Survival of Vascular Accesses in Chronic Hemodialysis Patients.

BACKGROUND/AIMS: Vascular access (VA) is the highest risk factor for blood infections, hospitalization, and mortality of patients undergoing hemodialysis (HD). The risk of mortality while using a catheter is greater than that while using grafts. The objective of this article is to know the survival rate in relation to the type of VA. METHODS: A retrospective cohort of HD patients was studied. The data gathered included age, gender, first VA at the surrogate site, days between the first and second access, number of accesses, and anatomical site of VA placement. Mean differences were estimated using χ2 or Student's t test. Survival was calculated using the Kaplan-Meier curves and included in tables. Statistical significance was established as p < 0.05. The statistical computer software package SPSSw v25 was used for the analysis. RESULTS: A total of 896 patients were included with a mean age of 47.88 years (SD ± 16.52), the duration of the first VA was 398.81 days (±565.79), the mean number of VAs used was 2.26 (±1.15), and the median time undergoing HD was 728.73 days. The duration of catheter placement was 330.42 days, and 728.60 days for fistula use (p = 0.001). The mean number of days of renal replacement was 611.59 days for catheter and 1,495.25 days for internal arteriovenous fistula (IAVF) patients (p = 0.001). CONCLUSIONS: The survival of the initial VA is greater for the IAVF, followed by the tunneled catheters and the lowest by the non-tunneled catheters, which continue to be frequently used in our setting.

Probiotics' effectiveness on symptoms, histological features and feeding tolerance in ulcerative colitis / Efectividad de probióticos sobre síntomas, histología y tolerancia alimentaria en colitis ulcerativa

Background: Probiotics have been used in the adjuvant treatment of Ulcerative Colitis (UC). Objective: To evaluate the role of a combination of probiotics on the clinical, histological changes and feeding tolerance in patients with UC. Methods: An open UC patients with mild to moderate activity and clinical trial was conducted. Patients were randomized to receive or a combination of 6 strains of probiotics for 3 months while continuing their drug treatment established. UC activity was assessed by Truelove and Witts scale and histological findings by Gupta index. Descriptive statistics, Chi square test and Student t test for comparison of the two groups was performed. Results: In each group 17 patients were included. An improvement was found in the disease activity (52.9% vs. 23.5%, p = 0.07) and in histologic index (82.3% vs. 41.1%, p = 0.03) in patients treated with probiotics compared to the control group. Improved food tolerance was also observed in patients treated with probiotics. Conclusion: The study shows a beneficial short-term effect on symptoms, histological findings and feeding tolerance with the administration of a combination of 6 strains of probiotics in patients with UC.

Introducción: los probióticos han sido utilizados en el tratamiento adyuvante de la colitis ulcerativa (CU). Objetivo: evaluar el papel de una combinación de probióticos sobre las manifestaciones clínicas, cambios histológicos y tolerancia alimentaria en pacientes con CU. Métodos: se realizó un ensayo clínico abierto de pacientes con CU y actividad leve a moderada. Los pacientes se aleatorizaron para recibir, o no, una combinación de 6 cepas de probióticos durante 3 meses, mientras continuaban con el tratamiento farmacológico establecido. Se evaluó la actividad de la CU mediante la escala de Truelove and Witts, y los hallazgos histológicos mediante el índice de Gupta. Se realizó estadística descriptiva, prueba de Chi cuadrada y t de Student para la comparación de ambos grupos. Resultados: se incluyeron 17 pacientes por grupo. Se encontró una mejoría en la actividad de la enfermedad (52.9% frente a 23.5%, p = 0.07) y en el índice histológico (82.3% frente a 41.1%, p = 0.03) en los pacientes tratados con probióticos en comparación con el grupo control. También se observó una mejor tolerancia alimentaria en los pacientes tratados con probióticos. Conclusión: el estudio muestra un efecto benéfico a corto plazo sobre los síntomas, hallazgos histológicos y tolerancia alimentaria con la administración de una combinación de 6 cepas de probióticos en pacientes con CU.

Splenectomy in systemic lupus erythematosus and autoimmune hematologic disease: a comparative analysis.

