Diverticular disease of the small bowel.

A diverticulum is a bulging sack in any portion of the gastrointestinal tract. The most common site for the formation of diverticula is the large intestine. Small intestine diverticular disease is much less common than colonic diverticular disease. The most common symptom is non-specific epigastric pain and a bloating sensation. Major complications include diverticulitis, gastrointestinal bleeding, acute perforation, pancreatic or biliary (in the case of duodenal diverticula) disease, intestinal obstruction, intestinal perforation, localized abscess, malabsorption, anemia, volvulus and bacterial overgrowth. We describe the clinical case of a 65-year-old female patient with a diagnosis on hospital admittance of acute appendicitis and a intraoperative finding of diverticular disease of the small intestine, accompanied by complications such as intestinal perforation, bleeding and abdominal sepsis. This was surgically treated with intestinal resection and ileostomy and a subsequent re-intervention comprising perforation of the ileostomy and stomal remodeling. The patient remained hospitalized for approximately 1 month with antibiotics and local surgical wound healing, as well as changes in her diet with food supplements and metabolic control. She showed a favorable clinical evolution and was dismissed from the hospital to her home. We include here a discussion on trends in medical and surgical aspects as well as early handling or appropriate management to reduce the risk of fatal complications.

[Comparative study of direct cost between open and laparoscopic cholecystectomy]. / Costos directos de colecistectomías abierta y laparoscópica.

OBJECTIVE: to compare the direct cost of open cholecystectomy (OCL) with laparoscopic cholecystectomy (LCL), using a microcosting approach. METHODS: in patients who underwent cholecystectomy (C) in the Hospital General de Mexico, we collected patient age and sex, time in the operative room (OR), anesthesia and surgical procedure; health personal (HP) involved; materials (M) and medications consumed; medical instruments (MI) and medical equipment (ME) used. RESULTS: there were 355 patients operated by C, were 248 included, 94 with CAB and 74 with CLP. CAB surgical time was longer than CLP (102 versus 82, p<0.00.1); CLP had a higher use of materials intraoperative ($5 329 versus $1 403, p<0.001). There are no differences in: cost for HP, MI and ME. The total direct cost was $7238 (US$615) for CAB and $12 507 (US$1 063) for CLP (p <0.001) at 11.76 Mexican pesos per dollar. CONCLUSIONS: the difference in costs between OCL and LCL is primarily explained by the cost of lab exams which represent 79% of the M cost for CLP.

Clinical characteristics of fatalities due to influenza A (H1N1) virus in Mexico.

BACKGROUND: Mexico has experienced a disproportionate mortality burden due to the influenza A(HIN1) pandemic. A study was undertaken to investigate the sociodemographic and clinical characteristics of the first 100 patients who died from confirmed influenza A(H1N1). METHODS: A clinical evaluation was made of the first 100 consecutive deaths of confirmed cases between 10 April and 28 May 2009 reported by the Federal Ministry of Health. Statistical analysis included disease frequencies and descriptive comparisons with national health data. RESULTS: Most patients (60%) were aged 30-79 years, 53% were female and 40% were residents of Mexico City. On admission, 50% had one or more chronic medical conditions including metabolic syndrome (40%), cardiovascular disease (21%), diabetes (20%), hypertension (20%) and respiratory disease (8%). 38% of women and 26% of men were obese based on body mass index). The main clinical symptoms were fever (84%), cough (85%), dyspnoea (75%) and myalgia (30%). The frequency of all chronic diseases was higher in this sample than in the national statistics. Most (82%) developed symptoms before the Mexican government issued the influenza alert (24 April). Median hospital stay prior to death was 4 days (range 0-58). CONCLUSIONS: Patients, mostly young adults, who died from A(HIN1) influenza had a high frequency of one or more chronic diseases upon admission. Most died shortly after the health authorities initiated national influenza control measures.

[Epidemiological profile of mortality due to human influenza A (H1N1) in Mexico]. / Perfil epidemiológico de la mortalidad por influenza humana A (H1N1) en México.

