First Results in the Search for Dark Sectors at NA64 with the CERN SPS High Energy Muon Beam.

We report the first search for dark sectors performed at the NA64 experiment employing a high energy muon beam and a missing energy-momentum technique. Muons from the M2 beamline at the CERN Super Proton Synchrotron with a momentum of 160 GeV/c are directed to an active target. The signal signature consists of a single scattered muon with momentum <80 GeV/c in the final state, accompanied by missing energy, i.e., no detectable activity in the downstream calorimeters. For a total dataset of (1.98±0.02)×10^{10} muons on target, no event is observed in the expected signal region. This allows us to set new limits on the remaining (m_{Z^{'}},g_{Z^{'}}) parameter space of a new Z^{'} (L_{µ}-L_{τ}) vector boson which could explain the muon (g-2)_{µ} anomaly. Additionally, our study excludes part of the parameter space suggested by the thermal dark matter relic abundance. Our results pave the way to explore dark sectors and light dark matter with muon beams in a unique and complementary way to other experiments.

Search for a New B-L Z

A search for a new Z^{'} gauge boson associated with (un)broken B-L symmetry in the keV-GeV mass range is carried out for the first time using the missing-energy technique in the NA64 experiment at the CERN SPS. From the analysis of the data with 3.22×10^{11} electrons on target collected during 2016-2021 runs, no signal events were found. This allows us to derive new constraints on the Z^{'}-e coupling strength, which, for the mass range 0.3≲m_{Z^{'}}≲100 MeV, are more stringent compared to those obtained from the neutrino-electron scattering data.

Elastografía en tiempo real (Supersonic), experiencia de un centro en Bogotá / Real-time elastography (Supersonic), experience of a medical center in Bogotá

Resumen Introducción: la elastografía en tiempo real, 2D-SWE (Supersonic), es una prueba no invasiva que se utiliza para determinar la elasticidad del hígado y, de esa forma, calcular el grado de fibrosis hepática. En Colombia, la prueba se introdujo en 2016 y no existen hasta el momento estudios del comportamiento de la prueba en todos los pacientes hepáticos, solo se han publicado en pacientes sanos y cirróticos. Objetivo: analizar la experiencia de la aplicación de la elastografía en tiempo real, en sujetos atendidos en el centro de enfermedades hepáticas y digestivas de Bogotá, Colombia. Materiales y métodos: estudio descriptivo retrospectivo de una cohorte de sujetos atendidos entre marzo de 2016 y julio de 2017. Se realizó una historia clínica completa y una prueba de elastografía en tiempo real (Supersonic). Resultados: se incluyeron 654 sujetos, con una mediana de edad de 55 años (rango intercuartílico [RIC]: 45-64). La mediana de valores de fibrosis expresada en kilopascales (kPs) fue de 8,3, con un promedio de 5 mediciones. Se observó una diferencia significativa en el grado de fibrosis entre los grupos de edad y en relación con el diagnóstico final, donde se evidenció una mayor fibrosis en el grupo de enfermedades colestásicas (autoinmune, colangitis biliar primaria [CBP] y superposición autoinmune-CBP). La tasa global de fracaso fue menor al 1%. Conclusiones: es la primera descripción del comportamiento de la prueba a nivel nacional. Los valores de rigidez hepática observados en los diferentes estadios demuestran la utilidad de la prueba para la determinación de la fibrosis hepática en pacientes con diferentes patologías.

Abstract Introduction: Real-time two-dimensional shear wave elastography (2D-SWE) (Supersonic Imagine SA), is a non-invasive test used to determine liver elasticity and calculate the degree of liver fibrosis. In Colombia, this test was introduced in 2016 and, to date, no study has tested its behavior in all liver patients, only in healthy and cirrhotic patients. Objective: To analyze the experience of real-time elastography implementation in subjects treated at the Centro de Enfermedades Hepáticas y Digestivas in Bogotá, Colombia. Materials and methods: This is a retrospective descriptive study of a cohort of subjects treated between March 2016 and July 2017. A complete medical report and a real-time elastography (Supersonic) test were performed. Results: 654 subjects were included, with a median age of 55 years (interquartile range [IQR]: 45-64). The median fibrosis values expressed in kilopascals (kPs) were 8.3, with an average of 5 measurements. There was a significant difference in the degree of fibrosis between the age groups and in relation to the final diagnosis, where there was a greater fibrosis in the cholestatic disease group (autoimmune, primary biliary cholangitis [PBC], and overlap). The overall failure rate was less than 1%. Conclusions: This is the first description of this test behavior in the country. Hepatic stiffness values observed in the different stages demonstrate the usefulness of the test to establish the degree of liver fibrosis in patients with multiple diseases.