The objective of the study is to analyze the efficacy and safety of splenectomy in the management of refractory autoimmune thrombocytopenia (AT)/autoimmune hemolytic anemia (AIHA) associated or not with systemic lupus erythematosus. Thirty-four patients after splenectomy due to severe AT and/or AIHA were divided into group 1 (G1) 18 SLE/APS patients: 9 AT/SLE patients, 6 SLE/antiphospholipid syndrome (APS), and 3 primary APS. Group 2 (G2): 16 patients without SLE/APS: 2 Fisher-Evans syndrome and 14 AIHA. Surgery approach when (1) platelets ≤ 50,000/ml despite 2 weeks on medical therapy, (2) medically dependent, and (3) medically intolerant or after two hemolytic crises in AIHA patients. Splenectomy response: (1) complete (CR): ≥ 150,000 platelets/ml, (2) partial: 50,000-149,000/ml, or (3) none: ≤ 50,000/ml. CR for AIHA: hemoglobin ≥9 g/dl. STATISTICAL ANALYSIS: descriptive statistics and chi-square test. The mean age was 34.6 years; mean follow-up: 28.5 months. Open splenectomy in 15/34 vs laparoscopy in 19/34 (p = NS). CR in 15/34, G1: 4/18, G2: 11/16, (p = 0.006). Complications in 6/34, 5 from G2 vs 1 from G1 (p = 0.05). Relapse in 7/18 patients in G1 and 3/16 in G2 (p = 0.05). Open and laparoscopic splenectomies in SLE and AT patients are as effective as in those without SLE; however, patients with SLE and APS had more relapses.

Educational and evaluation strategies in the training of physician specialists / Estrategias educativas y de evaluación en la formación de médicos especialistas

Background: Teaching strategies have been defined as procedures, means or resources that teachers used to promote meaningful learning. Aim: Identify teaching strategies and evaluation used by the professor with residents in tertiary hospitals health care. Methods: This is a cross-sectional study conducted with full, associate and assistant professors of various medical specialties. A questionnaire was applied to evaluate the strategies used by professors to teach and evaluate students. Results: We included a sample of 90 professors in 35 medical specialties. The most frequent teaching activities were: organizing students to develop presentations on specific subjects, followed by asking questions on previously reviewed subjects, In terms of the strategies employed, the most frequent "always" option was applied to case analyses. The most frequent methods used for the evaluation of theoretical knowledge were: participation in class, topic presentation and exams. Conclusions: Teaching activities were primarily based on the presentation of specific topics by the residents. The most commonly used educational strategies were clinical case analyses followed by problem-based learning and the use of illustrations. Evaluation of the residents' performance in theory knowledge, hinged on class participation, presentation of assigned topics and exams.

Antecedentes: Las estrategias didácticas se han definido como procedimientos, medios o recursos que el docente utiliza para promover el aprendizaje significativo. Objetivo: Identificar las estrategias de enseñanza y de evaluación que utiliza el profesor con residentes en hospitales de tercer nivel de atención médica. Método: Estudio transversal, con profesores de diversas especialidades, en el Centro Médico Nacional La Raza. Se aplicó un cuestionario que valora las estrategias utilizadas en la enseñanza y la evaluación. Resultados: En una muestra de 90 profesores, 35 especialidades médicas con profesores ayudantes, adjuntos y titulares, las actividades de enseñanza que más realizan son organizar a los alumnos a exponer temas, seguido de realizar preguntas sobre temas vistos. Respecto a las estrategias educativas, la más frecuente fue análisis de casos y aprendizaje basado en problemas. Para evaluación del desempeño teórico, los métodos más utilizados fueron participación en clase, exposición de temas y exámenes. Conclusiones: las actividades de enseñanza están basadas en la exposición de temas por los médicos residentes. La estrategia educativa más utilizada fue llevar a cabo análisis de casos clínicos, seguido por aprendizaje basado en problemas. La evaluación del desempeño en aspectos teóricos se realiza a partir de la participación en clase, la exposición de temas y exámenes.