OBJECTIVE: To carry out the epidemiological analysis of 122 influenza A (H1N1) deaths confirmed by laboratory and help to improve the diagnosis and timely managing of cases. MATERIAL AND METHODS: A total of 122 clinical records were analyzed of patients with confirmed influenza A (H1N1) virus infection who died. RESULTS: Fifty-one percent of patients were female and 49% were male. A total of 45.l% who died were between 20 and 39 years old. Overall fatality was 2.2% and ranged between 0.3% for the l0 to l9 year-old group to 6.3% for the 50 to 59 year-old group. Forty-three percent of deaths were concentrated in only two of the thirty-two states and 5l% received medical attention in social security institutions. Only l7% received hospital attention within 72 hours and 42% died within 72 hours of hospital attention. DISCUSSION: Novel Influenza A (H1N1) virus produces higher mortality in young people whereas seasonal influenza has a greater impact on young children and older people. Delay in medical care and the associated morbidity were relevant factors for death.

Perfil epidemiológico de la mortalidad por influenza humana A (H1N1) en México / Epidemiological profile of mortality due to human influenza A (H1N1) in Mexico

OBJETIVO: Efectuar el análisis epidemiológico de 122 defunciones por influenza A (H1N1) confirmadas por laboratorio y contribuir a mejorar el diagnóstico y atención oportuna de casos. MATERIAL Y MÉTODOS: Se Analizaron 122 expedientes de pacientes fallecidos por influenza A (H1N1). RESULTADOS: Una proporción de 51 por ciento correspondió a mujeres y 49 por ciento a varones. Hasta 45.1 por ciento ocurrió entre los 20 y 39 años. La letalidad general fue de 2.2 por ciento y varió entre 0.3 por ciento en el grupo de 10 a 19 años y 6.3 por ciento en el de 50 a 59. Una cifra de 43 por ciento de las defunciones se concentró en dos de las 32 entidades federativas y 5l por ciento se atendió en instituciones de seguridad social. Sólo 17 por ciento recibió atención hospitalaria en las primeras 72 horas y 42 por ciento falleció en las primeras 72 horas de hospitalización. En 58.2 por ciento de los fallecidos había algún padecimiento asociado. DISCUSIÓN: El Nuevo virus A (H1N1) produce mayor mortalidad en personas jóvenes, al contrario de lo que sucede con la influenza estacional que muestra un mayor impacto en niños pequeños y personas de edad avanzada. El retraso de la atención médica y la morbilidad asociada fueron factores relevantes del fallecimiento.

OBJECTIVE: To carry out the epidemiological analysis of 122 influenza A (H1N1) deaths confirmed by laboratory and help to improve the diagnosis and timely managing of cases. MATERIAL AND METHODS: A total of 122 clinical records were analyzed of patients with confirmed influenza A (H1N1) virus infection who died. RESULTS: Fifty-one percent of patients were female and 49 percent were male. A total of 45.l percent who died were between 20 and 39 years old. Overall fatality was 2.2 percent and ranged between 0.3 percent for the l0 to l9 year-old group to 6.3 percent for the 50 to 59 year-old group. Forty-three percent of deaths were concentrated in only two of the thirty-two states and 5l percent received medical attention in social security institutions. Only l7 percent received hospital attention within 72 hours and 42 percent died within 72 hours of hospital attention. DISCUSSION: Novel Influenza A (H1N1) virus produces higher mortality in young people whereas seasonal influenza has a greater impact on young children and older people. Delay in medical care and the associated morbidity were relevant factors for death.

[Frequency of organic failure in acute necrotic pancreatitis]. / Frecuencia de falla orgánica en la pancreatitis aguda necrótica.

INTRODUCTION: Theacute pancreatitis is classified as severe by the presence of glandular necrosis or organic failure. However both conditions are not simultaneous. We determine the frequency of organic failure in patients with pancreatic necrosis for acute pancreatitis. MATERIAL AND METHODS: A study retrospective, traverse, descriptive and observational is carried. Were included the cases of pancreatic necrosis by acute pancreatitis presented of January 1 from 1996 to December 31 2000. The presence of organic failure was determined, as well as ages, sex, etiology, nutritional state, Ranson's criteria, surgeries carried and mortality. RESULTS: 45% of the patients with necrosis pancreatic development organic failure. The masculine sex and the realization of some surgery predominated in them. 92% of the patients with organic failure presents it to the admission, the system circulatory was the more frequently affected, continued by the respiratory, and the renal. The patients with organic failure had a mortality of 88% against 0% of those that didn't present it. The SIRPA and irreversible shock were the causes of death. DISCUSSION: Not is clear the relationship between necrosis and organic failure. The death of pancreatic tissue for apoptosis, that limits the damage and the necrosis, that it favors, is factors to consider. The hypoperfusion tissular can be the determinant among these two lesion forms.