Conversion to Roux-en-Y gastric bypass surgery through a robotic-assisted hybrid technique after failed sleeve gastrectomy: Short-term results. / Conversión por técnica híbrida robótica a bypass gástrico en Y de Roux posterior a falla de manga gástrica: resultados a corto plazo.

INTRODUCTION AND AIMS: Laparoscopic sleeve gastrectomy (LSG) is the most widely performed bariatric surgery worldwide but complications and failed procedures are on the rise. AIMS: To determine the reasons for failed LSGs and report the results of conversion to gastric bypass surgery, comparing the outcomes with those of primary gastric bypass surgery. MATERIALS AND METHODS: Patients with failed LSG that underwent conversion to gastric bypass surgery through a robotic-assisted and laparoscopic (hybrid) technique were evaluated. Outcomes and follow-up related to weight loss failure (WLF) were compared with those in patients that underwent primary laparoscopic gastric bypass (pLGB) surgery. RESULTS: Revisional surgery was performed on 13 patients due to WLF, on 3 patients because of refractory gastroesophageal reflux disease (GERD), and on 2 patients due to gastric stricture. There were no differences between the preoperative characteristics of the patients with WLF before undergoing conversion to gastric bypass and the patients that underwent pLGB surgery. At postoperative month 36, the percentage of excess weight loss was greater in the patients that underwent pLGB surgery, than in those with WLF that underwent conversion to gastric bypass (69.17±23.73 vs. 54.17±12.48, respectively; P<0.05). Refractory GERD, symptoms due to gastric stricture, and comorbidities all improved after the revisional surgery. CONCLUSION: Revisional surgery resulted in acceptable weight loss at 36 months of follow-up and favored comorbidity remission. In addition, it resolved symptoms of refractory GERD and gastric stricture.

Grado de adherencia a la recomendación de actividad física, sedentarismo y riesgo cardiovascular en adolescentes de enseñanza media de Punta Arenas, Chile / Degree of adherence to physical activity recommendation, sedentary lifestyle and cardiovascular risk in teenagers from Punta Arenas, Chile

Objective: The aim of this study was to identify the degree of compliance to the global recommendations on physical activity and its association with cardiovascular risk, anthropometric and socio-demographic variables in teenagers from the district of Punta Arenas, Chile. Subjects and Methods: A random, stratified and proportional sample was obtained of322 students from private, private-subsidized and public local schools. Global physical activity questionnaire (GPAQv2), and anthropometric measurements of weight, height, waist circumference, and classification of nutritional status were applied according to the standards of the Chilean Ministry of Health. Results: 50.31% of the sample showed a normal nutritional status, 48.14% presented overweight status. We also found 666.8 min/day of average sedentary lifestyle between the means by gender. The female gender presents an OR: 1.9; 95% IC: 1.16 to 3.11 according to WHO recommendations. Discussion: It was found that most of the students resulted in the category "sufficiently active" as WHO recommended. An 82.30% showed no high cardiovascular risk. Conclusion: The level of physical activity would not be influenced by nutritional status, showing that the majority of students perform moderate physical activity on their free time.

Objetivo: El objetivo de este estudio fue identificar el grado de adherencia a las recomendaciones mundiales sobre actividad física, así como su asociación con riesgo cardiovascular, variables antropométricas y socio-demográficas en adolescentes de la comuna de Punta Arenas. Sujetos y métodos: Se obtuvo una muestra aleatoria, estratificada y proporcional de 322 estudiantes de establecimientos particular-pagados, particular-subvencionados y municipalizados. Se aplicó el cuestionario mundial sobre actividad física (GPAQv2), y mediciones antropométricas de peso, talla, perímetro de cintura, y clasificación del estado nutricional según normas MINSAL. Resultados: El 50,31% del total de la muestra tenía un estado nutricional normal y 48,14% presentó malnutrición por exceso. También, 666,8 min/día de sedentarismo promedio entre las medias por sexo. El sexo femenino presenta un OR: 1,9; 95%IC: 1,16-3,11 según recomendaciones de la OMS. Discusión: Se encontró a la mayoría de los estudiantes evaluados en la categoría "suficientemente activos" según las recomendaciones de la OMS. Se observó un alto porcentaje sin riesgo cardiovascular (82,30%). Conclusión: El nivel de actividad física no estaría condicionado por el estado nutricional, evidenciándose en la mayoría de los alumnos la realización de actividad física moderada en su tiempo libre.