Niveles de empatía y ética profesional en candidatos a sub-especialidad médica / Levels of empathy and professional ethics in candidates to Medical Graduate School

La percepción actual de una atención médica deshumanizada y de baja calidad ha cuestionado la capacidad empática y ética de los profesionales de la salud. Las investigaciones en este campo reportan fluctuaciones en estos atributos a lo largo de la formación de los médicos. Objetivo: explorar los niveles globales de empatía y ética profesional, así como los niveles de cada componente de ambos atributos, en una muestra de candidatos a subespecialidad médica. Metodología: Se incluyeron 65 residentes que solicitaron cursar subespecialidad en una unidad médica de alta especialidad. Como parte del proceso de solicitud, respondieron el Test de Empatía Cognitiva y Afectiva y la Escala de Actitudes Éticas Profesionales. Resultados:Las puntuaciones promedio de la muestra calificaron como media en empatía y como óptimas en ética profesional. La comparación por género, especialidad y competencias mostró menor empatía afectiva y mejor competencia ética en las mujeres; mayor empatía cognitiva en subespecialidades quirúrgicas; y ausencia de correlación entre las dos variables en general, y en particular por competencia. Conclusiones: Se resalta la importancia de medir las competencias particulares de cada atributo dado que la variación en competenciasespecíficas repercute en diferentes aspectos de la formación del médico, como la elección de especialidad, la selección de candidatos, la elaboración de programas académicos y el adecuado aprendizaje sobre la construcción de una efectiva relación médico-paciente

The current perception of a dehumanized medical attention and its low quality has questioned the empathic capacity and ethics of the health professionals. The research in this field reports variations in this attributes along the doctors' education. Objective: to explore the global levels of empathy and professional ethics, as well as the levels of each component of both attributes in a sample of applicants to a medical graduate program. Methodology: 65 residents that applied for graduation studies in a very specialized medical unit were included. As part of the application process, they answered the Cognitive and Affective Empathy Test and the Professional Ethical Attitudes Scale. Results: The average scores of the sample got Average in empathy and Optimal in professional ethics. The comparison by gender, specialty and competences showed less affective and better ethical competence in women, more cognitive empathy in surgical specialties, and in general an absence of correlation between the two variables and specifically by competence. Conclusions: The importance of measuring the specific competences of each attribute is highlighted given that the variation in specific competences impact in different aspects the doctor's education, as the specialty choice, the student selection, the development of academic programs and the adequate learning about the construction of an effective relation doctor-patient.

Programa de prevención del suicidio, tratamiento de trastornos mentales y promoción de la salud mental para médicos residentes / Program for suicidal prevention, mental disorder treatment, and mental health development for resident doctors

La elevada demanda asistencial aunada a la carga académica de los cursos de especialización en medicina afecta la salud mental de los médicos residentes produciendo manifestaciones que van desde el simple malestar emocional hasta el desarrollo de trastornos afectivos en personas predispuestas. El suicidio de médicos ha generado programas para su atención en algunos países. Presentamos la primera clínica de salud mental para médicos residentes de un hospital de alta especialidad en México, centrada en la prevención del suicidio y depresión, tratamiento de trastornos mentales y promoción de la salud mental. A diferencia de los reportes de baja tasa de respuesta en otros países, hemos conseguido una participación mayor al 95%, proporcionamos tratamiento oportuno y seguimiento a los residentes identificados con trastorno mental, y no se han presentado suicidios consumados. Suponemos que la utilización de diferentes estrategias (escrutinio, adaptación de modelos de prevención del suicidio como entrenamiento por pares y entrenamiento gatekeeper, sesiones informativas de desestigmatización y promoción de la salud mental, intervenciones dirigidas a individuos y grupos con conflictos) ha sido de utilidad contra las barreras que impiden que los médicos identifiquen los signos de alarma de riesgo de suicidio, busquen ayuda por la presencia de trastorno mental y procuren mejorar su salud mental

High demand of care and the academic burden of courses of specialization in medicine affect the mental health of medical residents with events ranging from simple emotional discomfort to development of affective disorders in susceptible individuals. The suicide of physicians has produced programs for their attention in some countries. We present the fi rst mental health clinic for residents of a high specialty hospital in Mexico, focused on the prevention of suicide and depression, treatment of mental disorders and mental health promotion. Unlike the reports of other countries, we get participation of more than 95%, we provide appropriate treatment and follow-up to residents with mental disorder, and there has not been a consummate suicide. We assume that the use of different strategies (scrutiny, adapting models of prevention of suicide as a peer and gatekeeper training, informative sessions of mental health promotion and stigma, interventions targeted at individuals and groups with confl icts) has been useful against barriers that do not allow doctors to identify the risk of suicide warning signs, seek help for mental disorder, and seek to improve their mental health.