Frecuencia de falla orgánica en la pancreatitis aguda necrótica / Frecuency of organic failure in acute necrosis pancreatitis

Introducción: La pancreatitis aguda se clasifica como severa por la presencia de necrosis glandular o falla orgánica. Sin embargo, ambas condiciones no son simultáneas. En este estudio determinamos la frecuencia de falla orgánica en pacientes con necrosis pancreática por pancreatitis aguda. Material y Métodos: Se realizó un estudio retrospectivo, transversal, descriptivo y observacional. Se incluyeron los casos de necrosis pancreática por pancreatitis aguda presentados del 1 de enero de 1996 al 31 de diciembre de 2000. Se determinó la presencia de falla orgánica, así como edades, sexo, etiología, estado nutricional, criterios de Ranson, cirugías realizadas y mortalidad. Resultados: De los pacientes con necrosis pancreática, 45% desarrolló falla orgánica. En ellos predominó el sexo masculino y la realización de alguna cirugía. De los pacientes con falla orgánica, 92% la presentó al ingreso; el sistema afectado más frecuente fue el circulatorio, seguido por el pulmonar y el renal. Los pacientes con falla orgánica tuvieron mortalidad de 88%. Las causas de muerte fueron SIRPA y choque irreversible. Discusión: La relación entre necrosis y falla orgánica no es clara. Existen factores a considerar tales como la muerte de tejido pancreático por apoptosis, que limita el daño y la necrosis que lo favorece. La hipoperfusión tisular puede ser determinante entre estas dos formas de lesión.

Introduction: The acute pancreatitis is classified as severe by the presence of glandular necrosis or organic failure. However both conditions are not simultaneous. We determine the frequency of organic failure in patients with pancreatic necrosis for acute pancreatitis. Material and Methods: A study retrospective, transverse, descriptive and observational is carried. Were included the cases of pancreatic necrosis by acute pancreatitis presented of January 1 from 1996 to December 31 2000. The presence of organic failure was determined, as well as ages, sex, etiology, nutritional state, Ranson's criteria, surgeries carried and mortality. Results: 45% of the patients with necrosis pancreatic development organic failure. The masculine sex and the realization of some surgery predominated in them. 92% of the patients with organic failure presents it to the admission, the system circulatory was the more frequently affected, continued by the respiratory and the renal. The patients with organic failure had a mortality of 88% against 0% of those that didn 't present it. The SIRPA and irreversible shock were the causes of death. Discussion: Not is clear the relationship between necrosis and organic failure. The death of pancreatic tissue for apoptosis, that limits the damage and the necrosis, that it favors, is factors to consider. The hypoperfusion tissular can be the determinant among these two lesion forms.

[Acute pancreatitis: five year experience at the Hospital General de Mexico]. / Pancreatitis aguda: experiencia de cinco años en el Hospital General De México.

INTRODUCTION: In Mexico acute pancreatitis is an important cause of morbility and mortality. We here describe the characteristics of patients managed with that diagnosis at the Hospital General de Mexico. MATERIAL AND METHODS: Retrospective, descriptive and observational study. Patients with acute panrcreatitis were seen between January 1996 to December 2000. RESULTS: The acute pancreatitis prevalence found in the hospital setting was 5%. We identified 104 patients, 62% men, with mean age 37 yrs. In 74% ofcases seen, we made a correct early diagnosis upon admission. The biliary (49%) and the alcoholic (37%) were the most frequent causes. Abdominal pain was the most common symptom at onset (94%). High leukocyte count (78%), followed by serum lipase (74%) was the most sensitive laboratory test. Only 34% of patients studied had an adequate nutritional status. 54% of' patients presented severe pancreatitis. The mean number of hospital days was 17 and 44% required ICU management. Thirty five percent required surgery where necrosectomy was performed and a mortality of 67% was found. The total mortality rate was 21%. CONCLUSIONS: The correct clinical diagnosis of acute pancreatitis is frequent. It is a more common finding than severe pancreatitis, but it does not increase the morbility and mortality in our patient population.

