Prevalence of metabolic associated fatty liver disease (MAFLD) in patients with gallstone disease. Study on a cohort of cases in South-Southeastern Mexico.

INTRODUCTION: Metabolic (dysfunction) associated fatty liver disease (MAFLD) and gallstone disease are entities that share similar risk factors. Numerous publications confirm their elevated frequency, but few studies have considered their prevalence and possible association. AIMS: To determine the prevalence of MAFLD in patients with gallstone disease and the usefulness of liver biopsy for diagnosing the liver disease. MATERIALS AND METHODS: A prospective study was conducted on patients that underwent laparoscopic cholecystectomy, in whom liver biopsy was performed. VARIABLES ANALYZED: Anthropometric characteristics, biochemical profile, conventional ultrasound, risk factors, and histopathologic study of the liver biopsy. STATISTICAL ANALYSIS: Descriptive statistics were carried out for the quantitative variables and the Student's t test and multivariate analysis through binary logistic regression were employed for the continuous variables, utilizing IBM-SPSS, 25.0 (Windows) software. RESULTS: A total of 136 patients were classified into 2 groups: 40 (29.41%) with normal liver and 96 (70.59%) with MAFLD. Of the 136 patients, 71 patients (52.21%) corresponded to hepatic steatosis, 21 (15.44%) to steatohepatitis, and 4 (2.94%) to cirrhosis. Perisinusoidal inflammation was found in 39 cases (28.68%) and fibrosis was found in 10 (7.35%). The risk factors for both groups were age, diabetes, high blood pressure, and obesity. Glucose, triglyceride, and aminotransferase levels were significantly higher in the MAFLD group and conventional ultrasound demonstrated moderate concordance for its detection. DISCUSSION AND CONCLUSIONS: The results confirmed the elevated frequency of MAFLD associated with gallstone disease, justifying liver biopsy during cholecystectomy for diagnosing MAFLD.

Knowledge acquired from Clinical Guidelines on the Diagnosis and Treatment of Acute Pancreatitis by attending physicians and residents in hospitals in Veracruz. / Conocimiento de las Guías Clínicas de Diagnóstico y Tratamiento de la Pancreatitis Aguda en médicos adscritos y residentes de los hospitales de Veracruz.

INTRODUCTION: Clinical practice guidelines on the diagnosis and treatment of acute pancreatitis (CPGDTAP) have been designed in an effort to reduce the morbidity and mortality of that severe disease. AIM: To identify the knowledge acquired from CPGDTAP in hospitals in Veracruz. MATERIALS AND METHODS: A descriptive, observational, multicenter study was conducted at four hospitals in Veracruz, through the application of a survey to evaluate the knowledge of attending physicians and residents that treat patients with acute pancreatitis. Descriptive statistics were employed to analyze the results. RESULTS: A total of 74 physicians were surveyed: 55.41% of whom were attending physicians and 44.59% of whom were resident physicians. The majority of physicians (67.57%) were familiar with CPGDTAP from the Asociación Mexicana de Gastroenterología (AMG), followed by those of the General Health Council of the Mexican Department of Health (CENETEC, the Spanish acronym) (54.05%) and the American College of Gastroenterology (ACG) (48.65%). A total of 97.30% of the physicians routinely use a nasogastric tube, 79.73% considered early enteral nutrition to be very important, as did 98.65% regarding generous fluid replacement, 85.14% did not routinely use antimicrobials, 63.51% ordered a CAT scan at 72h or later, and 87.84% answered that infected necrosis was the indication for surgery, preferably after the third week. DISCUSSION AND CONCLUSIONS: In our hospital environment, the CPGDTAP issued by the AMG and CENETEC were the most well-known, but their recommended measures were given importance by under 85% of the physicians surveyed. Therefore, the diffusion of the knowledge they contain is advisable to guarantee optimal results in acute pancreatitis management.

Influence of socioeconomic and cultural factors in the etiology of cirrhosis of the liver. / Influencia los factores socioeconómicos y culturales en la etiología de la cirrosis hepática.

