Immediate changes in intra-abdominal pressure and lung indicators in patients undergoing complex ventral hernia repair with the transversus abdominis muscle release, with and without preoperative botulinum toxin.

PURPOSE: The current treatment of complex ventral hernias involves muscle closure with components separation techniques and mesh placement. The purpose of this study is to evaluate the immediate postoperative changes in the intra-abdominal pressure (IAP), and lung indicators after treatment of complex ventral hernias with the transversus abdominis reléase (TAR) technique. METHODS: All patients with complex ventral hernias treated between November 28th, 2016 and October 6th, 2021 were initially included. We excluded patients with lung and/or heart comorbidities. A total of 43 patients were studied, measuring IAP, lung compliance, pulmonary plateau pressure (PPP), and end-tidal CO2 before and after surgical treatment. RESULTS: Median IAP increased from 5 to 9 mmHg (p < 0.0001), and PPP from 11 to 12 mmHg (p = 0.004). Increased body mass index (BMI) was associated to a PPP increase above normal values. Postoperative changes were not different in patients receiving preoperative preparation with botulinum toxin. CONCLUSION: After complex ventral hernia closure, there is an immediate impact on IAP and PPP, the latter more frequent in patients with the highest BMI, and this may not be prevented by the preoperative administration of botulinum toxin.

[Basal cell carcinoma of the perianal region: a case report and literature review]. / Carcinoma basocelular de la región perianal: reporte de un caso y revisión de la literatura.

The literature reports an annual incidence of 5,900 cases of anal cancer in the developed countries. These involve three different anatomic zones: carcinoma of the anal canal, perianal carcinoma (formerly known as carcinoma of the anal margin, located at a distance of less than 5cm from the anal margin), and carcinoma of the perianal skin (at a distance greater than 5cm from the anal margin). Basal cell carcinoma of the perianal region is an uncommon tumor (0.27% of all diagnosed basal cell carcinomas) that in the majority of cases is treated by resection with disease-free margins. It must be differentiated from the basaloid and epidermoid variants of carcinoma, given that it has good outcome and its spread potential is practically null.

Closure of midline contaminated and recurrent incisional hernias with components separation technique reinforced with plication of the rectus muscles.

PURPOSE: Midline incisional hernia reconstruction by defect closure and reinforcement with either prosthetic or biologic materials has shown to significantly decrease recurrence rates even for complex cases. The purpose of this study is to evaluate outcomes regarding large incisional hernia reconstruction with components separation technique using rectus muscle plication as a reinforcement method. METHODS: Thirteen patients having large midline incisional hernias and either history of abdominal wall contamination or recurrence in the presence of mesh were treated between January 2007 and December 2011 with closure using components separation technique reinforced by rectus muscle plication. RESULTS: Average hernia square was 222 cm(2), and mean follow-up was 24 months. Complications occurred in 6 patients with a mean time to resolution of 59 days. One recurrence was present. CONCLUSIONS: When use of mesh or biologic materials is not desired, rectus muscle plication is a feasible tool as a reinforcement method after large hernia closure with components separation.

[Surgical treatment of a perianal giant condyloma acuminata in a HIV patient]. / Tratamiento quirúrgico de un condiloma gigante perianal en una paciente con síndrome de inmunodeficiencia adquirida humana.

Buschke-Löwenstein tumor is a slowly growing neoplasm with high potential of local invasion. We described a 29 year-old female with acquired immunodeficiency syndrome who was surgically treated for a Buschke- Löwenstein tumor with a wide local excision, bilateral gluteal flaps and loop ileostomy. At 12 months follow-up, there was no evidence of recurrence. Despite it does not metastasize, Buschke-Löwenstein tumor has a high recurrence rate and a 50% risk of malignant transformation into squamous cell carcinoma. Surgery is considered the treatment of choice for this disease. Podophyllin, immunotherapy, interferon and radiotherapy are other treatments with a limited therapeutic response.

Ecological niche modelling as an exploratory tool for identifying species limits: an example based on Mexican muroid rodents.

