The effect of a cognitive training therapy based on stimulation of brain oscillations in patients with mild cognitive impairment in a Chilean sample: study protocol for a phase IIb, 2 × 3 mixed factorial, double-blind randomised controlled trial.

BACKGROUND: The ageing population has increased the prevalence of disabling and high-cost diseases, such as dementia and mild cognitive impairment (MCI). The latter can be considered a prodromal phase of some dementias and a critical stage for interventions to postpone the impairment of functionality. Working memory (WM) is a pivotal cognitive function, representing the fundamental element of executive functions. This project proposes an intervention protocol to enhance WM in these users, combining cognitive training with transcranial electrical stimulation of alternating current (tACS). This technique has been suggested to enhance the neuronal plasticity needed for cognitive processes involving oscillatory patterns. WM stands to benefit significantly from this approach, given its well-defined electrophysiological oscillations. Therefore, tACS could potentially boost WM in patients with neurodegenerative diseases. METHODS: This study is a phase IIb randomised, double-blind clinical trial with a 3-month follow-up period. The study participants will be 62 participants diagnosed with MCI, aged over 60, from Valparaíso, Chile. Participants will receive an intervention combining twelve cognitive training sessions with tACS. Participants will receive either tACS or placebo stimulation in eight out of twelve training sessions. Sessions will occur twice weekly over 6 weeks. The primary outcomes will be electroencephalographic measurements through the prefrontal theta oscillatory activity, while the secondary effects will be cognitive assessments of WM. The participants will be evaluated before, immediately after, and 3 months after the end of the intervention. DISCUSSION: The outcomes of this trial will add empirical evidence about the benefits and feasibility of an intervention that combines cognitive training with non-invasive brain stimulation. The objective is to contribute tools for optimal cognitive treatment in patients with MCI. To enhance WM capacity, postpone the impairment of functionality, and obtain a better quality of life. TRIAL REGISTRATION: ClinicalTrials.gov NCT05291208. Registered on 28 February 2022. ISRCTN87597719 retrospectively registered on 15 September 2023.

Oscillatory activity underlying cognitive performance in children and adolescents with autism: a systematic review.

Autism spectrum disorder (ASD) is a neurodevelopmental condition that exhibits a widely heterogeneous range of social and cognitive symptoms. This feature has challenged a broad comprehension of this neurodevelopmental disorder and therapeutic efforts to address its difficulties. Current therapeutic strategies have focused primarily on treating behavioral symptoms rather than on brain psychophysiology. During the past years, the emergence of non-invasive brain stimulation techniques (NIBS) has opened alternatives to the design of potential combined treatments focused on the neurophysiopathology of neuropsychiatric disorders like ASD. Such interventions require identifying the key brain mechanisms underlying the symptomatology and cognitive features. Evidence has shown alterations in oscillatory features of the neural ensembles associated with cognitive functions in ASD. In this line, we elaborated a systematic revision of the evidence of alterations in brain oscillations that underlie key cognitive processes that have been shown to be affected in ASD during childhood and adolescence, namely, social cognition, attention, working memory, inhibitory control, and cognitive flexibility. This knowledge could contribute to developing therapies based on NIBS to improve these processes in populations with ASD.

Guía práctica interinstitucional para el tratamiento del infarto agudo de miocardio / Interinstitutional clinical practice guidelines for the treatment of acute myocardial infarction

Resumen Introducción: México tiene la mortalidad más alta a 30 días por infarto agudo de miocardio (IAM), el cual constituye una de las principales causas de mortalidad en el país: 28 % versus 7.5 % del promedio de los países de la Organización para la Cooperación y el Desarrollo Económicos. Objetivo: Establecer las rutas críticas y las estrategias farmacológicas esenciales interinstitucionales para la atención de los pacientes con IAM en México, independientemente de su condición socioeconómica. Método: Se reunió a un grupo de expertos en diagnóstico y tratamiento de IAM, representantes de las principales instituciones públicas de salud de México, así como las sociedades cardiológicas mexicanas, Cruz Roja Mexicana y representantes de la Sociedad Española de Cardiología, con la finalidad de optimizar las estrategias con base en la mejor evidencia existente. Resultados: Se diseñó una guía de práctica clínica interinstitucional para el diagnóstico temprano y tratamiento oportuno del IAM con elevación del segmento ST, siguiendo el horizonte clínico de la enfermedad, con la propuesta de algoritmos que mejoren el pronóstico de los pacientes que acuden por IAM a los servicios de urgencias. Conclusión: Con la presente guía práctica, el grupo de expertos propone universalizar el diagnóstico y tratamiento en el IAM, independientemente de la condición socioeconómica del paciente.