Pancreatitis aguda: experiencia de cinco años en el Hospital General de México / Acute pancreatitis: five year experience at the Hospital General de Mexico

Introducción: la pancreatitis aguda constituye una importante causa de morbilidad y mortalidad en México. Se describen las características de la población manejada con ese diagnóstico en el Hospital General de México. Material y métodos: estudio retrospectivo, descriptivo y observacional. Se obtuvieron los datos de los pacientes con pancreatitis aguda manejados del 1 de enero de 1996 al 31 de diciembre de 2000. Resultados: la prevalencia de pancreatitis aguda entre la población hospitalaria es de 3%. Se identificaron 104 pacientes, 62% hombres, con edad promedio de 37 años. En 74% se sospechó correctamente el diagnós tico al ingreso. Las causas más frecuentes fueron la biliar (49%) y la alcohólica (37%). El síntoma de inicio más común fue el dolor abdominal (94%). El estudio de laboratorio más sensible fue la presencia de leucocitosis (78%), seguido por la lipasa sérica (74%). Sólo 34% de los pacientes tuvieron un adecuado estado nutricional. El 54% de los pacientes presentaron pancreatitis severa. Los días promedio de hospitalización fueron 17 y 44% necesitaron manejo en la UCI. El 35% de los pacientes fueron sometidos a cirugía, en los que se realizó necrosectomía la mortalidad fue de 67%. La mortalidad total fue de 21%. Conclusión: el diagnóstico clínico correcto de la pancreatitis aguda es frecuente. La pancreatitis severa es más común, pero no incrementó la morbilidad y la mortalidad en la muestra.

Introduction: In Mexico acute pancreatitis is an important cause of morbility and mortality. We here describe the characteristics of patients managed with that diagnosis at the Hospital General de Mexico. Material and methods: Retrospective, descriptive and observational study. Patients with acute pancreatitis were seen between January 1996 to December 2000. Results: The acute pancreatitis prevalence found in the hospital setting was 5%. We identified 104 patients, 62% men, with mean age 37 yrs. In 74% of cases seen, we made a correct early diagnosis upon admission. The biliary (49%) and the alcoholic (37%) were the most frequent causes. Abdominal pain was the most common symptom at onset (94%). High leukocyte count (78%), followed by serum lipase (74%) was the most sensitive laboratory test. Only 34% of patients studied had an adequate nutritional status. 54% of patients presented severe pancreatitis. The mean number of hospital days was 17 and 44% required ICU management. Thirty five percent required surgery where necrosectomy was performed and a mortality of 67% was found. The total mortality rate was 21%. Conclusions: The correct clinical diagnosis of acute pancreatitis is frequent. It is a more common finding than severe pancreatitis, but it does not increase the morbility and mortality in our patient population.

[Open vs. closed abdomen in acute peritonitis. A comparative study]. / Abdomen abierto vs cerrado en peritonitis grave por traumatismo. Estudio comparativo.

INTRODUCTION: Open abdomen is a management alternative that, however, is not exempt from complications. We evaluated, in a comparative manner, the handling with open abdomen (OA) against closed abdomen (CA) in treatment of patients with severe peritonitis for traumatic lesion. MATERIAL AND METHODS: We carried out an observational, retrospective, longitudinal, and comparative study. It included patients managed with diagnosis severe peritonitis due to abdominal trauma between 1998 and 2000. They were divided into two groups, according to management with OA or CA. We compared age, sex, trauma type, severity of lesion, morbility and mortality. RESULTS: 12 patients were managed with OA, which presented longer hospitalization and 24 with CA who in turn presented a greater lesion severity. There were statistical differences in other parameters, including complications and mortality. However, patients managed with OA frequently presented more complications. DISCUSSION: OA does not improve morbility and mortality of patients, although they presented less severe lesions that those managed with CA.

