[Fiftieth anniversary of the Medical Movement in Mexico (1964-1965)]. / Cincuentenario del Movimiento Médico en México (1964-1965).

This Symposium highlights the recognition that this year reaches half a century of the Medical Movement (1964-1965), and 27 years of publishing the book titled, "Documental Memories and Reflections" ("Crónica Documental y Reflexiones") edited by the Faculty of Medicine of the UNAM, at that time directed by the prestigious Dr. Fernando Cano Valle. Our President Dr. Graue indicated that Dr. Alejandro Treviño-Becerra assumed the coordination of this session with the commitment to be published in the Medical Gazette of Mexico for current and future generations. The Academic participants were: Norberto Treviño García-Manzo, president of the Academy in 1988. Dr. Felipe Mota Hernández was the Recording Secretary of the Mexican Medical Alliance ("Alianza de Médicos Mexicanos"). Now he is the Dean of the Children's Hospital of Mexico "Federico Gómez". Dr. Cesar Gutiérrez Samperio, surgeon at IMSS and professor at Medicine School, University of Queretaro until a year ago. Dr. Fernando Cano Valle, former Head of the Medical Faculty, UNAM, presently a researcher in Medicine and Human Rights in the Institute for Juridical Research, UNAM. I quote the Academic Treviño Zapata: "I believe that it will be difficult to bring again the conditions and circumstances that made possible the vigorous realization of the Medical Movement, the enthusiastic and hopeful creation of the Mexican Medical Alliance, and the promising start and progress of the integration of the national medical union."

[Palliativer medicine in surgery]. / Medicina paliativa en cirugía.

The concepts and background of palliative medicine, the patient-health team relationship and the right of the patients to receive palliative care, its application in surgery, the criterion defining the terminally ill, proportionate and disproportionate measures, where it is applied and what this consists of, drugs and procedures used, who should administrate them and for how long, the requirements for advanc directives and avoidance of therapeutic obstinacy, were reviewed. It describes and reflects their ethical and legal bases. It describes the main changes to the law in México in 2009 and 2012. It concludes that palliative medicine is not against scientific and technological progress, but promotes its appropriate use with respect to the will and dignity of the patient. It should be applied by a multidisciplinary team, who accompany the patient throughout the progression of their condition, strengthening the doctor's and health team's relationship with the patients and their families.

[The Medical Movement in Mexico 1964-1965: What's happening half a century later?]. / El Movimiento Médico en México (1964-1965). ¿Qué pasa medio siglo después?

We reviewed the literature covering the medical movement in 1964-1965, which began on November 26, 1964 with the ISSSTE November 20 Hospital scholarship protest and the emergence of the Mexican Resident Interns Physicians Association (Asociación Mexicana de Médicos Residentes e Internos, AMMRI) and the Mexican Medical Alliance (Alianza de Médicos Mexicanos, AMM). We describe four work stoppages, two protest marches, the takeover of hospitals by the police, four interviews with Licenciado Gustavo Diaz Ordaz and his first presidential report. After that, attacks in the press, harassment, and repression provoked the weakening of the movement that ended in the AMM assembly on January 18, 1966.

[Bilateral and synchronous testicular teratoma: a case report and literature review]. / Teratoma testicular bilateral sincrónico: reporte de un caso y revisión de la literatura.

BACKGROUND: Testicular germ-cell carcinoma is the most frequent neoplasm in males aged 15 to 35 years old. It is bilateral in 2% to 3%, and synchronous in 20% to 25% of the cases. CLINICAL CASE: The case is presented of a 19 year-old male, with abdominal pain. Physical examination revealed abdominal mass in the umbilical region, and the computed tomography scan showed a retroperitoneal tumour, with α-fetoprotein, lactate dehydrogenase, and human chorionic gonadotropin above limits. Testicular ultrasound showed bilateral lesions. Exploratory laparotomy was performed, identifying an unresectable retroperitoneal tumour. Biopsies were taken, reporting mixed germ cell tumour composed of choriocarcinoma and embryonal carcinoma. Six cycles of chemotherapy were given, based on bleomycin, etoposide and cisplatin, with partial tumour response. Later on, the patient underwent bilateral radical orchiectomy, with pathology reporting a synchronous bilateral testicular teratoma. A second line of chemotherapy was given, based on vincristine, etoposide, ifosfamide and cisplatinum. Nevertheless, the disease progressed, with metastatic dissemination and the patient died. DISCUSSION: Germ cells tumours can present in primary extra-gonadal locations. It is difficult to distinguish a retroperitoneum primary germ cell tumour from metastatic disease of a clinically undetected gonadal tumour or one that has regressed, like the situation described in the case presented. CONCLUSIONS: Ninety percent of patients diagnosed with germ cell tumours can be cured. However, delay in diagnosis correlates with an advanced clinical stage and poor prognosis.

Enzymatic detergent in rat peritoneum. A comparative study with physiological solution.

