Neurosurgical treatment for dystonia: long-term outcome in a case series of 80 patients.

INTRODUCTION: In this study, we assessed the outcomes of patients with dystonia who underwent surgery treatment following the same algorithm. PATIENTS AND METHODS: Eighty consecutive patients with dystonia were submitted to neurosurgical management by means of intrathecal pump implantation, pallidotomy or deep brain stimulation (GPi or VIM). These patients included 48 patients with primary dystonia and 32 patients with secondary dystonia. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) was used to access pre- and post-operative outcomes. Patients were followed from 12 to 114 months. RESULTS: Mean improvement in BFMDRS score among patients with PrD was 87.54% and 42.21% for SeD. Hemidystonic patients in both groups (PrD, SeD) showed a mean improvement in BFMDRS of 71.05% with GPiDBS. Patients with SeD due to previous perinatal insults showed a mean improvement in BFMDRS of 41.9%, with better results in purely dyskinetic patients (mean improvement of 61.2%). CONCLUSION: Use of the proposed algorithm facilitated surgical decision planning, which translated in improved diagnostic rates, earlier interventions, appropriate management plans, and outcomes for both groups (PrD, SeD). Therefore, neuroimaging findings had a positive prognostic significance in the response to treatment in patients with primary dystonia compared with patients with secondary dystonia or distortion of basal ganglia anatomy. However, further studies in this line are warranted.

Mejorando la cadena de suministro en un hospital mediante la gestión Lean / Improving a hospital's supply chain through lean management

Objetivos. La gestión del suministro constituye un área en la que los hospitales tienen importantes oportunidades de mejora. Este trabajo pretende analizar cómo la aplicación de los principios de Lean puede mejorar los costes logísticos y la satisfacción de los usuarios. Métodos. Análisis de los resultados de una experiencia de reorganización del sistema logístico de un hospital basada en algunos principios Lean. Para el cálculo de los costes logísticos se ha utilizado el método del coste completo o full costing de contabilidad analítica de gestión. La satisfacción del usuario se evaluó mediante encuesta anónima. El tratamiento de los datos de la encuesta incluyó análisis factorial y el modelo de análisis de la varianza ANOVA. Resultados. Los datos obtenidos mostraron una mejora en la gestión de logística tras la implantación de Lean, con reducción de costes y mejora del nivel de satisfacción del usuario interno. Se ha observado que el personal sanitario percibe y valora el servicio logístico de manera global, sin diferenciar los aspectos del servicio, detectándose diferencias en cuanto al grado de satisfacción percibida por distintos grupos de usuarios. Conclusiones. La experiencia analizada ha permitido comprobar la aplicabilidad e idoneidad de los principios Lean para mejorar los costes e incrementar la satisfacción de los usuarios de servicios logísticos hospitalarios (AU)

Objectives: Supply management is an area where hospitals have significant opportunities for improvement. The main objective of this paper has been to analyze how the application of Lean principles can improve logistics costs and user satisfaction. In connection with satisfaction, it also aimed to examine which aspects of the service define it and check for differences between different groups of users. Methods: The results of an experience to reorganize the hospital logistic system based on some Lean principles have been studied. This is therefore a case study, which combine different methods of data collection. The logistics cost calculation was carried out using the full costing method. To measure satisfaction of healthcare personnel, the internal logistics service users, an anonymous survey was conducted. Processing of the data obtained from the survey have included exploratory analysis, factor analysis and ANOVAs. Results: The data have showed an improvement in logistics management after the implementation of Lean principles. Logistics costs were reduced and the satisfaction level of the internal users with the new logistics system was increased. Some differences in the degree of satisfaction by different groups of users were also detected, although they did not seem to distinguish between different aspects of logistic service. Conclusions: The analyzed experience shows the applicability and suitability of Lean principles to improve logistics operational costs and increase user satisfaction (AU)

Using PCR-RFLP for sexing of the endangered Galápagos petrel (Pterodroma phaeopygia).