Niche conservatism theory suggests that recently diverged sister species share the same ecological niche. However, if the ecological niche evolves as part of the speciation process, the ecological pattern could be useful for recognizing cryptic species. In a broad sense systematists agree that the niche characters could be used for species differentiation. However, to date such characters have been ignored. We used the genetic algorithm for rule-set production for modelling the ecological niche as a means of inferring ecological divergence in allopatric populations of muroid rodents for which taxonomic identity is uncertain. Our results show that niche differentiation is significant in most of the identified phylogroups. The differentiation is likely associated with natural evolutionary units, which can be identified by applying species concepts based on phylogenetic and ecological patterns (e.g. phylogenetic, cohesive, evolutionary). Even so, the role of the niche partition within phylogenetic reconstruction may be a limited one.

[Nesidioblastosis as extracolonic manifestation associated with adenomatous familial polyposis]. / Nesidioblastosis como una manifestación extracolónica asociada a poliposis familiar adenomatosa.

OBJECTIVE: To describe the case of a patient with familial adenomatous polyposis (FAP) who developed organic hyperinsulinemia and hypoglycemia due to pancreatic nesidioblastosis. BACKGROUND: FAP can be considered as one of the familial cancer syndromes. The development of endocrine tumors in these patients is an infrequent event, and most of these tumors have been well-differentiated thyroid neoplasms. To our knowledge, the occurrence of organic hyperinsulinemia in the context of FAP has not been reported. METHODS: Organic hyperinsulinemia was demonstrated during a 72-h fast, measuring insulin and C-peptide by RIA at the time of hypoglycemia. Immunohistochemistry for insulin and other pancreatic hormones was performed on the surgical pancreatic specimen. RESULTS: The patient underwent a distal pancreatectomy with resolution of hypoglycemia. Histopathologically, the excised pancreas showed beta cell hyperplasia arising from the ductal epithelium. Such beta cells strongly immunostained for insulin, pancreatic polypeptide, and neuron-specific enolase. CONCLUSIONS: The development of endocrine tumors in an inherited cancer syndromes such as FAP is rare. Such an association may suggest shared mechanisms of tumorigenesis. The case herein reported should prompt us to consider organic hyperinsulinism as an extracolonic manifestation of FAP.

[Cushing syndrome. The diagnostic and therapeutic challenges]. / Síndrome de Cushing. Desafíos diagnósticos y terapéuticos.

Endogenous hypercortisolism is characteristically a condition that should be diagnosed and treated in tertiary care centers with the participation of several specialists. Cushing's syndrome represents the clinical expression of a prolonged exposure to glucocorticoids, independently of its origin. The term Cushing's disease refers to the hypercortisolism that results from the excessive secretion of corticotropin (ACTH) by a pituitary microadenoma. The mechanisms that give rise to the different forms of hypercortisolism are complex and its precise differential diagnosis is one of the major challenges in modern endocrinology. This review focuses on current aspects of the pathophysiology, differential diagnosis and treatment of Cushing's syndrome.

The after breakfast 50-g, 1-hour glucose challenge test in urban Mexican pregnant women: its sensitivity and specificity evaluated by three diagnostic criteria for gestational diabetes mellitus.

BACKGROUND: To study the sensitivity and specificity of the 50-g, 1-hour gestational glucose challenge test performed 1 to 2 hours after a non-standardized home breakfast in urban Mexican women by using three different gestational diabetes mellitus diagnostic criteria. METHODS: Four hundred and forty-five consecutive women of 24-28 weeks gestation were studied. The glucose challenge test was performed in the fed state and a week later a fasting 100-g, 3-hours oral glucose tolerance test was carried out in all of them. Duplicate serum glucose concentrations were determined by a glucose-oxidase method. Sensitivity and specificity were calculated using three different diagnostic criteria for gestational diabetes mellitus. RESULTS: The glucose challenge test performed as indicated, with a cutoff of 7.8 mmol/L, had 88-89% sensitivity and 85-87% specificity when using as diagnostic criteria those proposed by the National Diabetes Data Group and by Carpenter & Coustan; by using Sacks et al. criteria, the values were 82% and 88%, respectively. Considering only pregnant women > or = 25 years of age, the sensitivity increased to 92% with the National Diabetes Data Group criteria. Pregnant women < 25 years of age had significantly lower blood glucose values than those with age > or = 25 years during the glucose tolerance test. CONCLUSIONS: For the general group the sensitivity of the glucose challenge test performed 1 to 2 hours after breakfast was similar, based on the National Diabetes Data Group and the Carpenter & Coustan's diagnostic criteria for gestational diabetes mellitus. However, when pregnant women > or = 25 years of age were considered, the use of the former criteria yielded a slightly better sensitivity.