[Frequency, clinical evolution and prognosis of toxic megacolon]. / Frecuencia, evolución clínica y pronóstico del megacolon tóxico.

INTRODUCTION: Toxic megacolon (MT) is a potentially lethal complication of inflammatory, ischemic and infectious colitis. Usually it is related to ulcerative nonspecific colitis or Crohn disease. Recently it has been observed an increased in pseudomembranous colitis as cause of TM. The aim of this study is to describe the frequency, clinical evolution and prognosis of patients with TM. METHODS: Retrospective study, from January 2009 to January 2014 1500 patients were hospitalized in the Department of Coloproctology. We included 13 of 1500 patients with diagnosis of TM according to Jalan criteria and surgically corroborated. To determine the averages descriptive statistics was used. RESULTS: We studied 13 patients with TM (79.9% male and 20.1% female), the average age was 47.69±18.3 years. The most frequently associated diseases were: nonspecific ulcerative colitis (30.8%), pseudomembranous colitis (30.8%), neutropenic colitis (23.1%), Crohn Disease (7.7%) and ischemic colitis (7.7%). Subtotal colectomy plus terminal ileostomy was done in 84.6%, extended right hemicolectomy with ileostomy plus mucous fistula in 7.7% and extended right hemicolectomy with ileostomy plus Hartmann pouch in 7.7%. The mortality was 61.5%. The prevalence in the 5 years was 13 of 1500 (0.86%) patients. CONCLUSIONS: The prevalence of TM is low with a high mortality. A prompt diagnosis and treatment can improve the poor prognosis in these patients.

Introducción: el megacolon tóxico (MT) es una complicación potencialmente mortal de la colitis infl amatoria, isquémica e infecciosa. Usualmente se relaciona con la colitis ulcerosa inespecífica y la colitis de Crohn. Recientemente, se ha observado un repunte de la colitis pseudomembranosa como causa del MT. El objetivo fue describir la frecuencia, evolución clínica y pronóstico de los pacientes con MT.Métodos: estudio retrospectivo de enero de 2009 a enero de 2014 se hospitalizaron 1500 pacientes en el departamento de Coloproctología. De estos pacientes, se incluyeron a 13 de ellos con diagnóstico de MT de acuerdo a los criterios de Jalan y corroborados por cirugía. Se utilizó estadística descriptiva.Resultados: se estudiaron 13 pacientes con MT. Las enfermedades más frecuentemente asociadas al MT fueron: colitis ulcerosa inespecífica, colitis pseudomembranosa y colitis neutropénica, enfermedad de Crohn y colitis isquémica. En el 84.6 % se realizó colectomía subtotal más ileostomía terminal; hemicolectomía derecha extendida con ileostomía más fístula mucosa en el 7.7 %, y hemicolectomía derecha extendida con ileostomía más bolsa de Hartmann en el 7.7 %. La mortalidad fue del 61.5 %. La prevalencia en los 5 años fue de 13/1500 pacientes (0.86 %).Conclusiones: la prevalencia del MT es baja, con alta mortalidad. El diagnóstico y tratamiento oportunos puede mejorar el mal pronóstico de estos pacientes.

[Depression, anxiety and suicide risk symptoms among medical residents over an academic year]. / Síntomas de depresión, ansiedad y riesgo de suicidio en médicos residentes durante un año académico.

BACKGROUND: One of the causes of dissatisfaction among residents is related to burnout syndrome, stress and depression. The aim of this study is to describe the prevalence of depression, anxiety and suicide risk symptoms and its correlation with mental disorders among medical residents over an academic year. METHODS: 108 medical residents registered to second year of medical residence answered the Beck Depression Inventory, the State-Trait Anxiety Inventory and the Suicide Risk Scale of Plutchik: at the entry, six months later and at the end of the academic year. RESULTS: Residents reported low depressive symptoms (3.7 %), low anxiety symptoms (38 %) and 1.9 % of suicide risk at the beginning of the academic year, which increased in second measurement to 22.2 % for depression, 56.5 % for anxiety and 7.4 % for suicide risk. The statistical analysis showed significant differences between the three measurements (p < 0.001). The prevalence of depressive disorder was 4.6 % and no anxiety disorder was diagnosed. Almost all of the residents with depressive disorder had personal history of depression. None reported the work or academic environment as a trigger of the disorder. There was no association by specialty, sex or civil status. CONCLUSIONS: The residents that are susceptible to depression must be detected in order to receive timely attention if they develop depressive disorder.