Pterodroma phaeopygia is a critically endangered avian species of the Galápagos Islands. This bird is sexually monomorphic, making it difficult to identify the sex. This information, however, is relevant to studies of behavior, ecology, and management of wild or captive populations. Here, we aimed to implement a molecular approach for determining sex in this petrel. DNA was extracted from the blood and the feathers of 24 adult P. phaeopygia, with samples from a female and a male Gallus gallus for comparison. We amplified the cromo-helicase DNA binding protein 1 (CHD-1) gene by PCR, using primers P2 and P8. Allele CHD-1W is unique to females and CHD-1Z occurs in both sexes. We then digested these PCR products using the restriction enzyme HaeIII. The PCR amplified a 400-bp product for both alleles. The digestion of the G. gallus, amplicons split the CHD-1Z allele into two fragments (of 320 and 80 bp), while CHD-1W remained intact. Thus, the male exhibited two bands (digested CHD- 1Z) and the female three bands (undigested CHD-1W and digested CHD-1Z). Applying this RFLP method on DNA derived from blood, 9 of the 24 petrels were found to be male, while 15 were females. The same results were obtained using feathers as the source of DNA. To our knowledge, this is the first report of molecular method for sexing this species. The potential of sexing this petrel from feathers is remarkable as it minimizes blood sampling induced stress. This method could be used to reinforce the conservation efforts for this bird, to investigate population sex ratios and to develop new conservation strategies.

Dos nuevas mutaciones en el gen que codifica la alfa-glucosidasa ácida en un adolescente con enfermedad de Pompe de inicio tardío / Two new mutations in the gene that codes for acid alpha-glucosidase in an adolescent with late-onset Pompe disease

Introducción. La glucogenosis tipo II o enfermedad de Pompe es una enfermedad lisosomal con un patrón de herencia autosómico recesivo. La enfermedad de Pompe de inicio tardío es una miopatía metabólica progresiva causada por una disminución de la actividad de la enzima alfa-glucosidasa ácida (GAA), lo que origina una disminución de la degradación y posterior acúmulo del glucógeno dentro de los lisosomas y el citoplasma celular. Caso clínico. Adolescente venezolano, de 16 años, diagnosticado de glucogenosis tipo II o enfermedad de Pompe, de comienzo tardío, basado en la clínica del paciente y los hallazgos bioquímicos. La atrofia muscular de los miembros superiores e inferiores era evidente y presentaba maniobra de Gowers positiva. Los niveles séricos de creatincinasa eran elevados. Su capacidad funcional respiratoria estaba disminuida. La cuantificación de la actividad enzimática de la GAA en papel de filtro no mostraba una disminución significativa de la actividad. El análisis genético molecular reveló la existencia de dos mutaciones en condición homocigótica en el gen GAA, c.547-67C>G y c.547-39T>G, ambas en el exón 2 del cromosoma 17. De acuerdo con la base de datos del genoma humano y la revisión emprendida, los cambios detectados en este paciente representan nuevas mutaciones en el gen GAA. Esta afirmación está en concordancia con la clínica y cambios bioquímicos encontrados en el paciente. Conclusión. Es obligatorio el estudio genético molecular en un paciente en el que se sospecha la enfermedad (AU)

Introduction. Glycogen storage disease type II, or Pompe disease, is a lysosomal disease with an autosomal recessive pattern of inheritance. Late-onset Pompe disease is a progressive metabolic myopathy caused by decreased activity of the enzyme acid alpha-glucosidase (GAA), which gives rise to reduced degradation and later accumulation of glycogen in the lysosomes and cell cytoplasm. Case report. A 16-year-old Venezuelan male, diagnosed with late-onset glycogen storage disease type II, or Pompe disease, based on the patient’s clinical picture and the biochemical findings. The patient presented unmistakable signs of muscular atrophy in the upper and lower limbs, as well as positive Gowers’ sign. Levels of creatinkinase in serum were high. His functional respiratory capacity was diminished. The quantification of the enzymatic activity of acid alpha-glucosidase on filter paper did not show any significant decrease in activity. A molecular genetic analysis revealed the existence of two homozygotic mutations in the gene GAA, c.547-67C>G and c.547-39T>G, both on exon 2 of chromosome 17. According to the human genome database and the review that was undertaken, the changes detected in this patient represent new mutations in the acid alpha-glucosidase gene, GAA. This claim is in agreement with the clinical features and biochemical changes found in the patient. Conclusion. A molecular genetic study is mandatory in patients suspected of having this disease (AU)

[Improving a hospital's supply chain through lean management]. / Mejorando la cadena de suministro en un hospital mediante la gestión Lean.