Abstract Introduction: Mexico has the highest 30-day acute myocardial infarction (AMI) mortality rate: 28% versus 7.5% on average for the OECD countries, and it constitutes one of the main causes of mortality in the country. Objective: To establish critical pathways and essential interinstitutional pharmacological strategies for the care of patients with AMI in Mexico, regardless of their socioeconomic status. Method: A group of experts in AMI diagnosis and treatment, representatives of the main public health institutions in Mexico, as well as the Mexican cardiology societies, the Mexican Red Cross and representatives of the Spanish Society of Cardiology, were brought together in order to optimize strategies based on the best existing evidence. Results: An interinstitutional clinical practice guideline was designed for early diagnosis and timely treatment of AMI with ST elevation, following the clinical horizon of the disease, with the proposal of algorithms that improve the prognosis of patients who attend the emergency services due to an AMI. Conclusion: With these clinical practice guidelines, the group of experts proposes to universalize AMI diagnosis and treatment, regardless of patient socioeconomic status.

Excerpts from the documents of Mexican positions and recommendations in cardiovascular diseases and COVID-19.

The recommendations in which the Mexican Society of Cardiology (SMC) in conjunction with the National Association of Cardiologists of Mexico (ANCAM) as well as different Mexican medical associations linked to cardiology are presented, after a comprehensive and consensual review and analysis of the topics related to cardiovascular diseases in the COVID-19 pandemic. Scientific positions are analyzed and responsible recommendations on general measures are given to patients, with personal care, healthy eating, regular physical activity, actions in case of cardio-respiratory arrest, protection of the patient and health personnel as well as precise indications in the use of non-invasive cardiovascular imaging, prescription of medications, care in specific topics such as systemic arterial hypertension, heart failure, arrhythmias and acute coronary syndromes, in addition to emphasizing electrophysiology, interventionism, cardiac surgery and in cardiac rehabilitation. The main interest is to provide the medical community with a general orientation on what to do in daily practice and patients with cardiovascular diseases in the setting of this unprecedented epidemiological crisis of COVID-19.

Se presentan las recomendaciones en las cuales la Sociedad Mexicana de Cardiología (SMC) en conjunto con la Asociación Nacional de Cardiólogos de México (ANCAM), así como diferentes asociaciones médicas mexicanas vinculadas con la cardiología, después de una revisión y análisis exhaustivo y consensuado sobre los tópicos relacionados con las enfermedades cardiovasculares en la pandemia de COVID-19, se analizan posturas científicas y se dan recomendaciones responsables sobre medidas generales a los pacientes, con cuidados personales, alimentación saludable, actividad física regular, acciones en caso de paro cardiorrespiratorio, la protección del paciente y del personal de salud así como las indicaciones precisas en el uso de la imagen cardiovascular no invasiva, la prescripción de medicamentos, cuidados en tópicos específicos como en la hipertensión arterial sistémica, insuficiencia cardiaca, arritmias y síndromes coronarios agudos, además de hacer énfasis en los procedimientos de electrofisiología, intervencionismo, cirugía cardiaca y en la rehabilitación cardiaca. El interés principal es brindar a la comunidad médica una orientación general sobre el quehacer en la práctica cotidiana y pacientes con enfermedades cardiovasculares en el escenario esta crisis epidemiológica sin precedentes de COVID-19.

Interinstitutional clinical practice guidelines for the treatment of acute myocardial infarction.

