly plus ribavirin daily for 48 weeks. METHODS: HCV-RNA was measured at baseline, 48 h, 4, 12, 24 and 48 weeks of treatment and 24 weeks after treatment. RESULTS: Eighteen HCV genotype 1 patients were included (13 male, five female) with a mean age of 44.4+/-11.9 years. Nine patients achieved SVR (50%). Viral decline occurred as early as 48 h; the magnitude of decline was statistically different between both groups (P<0.01). Responders had a > or =1 log(10) drop in HCV-RNA at 48 h (positive predictive value (PPV) of 89% to achieve SVR) that persisted at week 4. By week 12, serum HCV-RNA was undetectable (PPV 100%). CONCLUSIONS: Our data indicate that peginterferon alpha-2b plus ribavirin treatment produces significant changes in HCV dynamics that can be detected as early as 48 h after the first dose of peginterferon alpha-2b and that these changes are useful in predicting response to therapy in CHC patients.

[A 10-year prolective study on cancer of the digestive system]. / Estudio prolectivo de 10 años de cáncer del aparato digestivo.

OBJECTIVE: A ten year prolective and multicentre study of cancer of the Digestive Tract aims to evaluate the variations on frequency and to identify risk factors. METHODS: Ten hospitals are participating five in Mexico City and five in other states. Data were obtained through the hospitals files and specially designed questionnaires, the latter mainly diet and habits oriented. RESULTS: Through this ten years in the 4,715 cases studied we can appreciate a decreasing tendency of the carcinoma of the stomach (GC) that has been the most frequent until 1984 in the general group General Hospital and Instituto Nacional de la Nutrición. Since then and up to date, first place in frequency in shared between the stomach and colorectal carcinoma (CRC). CRC has been increasing even in the General Hospital in which GC was very high. Eighth years ago we found that people in those hospitals in which GC was high the diet was poor in proteins, fat A and C vitamin. People in those hospitals with high frequency of CRC had diet high in protein, fat and low in fiber. A new study on diet is ongoing. Gallbladder and biliary tract carcinoma has been increasing in all the hospitals. A high O blood group was found in the Juarez Hospital in which gallbladder carcinoma was the highest. O group is highest in the indian people. Cancer of the gallbladder is very high in Pimas and Navajos indians. A plan to study litogenic index and culture of salmonella is going to be practiced in bile from normal and gallbladder carcinoma. Concerning habits, tobacco and alcohol consumption are most frequent in cancer of the esophagus and pancreas. Also coffee consumption is high in the latter. CONCLUSIONS: Along this 10-year study, the frequency of gastric cancer has been decreasing. Instead, the frequencies of colo rectal and biliary tract cancers have been increasing. Variations in frequencies correlated with the composition of the diet, fiber consumption habits and racial characteristics of the different groups.