Tracheal malformation in a bicephalic Honduran milk snake (Lampropeltis hondurensis) and subsequent fatal Salmonella arizonae infection.

A bicephalic Honduran milk snake (Lampropeltis hondurensis) with tracheal duplication and malformation and Salmonella arizonae infection is described. There were atypically wide collapsed tracheal rings with necrotizing tracheitis and abundant necrotic epithelial debris and inflammatory cells obstructing the lumen in one of the duplicate tracheae. Salmonella arizonae was cultured from the malformed duplicate trachea and was considered to be the etiologic agent causing necrosis.

[Androgen response in women with polycystic ovary syndrome and hyperinsulinemia during stimulation with corticotrophin and inhibition with dexamethasone]. / Respuesta de andrógenos en mujeres con síndrome de ovarios poliquísticos e hiperinsulinemia durante la estimulación con córticotrofina e inhibición con dexametasona.

The adrenal response to adrenocorticotropic hormone (ACTH) stimulation and dexamethasone (DEX) inhibition tests in six healthy ovulatory control women (31.6 +/- SD 0.6 years old) with a body mass index (BMI) of 24.8 +/- 1.3 kg/m2 (Group 1) were compared against seven women (28.1 +/- 0.8 years old, BMI 30.9 +/- 2.1 kg/m2) with polycystic ovary syndrome (PCOS) and hyperinsulinism (Group 2). In both groups the following tests were performed: a) a 100-g 2-h oral glucose tolerance test (OGTT) with serum glucose and insulin measurements; b) an ACTH stimulation test (2-h 0.25 mg iv bolus); and c) a 1 mg oral midnight DEX inhibition test. Assays of serum cortisol. 17-hydroxyprogesterone, dehydroepiandrosterone sulfate (DHEA-S), free testosterone (FT), and androstenedione during the ACTH and DEX tests were performed. Contrary to Group 1, Group 2 showed: a) higher basal luteinizing hormone follicle-stimulating hormone ratio, FT, and insulin, and hyperinsulinism during the OGTT; b) FT significantly higher after ACTH; and c) FT and DHEAS did not show a significant inhibition with DEX. Our results suggest a certain degree of adrenal participation in the pathogenesis of the hyperandrogenism in these women, which may be the final expression of a synergistic stimulation of the adrenals by hyperinsulinism, relatively high LH, and chronic hyperestrogenism, all of which are present virtually in all women with PCOS.

Serum insulin in clomiphene responders and nonresponders with polycystic ovarian disease.

OBJECTIVE: To investigate insulin levels in women with polycystic ovarian disease (PCOD) who are responders or nonresponders to clomiphene citrate (CC). DESIGN: Open and prospective study. SETTING: Outpatient infertility clinic of a third level medical institution. PATIENTS: Ten healthy women (group 1) and 35 PCOD women classified as responders (group 2 n = 10) or nonresponders (group 3 n = 25) on the basis of serum progesterone > or = 19 nmol/L in response to CC repeatedly administered in doses up to 250 mg/day for five days; they were further subdivided if body mass index (BMI) was below (N) or above (H) mean + 3 SD of group 1. INTERVENTIONS: Blood samples were obtained in a 100-g, 2-hours oral glucose tolerance test (OGTT). MAIN OUTCOME MEASURES: Serum glucose, insulin, free testosterone (free-T), dehydroepiandrosterone sulphate (DHEA-S), and androstenedione (A) were determined in the samples OGTT and the areas under the curve (AUC) were calculated. RESULTS: Group 3 had higher BMI, basal LH, and insulin and AUC insulin than groups 1 and 2; free-T was higher in groups 2 and 3 than in group 1, and basal PRL was higher in group 2 compared to groups 1 and 3. When BMI < or = 25.4 kg/m2 (mean + 1 SD of group 1) 77% of the PCOD cases responded (10 out of 13) whereas none with BMI > 25.4 responded to CC (n = 22) irrespectively of basal insulin concentration or AUC insulin. CONCLUSION: Moderate to excessive overweight seems more frequently and closely associated to a negative CC response in women with PCOD than hyperinsulinemia.