INTRODUCTION: Mexico has the highest 30-day mortality due to acute myocardial infarction (AMI), which constitutes one of the main causes of mortality in the country: 28 % versus 7.5 % on average for the Organization for Economic Co-operation and Development member countries. OBJECTIVE: To establish critical pathways and essential interinstitutional pharmacological strategies for the care of patients with AMI in Mexico, regardless of their socioeconomic status. METHOD: A group of experts in AMI diagnosis and treatment, representatives of the main public health institutions in Mexico, as well as the Mexican cardiology societies, the Mexican Red Cross and representatives of the Spanish Society of Cardiology, were brought together in order to optimize strategies based on the best existing evidence. RESULTS: An interinstitutional clinical practice guideline was designed for early diagnosis and timely treatment of AMI with ST-segment elevation, following the clinical horizon of the disease, with the proposal of algorithms that improve the prognosis of patients who attend the emergency services due to an AMI. CONCLUSION: With these clinical practice guidelines, the group of experts proposes to universalize AMI diagnosis and treatment, regardless of patient socioeconomic status. INTRODUCCIÓN: México tiene la mortalidad más alta a 30 días por infarto agudo de miocardio (IAM), el cual constituye una de las principales causas de mortalidad en el país: 28 % versus 7.5 % del promedio de los países de la Organización para la Cooperación y el Desarrollo Económicos. OBJETIVO: Establecer las rutas críticas y las estrategias farmacológicas esenciales interinstitucionales para la atención de los pacientes con IAM en México, independientemente de su condición socioeconómica. MÉTODO: Se reunió a un grupo de expertos en diagnóstico y tratamiento de IAM, representantes de las principales instituciones públicas de salud de México, así como las sociedades cardiológicas mexicanas, Cruz Roja Mexicana y representantes de la Sociedad Española de Cardiología con la finalidad de optimizar las estrategias con base en la mejor evidencia existente. RESULTADOS: Se diseñó una guía de práctica clínica interinstitucional para el diagnóstico temprano y tratamiento oportuno del IAM con elevación del segmento ST, siguiendo el horizonte clínico de la enfermedad, con la propuesta de algoritmos que mejoren el pronóstico de los pacientes que acuden por IAM a los servicios de urgencias. CONCLUSIÓN: Con la presente guía práctica, el grupo de expertos propone universalizar el diagnóstico y tratamiento en el IAM, independientemente de la condición socioeconómica del paciente.

Choledochus angulation by T-tube. / Angulación de colédoco por sonda en T.

BACKGROUND: The presence of bile stasis is a frequent mechanism for presenting choledocholithiasis and recurrence of this one. The bile duct angulation, also known as "elbow sign," could be a risk factor for reducing the flow of bile and forming stones and it has been reported as a consequence secondary to the use of T-tube. The recurrence of choledocholithiasis without the use of T-tube in the bile duct is minimal, whereas in those with T-tube is four times higher in bile duct exploration surgeries. We present a case report of a patient who underwent T-tube laparoscopic bile duct exploration surgery, who had a bile duct angulation and residual choledocholithiasis as a complication. CASE REPORT: 34-yeard-old female, who presented acute cholecystitis and underwent cholecystectomy. In this operation it was detected choledocholithiasis, which is why it was carried out a T-tube bile duct exploration surgery for acute cholecystitis, without solving the choledocholithiasis condition. Afterwards, she had three endoscopic retrograde cholangiopancreatography procedures, requiring endoscopic hemoclip. Four months later, she was referred to a third-level hospital for definitive treatment with unsolved choledocholithiasis. CONCLUSIONS: The bile duct angulation by T-tube is unusual and it favors bile duct dilatation, stasis of bile pigments and new stones formation. We consider that the best surgical option is the biliary bypass.