INTRODUCTION: Cirrhosis of the liver is a serious public health problem worldwide, with regional variations determined by cultural factors and economic development. AIM: To know the characteristics of the social, cultural, and economic factors of the patients with cirrhosis of the liver in Veracruz. MATERIALS AND METHODS: A multicenter, retrolective, relational research study was conducted on patients with cirrhosis of the liver at five healthcare institutions in Veracruz. The variables analyzed were etiology, age, sex, civil status, educational level, occupation, and income. Descriptive and inferential statistics were utilized, and statistical significance was set at a P<.05. The Windows IBM-SPSS version 25.0 program was employed. RESULTS: A total of 182 case records of patients with cirrhosis of the liver were included. The etiologic factors were chronic alcohol consumption (47.8%), viral disease (28.5%), nonalcoholic fatty liver disease (NAFLD) (8.79%), autoimmune liver disease (4.4%), cholestasis (1.64%), and cryptogenic liver disease (8.8%). Mean patient age was 66.14±13.91, with a predominance of men (58.79%). In comparing the socioeconomic and cultural factors related to etiology, secondary and tertiary education and singleness were statistically significant in male alcoholics (P<.05), viral diseases and NAFLD were significantly associated with women with no income (P<.05), cryptogenic liver disease was significantly associated with women (P<.05), and cholestasis and autoimmune liver disease were not significantly associated with any of the factors. CONCLUSIONS: The study results revealed the influence of socioeconomic and cultural factors related to the different causes of cirrhosis of the liver in our environment.

Cancer of the digestive system in Veracruz. The magnitude of the problem by 2025. / Cáncer del aparato digestivo en Veracruz. La magnitud del problema al año 2025.

INTRODUCTION: Malignant tumors of the digestive system are a public health problem with epidemiologic variations attributed to factors resulting from the aging of the population and lifestyle changes. Therefore, estimating the future magnitude of the problem is prudent. AIM: To determine the epidemiologic projection up to 2025 of malignant tumors of the digestive system in Veracruz. MATERIALS AND METHODS: A predictive, analytic, observational study was conducted on patients belonging to the Public health sector of Veracruz that presented with digestive system cancer, within the time frame of 2000-2016, carrying out a disease projection up to 2025. The IBM SPSS 22.0 program was utilized for the statistical analysis, employing simple linear regression. A comparative analysis of the data was carried out and results are shown in scatter graphs. RESULTS: A total of 2,540 cases were included in the study. Mean patient age was 63.25±13.43, with a predominance of men at 56.65%. The most frequent tumor locations were in the colon and rectum (25.04%), liver (23.66%), and stomach (21.93%). Less frequent sites were the esophagus (4.88%) and small bowel (5.08%). A general 7.63% increase in the disease was predicted for 2025, with increases to 11.51% for esophageal cancer, 7.22% for gastric cancer, 9.09% for colorectal cancer, 5.98% for liver cancer, 7.88% for pancreatic cancer, and 6.86% for cancer of the gallbladder and bile ducts. Only cancer of the small bowel showed a predicted decrease to 3.33%. DISCUSSION AND CONCLUSIONS: The results of the present study predict that digestive system cancers in Veracruz will increase importantly by 2025, with colorectal cancer, hepatocellular carcinoma, and gastric cancer as the most frequent tumors, in descending order. The other cancers are estimated to maintain a discrete line of growth. In addition to predicting the behavior of those cancers, the results of the present study are useful for estimating the resources that will be needed for their care by 2025.

Safety of laparoscopic subtotal cholecystectomy in acute cholecystitis. Experience in Southeast Mexico. / Seguridad de la colecistectomía subtotal laparoscópica en colecistitis aguda. Experiencia en el sureste de México.

INTRODUCTION: Subtotal cholecystectomy has been employed in cases of tecnically difficult cholecystectomy to prevent common bile duct injury. Given that there are few reports in Mexico on the theme, we consider it important to present the 18-year experience of a surgical group in the South-Southeast of Mexico. AIM: To determine the safety of laparoscopic subtotal cholecystectomy in patients with acute cholecystitis. MATERIALS AND METHODS: A retrospective, observational, and comparative study was conducted on patients with gallstones that underwent laparoscopic cholecystectomy. The variables analyzed were: anthropometric characteristics, comorbidities, conversion rate, surgery duration, hospital stay, and morbidity and mortality. STATISTICAL ANALYSIS: Descriptive statistics were applied through measures of central tendency and dispersion and standard deviation, utilizing the SPSS v22 program. RESULTS: A total of 1,101 medical records of patients with gallstones were reviewed. Of those patients, 223 presented with acute cholecystitis (20.25%) and they were divided into 2 groups: A) total cholecystectomy (82.95%) and B) subtotal cholecystectomy (17.05%). The anthropometric characteristics, risk factors, conversion rate, and hospital stay were similar in both groups. Only surgery duration was longer in the subtotal cholecystectomy group. Complications were more frequent, there was 1 death, and there was no bile duct injury in the subtotal cholecystectomy group. Those results were not statistically significant between the two groups. CONCLUSIONS: Subtotal cholecystectomy is a valuable resource in patients with acute cholecystitis. In our case series, it was a safe and reliable procedure for preventing bile duct injury. A larger number of cases are needed to corroborate those results.

