[Endoscopic cholangiopancreatography in the elderly: a prospective comparative study in northern Mexico]. / Colangiopancreatografía endoscópica en la tercera edad; un estudio prospectivo y comparativo en el norte de México.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is a widely used technique for the diagnosis and treatment of bilio-pancreatic diseases. According to Mexican Statistics, there is increasing life expectancy in Mexican population. The incidence of biliary tract pathologies is also increasing, leading to an increased demand of ERCP. AIM: Compare the utility and safety of ERCP in elderly and younger patients. METHODS: Prospective and comparative study including 450 patients who underwent ERCP during 2007. Patients were divided into two groups: 65 years age and older (group A) and less than 65 years old (group B). We registered gender, age, indication and length of the endoscopic procedure, morbidity and mortality. RESULTS: Mean patient age was 74.5 ± 6.9 and 43.0 ± 13.5 years old in groups A and B respectively. Choledocholithiasis was the more frequent diagnosis in both groups (48.62 %), followed by benign biliary stenosis (22.02 %) and malignant biliary obstruction (16.28 %). In 428 patients (98.16%) therapeutic procedures were performed. Endoscopic complications occurred in 1.37 % and there were not significant differences between groups (p = 0.218). There was no mortality. CONCLUSION: ERCP is a safe procedure in elderly patients with a very low rate of complications and excellent therapeutic efficacy.

[Difficulty to cannulate papilla of Vater in the presence of periampullary duodenal diverticulum]. / Grado de dificultad para canular papila de Vater en presencia de divertículo duodenal periampular.

BACKGROUND: There are conflicting results in the literature regarding the impact of duodenal diverticula on the technical success and complications of endoscopic retrograde cholangiopancreatography (ERCP). AIM: To evaluate if the presence of periampullary duodenal diverticulum increases the risk of failure of ampulla cannulation. METHODS: Patients who underwent ERCP between January 2008 and December 2009 were evaluated. They were divided in group A (without duodenal diverticulum) or group B (with duodenal diverticulum). Gender, age, endoscopic and radiological diagnosis, difficulty to cannulate, endoscopic sphincterotomy, precut technique, therapeutic procedure and complications were documented. RESULTS: 1159 patients were included: 1100 in group A and 59 in group B. A successful cannulation was obtained in 1061 patients of group A and 53 of group B (96.46 vs. 89.83%, p < 0.0001, OR 0.03). The failure of cannulation was observed in 39 patients of group A and 6 of group B (3.54 vs. 10.17%, p= 0.021, OR 2.94). The presence of intradiverticular papilla was the cause of failure in all cases. The therapeutic procedures showed statistical differences in choledocholithiasis clearance as well as endoscopic sphincterotomy and biliary stents insertion, but there was no significant difference in complications. We found statistical significant differences in biliary lithiasis, malignant stenosis, mechanical lithotripsy and insertion of biliary stents. CONCLUSIONS: Periampullary duodenal diverticula increase the risk of failure for cannulation of ampulla. However, it should not be considered as contraindication for ERCP.

[Does the use of fentanyl make Vater's ampulla cannulation difficult? A prospective and comparative study]. / ¿Dificulta la canulación del ámpula de Vater el uso de fentanilo? Un estudio prospectivo y comparativo.

BACKGROUND: Fentanyl is a synthetic opioid with excellent results in perioperative analgesia. It is commonly used for proximal and distal gastrointestinal endoscopic procedures, but its contracting action on the sphincter of Oddi, similar to that of morphine, makes its use for endoscopic cholangiopancreatography (ERCP) controversial. OBJECTIVE: To determinate if intravenous fentanyl as part of deep sedation hinders the cannulation of Vater's papilla during ERCP. MATERIAL AND METHODS: Prospective, comparative, randomized and double-blind trial that enrolled patients undergoing ERCP in 2008, > 18 years old, without previous endoscopic or surgical procedures related with Vater s papilla. Patients were randomized into two groups: patients in whom ERCP was performed with intravenous propofol (group A), and patients in whom the procedure was performed with intravenous fentanyl and propofol (group B). Gender, age, comorbid conditions, reasons for referral, difficulty of cannulation, diagnosis, therapeutic procedures, procedure time and endoscopic complications were all documented. RESULTS: 432 were included: 214 in group A and 218 in group B. Both groups were similar in relation with demographic characteristics, time of sedation and endoscopic procedure. Difficulty in cannulation had not a statistical significance (p = 0.163). The administered dose of propofol were less for group B (p < 0.001). No procedure-related mortality was documented. CONCLUSION: The combination of fentanyl and propofol may be used during ERCP, since it does not hinder the cannulation of Vater's papilla.