BACKGROUND: Peritoneal washing out with physiological solution with different substances added is useful in peritoneal infections, but the effect of enzymatic detergents, such as quaternary didecyl-dimethyl ammonium compounds (DDAC), used in the sterilization of surgical material is unknown. We undertook this study to determine histological changes (inflammation, fibrosis and new vessel formation) in the peritoneum of Wistar rats after the application of physiological solution or DDAC. METHODS: The minimum inhibitory concentration (MIC) of DDAC for E. coli (512 µg/ml) and E. faecalis (128 µg/ml) was determined. Sixty-three Wistar rats weighing 200 ± 20 g were studied. They were divided into three groups: control: 7 rats were instilled with 3 ml of physiological solution in peritoneal cavity; groups 1 and 2 were instilled with 3 ml of MIC for E. coli and E. faecalis, respectively. These groups were divided into four subgroups of seven animals. In every rat, 1 cm(2) of peritoneum was obtained at 2, 7, 14, and 21 days for histological study with hematoxylin-eosin. Ten fields were evaluated. The data obtained were analyzed with the Mann-Whitney test. RESULTS: There were no significant differences in inflammation, fibrosis and new vessel formation with the physiological solution vs. DDAC at 2, 7, 14, and 21 days (p >0.05), except for inflammation at 2 days in group 2 (p = 0.026), which remitted. CONCLUSIONS: There was no significant difference in changes in rat peritoneum after physiological solution or DDAC application.

[What is continuous medical education?]. / Qué es la educación médica continua?

The physician never stops his/her education. Continuous medical education has many tools: self-learning; electronic information, and correspondence and resident courses. Continuously education usually has been oriented toward specialist physicians, but of late has been directed toward generalphysicians, who provide primary care to 85% of the general population. The National Program of Actualization for General Physicians (PRONADAMEG) of the National of Academy of Medicine is offered at 76 headquarters to more than 10,000 students, initially with 400 hours over four semesters, sufficient for certification; at present, 200 hours over four quarters, it affords sufficient points to obtain general physician recertification. Student age is not a limitation, for physicians enrolled in PRONADAMEG as well as physicians who recently graduated. From medical school we have added at the end of every medical specialty a round table with active participation of students anda clinical for graduate medical can attend.

[Bioethics in genetic engineering]. / Bioética en ingeniería genética.

The advances in the field of molecular biology and genetics have widened the possibilities for the diagnosis and treatment of hereditary diseases. At the same time research into this field has broken bounds of its legal and ethical regulation. The intention of this paper is not to analyze these advances from scientific and technical point of view which is the area of the specialist, but rather to review historical antecedents of genetic engineering; the legal and ethical repercussions of the human genome project (HGP); in vitro fertilization and embryo transfer (FIVET); the embryo research which is being caused out and which may be possible; other fields of genetics and cloning especially germinal cells and human beings; genetic diagnosis and its family, social and work repercussions; treatment through genetic engineering, research into cloning in order to obtain organs and tissues for transplants; and the use of genetic engineering in the biomedical industry. To avoid these advances working against humans, the organization and participation of multidisciplinary bodies are required to provide legal and ethical supervision.

Bioética en ingeniería genética / Bioethics in genetic engineering

The advances in the field of molecular biology and genetics have widened the possibilities for the diagnosis and treatment of hereditary diseases. At the same time research into this field has broken bounds of its legal and ethical regulation. The intention of this paper is not to analyze these advances from scientific and technical point of view which is the area of the specialist, but rather to review historical antecedents of genetic engineering; the legal and ethical repercussions of the human genome project (HGP); in vitro fertilization and embryo transfer (FIVET); the embryo research which is being caused out and which may be possible; other fields of genetics and cloning especially germinal cells and human beings; genetic diagnosis and its family, social and work repercussions; treatment through genetic engineering, research into cloning in order to obtain organs and tissues for transplants; and the use of genetic engineering in the biomedical industry. To avoid these advances working against humans, the organization and participation of multidisciplinary bodies are required to provide legal and ethical supervision.

El paciente quirúrgico en estado crítico: avances en el proceso diagnóstico terapéutico / The acute-stage surgical patient: avances in the diagnostic therapeutic process

En base al avance en los conocimientos científicos, se revisan las circunstancias en las que el enfermo sometido a cirugía puede estar en estado crítico, en el pre, trans y posoperatorio, los cambios fisiopatológicos que ocurren en estos pacientes: hipovolemia, síndrome de respuesta inflamatoria sistémica, infección, sepsis, choque séptico e insuficiencia orgánica múltiple; la utilidad y avances en los procedimientos diagnósticos, con énfasis en los métodos no invasivos, la dosificación de los intermediarios de la inflamación y el uso de los índices pronósticos. En tratamiento, la reposición del volumen circulante efectivo, el manejo de insuficiencias órgano-funcionales, la aplicación racional de aminas vasoactivas, antibióticos y anticuerpos monocionales, el tratamiento quirúrgico con la eliminación del foco séptico y el apoyo nutricional pre y posoperatorio.