Frequency of human papillomavirus infection in patients with gastrointestinal cancer. / Frecuencia de infección por virus del papiloma humano en pacientes con cáncer del aparato digestivo.

INTRODUCTION AND AIM: Cancer is the result of the interaction of genetic and environmental factors. It has recently been related to viral infections, one of which is human papillomavirus. The aim of the present study was to describe the frequency of human papillomavirus infection in patients with digestive system cancers. MATERIALS AND METHODS: A prospective, multicenter, observational study was conducted on patients with gastrointestinal cancer at 2public healthcare institutes in Veracruz. Two tumor samples were taken, one for histologic study and the other for DNA determination of human papillomavirus and its genotypes. Anthropometric variables, risk factors, sexual habits, tumor location, and histologic type of the cancer were analyzed. Absolute and relative frequencies were determined using the SPSS version 24.0 program. RESULTS: Fifty-three patients were studied. They had gastrointestinal cancer located in: the colon (62.26%), stomach (18.87%), esophagus (7.55%), rectum (7.55%), and small bowel (3.77%). Human papillomavirus was identified in 11.32% of the patients, 66.7% of which corresponded to squamous cell carcinoma and 33.3% to adenocarcinoma. Only genotype 18 was identified. Mean patient age was 61.8±15.2 years, 56.60% of the patients were men, and 43.40% were women. A total of 15.8% of the patients had a family history of cancer and 31.6% had a personal history of the disease, 38.6% were tobacco smokers, and 61.4% consumed alcohol. Regarding sex, 5.3% of the patients said they were homosexual, 3.5% were bisexual, 29.8% engaged in oral sex, and 24.6% in anal sex. CONCLUSIONS: Our study showed that human papillomavirus infection was a risk factor for the development of gastrointestinal cancer, especially of squamous cell origin.

Bone targeting compounds for radiotherapy and imaging: *Me(III)-DOTA conjugates of bisphosphonic acid, pamidronic acid and zoledronic acid.

BACKGROUND: Bisphosphonates have a high adsorption on calcified tissues and are commonly used in the treatment of bone disorder diseases. Conjugates of bisphosphonates with macrocyclic chelators open new possibilities in bone targeted radionuclide imaging and therapy. Subsequent to positron emission tomography (PET) examinations utilizing 68Ga-labelled analogues, endoradiotheraphy with 177Lu-labelled macrocyclic bisphosphonates may have a great potential in the treatment of painful skeletal metastases. METHODS: Based on the established pharmaceuticals pamidronate and zoledronate two new DOTA-α-OH-bisphosphonates, DOTAPAM and DOTAZOL(MM1.MZ) were successfully synthesized. The ligands were labelled with the positron emitting nuclide 68Ga and the ß- emitting nuclide 177Lu and compared in in vitro studies and in ex vivo biodistribution studies together with small animal PET and single photon emission computed tomography (SPECT) studies against [18F]NaF and a known DOTA-α-H-bisphosphonate conjugate (BPAPD) in healthy Wistar rats. RESULTS: The new DOTA-bisphosphonates can be labelled in high yield of 80 to 95 % in 15 min with post-processed 68Ga and >98 % with 177Lu. The tracers showed very low uptake in soft tissue, a fast renal clearance and a high accumulation on bone. The best compound was [68Ga]DOTAZOL (SUV Femur = 5.4 ± 0.6) followed by [18F]NaF (SUV Femur = 4.8 ± 0.2), [68Ga]DOTAPAM (SUV Femur = 4.5 ± 0.2) and [68Ga]BPAPD (SUV Femur = 3.2 ± 0.3). [177Lu]DOTAZOL showed a similar distribution as the diagnostic 68Ga complex. CONCLUSION: The 68Ga labelled compounds showed a promising pharmacokinetics, with similar uptake profile and distribution kinetics. Bone accumulation was highest for [68Ga]DOTAZOL, which makes this compound probably an interesting bone targeting agent for a therapeutic approach with 177Lu. The therapeutic compound [177Lu]DOTAZOL showed a high target-to-background ratio. SPECT experiments showed concordance to the PET scans in healthy rats. [68Ga/177Lu]DOTAZOL appears to be a potential theranostic combination in the management of disseminated bone metastases.