OBJECTIVES: Supply management is an area where hospitals have significant opportunities for improvement. The main objective of this paper has been to analyze how the application of Lean principles can improve logistics costs and user satisfaction. In connection with satisfaction, it also aimed to examine which aspects of the service define it and check for differences between different groups of users. METHODS: The results of an experience to reorganize the hospital logistic system based on some Lean principles have been studied. This is therefore a case study, which combine different methods of data collection. The logistics cost calculation was carried out using the full costing method. To measure satisfaction of healthcare personnel, the internal logistics service users, an anonymous survey was conducted. Processing of the data obtained from the survey have included exploratory analysis, factor analysis and ANOVAs. RESULTS: The data have showed an improvement in logistics management after the implementation of Lean principles. Logistics costs were reduced and the satisfaction level of the internal users with the new logistics system was increased. Some differences in the degree of satisfaction by different groups of users were also detected, although they did not seem to distinguish between different aspects of logistic service. CONCLUSIONS: The analyzed experience shows the applicability and suitability of Lean principles to improve logistics operational costs and increase user satisfaction.

Gestión Lean en logística de hospitales: estudio de un caso / Lean logistics management in healthcare: a case study

Objetivo. Estudiar la aplicabilidad de los principios de la gestión Lean a la gestión de la cadena de suministros de un hospital. En concreto, tratamos de conocer qué prácticas y principios de Lean son aplicables, los beneficios que se pueden obtener y las principales barreras para su aplicación. La gestión de la cadena de suministros de los hospitales es un tema importante, tanto por su incidencia en la calidad asistencial como por su impacto en los costes. Métodos. Este trabajo se basa en un estudio de caso durante el periodo 2005-2010. Ámbito: Hospital Virgen Macarena de Sevilla. Proceso de implantación de un plan integral de gestión logística basado en la aplicación de principios Lean y en el desarrollo de inversiones tecnológicas. Resultados. La implantación del plan integral ha reducido los inventarios, disminuido los plazos de entrega y mejorado la calidad del servicio. Asimismo, se han producido otras mejoras importantes: mejora en la satisfacción de los trabajadores e incremento de la productividad del personal, tanto sanitario como del dedicado a tareas logísticas. Conclusiones. La experiencia analizada ha permitido comprobar la aplicabilidad e idoneidad de los principios Lean y de algunas de sus técnicas a la gestión de la logística de hospitales. También se han identificado algunas de las principales dificultades que pueden presentarse(AU)

Objective. To study the applicability of the principles of Lean Production to manage the supply chain of a hospital. In particular, to determine which Lean practices and principles are applicable, the benefits obtained and the main barriers for its implementation. Managing the hospital supply chain is an important issue, both for its effect on the quality of care and its impact on costs. Methods. This study is based on a case study. Study period: 2005-10. Scope: Hospital Virgen Macarena in Seville. Process of implementing a comprehensive logistics management plan based on Lean principles and technological investments. Results. The implementation of the comprehensive plan has reduced inventory, decreased lead times and improved service quality. Also, there have been other important improvements: enhanced employee satisfaction and increased staff productivity, both dedicated to health and the logistics. Conclusions. The experience analysed has shown the applicability and appropriateness of Lean principles and some of its techniques in managing the logistics of hospitals. It also identifies some of the main difficulties that may arise(AU)

[Lean logistics management in healthcare: a case study]. / Gestión Lean en logística de hospitales: estudio de un caso.

OBJECTIVE: To study the applicability of the principles of Lean Production to manage the supply chain of a hospital. In particular, to determine which Lean practices and principles are applicable, the benefits obtained and the main barriers for its implementation. Managing the hospital supply chain is an important issue, both for its effect on the quality of care and its impact on costs. METHODS: This study is based on a case study. STUDY PERIOD: 2005-10. SCOPE: Hospital Virgen Macarena in Seville. Process of implementing a comprehensive logistics management plan based on Lean principles and technological investments. RESULTS: The implementation of the comprehensive plan has reduced inventory, decreased lead times and improved service quality. Also, there have been other important improvements: enhanced employee satisfaction and increased staff productivity, both dedicated to health and the logistics. CONCLUSIONS: The experience analysed has shown the applicability and appropriateness of Lean principles and some of its techniques in managing the logistics of hospitals. It also identifies some of the main difficulties that may arise.