Introducción: uno de los orígenes de la insatisfacción de los médicos residentes está relacionado con el síndrome de burnout, el estrés y la depresión. El objetivo es describir la prevalencia y las características clínicas de los síntomas de depresión, ansiedad y riesgo de suicidio y su correlación con trastorno mental en residentes de medicina a lo largo de un año académico. Métodos: se incluyeron 108 residentes de segundo año que respondieron el inventario de depresión de Beck, el inventario de ansiedad rasgo-estado y la escala de riesgo suicida de Plutchik al inicio del ciclo académico, así como seis y doce meses después. Resultados: en la primera medición se reportó una prevalencia de 3.7 % para síntomas de depresión, 38 % para síntomas de ansiedad y 1.9 % para riesgo de suicidio; a los seis meses la prevalencia aumentó a 22.2 % para depresión, 56.5 % para ansiedad y 7.4 % para riesgo de suicidio. El análisis estadístico mostró diferencias significativas entre las tres mediciones (p < 0.001). La prevalencia de trastorno depresivo fue de 4.6 %. Casi todos los residentes que desarrollaron trastorno depresivo tenían antecedente personal de depresión. El ambiente académico y laboral tuvo poca asociación con los trastornos. Conclusiones: es recomendable la detección de residentes con vulnerabilidad a la depresión con el objeto de que reciban atención oportuna en caso de que desarrollen trastorno depresivo.

[Surgical complications of gallbladder and the biliary tree in the elderly patients]. / Complicaciones quirúrgicas de la vesícula y la vía biliar en el paciente geriátrico.

BACKGROUND: the morbidity and mortality in surgery of gallbladder and biliary tract (SGBT) in the geriatric patient define the prognostic. The aim was to describe the perioperative and immediate post-operative complications of the geriatric patient undergoing SGBT. METHODS: A cross-sectional study with control group in patients older than 60 years was done. The patients were divided into two groups by age (I: 60-69 years and II: > 70 years). The variables analyzed were morbidity, anesthetic risk, type of surgery, perioperative and post-operative complications, conversion rate and length of hospital stay. RESULTS: a total of 236 patients were included: 65.2 % were females with a mean age 68.5 years. Chronic cholelithiasis accounted for 83 % and laparoscopic cholecystectomy was the procedure most commonly performed (72.8 %). Surgery was scheduled in 92 % cases and urgently in 8 %. In both groups, ASA rank was I-II in 76.2 % vs. 70.1 %; the conversion rate was 2.5 %. Complications were 13.5 %, of which 9.3 % were postoperative and 4.2 % of perioperative. Complications were higher in emergency surgery than elective surgery (36.8 % vs. 11.8 %). The average hospital stay was 4.2 days and there was no mortality. CONCLUSIONS: the age does not represent an increase in complications. The laparoscopic cholecystectomy is safe and applicable in elderly. Complications presented were related to the urgent nature of the surgery.

Introducción: en el anciano, la morbilidad posoperatoria en la cirugía de vesícula y vía biliar se relaciona con el pronóstico. Se describen las complicaciones trans y posoperatorias en el anciano sometido a esa cirugía. Métodos: estudio transversal descriptivo en pacientes mayores de 60 años. Se integraron dos grupos: I, pacientes de 60 a 69 años; II, mayores de 70 años. Se registraron comorbilidad, riesgo quirúrgico, tipo de cirugía, complicaciones trans y posoperatorias inmediatas, conversión y estancia hospitalaria. Resultados: se incluyeron 236 pacientes (65.2 % mujeres) con edad media de 68.5 años. La colecistitis crónica litiásica representó 83 % y la colecistectomía laparoscópica se utilizó en 72.8 %. La cirugía fue programada en 92 %. Se identificó ASA I-II en 76.2 y 70.1 % de los grupos I y II, respectivamente; la conversión fue de 2.5 %. Hubo complicaciones en 13.5 % (9.3 % en el posoperatorio y 4.2 % en el transoperatorio) y su proporción fue mayor en las cirugías urgentes (36.8 %) que en las programadas (11.8 %). La estancia hospitalaria fue de 4.2 días. No hubo mortalidad. Conclusiones: las complicaciones no se incrementaron con la edad pero sí con la urgencia de la cirugía. La colecistectomía laparoscópica es segura en geriatría.