System L amino acid transporter LAT1 accumulates O-(2-fluoroethyl)-L-tyrosine (FET).

O-(2-fluoroethyl)-L-tyrosine (FET) labeled with fluorine-18 is an important and specific tracer for diagnostics of glioblastoma via positron emission tomography (PET). However, the mechanism of its quite specific accumulation in tumor tissue has not been understood so far. In this work we demonstrate that [(3)H]L-tyrosine is primarily transported by the system L transporter LAT1 in human LN229 glioblastoma cells. FET reduced tyrosine transport, suggesting that it shares the same uptake pathway. More importantly, accumulation of FET was significantly reduced after siRNA-mediated downregulation of LAT1. Xenopus laevis oocytes expressing human LAT1 together with the glycoprotein 4F2hc (necessary to pull LAT-1 to the plasma membrane) exhibited a similar accumulation of FET as observed in glioblastoma cells. In contrast, no accumulation was observed in control oocytes, not overexpressing an exogenous transporter. Because LAT1 works exclusively as an exchanger of amino acids, substrates at one side of the membrane stimulate exchange against substrates at the other side. Extracellular FET stimulated the efflux of intracellular [(3)H]L-leucine, demonstrating that FET is indeed an influx substrate for LAT1. However, FET injected into oocytes was not able to stimulate uptake of extracellular [(3)H]L-leucine, indicating that FET is not a good efflux substrate. Our data, therefore, suggest that FET is trapped within cells due to the asymmetry of its intra- and extracellular recognition by LAT1. If also found for other transporters in tumor cells, asymmetric substrate recognition may be further exploited for tumor-specific accumulation of PET-tracers and/or other tumor-related drugs.

Tropane-derived (11) C-labelled and (18) F-labelled DAT ligands.

Radiolabelling of cocaine-derived 3-phenyltropanes for dopamine transporter positron emission tomography with (18) F and (11) C is reviewed.

Spectroscopic, radiochemical, and theoretical studies of the Ga3+-N-2-hydroxyethyl piperazine-N'-2-ethanesulfonic acid (HEPES buffer) system: evidence for the formation of Ga3+ - HEPES complexes in (68) Ga labeling reactions.

Recent reports have claimed a superior performance of HEPES buffer in comparison to alternative buffer systems for (67/68) Ga labeling in aqueous media. In this paper we report spectroscopic ((1) H and (71) Ga NMR), radiochemical, mass spectrometry and theoretical modeling studies on the Ga(3+)/HEPES system (HEPES = N-2-hydroxyethylpiperazine-N'-2-ethanesulfonic acid) performed with the aim of elucidating a potential contribution of HEPES in the (68/67) Ga radiolabeling process. Our results demonstrate that HEPES acts as a weakly but competitive chelator of Ga(3+) and that this interaction depends on the relative Ga(3+): HEPES concentration. A by-product formed in the labeling mixture has been identified as a [(68) Ga]Ga(HEPES) complex via chromatographic comparison with the nonradioactive analog. The formation of this complex was verified to compete with [(68) Ga]Ga(NOTA) complexation at low NOTA concentration. Putative chelation of Ga(3+) by the hydroxyl and adjacent ring nitrogen of HEPES is proposed on the basis of (1)H NMR shifts induced by Ga(3+) and theoretical modeling studies.

44Sc-DOTA-BN[2-14]NH2 in comparison to 68Ga-DOTA-BN[2-14]NH2 in pre-clinical investigation. Is 44Sc a potential radionuclide for PET?