Clinical and hormonal response to short-term intermittent versus continuous oral bromocriptine in hyperprolactinemic women.

UNLABELLED: OBJECTIVE -- To determine if intermittent oral bromocriptine administration could be a useful therapeutic alternative in infertile hyperprolactinemic women. DESIGN -- Open, randomized and prospective study. SETTING -- Outpatient infertility clinic of a third-level medical institution. PATIENTS -- Fourteen low-income women, 23 to 36 years of age with anovulatory infertility (1-13 years in duration) secondary to hyperprolactinemia (>35 ng/mL). Endocrine profile ruled out anovulation of other origin. INTERVENTIONS -- After a control period of 30 days, seven women (group 1) received daily oral bromocriptine (2.5-10.0 mg/day) continuously during two consecutive 30-day periods (T-1 and T-2), and seven women (group 2) received oral bromocriptine only from day 1 to 15 of each 30-day period of treatment. Morning blood samples were drawn similarly during the three periods on days 6 to 8, 13 to 15, and 21 to 23. MAIN OUTCOME MEASURES -- FSH, LH, and prolactin were determined in all samples, estradiol only in samples of days 6 to 8 and 13 to 15, and progesterone exclusively between days 21 and 23. RESULTS: Mean serum prolactin levels during the control period were similarly elevated in groups 1 and 2. A marked decrease occurred during period T-1 (P < .004) and further during period T-2 (P < .05) in both groups, but at no time were significant intergroup differences documented. During the control period all women had a serum progesterone < 3.0 ng/mL (<9.54 nmol/L); during period T-2 it was > or = 3.0 ng/mL in three and five women of groups 1 and 2, respectively. Over the following 10 months of treatment, two and three normal pregnancies and deliveries ensued in groups 1 and 2, respectively. CONCLUSION -- The intermittent use of oral bromocriptine may indeed be a useful therapeutic approach in treating infertile hyperprolactinemic women.

Fasting glucose/insulin ratio. An index to differentiate normo from hyperinsulinemic women with polycystic ovary syndrome.

OBJECTIVE: To evaluate a simple laboratory index useful to differentiate normo from hyperinsulinemic women with polycystic ovary syndrome. DESIGN: Open and prospective study. SETTING: Outpatient infertility clinic of a third level medical institution. PATIENTS: Twenty five women 27.8 +/- 3.4 years of age with chronic anovulation, hirsutism and hyperandrogenemia (free testosterone [free-T] > 3.4 pg/mL) but no acanthosis nigricans (group 1) were compared with ten healthy women 27.5 +/- 1.5 years of age (group 2). INTERVENTIONS: Three fasting blood samples were obtained followed by a 100-g, 2-hours oral glucose tolerance test (OGTT). MAIN OUTCOME MEASURES: Glucose, insulin, FSH, LH, E2, free-T, androstenedione (A), DHEAS and 17 alpha-hydroxyprogesterone (17-OHP) were measured in the three fasting samples. Glucose and insulin were also determined in the OGTT samples. The fasting glucose/insulin (G/I) ratio was calculated. RESULTS: In group 2 the fasting insulin was < 16.8 microU/mL, the sum of serum insulin (sigma INS) during the OGTT was < 385 microU/mL (mean + 3SD) and the fasting G/I ratio was > 4.5. The fasting LH, FSH, free-T, cortisol, and insulin were higher in group 1 than in group 2. In group 1, eleven women had a sigma INS below and fourteen above 385 microU/mL. Fasting insulin had a linear correlation with sigma INS (r = 0.780) while the fasting G/I ratio had an exponential correlation with sigma INS (r = -0.699). Fasting insulin versus the G/I ratio best fitted a reciprocal regression model (r = 0.912). For screening of hyperinsulinemia during OGTT, fasting insulin had a 75% sensitivity and 62% specificity while for the G/I ratio it was 79% and 73%, respectively. CONCLUSIONS: Both fasting hyperinsulinemia (> 16.8 microU/mL) and a fasting G/I ratio < or = 4.5 can satisfactorily differentiate women with hyperandrogenism and hyperinsulinemia from those with normoinsulinemia. However, the ratio does not require a previous definition of a normal value as for fasting or post-oral glucose insulin levels, and thus, it can be easily calculated in daily clinical practice to establish specific therapeutic maneuvers at an early stage of the evaluation of such patients.