INTRODUCCIÓN: La presencia de estasis biliar es un mecanismo frecuente para presentar coledocolitiasis y su recurrencia. La angulación del conducto biliar, también llamada «signo del codo¼, puede ser un factor de riesgo para disminuir el flujo biliar y propiciar la formación de litos, y ha sido reportada como una complicación del uso de sonda en T. La posibilidad de recurrencia de la coledocolitiasis sin colocación de sonda en T en una exploración quirúrgica de vía biliar es mínima, y en aquellas con sonda es cuatro veces mayor. Se presenta el caso de una paciente operada de exploración de la vía biliar con colocación de sonda en T que presentó como complicación una angulación de la vía biliar y coledocolitiasis residual. CASO CLÍNICO: Mujer de 34 años con colecistitis crónica litiásica agudizada que fue sometida a colecistectomía. En la intervención se notó la presencia de coledocolitiasis, por lo que se hizo una exploración de vía biliar y se colocó una sonda en T, sin resolver el cuadro de coledocolitiasis. Posteriormente se hicieron tres colangiopancreatografías retrógradas endoscópicas que fueron fallidas, lo cual ameritó la colocación de hemoclip por sangrado. Cuatro meses después, la paciente fue referida a tercer nivel con diagnóstico de coledocolitiasis no resuelta para tratamiento definitivo. CONCLUSIONES: La angulación de la vía biliar por sonda en T es poco frecuente y favorece la dilatación del conducto biliar común, la estasis de pigmentos biliares y la formación de litos. Consideramos que la mejor opción quirúrgica es la derivación biliodigestiva.

Extractos de los documentos de posicionamientos y recomendaciones mexicanas en enfermedades cardiovasculares y COVID-19 / Excerpts from the documents of Mexican positions and recommendations in cardiovascular diseases and COVID-19

Resumen Se presentan las recomendaciones en las cuales la Sociedad Mexicana de Cardiología (SMC) en conjunto con la Asociación Nacional de Cardiólogos de México (ANCAM), así como diferentes asociaciones médicas mexicanas vinculadas con la cardiología, después de una revisión y análisis exhaustivo y consensuado sobre los tópicos relacionados con las enfermedades cardiovasculares en la pandemia de COVID-19, se analizan posturas científicas y se dan recomendaciones responsables sobre medidas generales a los pacientes, con cuidados personales, alimentación saludable, actividad física regular, acciones en caso de paro cardiorrespiratorio, la protección del paciente y del personal de salud así como las indicaciones precisas en el uso de la imagen cardiovascular no invasiva, la prescripción de medicamentos, cuidados en tópicos específicos como en la hipertensión arterial sistémica, insuficiencia cardiaca, arritmias y síndromes coronarios agudos, además de hacer énfasis en los procedimientos de electrofisiología, intervencionismo, cirugía cardiaca y en la rehabilitación cardiaca. El interés principal es brindar a la comunidad médica una orientación general sobre el quehacer en la práctica cotidiana y pacientes con enfermedades cardiovasculares en el escenario esta crisis epidemiológica sin precedentes de COVID-19.

Abstract The recommendations in which the Mexican Society of Cardiology (SMC) in conjunction with the National Association of Cardiologists of Mexico (ANCAM) as well as different Mexican medical associations linked to cardiology are presented, after a comprehensive and consensual review and analysis of the topics related to cardiovascular diseases in the COVID-19 pandemic. Scientific positions are analyzed and responsible recommendations on general measures are given to patients, with personal care, healthy eating, regular physical activity, actions in case of cardio-respiratory arrest, protection of the patient and health personnel as well as precise indications in the use of non-invasive cardiovascular imaging, prescription of medications, care in specific topics such as systemic arterial hypertension, heart failure, arrhythmias and acute coronary syndromes, in addition to emphasizing electrophysiology, interventionism, cardiac surgery and in cardiac rehabilitation. The main interest is to provide the medical community with a general orientation on what to do in daily practice and patients with cardiovascular diseases in the setting of this unprecedented epidemiological crisis of COVID-19.

[Esophageal bronchogenic cyst: an uncommon cause of dysphagia in adults. Case report and literature review]. / Quiste broncogénico esofágico: una causa poco común de disfagia en adultos. Reporte de caso y revisión de la literatura.

