Conversion from laparoscopic to open cholecystectomy: Risk factor analysis based on clinical, laboratory, and ultrasound parameters.

INTRODUCTION AND AIMS: The standard of care for gallbladder disease is laparoscopic cholecystectomy. Difficult dissection of the hepatocytic triangle and bleeding can result in conversion to open cholecystectomy, which is associated with increased morbidity. Identifying risk factors for conversion in the context of acute cholecystitis will allow patient care to be individualized and improve outcomes. MATERIALS AND METHODS: A retrospective case-control study included all patients diagnosed with acute cholecystitis, according to the 2018 Tokyo Guidelines, admitted to a tertiary care academic center, from January 1991 to January 2012. Using logistic regression, we analyzed variables to identify risk factors for conversion. Variables that were found to be significant predictors of conversion in the univariate analysis were included in a multivariate model. We then performed an exploratory analysis to identify the risk factor summation pathway with the highest sensitivity for conversion. RESULTS: The study included 321 patients with acute cholecystitis. Their mean age was 49 years (±16.8 SD), 65% were females, and 35% were males. Thirty-nine cases (12.14%) were converted to open surgery. In the univariate analysis, older age, male sex, gallbladder wall thickness, and pericholecystic fluid were associated with a higher risk for conversion. In the multivariate analysis all of the variables, except pericholecystic fluid, were associated with conversion. Our risk factor summation model had a sensitivity of 84%. CONCLUSIONS: Preoperative clinical data can be utilized to identify patients with a higher risk of conversion to open cholecystectomy. Being aware of such risk factors can help improve perioperative planning and preparedness in challenging cases.

Pancreatic ductal adenocarcinoma: Eleven years of experience at a tertiary care hospital center. / Adenocarcinoma ductal de páncreas. Experiencia de 11 años en un centro de tercer nivel.

INTRODUCTION AND AIM: Pancreatic cancer is considered one of the most aggressive solid tumors. In Mexico, it is the twelfth cause of cancer, with 4,489 cases diagnosed annually, and accounts for 4.9% of oncologic deaths. The aim of our study was to describe the clinical and epidemiologic characteristics of the patients diagnosed with pancreatic cancer spanning an 11-year period at the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán". METHODS: A retrospective, cross-sectional study was conducted that included 479 patients diagnosed with pancreatic cancer, within the time frame of 2003-2013. The documented findings were summarized through descriptive statistics. RESULTS: Of the patients with pancreatic ductal adenocarcinoma, 50.9% were women, and the mean patient age at diagnosis was 61.5 years. A total of 48.4% of the cases were diagnosed at clinical stage IV, 12.9% presented with clinical stage III, and 25.0% had localized disease. Surgery was performed on 37.5% of the patients, the most frequent of which was pancreatoduodenectomy. The surgical mortality rate was 5.5%. CONCLUSION: The clinical characteristics in our study group were similar to those described in the literature. However, the number of candidates for surgical treatment was higher than that reported in other hospitals and the percentage of borderline tumors was lower. Those differences, respectively, are possibly associated with the nature of our referral center and the prolonged intervals between diagnosis and treatment that result in the loss of potential surgical patients.

Conversion from laparoscopic to open cholecystectomy: Risk factor analysis based on clinical, laboratory, and ultrasound parameters. / Conversión de colecistectomía laparoscópica a abierta: análisis de factores de riesgo con base en parámetros clínicos, de laboratorio y de ultrasonido.