[Adenocarcinoid neoplasm of the colon. Case report]. / Tumor adenocarcinoide de colon. Informe de un caso.

BACKGROUND: adenocarcinoid tumor is a rare malignancy that combines clinical and histological features of epithelial origin (adenocarcinoma) and neuroendocrine (carcinoid), occupies less than 1 % of all colorectal cancer histology, occurring mainly in the appendix and its presence in the colon is rare. CLINICAL CASE: we present a case of a 41-year-old female with sigmoid colon tumor, who underwent an extended left hemicolectomy and anastomosis; having a good postoperative evolution, with hospital stay of seventh days. The final histopathological study reported was adenocarcinoid colon tumor with free margins of injuries and four positive nodes of adenocarcinoma. CONCLUSIONS: adenocarcinoid tumors are present in the appendix in 85 to 95 % of all cases and only 6 % are located in the colon (13 % in sigmoid). Early diagnosis is certainly the most important determinant of good prognosis, in these cases the five-year survival is 80 to 84 %, and 15 years of 60 %.

[Profile of maxillofacial trauma in bicycle accidents]. / Perfil del trauma maxilofacial en accidentes de bicicleta.

OBJECTIVE: To determine the maxillofacial trauma profile, concomitant results and treatment of those persons injured in bicycle accidents. Several variables were identified such as age, sex, mechanism, place, month, injury patterns and symptomatology, time for receiving medical care, and treatments. MATERIAL AND METHODS: This was an exploratory, descriptive, analytic, and retrospective study. All patients with maxillofacial trauma injury as a result of bicycle accidents were admitted to the emergency service in 2002 in the traumatology hospital Victorio de la Fuente Narváez, Mexican Institute of Social Security that covers the entire Federal District zone and some suburbs, without any distinction made as to injury specialty. RESULTS: Patients (127) with maxillofacial trauma from bicycle accidents were identified. Children aged 6 to 10 years were the most affected. There was more injury in soft tissue in the midfacial area, such as contusions, injuries dermabrasion and some fractures resulting in nose trauma. Most of the accidents happened in the streets by falling from the bicycles. Forty six persons had more than two maxillofacial injuries. Head trauma with cervically projected sprain was demonstrated as associated trauma. More than 50% of the patients received immediate treatment under local anesthesia by maxillofacial surgery or orthopedics and traumatology during the afternoon and night. CONCLUSIONS: Prevention programs for parents and children in homes, schools and medical care facilities should be established to encourage traffic education and the use of protective headgear.

[Duodenogastroesophageal reflux- and esophagitis-induced disease]. / Enfermedad por reflujo duodenogastroesofágico y esofagitis.

OBJECTIVE: Our objective was to determine the relationship between reflux of duodenogastric contents with different degrees of esophagitis, and its levels and activity, with regard to the severity of esophagitis-induced duodenogastroesophageal reflux disease (DGERD). MATERIAL AND METHODS: Our study design was prospective, transversal, descriptive, observational, and open. We took samples of gastric and esophageal juices from patients with a diagnosis of gastroesophageal reflux disease (GERD) and esophagitis during the period from March to August 2002. Sample material was placed in black rubber-covered assay tubes to prevent bilirubin degradation. In our Unit's central laboratory, these samples were centrifuged for 30 min, the dissolved material separated, and a reactive strip was introduced to measure the amount of bile pigment. Endoscopic study reports were provided by this Department on terminating the procedure. Univariate analysis was used to obtain results. RESULTS: In 60% of cases, the esophageal liquid was positive for total bilirubin; 40% presented stage II esophagitis, 27% chronic esophagitis, and 27%, stage I esophagitis. Specific quantifications of total bilirubin at different stages of esophagitis demonstrated in stage II 50% with levels of 0.1-1, 33% with a level of 2-3, in cases of chronic esophagitis 75% with levels of 0.1-1, and with stage I esophagitis, 25% with levels of 2-3 mg/dl. Measurement of gastric pH showed 18 (69%) <3 and esophageal pH of 20 (67%) > 4, with 10 (33%) referring occasional or asymptomatic dyspepsia. We determined presence of duodenal elements in esophagus by means of quantification of total bilirubin in 60% of patients, observing greatest frequency of stage II esophagitis. Low but continuous levels of duodenal, principally biliary, elements continued in patients with DGERD, producing greatest damage in esophageal mucosa.