Reacción en cadena de la polimerasa vs. serología en el Screening de citomegalovirus en mujeres embarazadas y sus recién nacidos / Polymerase chain reaction vs. CMV serology test in pregnant women and their offspring

Antecedentes: la afectación por Citomegalovirus es la causa más común de infección intrauterina. Objetivo: determinar la sensibilidad y especificidad del examen serológico versus la reacción en cadena de polimerasa para el diagnóstico de infección por Citomegalovirus en mujeres embarazadas y recién nacidos. Metodología: se tomaron 90 muestras de sangre periférica de mujeres embarazadas en trabajo de parto y 90 muestras de sangre de cordón umbilical de sus respectivos hijos, las cuales se analizaron por ImmunoLISA para anti CMV IgM y luego se realizó Nested PCR, ambos resultados fueron comparados estadísticamente. Resultados: la prevalencia de Citomegalovirus del grupo de madres fue por 15 en PCR y 10 en serología. En los recién nacidos la prevalencia fue de por 33 en PCR y el 44 para anti CMV IgM. La tasa de transmisión vertical observada de los analizados por serología fue del 37 y del 15 por PCR. El 91 (serología) y 93 (PCR) de los recién nacidos infectados fueron de madres aparentemente sanas. Con respecto a la PCR la IgM presenta una sensibilidad del 56 y una especificidad del 81. Conclusión: la PCR es un método rápido, sensible y específico que detecta la presencia del virus antes que la IgM, para el diagnóstico de infección congénita por CMV y para evaluar la tasa de transmisión vertical.

A provider-based water planning and management model--WaterSim 4.0--for the Phoenix Metropolitan Area.

Uncertainty in future water supplies for the Phoenix Metropolitan Area (Phoenix) are exacerbated by the near certainty of increased, future water demands; water demand may increase eightfold or more by 2030 for some communities. We developed a provider-based water management and planning model for Phoenix termed WaterSim 4.0. The model combines a FORTRAN library with Microsoft C# to simulate the spatial and temporal dynamics of current and projected future water supply and demand as influenced by population demographics, climatic uncertainty, and groundwater availability. This paper describes model development and rationale. Water providers receive surface water, groundwater, or both depending on their portfolio. Runoff from two riverine systems supplies surface water to Phoenix while three alluvial layers that underlie the area provide groundwater. Water demand was estimated using two approaches. One approach used residential density, population projections, water duties, and acreage. A second approach used per capita water consumption and separate population growth estimates. Simulated estimates of initial groundwater for each provider were obtained as outputs from the Arizona Department of Water Resources (ADWR) Salt River Valley groundwater flow model (GFM). We compared simulated estimates of water storage with empirical estimates for modeled reservoirs as a test of model performance. In simulations we modified runoff by 80%-110% of the historical estimates, in 5% intervals, to examine provider-specific responses to altered surface water availability for 33 large water providers over a 25-year period (2010-2035). Two metrics were used to differentiate their response: (1) we examined groundwater reliance (GWR; that proportion of a providers' portfolio dependent upon groundwater) from the runoff sensitivity analysis, and (2) we used 100% of the historical runoff simulations to examine the cumulative groundwater withdrawals for each provider. Four groups of water providers were identified, and discussed. Water portfolios most reliant on Colorado River water may be most sensitive to potential reductions in surface water supplies. Groundwater depletions were greatest for communities who were either 100% dependent upon groundwater (urban periphery), or nearly so, coupled with high water demand projections. On-going model development includes linking WaterSim 4.0 to the GFM in order to more precisely model provider-specific estimates of groundwater, and provider-based policy options that will enable "what-if" scenarios to examine policy trade-offs and long-term sustainability of water portfolios.

First Report of Passalora Leaf Spot Caused by Passalora bougainvilleae on Bougainvillea in Mexico.