BACKGRONUND: Bronchogenic cysts result from abnormal budding of the primitive tracheobronchial tube and are rare congenital cystic lesions. The location of the cyst depends on the embryological stage of abnormal budding. Although periesophageal bronchogenic cysts have been frequently reported, a completely intramural cyst is very rare. CLINICAL CASE: A 42-year-old female patient, a three-month course with retrosternal pain associated with food intake, accompanied by intermittent dysphagia to solids. Esophagogram, high resolution thoracic tomography and endoscopic ultrasound are performed, concluding a probable esophageal bronchogenic cyst. Resection is performed by video-assisted thoracic surgery, without complications. Patient presents with adequate evolution and complete remission of the symptomatology. CONCLUSION: Bronchogenic cysts of the esophageal wall are extremely uncommon lesions. Its surgical treatment is indicated to be symptomatic; video-assisted thoracoscopic surgery resection is of choice, with excellent long-term results and minimal morbidity.

ANTECEDENTES: Los quistes broncogénicos son lesiones congénitas raras que resultan de brotes anormales del tubo traqueobronquial primitivo. La localización del quiste depende de la etapa embriológica del brote anormal. Aunque los quistes broncogénicos periesofágicos han sido frecuentemente reportados, un quiste completamente intramural es muy raro. CASO CLÍNICO: Mujer de 42 años con cuadro de 3 meses de evolución, con dolor retroesternal asociado a la ingestión de alimentos, acompañado de disfagia intermitente a sólidos. Se realiza esofagograma, tomografía de tórax de alta resolución y ultrasonido endoscópico, que concluyen probable quiste broncogénico esofágico. Se realiza resección por cirugía torácica videoasistida, sin complicaciones. La paciente cursa con adecuada evolución y remisión completa de la sintomatología. CONCLUSIÓN: Los quistes broncogénicos de la pared esofágica son lesiones extremadamente poco comunes. Está indicado su tratamiento quirúrgico al ser sintomáticos; es de elección la resección por cirugía torácica videoasistida, con excelentes resultados a largo plazo y mínima morbilidad.

High Serum Levels of High-Mobility Group Box 1 (HMGB1) and Low Levels of Heat Shock Protein 70 (Hsp70) are Associated with Poor Prognosis in Patients with Acute Pancreatitis.

INTRODUCTION: Cell damage in Acute Pancreatitis (AP) lead to release of cytokines and HMGB1 and Hsp70. While Hsp70 plays a role in cytoprotection, when released to extracellular milieu constitutes, as HMGB1, a danger signal and trigger pro-inflammatory responses. These molecules seem to be related to the clinical progression; but because no evidence exists about them as molecular network in AP development, we quantify HSP70, HMGB1, and cytokines in patients with AP and search for correlations with severity and prognosis. METHODS: Fifteen patients with AP were included. The average age was 52 years. Six patients had mild pancreatitis, 4 were moderately severe and 5 with a severe form. Blood samples were taken within the first 24 h, at 3d and 7d from the start. Serum HMGB1 and Hsp70 were determined using ELISA; TNF-α, IL-1ß, IL-6, IL-8, IL-10 and IL-12p70 were determined by bead based immuassay. RESULTS: Of all 15 patients recruited, 4 were women. Eight patients had APACHEII score higher than 8. Two patients died from AP related complications. Increase in serum HMGB1 and decrease of Hsp70 were associated with the severity and mortality. TNF-α, IL-6 and IL-8 were higher in patients that did not survive, in those with an APACHE II >8, and in those with severe AP. CONCLUSIONS: High HMGB1 and low Hsp70 were associated with poor prognosis. Hsp70 might play a protective role in AP. TNF-α, IL-6, IL-8, HMGB1 and Hsp70 during hospital admissions might serve to evaluate risk of death due to AP.

Effect of Oral ω3-Polyunsaturated Fatty Acids as a Complement Management to Control Fistula Output and Inflammation in Patients With Digestive Fistula.