[Foreign body reaction to biodegradable esophageal prosthesis. A case report]. / Reacción a cuerpo extraño de una prótesis esofágica biodegradable. Informe de un caso.

Although benign esophageal stricture induced by various factors can often be managed with dilatations using hydrostatic balloons or different dilators, some patients have esophageal stenosis that is refractory to such treatment. Endoprothesis have facilitated the palliation of malignant esophageal strictures. However, the indications for permanent esophageal stenting in patients with benign esophageal strictures have not been established. Everyday, the use of plastic self-expanding endoprosthesis is more common in esophageal strictures because of their advantages over metallic stents, ease of placement and retrieval, and limited local tissue reaction. More recently, biodegradable stents have been used to manage benign esophageal stenosis. We report a case of a 72 years woman who was attended because of the presence of esophageal stenosis secondary to caustic ingestion refractory to dilatation, was placed a biodegradable stent and developed a foreign body reaction.

[Intravenous sedation in endoscopic cholangiopancreatography: a prospective and comparative trial.]. / Sedación endovenosa en colangiopancreatografía endoscópica; un estudio prospectivo y comparativo.

INTRODUCTION: Endoscopic cholangiopancreatography (ECP) has an established role in the diagnostic and treatment of biliopancreatic diseases. It is performed in supine position, under intravenous sedation to avoid movements and discomfort of the patient. OBJECTIVE: To evaluate the safety of anesthetic procedure in elderly and younger patients who underwent ECP. PATIENTS AND METHODS: A prospective, comparative study enrolling 450 consecutive patients who underwent ERCP in 2007 was performed. The following variables were documented: gender, age, comorbid conditions, reason for referral, diagnostic, therapeutic procedures, American Society of Anesthesiology (ASA) classification, anesthetic drugs, duration of the procedure and complications. RESULTS: Patients were divided into two groups: 126 patients >65 years of age and 324 <65 years of age. Group A had a higher incidence of comorbid conditions (p <0.001). All procedures were performed under sedation with propofol. Anesthetic complications were detected in 6% of patients, without a statistical significance between ASA group (p = 0.7) or age groups (p = 0.1). No procedure-related mortality was documented. CONCLUSION: ECP under deep IV sedation is a safe procedure in elderly patients and has a low anesthetic complication rate.

Amygdala kindling differentially regulates the expression of the elements involved in TRH transmission.

Subthreshold electrical stimulation of the amygdala (kindling) activates neuronal pathways increasing the expression of several neuropeptides including thyrotropin releasing-hormone (TRH). Partial kindling enhances TRH expression and the activity or its inactivating ectoenzyme; once kindling is established (stage V), TRH and its mRNA levels are further increased but TRH-binding and pyroglutamyl aminopeptidase II (PPII) activity decreased in epileptogenic areas. To determine whether variations in TRH receptor binding or PPII activity are due to regulation of their synthesis, mRNA levels of TRH receptors (R1, R2) and PPII were semi-quantified by RT-PCR in amygdala, frontal cortex and hippocampus of kindled rats sacrificed at stage II or V. Increased mRNA levels of PPII were found at stage II in amygdala and frontal cortex, and of pro-TRH and TRH-R2, in amygdala and hippocampus. At stage V, pro-TRH mRNA levels increased and those of PPII, decreased in the three regions; TRH-R2 mRNA levels diminished in amygdala and frontal cortex and of TRH-R1 only in amygdala. In situ hybridization analyses revealed, at stage II, enhanced TRH-R1 mRNA levels in dentate gyrus and amygdala while decreased in piriform cortex; those of TRH-R2 increased in amygdala, CA2, dentate gyrus, piriform cortex, thalamus and subiculum and of PPII, in CAs and piriform cortex. In contrast, at stage V decreased expression of TRH-R1 occurred in amygdala, CA2/3, dentate gyrus and piriform cortex; of TRH-R2 in CA2, thalamus and piriform cortex, and of PPII in CA2, and amygdala. The magnitude of changes differed between ipsi and contralateral side. These results support a trans-synaptic modulation of all elements involved in TRH transmission in conditions that stimulate the activity of TRHergic neurons. They show that reported changes in PPII activity or TRH-binding caused by kindling relate to regulation of the expression of TRH receptors and degrading enzyme.