Efecto del análogo de la somatostatina (SMS 201 995) sobre la circulación esplácnica / Effect of somatostatine analogue (octreotide SMS 201 995) on splacnic circulation

La somatostatina es una hormona con acción inhibitoria sobre otras hormonas, disminuye la motilidad, la secreción gastrointestinal y la circulación esplácnica, su vida media (T 1/2) es menor de tres minutos, por lo que su aplicación terpéutica es limitada; el análogo de ocho aminoácidos SMS 201 995 administrado por vía intravenosa tiene una T 1/2 de 43 minutos y una potencia 20 veces mayor que la hormona natural, por lo que se amplía su aplicación clínica, pero se desconoce la dosis más adecuada. Se hicieron 20 experimentos en 10 perros criollos, se comparó el efecto de 2 mcg/kg y 5 mcg/kg del octeótrico SMS 201 995, administrado por vía intravenosa en forma de bolo o en infusión continua. Para valorar la acción sobre la cirulación mesentérica se utilizó el equipo Vascular Minilab Portable Parcks 1059, con registro gráfico de doppler y fotopletismografía (PPG). La administración del SMS 201 995 produjo disminución de la PPG y en menor grado del doppler, la respuesta fue mayor con la dosis de 2 mcg/kg y con laa plicación en forma de bolo, aunque la diferencia no fue significativa. En dos animales hubo respuesta paradójica con aumento del flujo sanguíneo visceral. La administración del octeótrido SMS 201 995, sola o junto con otros procedimientos puede ser útil en el tratamiento de la hemorragia de vías digestivas

Síndrome oculofaringeo: informe de un paciente / Oculopharyngeal syndrome: report of one case

El síndrome oculofaríngeo (Distrofia Muscular oculofaríngea) es una enfermedad transmitida genéticamente con carácter autosómico dominante, caracterizada por la presencia de ptosis palpebral bilateral con disfagia progresiva que se presenta en etapas tardias de la vida; sido observada también se ha informado en familias de distintos grupos étnicos. El origen de la enfermedad no es completamente conocido, algunas evidencias sugieren que el problema es primariamente miopático; su identificación se bas en la forma de presentación del cuadro clínico, las alteraciones motoras inespecíficas de la región faringoesofágica y los hallazgos histopatológicos en músculo esquelético estriado; el tratamiento más satisfactorio de este tipo de disfagia, es la miotomía cricofaríngea. Se informa de un caso estudiado en el Depto. Cirurgía General del H.G. CM "La Raza", I.M.S.S. Masculino de 61 años, con antecedente del síndrome en su padre, su padecimiento de 4 años de evolución con ptosis palpebral bilateral, disfagia progresiva y últimamente disfonía; la evolución clínica, los resultados de laboratorio (TGO-DHL-IGA-IgG), los estudios de gabinete (esófago fluoroscopía, laringoscopía indrecta, esofagoscopía, manometría esofágica, electromiografía) y los hallazgos histopatológicos e inmunocitoquímicos de músculo estriado, confirmaron la presencia del síndrome; fue sometido a miotomia cricofaríngea de 5.0 cm. de longitud, evolucionó satisfactoriamente por alivio de la disfagia y mejoria nutricional. Es important

Tumores funcionantes del páncreas

Con los avances técnicos como la microscopía electrónica, citoquímica e inmunopatología, ha sido posible identificar en los islotes de Langerhans diferentes células productoras de hormonas. Puede ocurrir hiperplasia (nesidioblastosis), formarse adenomas benignos o malignos a partir de estas células, cuya secreción hormonal no depende de estíulos fisiológicos. El tumor frecuente es el Insulinoma, que secreta insulina y el péptido C, da lugar a hipoglicemia, síntomas por respuesta adrenérgica y a neuroglucopenia; el diagnóstico se basa en la hipoglicemia algunas veces provocada por el ayuno, el ejercicio, o el aumento desproporcinado de la insulina circulante en relación con la glicemia, lo que se hace más aparente después del estímulo con tolbutamida o calcio. Se informan cinco casos vistos en nuestra Institución. Otro es el Gastrinoma que secreta gastrina, cursa con hipersecreción gástrica, úlcera péptica de localización atípica, complicada y rebelde al tratamiento, así como diarrea; el diagnóstico se hace por el quimismo gástrico basal y dosificación de la gastrina sérica, tanto en condiciones basales como despúes del estímulo con calcio o secretina, 60% de los gastrinomas son malignos. Se informan siete casos. El Glucagonoma, otro tumor pancreático produce glucagón y se manifiesta por diabetes de fácil control, eritema migratorio necrolítico, desnutrición y anemia hipocrómica; el aumento del glucagón sérico da el diagnóstico. El somatostatinoma se manigfiesta por diabetes, diarrea, esteatorrea y disfunción vesicular con formación de cálculos; el aumento de la somatostatina sérica confirma el diagnóstico. También se han descrito adenomas de células F productoras de polipéptidos pancreáticos, que cursan con diarrea, y Vipomas a partir de las células H, que producen el polipéptido intestinal vasoactivo y se manifiestan por diarrea acuosa, aclorihidria e hipokalemia...