El consumo de nitrato y su potencial efecto benéfico sobre la salud cardiovascular / Nitrate consumption and potential beneficial effect on cardiovascular health

Vegetable consumption is associated with a lower risk of suffering cardiovascular disease and cancer, traditionally ascribed to their content in antioxidants. Recently it has been proposed that this effect may be due to the presence of nitrates in vegetables. Cardiovascular diseases are usually associated with an impaired production of nitric oxide (NO) in blood vessels. One strategy aimed to correct this defective production is to generate NO from inorganic nitrates contained in vegetables. However, it has been traditionally thought that nitrites and nitrites, as those used in curing meats and as food preservers, could generate adducts that may increase cancer risk. This paradigm is now being revisited since the evidence that vegetables rich in nitrates may have a beneficial impact on human health, particularly on cardiovascular parameters, has showed promising results, although more complete clinical evidence is needed.

El consumo de vegetales está asociado a un menor riesgo de desarrollar enfermedades cardiovasculares y cáncer, efecto que tradicionalmente se le ha atribuido a su contenido en antioxidantes. Recientemente se ha propuesto que parte de estos efectos se deberían al contenido de nitratos en los vegetales. La enfermedades cardiovasculares se asocian a una disminución en la producción del óxido nítrico (NO). Una estrategia para corregir esta producción defectuosa es generar NO a partir de nitratos inorgánicos contenidos en los alimentos. Sin embargo, se ha propuesto que los nitratos, como los usados en el proceso de curación de carnes y preservación de alimentos, podrían generar aductos cancerígenos. Este paradigma está siendo revisado y la evidencia que los alimentos ricos en nitratos pudieran tener efectos benéficos sobre la salud, particularmente sobre parámetros cardiovasculares, ha generado resultados alentadores, aunque aun se necesitan estudio clínicos más completos.

Caracterización epidemiológica de cáncer de esófago en Hospital Base Valdivia, período 2002-2011 / Epidemiologic characterization of esophagus neoplasm, Valdivia Hospital, 2002-2011

INTRODUCCIÓN: El cáncer de esófago posee para el 2007 una tasa de incidencia estimada en Chile de 5,7x100.000 habitantes. Los tipos histológicos más frecuentes son carcinoma de células escamosas y adenocarcinoma, esta última ha experimentado un aumento de su incidencia. OBJETIVOS: Caracterizar población de pacientes diagnosticados con cáncer de esófago, entre los años 2002 y 2011, del Hospital Base de Valdivia (HBV). METODOLOGÍA: Estudio descriptivo retrospectivo, cuyos datos se obtuvieron por revisión de libros de biopsias del Servicio de Anatomía Patológica de Hospital Base Valdivia entre los años 2002-2011 registrando datos sobre sexo, edad y tipo histológico. Los datos fueron tabulados y graficados en programa Excel 2010. RESULTADOS: Se analizaron 151 biopsias, con promedio de edad 70 años. La incidencia promedio fue de 4,14/100.000 habitantes con una relación 5:3 para sexo masculino y femenino respectivamente. La incidencia anual para hombres fue de 1,7 en 2002 y 7,2 en 2011. La incidencia anual promedio para carcinoma escamoso fue de 3,4/100.000 habitantes, para adenocarcinoma 0,58/100.000 habitantes, y otros tipos histológicos 0,2/100.000 habitantes. DISCUSIÓN: La incidencia por género fue más baja para varones que las cifras nacionales, pero con tendencia al alza. El tipo histológico más frecuente fue carcinoma escamoso. A diferencia de lo esperado el adenocarcinoma no tiene tendencia al alza.

INTRODUCTION: The year 2007 the esophageal neoplasms has an estimated incidence in Chile of 5,7/100.000. The most frequently histologic kinds are the Squamous Cell Carcinoma and the Adenocarcinona, the last one has shown an incidence rise. OBJECTIVES: Epidemiologic characterization of esophagus neoplasm cases for the 2002-2011 period. METODOLOGY: Retrospective descriptive study, where the data was obtained by biopsy books revision from the anatomy department at Valdivia hospital. Tabulation and analysis performed whit excel 2010. RESULTS: 151 cases were analyzed, average age were 70 years. The average incidence for men cases: 1,7/100.000 in 2002 and 7,2/100.000 in 2011. The Squamous Cell Carcinoma average incidence: 3,4/100.000 and for the adenocarcinoma: 0,58/100.000. DISCUSSION: The average incidence was lower for men than the national rates, but it's increasing. The mostcommon histologic kind is the quamous Cell Carcinoma. The adenocarcinoma isn't increasing as was expected.