[The effect of the early administration of progesterone on egg recovery, fertilization and pregnancy in an institutional fertilization in vitro program]. / Efecto de la administración temprana de progesterona sobre la tasa de captura ovular, fertilización y embarazo en un programa institucional de fertilización in vitro.

39 patients which underwent an IVF-ET procedure at the INPer were divided in two groups. To one of them, progesterone was administered since the day of oocyte retrieval (group I), whereas the other group received progesterone 48 hours before hCG administration (group II). There were no statistical differences between the groups in the parameters analysed before the oocyte retrieval. There were statistical differences between the groups in progesterone levels in the day of oocyte retrieval in favour of group II, and in fertilization rate and transfer rate for group I. There were no valuable differences between the groups in pregnancy rate.

The reproducibility of the 50-g, 1-hour glucose screen for diabetes in pregnancy.

OBJECTIVE: To explore the day-to-day reproducibility of the 50-g, 1-hour glucose screening test performed on 2 consecutive days in the same women. METHODS: Eight women at 12-23.6 weeks' gestation (early subjects) and 80 women at 24-28 weeks (late subjects) without known diabetes mellitus were studied. The glucose screening test was performed in the morning on 2 consecutive days in the same women, under an identical or opposite sequence of fasting and fed conditions. The women were thus divided into four subgroups: fast-fast, fed-fed, fast-fed, and fed-fast. Duplicate serum glucose concentrations were measured by the glucose oxidase method. Paired Student t test was used to analyze day-1 versus day-2 glucose levels in each woman of each subgroup. RESULTS: The serum glucose concentrations were higher on day 1 than on day 2 in the subgroups fast-fast and fast-fed (P < .05) in both early and late patients, whereas the opposite was seen in the subgroups fed-fast (P < .05). No significant differences were observed in the subgroups of fed-fed. At three different glucose thresholds (130, 135, and 140 mg/dL), there was more than 90% daily reproducibility for normal results in both groups, and nearly 50 and 83% daily reproducibility for abnormal results in the early and late patients, respectively. CONCLUSIONS: Up to 28 weeks of pregnancy, the screening test had a high reproducibility for normal results. For abnormal results, daily reproducibility was better after than before 24 weeks' gestation, regardless of prior testing conditions. Depending on the pre-testing conditions, the use of a different serum glucose threshold seems warranted.

[Therapeutic efficacy of vaginal administration of bromocryptin in patients with hyperprolactinemia]. / Efectividad terapéutica de la bromocriptina (BEC) administrada por vía vaginal en pacientes con hiperprolactinemia.