[Preliminary report. Usefulness of computed tomographic angiography in the protocol of a kidney donor]. / Reporte preliminar. Utilidad de la angiotomografía renal en el protocolo del donador renal.

OBJECTIVE: To determine clinical correlation of reports of computed tomographic angiography renal (CT-AR) and surgical findings of the kidney donor patient. MATERIAL AND METHODS: Patients were submitted nephrectomy in the related live donor renal transplant program between January and December 2002 as paut of life to which he is made as he CT-AR study protocol. Statistical analysis was carried out by descriptive statistics. RESULTS: Anatomical characteristics of 35 kidneys of the same number of live donors (AD) submitted CT-AR were evaluated and comparison with report of surgical technique was made. Incidence of accessory renal arteries was 23%. As reported by CT-AR, the were 39 renal arteries (91%) compared with 43 arteries found during surgery. CT-AR identified four supernumerary renal arteries (50%) of eight identified during surgical technique; 36 hiliar arteries (90%) and three polar arteries were identified by CT-AR (100%). Only one a case report of early bifurcation of renal artery (20%) by CT-AR was recorded. Anatomical characteristics of veins were described in their totality. CT-AR is a useful instrument to identify alterations in anatomical structure of the renal vasculature, with results similar to other studies for description of renal arteries and veins. We propose ATR as the initial study for evaluation of the renal architecture of the live kidney (LKD).

Implantación de catéter blando por peritoneoscopia: experiencia de 2 años en el Hospital de Especialidades del Centro Médico Nacional La Raza IMSS / Implantation of soft catheters through peritoneoscopy. Two years experience in the specialities Hospital at the National Medical Center \"La Raza\", IMSS

Objetivo. Informar acerca de la morbimortalidad en la implantación del catéter blando para diálisis peritoneal, mediante peritoneoscopia. Diseño. Estudio retrospectivo, longitudinal y observacional, sin grupo testigo. Sitio. Servicio de Cirugía General del Hospital de Especialidades del Centro Médico Nacional, La Raza del IMSS, D.F. Pacientes. Se estuadiaron 549 sujetos con insuficiencia renal crónica en un programa de diálisis peritoneal. Trescientos diez y nueve fueron varones (58 por ciento), y 230 mujeres (42 por ciento), con una media de 22 años de edad. Resultados. El catéter blando recto se implantó en 227 (52 por ciento) y el curso (Swan-neck) en 214 (48 por ciento). La duración del procedimiento fue de 20 minutos. Las complicaciones tempranas se observaron en un 2 por ciento y las tardías en un 10 por ciento, se practicó omentectomía en el 3 por ciento de los enfermos. El recuento celular en el líquido de dialisis fue de cero. La sobrevida del catéter a dos años es de 75 por ciento y la mortalidad entre los pacientes es de cero. Conclusión. El procedimiento es rápido, brinda comodidad y seguridad al paciente, la frecuencia de complicaciones es menos en comparación con el método quirúrgico

Liposarcoma retroperitoneal: utilidad de la imagen por resonancia magnética (IMR) en su estudio / Retroperitoneal liposarcoma: magnetic resonance imaging

Presentamos los hallazgos en un paciente con diagnóstico de liposarcoma retroperitoneal estudiado convencionalmente y con Imagen por Resonancia Magnética (IRM) que delimtó las relaciones anatómicas tumorales, descartó la invasión local vascular y orgánica, sugirió la estirpe histológica e identificó una pseudocápsula, hallazgos que superan las expectativas imagenológicas convencionales. La resolución multiplanar, no invasividad, alto contraste de tejidos blandos y sensibilidad a los flujos sanguíneos, hacen la IRM la técnica de elección para el estudio de los tumores retroperitoneales