Effect of glucose concentration on the rate of fructose consumption in native strains isolated from the fermentation of Agave duranguensis.

Studies on hexose consumption by Saccharomyces cerevisiae show that glucose is consumed faster than fructose when both are present (9:1 fructose to glucose) in the medium during the fermentation of Agave. The objective of this work was to select strains of S. cerevisiae that consume fructose equal to or faster than glucose at high fructose concentrations by analyzing the influence of different glucose concentrations on the fructose consumption rate. The optimal growth conditions were determined by a kinetics assay using high performance liquid chromatography (HPLC) using 50 g of glucose and 50 g of fructose per liter of synthetic medium containing peptone and yeast extract. Using the same substrate concentrations, strain ITD-00185 was shown to have a higher reaction rate for fructose over glucose. At 75 g of fructose and 25 g of glucose per liter, strain ITD-00185 had a productivity of 1.02 gL(-1) h(-1) after 40 h and a fructose rate constant of 0.071 h(-1). It was observed that glucose concentration positively influences fructose consumption when present in a 3:1 ratio of fructose to glucose. Therefore, adapted strains at high fructose concentrations could be used as an alternative to traditional fermentation processes.

Further assessment of the clinically effective dose range of etoricoxib: a randomized, double-blinded, placebo-controlled trial in rheumatoid arthritis.

OBJECTIVE: To further assess the clinically active dose range of etoricoxib, a COX-2 selective inhibitor, in rheumatoid arthritis (RA). METHODS: RA patients were randomized to etoricoxib 10, 30, 60, or 90 mg or placebo in a double-blind, 12-week study. DMARDs (methotrexate, biologics) or low-dose corticosteroids were allowed in stable doses. The primary endpoint was the proportion of patients completing the study and achieving an American College of Rheumatology 20% (ACR20) response. Secondary endpoints included individual components of the ACR index and Patient Global Assessment of Pain. Safety was assessed by physical exam and adverse experiences (AEs) occurrences. RESULTS: Etoricoxib 90 mg was the only dose to reach a statistically significant difference from placebo (p < 0.001) on the primary endpoint; etoricoxib 60 mg approached significance (p = 0.057). Significant pain improvement vs. placebo was observed with etoricoxib 90 mg (p < 0.001), 60 mg (p = 0.018), and 30 mg (p = 0.017). Despite the use of background biologics and corticosteroids, a dose response was still apparent. A higher proportion of etoricoxib 60 and 90 mg patients had renovascular AEs (i.e., edema and hypertension) compared with placebo, although discontinuations for renovascular AEs were rare. Etoricoxib 90 mg had a higher incidence of serious AEs (n = 5; 1 was considered drug-related) versus placebo (n = 0). LIMITATIONS: The present study was not powered to detect differences in cardiovascular or gastrointestinal safety by dose. Additionally, further research is needed to clarify the role of doses less than the etoricoxib 90 mg dose for pain management in RA patients. CONCLUSION: Etoricoxib 90 mg demonstrated statistically superior efficacy (ACR20) compared with placebo and numerical superiority over the other doses of etoricoxib studied. Etoricoxib 30 and 60 mg demonstrated significant pain improvement versus placebo, suggesting utility for some patients.

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.

Presencia de Cotylophoron cotylophorum (Trematoda, Taramphistomidae)en bovinos de Loreto, Perú / Report of Cotylophoron cotylophorum (Trematoda, Taramphistomidae) in bovine from Loreto, Perú

La paranfistomosis es una infección ocasionada por trematodes pertenecientes al suborden Paramphistomata, algunas de estas especies son parásitos del rúmen y retículo de rumiantes. Uno de los trematodos más frecuentesen todo el mundo es el Cotylophoron que afecta a rumiantes domésticos y silvestres, especialmente a vacas, ovejas, cabras y búfalos especialmente en regiones tropicales y subtropicales. Se realizó la evaluación parasitaria a 61 ejemplares de ganado bovino aparentemente sanos (42 hembras adultos y 19 menores de un año), manejados al pastoreo, en un fundo ganadero ubicado en la cuenca del río Nanay –Iquitos. Las heces fueron obtenidas mediante palpación rectal y procesada mediante el método Dennis modificado. Dos vacas fueron sacrificadas para obtener parásitos adultos. Los resultados indican la presencia de Cotylophoron cotylophorum(Fischoeder, 1901) Stiles & goldeberger, 1910 en los animales estudiados y es un nuevo registro para el Perú, encontrando porcentajes de infección de 62 y 53 por ciento en adultos y terneros respectivamente. El rango de la carga parasitaria (huevo/gramo de heces) en adultos fue 1—44 y 1—55 en animales menores de un año. El estudio revela la existencia del trematodo en un grupo de ganado cruzado manejados al pastoreo, aunque se desconoce los efectos negativos que podría estar causando en la reducida ganadería amazónica.

