Cyclic vomiting syndrome: From pathophysiology to treatment.

Cyclic vomiting syndrome (CVS) is a disorder characterized by recurrent and unpredictable episodes of intense vomiting, interspersed with periods of apparent wellbeing. This disorder, which primarily affects children and adolescents but can persist into adulthood, has recently been the subject of extensive study and analysis in the medical literature. The aim of the present review is to examine the most important aspects of the epidemiology, pathophysiology, subtypes, diagnostic criteria, and current management of CVS. Even though the exact etiology remains unknown, genetic factors (polymorphisms), nervous system alterations and autonomic dysregulation, and environmental factors (use and abuse of cannabinoids) are postulated as possible triggers. CVS has significant diagnostic challenges, given that there is no specific test for confirming its presence. Thorough evaluation of symptoms and the ruling out of other possible causes of recurrent vomiting are required. Management of CVS typically involves a multidisciplinary approach. Pharmacologic options are explored, such as antiemetics and preventive medications, as well as behavioral and psychologic support therapies. Treatment personalization is essential, adapting it to the individual needs of each patient. Despite advances in the understanding of CVS, it remains a significant clinical challenge. This disorder impacts the quality of life of those affected and their families, underscoring the ongoing need for research and the development of more effective treatment strategies.

Papilla of Vater morphology as an influencing factor in successful cannulation during resident training in advanced endoscopy. A prospective clinical study.

INTRODUCTION AND AIM: Endoscopic retrograde cholangiopancreatography (ERCP) is a complex procedure. Clinical guidelines assess competence in ERCP through a defined number of procedures, but multiple factors are involved. Our aim was to analyze the morphology of the papilla of Vater as an independent factor in selective common bile duct cannulation during resident training. MATERIAL AND METHODS: Patients that underwent ERCP were studied consecutively. All ERCPs were begun by a resident in training. The type of papilla was classified according to Haraldsson, including those with previous sphincterotomy. Cannulation difficulty and success and their relation to the type of papilla were documented. The analysis was divided into three 4-month periods. RESULTS: Of the 429 patients, cannulation was difficult in 101 (23.5%). The residents achieved selective cannulation of the common bile duct in 276 (64.3%) and the cannulation success rate at the end of their training was 81.7%. Cannulation was performed with the least difficulty in papillae with previous sphincterotomy (2.8%), unlike the type 4 papilla, which was difficult to cannulate in 50% of the cases. The lowest overall cannulation success was in the type 2 papilla (81.8%). CONCLUSION: Papilla type can influence cannulation success, but it is not the only related factor. Patients that underwent previous sphincterotomy appear to be the cases in whom ERCP training can be started.

Use of audiovisual devices in transnasal endoscopy without sedation to improve tolerance. A prospective clinical trial.

INTRODUCTION AND AIM: Transnasal endoscopy (TNE) has proven its diagnostic utility, but it has not been widely accepted given that it is performed without sedation. There are no previous studies on the use of methods to improve its tolerability. Our aim was to evaluate the tolerability of TNE, when simultaneously performed with an audiovisual device as a distractor. METHODS: We evaluated 50 patients, 10 of whom did not agree to participate. The performance of the procedure was explained, using an audiovisual device. Before randomization, we applied anxiety and depression scores. Patients were divided into 2 groups: Group I (using an audiovisual device during the procedure) and Group II (without a device). Anxiety and numeric pain rating scales were used, and vital signs were monitored and recorded before, during, and after the endoscopy. An overall procedure satisfaction score was applied at the end of the study and 24 h later. RESULTS: Mean age was 41.6 years and 35 of the patients were women (87.5%). The most frequent indication for TNE was refractory gastroesophageal reflux disease. There were no severe comorbidities, and none of the patients had a significant anxiety or depression score. One patient in Group II did not tolerate TNE due to nasal pain. There was no statistically significant difference between groups, regarding anxiety, pain, vital signs, and satisfaction scale. CONCLUSION: Our study showed that TNE was well tolerated and had a high acceptance rate in our patients. The use of distracting audiovisual devices did not increase tolerance to the endoscopic procedure.

Methylprednisolone for the treatment of children with refractory epilepsy.

Epilepsy is a disease characterized by unprovoked epileptic seizures resulting from a bioelectrical brain dysfunction. Antiepileptic treatment controls 75% of all epileptic patients; the other 25% continue to have epileptic seizures in spite of a combination of multiple antiepileptic drugs. The purpose of this work was to evaluate the use of methylprednisolone in the treatment of children with refractory epilepsy. Fourteen children with refractory epilepsy at the Hospital de Especialidades No. 25 of the Instituto Mexicano del Seguro Social in Monterrey, Northeast Mexico were included. For five consecutively days, each patient received methylprednisolone by intravenous administration at a dosage of 15 mg/kg/day each 8 h, once a month for 3 months. The frequency of epileptic seizures and possible related side effects were evaluated every month during the three months before, during, and after administration of methylprednisolone. The frequency of epileptic seizures was reduced by more than 50% in 12/14 patients during methylprednisolone treatment. The median number of seizures before treatment with methylprednisolone was 8, 8, and 7; during the treatment: 1, 1, and 1; and after treatment: 2, 2, and 3 (p=0.000). We conclude that methylprednisolone reduces the frequency of epileptic seizures in children with refractory epilepsy.