AIM: In the present study we demonstrate the in vitro and in vivo comparison of the (44)Sc and (68)Ga labeled DOTA-BN[2-14]NH(2). (44)Sc is a positron emitter with a half life of 3.92 h. Hence it could be used for PET imaging with ligands requiring longer observation time than in the case of (68)Ga. METHODS: The binding affinity of (nat)Sc-DOTA-BN[2-14]NH(2) and (nat)Ga-DOTA-BN[2-14]NH(2) to GRP receptors was studied in competition to [(125)I-Tyr(4)]-Bombesin in the human prostate cancer cell line PC-3. A preliminary biodistribution in normal rats was performed, while first microPET images were assessed in male Copenhagen rats bearing the androgen-independent Dunning R-3327-AT-1 prostate cancer tumor. RESULTS: The affinity to GRP receptors in the PC-3 cell line was higher for (nat)Ga-DOTA-BN[2-14]NH(2) (IC(50)(nM)=0.85 ± 0.06) than that of (nat)Sc-DOTA-BN[2-14]NH(2) (IC(50) (nM)=6.49 ± 0.13). The internalization rate of (68)Ga labeled DOTA-BN[2-14]NH(2) was slower than that of (44)Sc, but their final internalization percents were comparable. (68)Ga-DOTA-BN[2-14]NH(2) was externalized faster than (44)Sc-DOTA-BN[2-14]NH(2). The biodistribution of (44)Sc-DOTA-BN[2-14]NH(2) and (68)Ga-DOTA-BN[2-14]NH(2) in normal rats revealed a higher uptake in target organs and tissues of the first one while both excreted mainly through urinary tract. In microPET images both tracers were accumulated in the tumor with similar uptake patterns. CONCLUSIONS: Despite the differences in the receptor affinity both the (68)Ga- and the (44)Sc-labeled DOTA-BN[2-14]NH(2) tracers showed comparable distribution and similar time constants of uptake and elimination. Moreover no differences in tumor accumulation (neither in the overall uptake nor in the dynamics) were observed from the microPet imaging. From that perspective the use of either (44)Sc or (68)Ga for detecting tumors with GRP receptors is equivalent.

Maturation of a key resource - the germanium-68/gallium-68 generator: development and new insights.

(68)Ge/(68)Ga radionuclide generators have been investigated for almost fifty years, since the cyclotron-independent availability of positron emitting (68)Ga via the (68)Ge/(68)Ga system had always attracted researches working in basic nuclear chemistry as well as radiopharmaceutical chemistry. However, it took decades and generations of research (and researchers) to finally reach a level of (68)Ge/(68)Ga radionuclide generator designs adequate to the modern requirements of radiometal labelling chemistry. Nevertheless, most of the existing commercial generator systems address aspects of (68)Ge breakthrough and safe synthesis of (68)Ga radiopharmaceuticals by adopting eluate post-processing technologies. Among the strategies to purify (68)Ga eluates, the cation exchange based version is relevant in terms of purification efficiency. In addition, it offers more options towards further developments of (68)Ga radiopharmaceuticals. Today, one may expect that the (68)Ge/(68)Ga radionuclide generator systems could contribute to the clinical impact of nuclear medicine diagnoses for PET similar to the established (99)Mo/(99m)Tc generator system for SPECT. The exciting perspective for the (68)Ge/(68)Ga radionuclide generator system, in turn, asks for systematic chemical, radiochemical, technological and radiopharmaceutical efforts, to guarantee reliable, highly-efficient and medically approved (68)Ge/(68)Ga generator systems.

Scandium-44: benefits of a long-lived PET radionuclide available from the (44)Ti/(44)Sc generator system.

(44)Ti/(44)Sc radionuclide generators are of interest for molecular imaging. The 3.97 hours half-life of (44)Sc and its high positron branching of 94.27% may stimulate the application of (44)Sc-labeled PET radiopharmaceuticals. This review describes the current status of (44)Ti production, (44)Ti/(44)Sc radionuclide generator development, post-processing of generator eluates towards medical application, identification of ligands adequate to Sc(III) co-ordination chemistry, proof-of-principle labeling of (44)Sc-DOTA-octreotides, investigation of in vitro and in vivo parameters, and initial applications for molecular imaging - both in small animals and humans.

Method development studies for repeatedly measuring anxiolytic drug effects in healthy humans.