The paramfistomosis is an infection caused by a trematode belonging to the sub order Paramphistomata, some their species are parasitics of the rumen and reticulo of ruminant. One of the most frequent trematodos in the world is Cotylophoron, it affects to domestic and wild ruminant, especially cows, sheep, goats and buffalos in tropical and subtropical regions. We evaluate the parasitism in 61 specimens of apparently healthy cattle (42 adult females and 19 under one year), fed with wild pastures on a farm located on the Nanay River Basin, Iquitos. The samples of fresh grounds were obtained by means of rectal palpation and processed by means of the method of Dennis modified. Two cows were sacrificed to collect mature parasites. The results indicate the presence of Cotylophoron cotylophorum (Fischoeder, 1901) Stiles & goldeberger, 1910, in the studied animals, which is a new record from Peru, being percentages of 62 and 53 per cent respectively in adults and calves. The range of the parasitic load (egg/grams of grounds) in adults was 1—44 and 1—55 in animals smaller than one year. The study reveals the existence of the trematodo in a group of livestock crusader managed to the shepherding, although one ignores the negative effects that it could be causing in the reduced Amazon cattle raising.

Predicting geographic and ecological distributions of triatomine species in the southern Mexican state of Puebla using ecological niche modeling.

We analyzed the geographic distribution using ecological niche modeling of three species of triatomines distributed in the Mexican state of Puebla. Punctual records were gathered for a period of 5 yr of fieldwork sampling. We used the genetic algorithm for rule-set production (GARP) to achieve the potential distribution of the ecological niche of triatomines. The models showed that Triatoma barberi and Meccus pallidipennis are sympatric and widely distributed in the central-southern part of the state, whereas T. dimidata is restricted to the northern mountains of the state with no overlapping among other species, M. bassolsae was not modeled because of the scarce number of locality records. We highlighted the warm and dry conditions in southern Puebla as important potential areas for triatomine presence. Finally, we correlated the species potential presence with the human population at risk of acquiring Chagas disease by vector-borne transmission; it is showed that M. pallidipennis presents the highest values of both ecological and poverty risk scenarios representing the main potential vector in the state.

Gestión de la calidad como herramienta gerencial en la ESE Hospital San Juan de Dios de El Carmen de Viboral / Quality management as a managerial tool in the state social company Hospital San Juan de Dios de El Carmen de Viboral

Se ilustra en el presente artículo la experiencia de una Empresa Social del Estado (ESE) en la implementación de un sistema de gestión de la calidad (SGC), basado y orientado bajo el esquema de la norma internacional ISO 9001 del 2000, así como su metodología y las diferentes etapas recorridas hasta llegar por último a la obtención del certificado de calidad bajo la norma en mención. Igualmente, se da a conocer el mapa de procesos del sistema implementado

Combined median and medial antebrachial cutaneous neuropathies: an upper-arm neurovascular syndrome.

The neurovascular bundle anatomy in the upper arm displays changing relationships of nerve and vascular structures along short segments. Fibrous tissues segregate these elements into enclosed compartments allowing for specific patterns of injury. We report a patient with a iatrogenic brachial artery injury in this region who featured combined median and MAC neuropathies, which were consistent with complete axonotmesis on neurophysiological assessment. Increased intracompartmental pressure may have led to nerve injury either thorough an ischemic mechanism or to focal compression. Recognition of this unusual pattern of nerve damage is important, since injury can be accurately localized to the midportion of the neurovascular compartment in the upper arm.

[Ilioinguinal neuropathy: usefulness of conduction studies]. / Neuropatía ilioinguinal: utilidad de los estudios de conducción.