[Laparoscopic management of gastroesophageal reflux disease. Experience with 100 cases]. / Manejo laparoscópico de la enfermedad por reflujo gastroesofágico. Experiencia en 100 casos.

OBJECTIVE: To evaluate the results of laparoscopic Nissen-Rossetti funduplication and to compare them with the results obtained in open surgery. DESIGN: Prospective, observational, longitudinal, pre and post-procedure. CENTERS: Beneficencia Española, Hospital Angeles, and Hospital Francisco Galindo Chávez, ISSSTE, in Torreón, Coahuila, Mexico. PATIENTS AND METHOD: From December 1992 to February 1999, 100 patients with surgical indications due to gastroesophageal reflux disease (GERD) prospectively underwent a laparoscopic Nissen-Rossetti procedure. A clinical and endoscopic follow up from 3 months to 9 years was performed in 87 cases. RESULTS: Symptomatic control was achieved in 98% (85/87) of the cases and remission of overall endoscopic esophagitis in 79% (69/87); excluding Barrett cases, esophagitis remission was observed in 93% (67/72) of the subjects. The following recurrences took place: two with G-II and two with G-III esophagitis, one requiring pyloroplasty due gastric stasis, and other patient with G-IV esophagitis, who has needed to continue with postoperative dilations. Of 16 cases with Barrett's esophagus, two-showed remission and one did not return control. Perioperative complications included gastric perforations (3), acute pulmonary edema during the immediate postoperative period (1), deep vein thrombosis (1), and late esophageal perforation (1). All were resolved satisfactorily. Surgical mortality was 0 in the 100 cases undergoing the procedure. Eighty-six percent of cases had a 24-h hospital stay. Early morbidity: dysphagia in 60 patients, early satiety in 91 cases, abdominal distention in 25 cases, all this symptomatology disappears during the subsequent 3 months. Persistent morbidity: flatulence in 60% of patients, difficulty for vomiting in 10% of cases. CONCLUSION: The laparoscopic procedure is as effective as the open method with the advantage of being minimally invasive.

17Beta-estradiol increases intracellular calcium concentration through a short-term and nongenomic mechanism in rat vascular endothelium in culture.

17Beta-estradiol (E2) plays an important role in Ca2+ fluxes in several cell types. It has been proposed that some of its effects are of nongenomic origin E2 at vascular smooth muscle level can block calcium entry through L-type calcium channels, this mechanism cannot include vascular endothelial cells (VECs), in which increases in the intracellular calcium concentration ([Ca2+]i) are necessary to NO synthesis. We used male rat aorta ECs in culture loaded with fura-2 and a fluorescence imaging system to evaluate the short-term effects of E2 on [Ca2+]i kinetics. We explored the participation of the intracellular steroid receptor on the effects induced by E2, using tamoxifen (1 microM) and ICI 182,780 (10 microM). Our results showed that E2 (like bradykinin) induced an increase in [Ca2+]i. Such agonist-like effects showed a biphasic curve behavior. The 17beta-estradiol effects were not modified by the presence of the intracellular estradiol-receptor antagonist tamoxifen, but it is blocked in the presence of the ICI 182,780. The 17beta-estradiol effects were obtained even with restriction of steroid-free diffusion into cells (17beta-estradiol-bovine serum albumin). Phospholipase Cbeta activity is involved in these effects, because U-73122, a PLCbeta inhibitor, blocked E2 effects. All E2 effects were of rapid onset (milliseconds), exerted at the membrane level, and of rapid offset. We conclude that estradiol can influence the endothelium physiologic responses through effects of nongenomic origin.