Human experimental models for anxiety may serve as translational tools for translating preclinical psychopharmacological investigations into human studies. For the evaluation of drugs of which pharmacokinetics and pharmacodynamics are unidentified, repeating measurements after drug administration is necessary for characterising the time course of drug effects. In experiment 1, a threat-of-shock paradigm and adaptations of the Trier mental arithmetic test and the Stroop colour naming test were repeated four times within a day to evaluate whether anxiety responses to this test battery remain stable after repeated testing. This procedure was repeated on 4 days in a second experiment to evaluate suitability of the paradigm for a crossover design with multiple sessions. Results indicate no reductions or changes in fear potentiated startle, the main outcome measure for the threat paradigm, over test sessions or days. Skin conductance responses and subjective ratings under threat-of-shock showed significant fluctuations but also no systematic decline over time. Finally, the threat paradigm and Stroop test resulted in small increases in reported state anxiety while mental arithmetic produced larger effects that diminished after the first test day. It is concluded that especially the startle paradigm could be a useful new instrument for screening new anxiolytic drugs.

A combined 148Gd/244Cm source for energy calibration of alpha-spectrometers.

For high-resolution alpha-particle spectroscopy, detector calibration sources of highest performance are required concerning thickness and homogeneity. In addition, the alpha-emitting radionuclides must have adequate half-lives and alpha-emission energies. This paper describes a new type of alpha-emitting calibration source, represented by a mixture of 148Gd and 244Cm. This system covers an alpha-energy range from 3.18 MeV (148Gd) to 5.76 and 5.80 MeV (244Cm). The source has been prepared by electrolytic deposition and has good performance in terms of thickness and homogeneity.

Gender differences in lung cancer risk by smoking: a multicentre case-control study in Germany and Italy.

Several studies in the past have shown appreciably higher lung cancer risk estimates associated with smoking exposure among men than among women, while more recent studies in the USA report just the opposite. To evaluate this topic in a European population we conducted a case-control study of lung cancer in three German and three Italian centres. Personal interviews and standardized questionnaires were used to obtain detailed life-long smoking and occupational histories from 3723 male and 900 female cases and 4075 male and 1094 female controls. Lung cancer risk comparing ever-smokers with never-smokers was higher among men (odds ratios (OR) adjusted for age and centre = 16.1, 95% confidence interval (CI) 12.8-20.3) than among women (OR = 4.2, CI 3.5-5.1). Because the smoking habits of women were different from men, we conducted more detailed analyses using comparable levels of smoking exposure. After restriction to smokers and adjustment for other smoking variables, risk estimates did not differ appreciably between genders. The analysis of duration of smoking (0-19, 20-39, 40+ years) adjusted for cigarette consumption and time since quitting smoking revealed similar risk estimates in men (OR = 1.0, 3.3 [CI 2.6-4.2], 4.1 [CI 3.1-5.6]) and women (OR = 1.0, 2.7 [CI 1.7-4.1], 3.3 [CI 1.9-5.8]). The same was true of the analysis of average or cumulative smoking consumption, and also of analyses stratified by different histological types. We conclude that for comparable exposure to tobacco smoke, the risk of lung cancer is comparable in women and men.

Radiolabeling of an anti-carcinoembryonic antigen antibody Fab' fragment (CEA-Scan) with the positron-emitting radionuclide Tc-94m.

The goal of this work was to test whether an antibody-based agent approved for use as a single-photon-emitting imaging agent when radiolabeled with technetium-99m could be labeled comparably with a positron-emitting nuclide, technetium-94m. "Instant kits" containing lyophilized NP-4 antibody Fab' fragment of an anticarcinoembryonic antigen IgG (CEA-Scan) from the same manufactured lot were reconstituted with either Tc-99m or Tc-94m, as solutions of sodium pertechnetate in isotonic saline solution. Radioanalyses of the labeled Fab' fragments by size-exclusion high-performance chromatography and TLC were carried out. Equivalent results were obtained for radioimmunoconjugates when each was analyzed with both methods. Facile incorporation of Tc-94m into tumor-targeting Fab' antibody fragments will enable investigation of such agents for tumor-specific imaging using positron emission tomography.

[Spontaneous rupture of the esophagogastric junction. Report of a case]. / Ruptura espontánea de la unión cardio-esofágica Presentación de un caso.

It is presented a case of spontaneous rupture of the union cardioesophageal consecutive on ingestion of bicarbonate in an old patient with strangulated hiatal hernia. It is analyzed the phisiopathological factors of such complication and the surgical treatment employed.