INTRODUCTION AND AIMS: The standard of care for gallbladder disease is laparoscopic cholecystectomy. Difficult dissection of the hepatocytic triangle and bleeding can result in conversion to open cholecystectomy, which is associated with increased morbidity. Identifying risk factors for conversion in the context of acute cholecystitis will allow patient care to be individualized and improve outcomes. MATERIALS AND METHODS: A retrospective case-control study included all patients diagnosed with acute cholecystitis, according to the 2018 Tokyo Guidelines, admitted to a tertiary care academic center, from January 1991 to January 2012. Using logistic regression, we analyzed variables to identify risk factors for conversion. Variables that were found to be significant predictors of conversion in the univariate analysis were included in a multivariate model. We then performed an exploratory analysis to identify the risk factor summation pathway with the highest sensitivity for conversion. RESULTS: The study included 321 patients with acute cholecystitis. Their mean age was 49 years (±16.8 SD), 65% were females, and 35% were males. Thirty-nine cases (12.14%) were converted to open surgery. In the univariate analysis, older age, male sex, gallbladder wall thickness, and pericholecystic fluid were associated with a higher risk for conversion. In the multivariate analysis all of the variables, except pericholecystic fluid, were associated with conversion. Our risk factor summation model had a sensitivity of 84%. CONCLUSIONS: Preoperative clinical data can be utilized to identify patients with a higher risk of conversion to open cholecystectomy. Being aware of such risk factors can help improve perioperative planning and preparedness in challenging cases.

Laparoscopic Roux-en-Y gastric bypass in the treatment of obesity: evidence based update through randomized clinical trials and meta-analyses.

Bariatric surgery was introduced in 1953, but during the last 20 years its popularity has increased after the development of significant Romaevidenced based breakthroughs in the field. Currently, approximately 150 long-term randomized clinical trials and 40 meta-analyses support and give credibility to the surgical approaches for the treatment of obesity and its related metabolic disturbances. Bariatric surgery has demonstrated improved outcomes compared to medical treatment, conduct therapy, and endoscopic procedures. Roux-en-Y gastrojejunostomy (RYGB) and Sleeve gastrectomy (SG) are the surgical procedures most frequently performed, due to their satisfactory results and security profile. There is sufficient evidence in medical literature to perform these procedures when indicated; however, there are still several controversies regarding technical aspects that need to be further explored.

Myths and realities in the management of the open abdomen with negative pressure systems. A case report and literature review.

INTRODUCTION: The open abdomen is a useful resource for treating patients with abdominal hypertension and abdominal compartment syndrome. Currently, early closure assisted with negative pressure devices is considered standard of treatment, and its use has demonstrated favorable outcomes and a decreased rate of complications. PRESENTATION OF A CASE: We present a case of a 32-year-old male patient with diagnosis of non-seminomatous germinal testicular tumor (Stage IIIB (T3-N3-M1), which was summited to surgery, as a complication he presented massive bleeding, that culminated in acute compartment syndrome. With the aforementioned findings the patient re entered the operating room and was managed with open abdomen combined with a medial retraction technique of the abdominal fascia. Currently, the patient has not presented recurrence or late complications after a year. DISCUSSION: The use of negative pressure techniques for open abdomen management began to be generalized in 1995. Subsequently, this technique evolved to V.A.C therapy (Vacuum-assisted closure therapy). Currently, these negative pressure techniques have become the most used method for the temporary closure and management of open abdomen. Controversies continue to limit its widespread use and effectiveness. CONCLUSION: Adequate application of negative pressure therapy in combination with techniques of medial retraction of the abdominal fascia, have proved to be useful in management for patients with open abdomen.

Recurrent giant Brunner's gland adenoma.

Benign duodenal tumours are extremely rare, with an incidence of 0.008% among general population; those originating from Brunner's Gland represent 11% of this neoplasms. Most cases remain asymptomatic and are often diagnosed during routine endoscopic procedures, however their clinical presentation may be variable making resection treatment of choice in order to prevent complications. Recurrence has not been reported previously on literature. 59-year-old male presented to the emergency department nine months following endoscopic resection of a 2x1.5cm Brunner's gland adenoma complaining of bloating, weight loss and gastro intestinal bleeding, diagnostic approach revealed a 10x4cm mass occupying the duodenum. Tumour size did not allow for endoscopic resection and surgical removal was performed with excellent outcome and no further recurrence at 30 months.

Puesta al día en técnicas de fisioterapia respiratoria / Update in respiratory physiotherapy techniques

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[HIV prevalence among homosexual and bisexual men in Spain, 1992-2000]. / Prevalencia del virus de la inmunodeficiencia humana en varones homosexuales y bisexuales, 1992-2000.