Ilioinguinal neuropathy is an under-recognized etiology of pelvic pain, that is frequently misdiagnosed with alternative etiologies of pelvic pain. This is partially due to the limited usefulness of neurophysiological studies. Indeed, electromyography of the lower abdominal musculature identifies slightly more than half of the cases. In spite of an available conduction technique described in normal subjects, the usefulness of nerve conduction studies in ilioinguinal neuropathy is uncertain because their use has not been validated with patients. We describe the case of a patient with left inguinal pain following left inguinal herniorraphy. He underwent repeated surgeries and several analgesic treatments, without amelioration of pain. Conduction studies were consistent with ilioinguinal neuropathy. Anesthetic block relieved symptoms temporarily, and the symptoms disappeared upon section of the ilioinguinal nerve. This case describes the usefulness of conduction studies in the diagnosis of ilioinguinal neuropathy.

Neuropatía ilioinguinal: utilidad de los estudios de conducción / Ilioinguinal neuropathy: usefulness of conduction studies

La neuropatía ilioinguinal es una causa de dolor pélvico que acarrea notables dificultades diagnósticas, siendo frecuente la confusión con otras patologías causantes de dolor pélvico. Esto es, en parte, debido a la baja rentabilidad de los estudios neurofisiológicos. La electromiografía de la musculatura abdominal inferior sólo muestra anomalías en algo más de la mitad de los casos. La utilidad de los estudios de conducción motora, a pesar de disponer de una técnica descrita en sujetos normales, es incierta, por no haberse validado su utilidad en patología. Presentamos el caso de un paciente con dolor inguinal tras una herniorrafia inguinal izquierda. Se realizaron varias reintervenciones con el fin de identificar el origen del dolor, así como terapias empíricas antiálgicas, siendo todas ellas ineficaces. Finalmente un estudio de conducción documentó una neuropatía ilioinguinal izquierda. El bloqueo anestésico consiguió un control transitorio de los síntomas, que desaparecieron completamente con la sección quirúrgica del nervio. Éste es el primer caso descrito que confirma la utilidad de los estudios de conducción en el diagnóstico de la neuropatía ilioinguinal (AU)

Transcranial magnetic stimulation identifies upper motor neuron involvement in motor neuron disease.

OBJECTIVE: To evaluate the sensitivity of transcranial magnetic stimulation (TMS) to identify upper motor neuron involvement in patients with motor neuron disease. BACKGROUND: Diagnosis of ALS depends on upper and lower motor neuron involvement. Lower motor neuron involvement may be documented with electromyography, whereas definite evidence of upper motor neuron involvement may be elusive. A sensitive, noninvasive test of upper motor neuron function would be useful. METHODS: TMS and clinical assessment in 121 patients with motor neuron disease. RESULTS: TMS revealed evidence of upper motor neuron dysfunction in 84 of 121 (69%) patients, including 30 of 40 (75%) patients with only probable upper motor neuron signs and unsuspected upper motor neuron involvement in 6 of 22 (27%) patients who had purely lower motor neuron syndromes clinically. In selected cases, upper motor neuron involvement identified with TMS was verified in postmortem examination. Increased motor evoked potential threshold was the abnormality observed most frequently and was only weakly related to peripheral compound muscle action potential amplitude. In a subset of 12 patients reexamined after 11+/-6 months, TMS showed progression of abnormalities, including progressive inexcitability of central motor pathways and loss of the normal inhibitory cortical stimulation silent period. CONCLUSIONS: TMS provides a sensitive means for the assessment and monitoring of excitatory and inhibitory upper motor neuron function in motor neuron disease.

Experiencia de cirugía laparoscópica en masas anexiales en el Hospital Regional Temuco, Chile / Experience of laparoscopic surgery for adnexal masses in the Temuco regional hospital in Chile

Background: Laparoscopic surgery has clear advantages over open surgical procedures. In gynecology, laparoscopic surgery for adnexal masses in pre or post menopausal women has been used for several years. Aim: To report the experience with gynecologic laparoscopic surgery at the Temuco Regional Hospital. Patients and methods: Between 1996 and 1998, laparoscopic surgery was done in 96 patients aged 16 to 56 years and open surgery in 56 patients aged 15 to 74 years, with a clinical or ultrasound diagnosis of adnexal masses or ovarian dermoid cysts. Results: The most frequent tumors excised were epithelial and germinal cell. Laparoscopic surgery required a mean operative time of 69.9 min and it had a 3.1 percent of complications. Women subjected to this type of surgery had a mean hospital stay of 3.1 days and the mean postoperative stay was 2 days. Open surgery required an operative time of 69 min and it had no postoperative complications. The mean hospital stay for women subjected to this type of procedure was 9.5 days. Conclusions: Women subjected to laparoscopic surgical procedures for adnexal masses had a shorter hospital stay than women subjected to open surgical procedures