Bougainvillea (Bougainvillea spectabilis Willd) growing in 28 gardens during 2009 showed 100% disease incidence and 3 to 7% disease severity. Bougainvilleas with white flowers were the most affected. Symptoms consisted of light brown spots with dark brown margins visible on adaxial and abaxial sides of the leaves. Spots were circular, 2 to 7 mm in diameter, often surrounded by a chlorotic halo, and delimited by major leaf veins. Single-spore cultures were incubated at 24°C under near UV light for 7 days to obtain conidia. Pathogenicity was confirmed by spraying a conidial suspension (1 × 104 spores/ml) on leaves of potted bougainvillea plants (white, red, yellow, and purple flowers), incubating the plants in a dew chamber for 48 h and maintaining them in a greenhouse (20 to 24°C). Identical symptoms to those observed at the residential gardens appeared on inoculated plants after 45 to 60 days. The fungus was reisolated from inoculated plants that showed typical symptoms. No symptoms developed on control plants treated with sterile distilled water. The fungus produced distinct stromata that were dark brown, spherical to irregular, and 20 to 24 µm in diameter. Conidiophores were simple, born from the stromata, loose to dense fascicles, brown, straight to curved, not branched, zero to two septate, 14 × 2 µm, with two to four conspicuous and darkened scars. The conidia formed singly, were brown, broad, ellipsoid, obclavate, straight to curved with three to four septa, 40 × 4 µm, and finely verrucous with thick hilum at the end. Fungal DNA from the single-spore cultures was obtained using a commercial DNA Extraction Kit (Qiagen, Valencia, CA); ribosomal DNA was amplified with ITS5 and ITS4 primers and sequenced. The sequence was deposited at the National Center for Biotechnology Information Database (GenBank Accession Nos. HQ231216 and HQ231217). The symptoms (4), morphological characteristics (1,2,4), and pathogenicity test confirm the identity of the fungus as Passalora bougainvilleae (Muntañola) Castañeda & Braun (= Cercosporidium bougainvilleae Muntañola). This pathogen has been reported from Argentina, Brazil, Brunei, China, Cuba, El Salvador, India, Indonesia, Jamaica, Japan, Thailand, the United States, and Venezuela (3). To our knowledge, this is the first report of this disease on B. spectabilis Willd in Mexico. P. bougainvilleae may become an important disease of bougainvillea plants in tropical and subtropical areas of Mexico. References: (1) U. Braun and R. R. Castañeda. Cryptogam. Bot. 2/3:289, 1991. (2) M. B. Ellis. More Dematiaceous Hypomycetes. Commonwealth Mycological Institute, Kew, Surrey, UK, 1976. (3) C. Nakashima et al. Fungal Divers. 26:257, 2007. (4) K. L. Nechet and B. A. Halfeld-Vieira. Acta Amazonica 38:585, 2008.

Neumonía por Rhodococcus equi en un paciente con infección por el VIH. A propósito de un caso / Rhodococcus equi neumonia in a HIV infected patient: a case report

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First Report of Cercospora Leaf Spot Caused by Cercospora apii (= C. molucellae) on Bells-of-Ireland (Molucella laevis) in Mexico.