[Acute pancreatitis, diabetes, and sacoidosis. Case report and review of the literature]. / Pancreatitis aguda, diabetes y sarcoidosis. Reporte de un caso y revisión del tema.

INTRODUCTION: Sarcoidosis is a systemic, chronic, granulomatous disease of unknown cause. Pancreatic affection is rare and even more rare is the association among sarcoidosis, acute pancreatitis and diabetes mellitus. This is the first case reported in Mexico. CASE REPORT: Male 29 years. Sarcoidosis is diagnosed from the patient age of 20 years, with intermittent episodes affecting articulate, ophthalmic, cutaneous, lung and central nervous system. At 22 years of age the patient was diagnostic with diabetes mellitus. He was admitted with severe acute pancreatitis, that causes him to die. DISCUSSION: Diabetes mellitus is due to sarcoidotic infiltration of pancreas. Acute pancreatitis has been related with inflammatory or secondary process to frequent presence of hypercalcemia in the sarcoidosis. Diagnosis is not easy. This type of pancreatitis responds to treatment with steroids.

Pancreatitis aguda, diabetes y sarcoidosis: Reporte de un caso y revisión del tema / Acute Pancreatitis, Diabetes, and Sacoidosis: Case Report and Review of the literature

Introducción: la sarcoidosis es una enfermedad granulomatosa crónica sistémica de causa desconocida. La afección pancreática es rara y aún más la asociación entre sarcoidosis, pancreatitis aguda y diabetes mellitus. Se reporta el primer caso en México. Reporte de caso: masculino de 29 años, con diagnóstico de sarcoidosis desde los 20 años y episodios intermitentes de afección articular, oftálmica, cutánea, pulmonar y en sistema nervioso central. A los 22 años se diagnostica diabetes mellitus. Ingresa con cuadro de pancreatitis aguda grave, que le causa la muerte. Discusión: la diabetes mellitus se debe a infiltración sarcoidotica del páncreas. La pancreatitis aguda se ha relacionado con el proceso inflamatorio o bien secundaria a la presencia frecuente de hipercalcemia en la sarcoidosis. El diagnóstico no es fácil. Esta forma de pancreatitis responde al manejo con esferoides.

Introduction: Sarcoidosis is a systemic, chronic, granulomatous disease of unknown cause. Pancreatic affection is rare and even more rare is the association among sarcoidosis, acute pancreatitis and diabetes mellitus. This is the first case reported in Mexico. Case report: Male 29 years. Sarcoidosis is diagnosed from the patient age of 20 years, with intermittent episodes affecting articulate, ophthalmic, cutaneous, lung and central nervous system. At 22 years of age the patient was diagnostic with diabetes mellitus. He was admitted with severe acute pancreatitis, that causes him to die. Discussion: Diabetes mellitus is due to sarcoidotic infiltration of pancreas. Acute pancreatitis has been related with inflammatory or secondary process to frequent presence of hypercalcemia in the sarcoidosis. Diagnosis is not easy. This type of pancreatitis responds to treatment with steroids.

Abdomen abierto vs cerrado en peritonitis grave por traumatismo: Estudio comparativo / Open vs. Closed Abdomen in Acute Peritonitis: A comparative Study

Introducción: el abdomen abierto es una alternativa de manejo que, sin embargo no está exento de complicaciones. Se evaluó de forma comparativa el manejo con abdomen abierto (AA) contra el cerrado (AC) en el tratamiento de pacientes con peritonitis grave por lesión traumática. Material y métodos: se realizó un estudio observacional, retrospectivo, longitudinal y comparativo, incluyó los pacientes con diagnóstico de peritonitis grave por traumatismo abdominal manejados entre 1998 y2000. Se dividieron en dos grupos, de acuerdo al manejo con AA o AC. Se compararon edad, sexo, tipo de traumatismo, gravedad de la lesión, morbilidad y mortalidad. Resultados: se manejaron 12 pacientes con AA, los cuales presentaron mayor tiempo de hospitalización y 24 con AC, que a su vez presentaron una mayor gravedad de lesión. No existieron diferencias estadísticas en los demás parámetros, incluyendo complicaciones y mortalidad. Sin embargo, los pacientes manejados con AA presentaron complicaciones más frecuentemente. Discusión: el uso del AA no mejoró la morbilidad y mortalidad de los pacientes en los que se usó, a pesar de que presentaron lesiones menos graves que los manejados con AC.