Oral bromoergocriptine (BEC) is currently the treatment of choice in women with hyperprolactinemia secondary to a prolactinoma. However, undesirable side effects (of variable type and intensity) are frequently present in these women due to both local irritation and to a direct effect upon the central nervous system. The present work was undertaken as a pilot study to assess the therapeutic effectiveness of vaginally administered BEC and to corroborate if the side effects are less frequent and of minor intensity when compared to oral BEC. Initially, 16 women were included, but two of them did not accept to continue in the study; thus, a total of 14 women with hyperprolactinemia (> or = 40 ng/ml) were divided in two groups: Group A encompassed five women, aged 27 to 36 years old, two with normal menstrual cycles and three with oligomenorrhea; all had primary or secondary sterility during 3 to 12 years and galactorrhea from 6 months to 3 years; in only one patient a brain computerized axial tomography (CAT) was performed which showed the existence of a macroprolactinoma. All received oral BEC (2.5-5 mg/day, except one patient with 10 mg/day). Group B included nine women, aged 26 to 36 years old, four had normal menstrual cycles and five had oligomenorrhea; all had primary or secondary sterility during the last 2 to 7 years and eight out of nine, also had galactorrhea during 1 to 8 years; in four of them a CAT was performed showing a pituitary microadenoma.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ovulation induction with human menopausal gonadotropins in hypothalamic-hypophyseal disfunction]. / Inducción de ovulación con gonadotropinas menopáusicas humanas en disfunción hipotálamo-hipofisiaria.

This is a report on the institutional experience of the use of Human Menopausal Gonadotropins (HMG) in anovulatory women diagnosed as hypothalamic-hypophysiary dysfunction of Group II of WHO with previous failure to chlomifen citrate therapy. In a period of three years 180 patients were gathered with 420 cycle of treatment, obtaining ovulation in 340 cycles (81%). The ovarian hyperstimulation syndrome (OHS) was present in 15 cases (3.5%). There were 115 pregnancies that correspond to 33.8% of oculatory cycles and to 63.8% of the amount of patients. Multiple pregnancy incidence was 10.4%, and the gestational loses rate was 26%; these results are similar to what has been reported in literature. It is concluded that this medication is a good option of treatment for this type of patients, provided that there are the necessary means to expert and adequate surveillance.

[The functional ovarian reserve in assisted reproduction. A clinical dilemma]. / Reserva ovárica funcional en reproducción asistida. Dilema clínico.

The response to supraphysiological ovarian stimulation in Assisted Reproduction (particularly FIV-TE and GIFT) may be very heterogeneous, despite the fact that selected patients have clinical and paraclinical characteristics very homogeneous. Highly significant differences, were found, in two groups of patients with similar clinical characteristics, who were stimulated with the same scheme. Group I (Adequate response = 22 patients) and Group II (Inadequate response = 13 patients), regarding to basal seric levels of FSH (P = 0.007) and to quality of follicular response (P = 0.000). These results suggest that quality of response to supraphysiological ovarian stimulation, may reflect a "Functional ovarian reserve" and that this can be predicted (partially) with basal seric levels of FSH; but, may be, the inadequate response, paradoxical to certain point, would not represent an ovarian failure or a resistant ovarian syndrome, incipient or transitory during the reproductive age?

[Serum prolactin during oral metoclopramide in normal nulliparous women]. / Prolactina sérica durante metoclopramida oral en mujeres nuligestas normales.

As a first step in an extensive project planned to determine serum PRL levels in response to oral metoclopramide in women with a diverse gyneco-obstetric history, it was decided to study 51 clinically healthy nulliparous women, aged 15.8 to 48.2 years, with history of regular menses at least one year before the study (except the three postmenopausal women), with no regular drug ingestion during the last six months. Women were studied on days 18 to 22 of menstrual period, after a 30 minute rest on basal conditions (3 samples) at 60, 90, and 120 minutes after a single 10 mg. oral dose of metoclopramide. Duplicate PRL determinations were performed in all samples and progesterone(P) only in a pool of the three basal samples by radioimmunoanalysis. All women had serum P levels > or = 4.0 ng/ml. A significant linear positive correlation (r > or = 0.6795, p < 0.001) was observed between chronologic age (CA) and serum PRL levels, regardless the way they were expressed. Considering the individual responses it was decided to divide the group according to CA and it was observed that serum PRL levels--expressed in any form were always significantly greater in women aged > 25 years (Group 2) in contrast with women aged < or = 25 years (Group 1). Since differences were evident, percentiles 3, 50 and 97 for serum PRL levels were calculated during each test time for both groups.(ABSTRACT TRUNCATED AT 250 WORDS)