In late 2007, a new disease was found in commercial cutflower fields of bells-of-Ireland (Molucella laevis L.) in Texcoco, Mexico. Four plantings surveyed during this time had 100% incidence. A few spots on cutflowers make them unmarketable. Symptoms consisted of gray-green spots on leaves, calyxes, and stems, which turned brown with age. Spots were initially circular to oval, delimited by major leaf veins, and were visible on both adaxial and abaxial sides of the leaves. A Cercospora species was consistently associated with the spots. The fungus was isolated on V8 agar medium. Three single-spore cultures were obtained from isolation cultures. Cultures were incubated at 24°C under near-UV light for 7 days. Pathogenicity was confirmed by spraying a conidial suspension (1 × 104 condia/ml) on leaves of 16 potted M. laevis plants, incubating the plants in a dew chamber for 48 h, and maintaining them in a greenhouse (20 to 24°C). Identical symptoms to those observed in the field appeared on all inoculated plants after 2 weeks. No symptoms developed on control plants treated with autoclaved distilled water. The pathogenicity test was repeated twice with similar results. The fungus produced erumpent stromata, which were dark brown, spherical to irregular, 10 to 26 µm diameter, and giving rise to fascicles of five to nine divergent conidiophores, which were clear brown, paler near the subtruncate apex, straight to curved, not branched, rarely geniculate with two to four septa, and 57 × 3.4 µm. The conidia were formed singly, hyaline, acicular, base truncate, tip acute, straight to curved with 11 to 19 septa, and 172 × 3.5 µm. Fungal DNA from single-spore cultures was obtained with a commercial extraction kit (Qiagen, Hilden, Germany), amplified with ITS5 and ITS4 primers, and sequenced. The sequence, deposited at the National Center for Biotechnology Information Database (GenBank Accession No. EU564808), aligned almost perfectly (99% identity) to the bells-of-Ireland isolates from California (GenBank Accession Nos. AY156918 and AY156919) and New Zealand (Accession No. DQ233321). A 176-bp species-specific fragment was amplified with CercoCal-apii primers but not with CercoCal-beta or CercoCal-sp primers. These results, coupled with the morphological characteristics (1) and pathogenicity test, confirm the identity of the fungus as Cercospora apii sensu lato (including C. molucellae) (2,3,4). Although C. apii sensu lato has been reported on other hosts in Mexico (1,2), to our knowledge, this is the first report of this disease on M. laevis plants in this country. References: (1) C. Chupp. A Monograph of the Fungus Cercospora. Cornell University Press, Ithaca, NY, 1954. (2) P. W. Crous and U. Braun. CBS Biodiversity Series 1:1, 2003. (3) M. Groenewald et al. Phytopathology 95:951, 2005. (4) S. T Koike et al. Plant Dis. 87:203, 2003.

Valoración manométrica del esófago de pacientes operados de acalasia mediante cirugía laparoscópica / Manometric assessment of the esophagus in patients operated on of achalasia by laparoscopic surgery

La acalasia esofágica es un trastorno motor primario con ausencia de peristaltismo e incapacidad de relajación del esfínter esofágico inferior. El presente estudio tuvo como objetivo comparar la evolución clínica y las características manométricas del esófago de pacientes con acalasia esofágica, antes y después cirugía laparoscópica. Se realizó un estudio prospectivo descriptivo con 17 pacientes (6 del sexo masculino y 11 del femenino), con edad comprendida entre 38 y 70 años y diagnóstico radiológico y endoscópico de acalasia esofágica, confirmado por estudio manométrico. Posteriormente, estos pacientes fueron sometidos a tratamiento quirúrgico, mediante esofagocardiomiotomía de Heller con funduplicatura antirreflujo de Dor o Toupet, por videolaparoscopia de forma aleatoria. A todos se les realizó manometría esofágica evolutiva entre los 6 y 18 meses después de la operación. Se encontró notable mejoría clínica en todos los pacientes, aunque persistió una disfagia ocasional mínima a sólidos en el 64,7 por ciento y dolor retroesternal ligero en el 47 por ciento. La presión del esfínter esofágico inferior disminuyó de X= 47,7 mm Hg a X= 17,5 mm Hg (p < 0,01). La relajación del esfínter esofágico inferior aumentó de X= 59 por ciento a X= 75,5 por ciento. (p < 0,01). La presión intraesofágica se normalizó en el 70,6 por ciento de los casos, (p < 0,05). Persistió el aperistaltismo en los pacientes operados y asimetría del esfínter esofágico inferior en el 82,4 por ciento. Tras la valoración clínica y manométrica, se consideraron satisfactorios los resultados de la cirugía laparoscópica en el grupo estudiado(AU)