The genetic structure of the gynodioecious Kallstroemia grandiflora (Zygophyllaceae): the role of male sterility and colonization history.

In gynodioecious populations, the frequency of females is expected to have a strong influence on the contemporary genetic structure of populations. Historical patterns of range contraction and expansion are also known to influence the genetic diversity of plant populations. We explore the influence of male sterility and colonization history on the genetic diversity in populations of Kallstroemia grandiflora along the Pacific of México. Both the overall population Fis and Fis values of hermaphrodites showed a negative association with female frequency. Genetic diversity declined with latitude. Our results provide evidence that females have a significant effect on the genetic structure as predicted by theoretical models and provide support for the hypothesis that historical processes have modified the genetic structure of K. grandiflora.

Pelvic exenteration for recurrent or persistent cervical cancer: experience of five years at the National Cancer Institute in Mexico.

Cervical cancer constitutes a major health problem in Mexico and other developing countries. The purpose of our study was to assess the experience of a comprehensive national oncological reference center on pelvic exenteration for post-radiotherapy recurrent or persistent cervical cancer, describing the prognostic value of time to recurrence, procedure complications, and survival. Medical records from 42 patients with post-radiotherapy recurrent or persistent cervical cancer who underwent a pelvic exenteration with curative purposes from 1984 to 1989 were retrospectively reviewed. Histological diagnoses were squamous cell carcinoma (32 patients), adenosquamous carcinoma (9 patients), and adenocarcinoma (1 patient). Average follow up was of 56.3 mo after the procedure and global survival at 5 yr was 65.8%. Survival for patients with early recurrence was 56.9% vs 78% for patients with late recurrence (p = 0.05). Complications were observed in 65.3% of the cases with a surgical mortality of 4.8%. Pelvic exenteration is a surgical procedure with high morbidity in spite of the recent medical advances. Pelvic exenteration should not be indicated with palliative purposes owing to the high rate of complications. Patients with tumor persistence or early recurrence have a worse prognosis. In well-selected cases, exenteration may provide a survival benefit.

Mudanças no fluxo de gases frescos afetam o volume corrente liberado pelo ventilador durante anestesia / Changes in fresh gas affect the tidal volume discharged by the ventilator during anesthesia

O objetivo deste estudo foi provar que mudando o fluxo de gases fescos em ventiladores, alteraria o Vt (volume corrente) liberado para o paciente. Quatro ventiladores foram selecionados: Narco Air Shields, 702 Frazer Harlake, Dreger A-V e Ohio 7.000. Os volumes gerados pelos quatro ventiladores foram medidos, enquanto trocas no fluxo de gases frescos estavam sendo feitas simultaneamente. Os fluxos de gases frescos foram inicialmente fixados em 10 L. min-1 e a cada 15 minutos foram diminuídos em 1 L. Medidas de Vc (volume corrente) e V (volume minuto) foram feitas e os autores concluíram que os ventiladores estudados falharam em liberar o Vt indicado, quando os FGF foram trocados. A necessidade de um expirômetro foi observada como sendo uma maneira precisa de verificar o exato volume corrente liberado para o paciente anestesiado, tendo a respiraçäo mecanicamente controlada

Tratamiento conservador en tumores malignos del ovario. / Conservative treatment in malignant ovarian tumors

Se presentan 7 casos de pacientes portadores de tumores malignos del ovario, 4 de ellos asociados a gestacion, en los que se realizo tratamiento quirurgico inicialmente conservador obteniendose una sobrevida promedio de 7 anos. Se analizan los antecedentes bibliograficos existentes sobre tratamiento conservador en esta patologia y los parametros que deben ser tenidos en cuenta para efectuar dicha terapeutica, por ejemplo edad de la paciente, tipo y grado histologico, discutiendose las conductas seguidas en los casos presentados.Se concluye especificando las indicaciones actuales que le caben al tratamiento conservador en los tumores malignos del ovario y la necesidad de realizar hemiparticion y biopsia del ovario contralateral

Tratamiento conservador en tumores malignos del ovario. / Conservative treatment in malignant ovarian tumors

Se presentan 7 casos de pacientes portadores de tumores malignos del ovario, 4 de ellos asociados a gestacion, en los que se realizo tratamiento quirurgico inicialmente conservador obteniendose una sobrevida promedio de 7 anos. Se analizan los antecedentes bibliograficos existentes sobre tratamiento conservador en esta patologia y los parametros que deben ser tenidos en cuenta para efectuar dicha terapeutica, por ejemplo edad de la paciente, tipo y grado histologico, discutiendose las conductas seguidas en los casos presentados.Se concluye especificando las indicaciones actuales que le caben al tratamiento conservador en los tumores malignos del ovario y la necesidad de realizar hemiparticion y biopsia del ovario contralateral