Introduction: Open abdomen is a management alternative that, however, is not exempt from complications. We evaluated, in a comparative manner, the handling with open abdomen (OA) against closed abdomen (CA) in treatment of patients with severe peritonitis for traumatic lesion. Material and methods: We carried out an observational, retrospective, longitudinal, and comparative study. It included patients managed with diagnosis severe peritonitis due to abdominal trauma between 1998 and 2000. They were divided into two groups, according to management with OA or CA. We compared age, sex, trauma type, severity of lesion, morbility and mortality. Results: 12 patients were managed with OA, which presented longer hospitalization and 2 4 with CA who in turn presented a greater lesion severity. There were statistical differences in other parameters, including complications and mortality. However, patients managed with OA frequently presented more complications. Discussion: OA does not improve morbility and mortality of patients, although they presented less severe lesions that those managed with CA.

[Use of base deficit as a prognosis factor for acute pancreatitis]. / Utilidad del déficit de base como factor pronóstico en la pancreatitis aguda.

INTRODUCTION: Acute pancreatitis (AP) severe is accompanied by important morbidity and mortality. Tissular hypoperfusion has been suggested as a severity determinant. Base deficit (BD) demonstrated to be a good indicator of hypo-perfusion. We established predictive value in AP. MATERIAL AND METHODS: A retrospective, longitudinal, descriptive, and observational study was carried out. We included hospitalized patients from January 1996 to December 2000 with confirmed diagnosis of AP for laboratory, tomography and/or surgery; and with determination of BD on admission. Patients were divided into groups with or without BD and were compared with certain severity and mortality. RESULTS: We study 104 patients, 40(38%) without BD and 64 (62%) with BD. The mortality belonged to 22 patients (21.2%), all of the group with BD. The BD had a sensibility of 71.4% to predict severity and of 100% for the motility DISCUSSION: BD allows predicting severity and mortality in AP. These points out the role that carried out tissular hip perfusion; in addition, it can serve as guide for appropriate treatment.

Esplenectomía: experiencia en el Hospital General de México / Splenectomy: experience in the Hospital General de México

Se estudiaron los expedientes clínicos de pacientes sometidos a esplenectomía en el Servicio de Urgencias y Cirugía General del Hospital General de México, de la Secretaría de Salud, entre enero de 1995 y junio de 1999. Se incluyeron 51 casos, 75.5 por ciento correspondió a mujeres. La indicación más frecuente para realizar la esplenectomía fue púrpura trombocitopénica idiopática. La vía de abordaje más empleada fue la vía abierta, en 96.1 por ciento de los casos; se utilizó drenaje en 68.6 por ciento de los pacientes. Se presentaron complicaciones posoperatorias en 60.8 por ciento de los sujetos, siendo la más frecuente la presencia de sangrado; la mortalidad registrada fue del 5.9 por ciento.

Experiencia en trasplante renal en el Hospital General de México / Experience in kidney transplantation at the Hospital General de México

Objetivo. Analizar los resultados obtenidos y las complicaciones en los pacientes del Programa de Trasplante renal del Hospital General de México. Material y método. Se realizó un estudio retrospectivo, observacional de los sujetos sometidos a trasplante renal. Resultados. Las complicaciones urológicas fueron las más comúnmente asociadas con el procedimiento quirúrgico. La complicación más frecuente fue el rechazo del injerto. Conclusiones. Los resultados obtenidos en esta serie son similares a los reportados por otros grupos. El trasplante renal es actualmente el tratamiento ideal para la atención del paciente con insuficiencia renal terminal

Evaluación de la utilidad del drenaje Penrose en cirugía de tiroides / Assesment of the usefulness of Penrose drainage after thyroid surgery