Esophageal achalasia is a primary motor disorder with abscence of peristaltism and incapacity for relaxation of the lower esophageal sphincter. The present study was aimed at comparing the clinical evolution and manommetric characteristics of the esophagus of patients with esophageal achalasia before and after laparoscopic surgery. A prospective descriptive study was conducted in 17 patients (6 males and 11 females) aged 38-70 with radiological and endoscopic diagnosis of esophageal achalasia confirmed by manometric study. Later on, these patients underwent surgical treatment by Heller esophagocardiogram with Toupet or Dor's antireflux funduplication by randomized video-assisted laparoscopy. Evolutive esophageal manometry was performed in all of them between 6 and 18 months after surgery. A marked clinical improvement was found in all the patients, although a minimal occasional dysphagia to solids persisted in 64,7 percent, and mild retrosternal pain in 47 percent. The pressure of the lower esophageal sphincter decreased from X= 47,7 mm Hg to X= 17,5 mm Hg (p < 0.01).The relaxation of the lower esophageal sphincter increased from X= 59 percent to X= 75,5 percent. (p < 0.01).The intraesophageal pressure was normal in 70,6 percent of the cases, (p < 0.05). Aperistaltism persisted in the operated on patients and the asymmetry of the esophageal sphincter in 82,4. The results of laparoscopic surgery in the studied group were considered satisfactory after the clinical and manometric assessment..(AU)

Valoración manométrica del esófago de pacientes operados de acalasia mediante cirugía laparoscópica / Manometric assessment of the esophagus in patients operated on of achalasia by laparoscopic surgery

La acalasia esofágica es un trastorno motor primario con ausencia de peristaltismo e incapacidad de relajación del esfínter esofágico inferior. El presente estudio tuvo como objetivo comparar la evolución clínica y las características manométricas del esófago de pacientes con acalasia esofágica, antes y después cirugía laparoscópica. Se realizó un estudio prospectivo descriptivo con 17 pacientes (6 del sexo masculino y 11 del femenino), con edad comprendida entre 38 y 70 años y diagnóstico radiológico y endoscópico de acalasia esofágica, confirmado por estudio manométrico. Posteriormente, estos pacientes fueron sometidos a tratamiento quirúrgico, mediante esofagocardiomiotomía de Heller con funduplicatura antirreflujo de Dor o Toupet, por videolaparoscopia de forma aleatoria. A todos se les realizó manometría esofágica evolutiva entre los 6 y 18 meses después de la operación. Se encontró notable mejoría clínica en todos los pacientes, aunque persistió una disfagia ocasional mínima a sólidos en el 64,7 por ciento y dolor retroesternal ligero en el 47 por ciento. La presión del esfínter esofágico inferior disminuyó de X= 47,7 mm Hg a X= 17,5 mm Hg (p < 0,01). La relajación del esfínter esofágico inferior aumentó de X= 59 por ciento a X= 75,5 por ciento. (p < 0,01). La presión intraesofágica se normalizó en el 70,6 por ciento de los casos, (p < 0,05). Persistió el aperistaltismo en los pacientes operados y asimetría del esfínter esofágico inferior en el 82,4 por ciento. Tras la valoración clínica y manométrica, se consideraron satisfactorios los resultados de la cirugía laparoscópica en el grupo estudiado.

Esophageal achalasia is a primary motor disorder with abscence of peristaltism and incapacity for relaxation of the lower esophageal sphincter. The present study was aimed at comparing the clinical evolution and manommetric characteristics of the esophagus of patients with esophageal achalasia before and after laparoscopic surgery. A prospective descriptive study was conducted in 17 patients (6 males and 11 females) aged 38-70 with radiological and endoscopic diagnosis of esophageal achalasia confirmed by manometric study. Later on, these patients underwent surgical treatment by Heller esophagocardiogram with Toupet or Dor's antireflux funduplication by randomized video-assisted laparoscopy. Evolutive esophageal manometry was performed in all of them between 6 and 18 months after surgery. A marked clinical improvement was found in all the patients, although a minimal occasional dysphagia to solids persisted in 64,7 percent, and mild retrosternal pain in 47 percent. The pressure of the lower esophageal sphincter decreased from X= 47,7 mm Hg to X= 17,5 mm Hg (p < 0.01).The relaxation of the lower esophageal sphincter increased from X= 59 percent to X= 75,5 percent. (p < 0.01).The intraesophageal pressure was normal in 70,6 percent of the cases, (p < 0.05). Aperistaltism persisted in the operated on patients and the asymmetry of the esophageal sphincter in 82,4. The results of laparoscopic surgery in the studied group were considered satisfactory after the clinical and manometric assessment.

Neumonía por Rhodoccocus equi en paciente con infección por el VIH. A propósito de un caso / Rhodococcus equi pulmonary infection in an HIV-infected patient and radiological worsening following treatment. Case report

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