BACKGROUND: Our purpose was to describe the time trend in HIV seroprevalence among homo/ bisexual men. SUBJECTS AND METHOD: We analyzed 9,383 homo/ bisexual men who had a first voluntary test for HIV in 10 Spanish clinics from 1992 to 2000. RESULTS: HIV prevalence decreased from 20.3% in 1992 to 8.4% in 2000. In the multivariate analysis this decline appeared independently associated with the testing year and the birth cohort. CONCLUSIONS: New generations of voluntarily tested homo/bisexual men are less infected by HIV, but it is yet necessary to intensify the prevention programs.

[Mycoplasma sp. in the respiratory tract of hospitalized children]. / Investigación de Mycoplasma sp. en las vías respiratorias de niños hospitalizados.

Mycoplasma pneumoniae is one of the most common bacteria causing respiratory diseases in other countries, specially in older children, adolescents and young adults and less frequently in the age group studied here, nevertheless the determination of its presence in this group was considered important. Two hundred and fifty throat swabs were taken from children, under five years of age, hospitalized with a diagnosis of acute respiratory infections (ARI) and to 50 children, same age, with no ARI (controls). The samples were placed in transport media and were incubated at 37 degrees C during 7 to 15 days. They were reinoculated in PPLO agar and typical colonies were looked for, 5 to 8 days later. The organisms were identified by biochemical tests. Eight Mycoplasma sp (3.2%) were obtained, five of them were M. pneumoniae (2.0%) and three M. hominis (1.2%). Only in 2 cases adenoviruses with M. hominis were found in the absence of other pathogens. It was shown that M. pneumoniae also infects children under five years old, so its present should be suspected, specially when the patient's health does not improve with the installed treatment. Some important suggestions for the isolation of mycoplasma are given.

[Epidemiologic and etiologic study of acute respiratory infections in children under 5 years of age]. / Estudio epidemiológico y etiológico de las infecciones respiratorias agudas (IRA) en niños menores de cinco años.

This study also included epidemiologic data to determine the risk factors for the enhancement of these infections. The coagglutination technique for the rapid diagnosis of streptococcus was tried. Five hundred and thirty one samples of pharingeal swabs were obtained from children with ARI. 74% were younger than one year old. Brochopneumonias constituted 66.39% of the cases. In total 357 agents were isolated 35% corresponding to bacteria in pure culture, 23.3% to mixed infections and 11.6% only viruses. The bacteria were: Haemphilus influenza (12.4%), Streptococcus pneumoniae (11%), Staphylococcus aureus (9%), and Klebsiella pneumoniae (6.3%), Mycoplasma pneumoniae was identified in 5 children and M. hominis in 3. Adenoviruses were isolated in 98 patients, parainfluenza in 19, respiratory syncytial virus in 4, influenza in 1 and picornavirus in 2. Predominating socioeconomic factors were: overcrowding, deficient schooling and low income of parents which favor malnutrition. The more frequent agents were constitutes by bacteria. Viruses were a less cause of infection. It was confirmed that babies under 12 months are more susceptible to bacterial pneumonia and prompt treatment with antimicrobial agents lowered the lethality. Low socioeconomic level is a possible predisposing factor for respiratory diseases.

Factores que influyen en el paso de infeccion a enfermedad en la seudotuberculosis del raton. / Factors influencing the course of infection to disease in pseudotuberculosis of mice

Se estudiaron una serie de factores que influyen en el paso de la infeccion atenuada producida por Corynebacterium kutscheri en el raton a una enfermedad manifesta con grandes abscesos que hemos ya descrito en una comunicacion anterior. En animales procedentes de bioterios en los cuales se conocia que existia la infeccion se experimento la accion de la cortisona inyectada por via subcutanea: otro lote se conservo a baja temperatura (O a 4 graus C.) y otros se estimularon con endotoxina de Salmonella typhi murium, se esplenectomizaron, se adrenalectomizaron o se inyectaron con vacuna Pertussis. El metodo mas efectivo, entre los que nosotros empleamos fue la inyeccion de cortisona en aceite de cartamo, con el que se obtuvieron conversiones en un 35%. Los otros estimulos, sin embargo, tambien produjeron el paso de infeccion a enfermedad en cierta proporcion y, en algunos casos, como en el de la inyeccion de endotoxina o vacuna Pertussis el efecto dependio de la dosis empleada