Objetivo. Evaluar la utilidad del drenaje tipo Penrose en la cirugía de la glándula tiroides para prevenir la formación de colecciones líquidas en el lecho quirúrgico. Material y métodos. Se diseño un estudio prospectivo, longitudinal descriptivo y observacional. Se formaron dos grupos de estudio, constituidos por diez pacientes cada uno. En el grupo I se colocó drenaje Penrose y en el grupo II sin drenaje. Se realizaron cirugías de tiroides que incluyeron: hemitiroidectomía, tiroidectomía subtotal y tiroidectomía total. Resultados. En el grupo I se presentó un hematoma que requirió de reintervención quirúrgica, en el grupo II se presentó un seroma, el cual fue drenado por punción. No se observó diferencia estadísticamente significativa entre ambos grupos. Conclusiones. En este estudio el empleo de Penrose no fue útil para prevenir la formación de colecciones líquidas en el lecho quirúrgico en pacientes sometidos a cirugía tiroidea

Aplicabilidad del índice nutricional pronóstico de Buzby en población mexicana / Application of Buzby's pronostic nutritional index in mexican population

Objetivo: Evaluar el índice nutricional pronóstico desarrollado por Mullen y Buzby en población mexicana y analizar cuál de las variables empleadas es la más útil para identificar pacientes con riesgo de complicaciones debido a su estado nutricional. Material y métodos: Estudio prospectivo, observacional, longitudinal, que incluyó 83 pacientes a los cuales se les determinó índice nutricional pronóstico y se analizó la evolución de los pacientes en relación al resultado obtenido con este índice. Resultados: El resultado del índice nutricional pronóstico se correlacionó directamante con la presentación de complicaciones, encontrándose que del total de pacientes estudiados, 58 70 por ciento tuvieron un índice nutricional de nuestra población, su resultado se relacionó directamente con la evolución de los pacientes estudiados

Efecto de diferentes antimicrobianos administrados por vía intraperitoneal sobre la membrana peritoneal / Effect of different antimicrobial agents administered intraperitoneally on the peritoneal membrane

Objetivos: en este estudio se evaluó el efecto de los antimicrobianos sobre el peritoneo al ser administrado por vía intraperitoneal en un modelo exprerimental con ratas. Material y métodos: se emplearon ratas Wistar a las cuales, bajo técnicas asépticas, a nivel de la línea media abdominal, se les administró por vía intraperitoneal, por un periodo de diez días, uno de los siguientes agentes: clindamicina, cloramfenicol, gentamicina, ciprofloxacina, metronidazol o cefotaxima. Al final del periodo de observación los animales fueron sacrificados y se evaluó la presencia de adherencias; también se tomaron biopsias de peritoneo para estudio histopatológico. Resultados: se observó la presencia de adherencias; también se tomaron biopsias de peritoneo para estudio histopatológico. Resultados: se observó la presencia de adherencias principalmente en los grupos que recibieron gentamicina y metronidazol, pero sin que hubiera diferencias estadísticamente significativas al compararlos con el grupo control. El estudio histopatológico evidenció que la respuesta del peritoneno se caracterizó por una reacción inflamatoria leve y focal. Conclusiones: la administración de antimicrobianos por vía intraperitoneal condicionó un infiltrado inflamatorio leve y focal, y no favorecieron la formación de adherencias

Simposio: cirugía experimental en México (parte I). Utilidad de la naloxona en la sepsis peritoneal: modelo experimental en rata / Symposium: Experimental surgery in Mexico (part l). Usefulnes of naloxone in peritoneal sepsis: experimental model in rats

Evaluar la utilidad de diferentes secuestradores de radicales libres de oxígeno en el manejo de la sepsis peritoneal, en asociación con la administración de antibióticos. Diseño: Estudio en animales, prospectivo, con análisis estadístico. Material y método: Se emplearon ratas Wistar a las que se les produjo sepsis peritoneal por ligadura y punción del ciego. Doce horas posterior a la lesión se les administró intraperitonealmente alguno de los fármacos en estudio, que fueron; naloxona, piroxicam, clonixinato de lisina, naproxeno y Ketorolaco, Se registró sobrevida acumulada y el desarrollo de sepsis peritoneal generalizada. Resultados: En los animales tratados con naloxona se observó una sobrevida mayor, así como frecuencia de sepsis peritoneal generalizada, con diferencia estadísticamente significativa. Conclusiones: La naloxona en combinación con antibióticos mejoró la sobrevida y favoreció el desarrollo de sepsis peritoneal localizada