[Laparoscopic cholecystectomy. Analysis of 50 cases]. / Colecistectomía laparoscópica. Análisis de 50 casos.

Biliary lithiasis is considered a significant health problem. Traditionally open cholecystectomy has been considered the gold standard procedure for symptomatic cholecystitis. Laparoscopic cholecystectomy has recently emerged as an alternative, but its usefulness in community hospitals is still being evaluated. Herein we reported our experience in 50 patients treated for 7 months (August of 1991, to February of 1992) by laparoscopic cholecystectomy. It has been necessary to convert one case into an open surgery. There has been no mortality. Seven patients developed right shoulder pain postoperative, it was controlled with minor non addictive analgesics. One had umbilical hematoma, another patient had a superficial phlebitis, and another one developed urinary retention. 43 patients (86%) had had 12 to 24 h hospital stancy, and were back to their normal activities in 7 days; during a 7 months follow-up no complications have been reported. We concluded that laparoscopic cholecystectomy is a safe procedure and can be done by the average general surgeon in community hospitals in a selected patient population. However, we strongly support a continuous monitoring of a protocol for patient management for record-keeping-purposes and as an educational tool.

[3 cases of hematogenous lung abscess of amebic origin]. / Tres casos de absceso pulmonar hematógeno de origen amibiano.

Invasive amebiasis is a very serious health problem in Mexico as it is presumably related to the presence of virulent strains of Entamoeba histolytica and poor hygienic and sanitary conditions; other factors related to invasive amebiasis are undernutrition, alcoholism, and homosexuality. We present three patients with pulmonary amebic hematogenous abscess. Clinically all patients had the typical "chocolate" exudate. The three patients had pulmonary consolidations by chest roentgenogram; one of them had multiple opacities with air fluid level, and the others had an isolated opacity with air fluid level. The ultrasound and hepatogammagram were negative for diaphragmatic communication in all; in one of them the pneumoperitoneum was negative for diaphragmatic communication. The transthoracic needle biopsy of the lesions was positive to ameba in two patients. The serologic tests were positive in all. We treated the patients with metronidazole and emetine during 10 days; since the clinical picture and the radiologic findings did not remit completely, we gave a second course of metronidazole during 10 days more and achieved complete resolution.

[Historical monograph of the Ateneo Odontológico Mexicano]. / Monografía histórica del Ateneo Odontológico Mexicano.

This monograph is focused on the role the study group (as an instrument for professional improvement) has played in the development of Mexican Odontology. Today, it still is the most factible alternative for the one who does not wish to be relegated with regards to odontological innovations. Since the first professional societies emerged last century, they had the nature of study groups. And although their aspirations were nationwide, they gave the profession one of the most valuable means of information to the dentist of that time: the scientific magazine. From these societies (study groups) the idea of forming the first Dental School in the Mexican Republic in 1904 originated and crystallized. In the 1930's, societies of specialties appeared in the Mexican Republic working from that moment on as study groups. They are responsible for directing scientific information to the dental population in general, even stepping out of the subject-matter pertaining to their own area. These Associations were: Orthodontics and Buccal Surgery. In 1945, the Dental Study Group U.S.C. of Mexico appeared as a formal study group. Since then, this group offers the dental profession a seminar that is the second oldest Dental Seminar worldwide. One of the merits of the group was to initiate this type of education which spread throughout the Mexican Republic giving rise to the formation of new study groups. In 1966, the Ateneo Odontológico Mexicano was created, and the mystic of its formation, politics and performance are described in this monograph.