BACKGROUND: The presence of digestive fistula involves chronic inflammation and fibrosis. It has been reported that ω3-polyunsaturated fatty acids stimulate the resolution of inflammation. AIM: Determine if the administration of oral ω3 reduces fistula output and the time required for fistula closure. METHODS: Forty-nine patients with postoperative fistula were randomly divided in two groups: 26 received conventional treatment and 23 received the conventional treatment supplemented with ω3 (540 mg eicosapentaenoic acid and 360 mg docosahexaenoic acid) for 35 days. Patients were monitored daily for fistula output and spontaneous closure. Additionally, serum pro-inflammatory cytokines and C-reactive protein were quantified in four patients with conventional and in seven patients with ω3 treatment. RESULTS: Patients with ω3 had significantly decreased fistula output from days 2 to 27, compared to control (p < 0.05). Spontaneous fistula closure was achieved in 15 patients (65%) in the ω3 group and in 14 (54%) in the control group. ω3-polyunsaturated fatty intake also decreased the serum concentrations of interleukin-6 and C-reactive protein (p < 0.05). CONCLUSIONS: Our results suggest that ω3 supplementation to conventional medical treatment decreases fistula output and reduces inflammation (interleukin-6 and C-reactive protein), and these effects may increase the efficiency of conventional medical treatment.

The Impact of a Good Season Start on Team Performance in Elite Handball.

The aim of the current study was (i) to identify how important was a good season start in relation to elite handball teams' performance, and (ii) to examine if this impact was related to the clubs' financial budget. The match performances and annual budgets of all teams were collected from the Spanish Professional Handball League during ten seasons. The dependent variable was the difference between the ranking of each team in accordance to the annual budget and the ranking of each team at the end of the season. A k-means cluster analysis classified the clubs according to their budget as High Range Budget Clubs (HRBC), Upper-Mid Range Budget Clubs (UMRBC), Lower-Mid Range Budget Clubs (LMRBC) and Low Range Budget Clubs (LRBC). Data were examined through linear regression models. Overall, the results suggested that the better the team performance at the beginning of the season, the better the ranking at the end of the season. Each position in the ranking above expected in accordance to the budget of the teams in Rounds 3, 4 or 5 improved by 0.47, 0.50 or 0.49, respectively, in the ranking at the end of the season (p<0.05). However, the impact of the effect depended on the clubs' annual budget. For UMRBC, LMRBC and LRBC a good start to the season had a positive effect on the final outcome (p<0.05). Nevertheless, for HRBC, a good or a bad start of the season did not explain their final position. These variables can be used to develop accurate models to estimate final rankings. UMRBC, LMRBC and LRBC can benefit from fine-tuning preseason planning in order to accelerate the acquisition of optimal performances.

Conditioned inhibition in preweanling rats.

Inhibitory conditioning is a very well established phenomenon in associative learning that has been demonstrated in both humans and adult animals. But in spite of the fact that this topic has generated much empirical and theoretical work, there are no published studies assessing inhibitory learning during the early ontogeny of the rat. In this study we test the possibility of finding conditioned inhibition in infant rats (Day 10) using a conditioned taste aversion procedure. We tested whether the consumption of saccharin (A) was reduced when paired with a LiCl injection compared to the presentation of saccharin in compound with a lemon odor (AX) without any aversive consequence. After training, retardation, and summation tests were conducted in order to evaluate the inhibitory properties of the lemon odor (X). The results of this study showed that in male pups, after conditioned inhibition training, stimulus X passed both retardation and summation tests. These results indicate that conditioned inhibition can be established in the early development of the rat, suggesting that animals at this stage of ontogeny have the capacity to acquire and to express inhibitory conditioning, although this effect appears to be sex-dependent.

Objetivos financieros y deportivos en la eficiencia del fútbol europeo / Financial and sport objectives in the efficiency of european football

El objetivo del presente estudio es medir la eficiencia de los principales equipos europeos considerando los objetivos financieros y deportivos, por lo que se utilizan el beneficio y el coeficiente UEFA como outputs. Un modelo alternativo es presentado bajo la premisa de la maximización de los resultados deportivos y la minimización de las pérdidas financieras. Los resultados muestran un amplio margen de mejora, especialmente en la gestión financiera

The goal of this study is to measure the efficiency of the major European football teams under financial and win objectives using profits and UEFA coefficient as outputs. An alternative model is presented maximizing wins and minimizing financial losses. Results show much room for improvement, especially in financial management

[Usefulness of hepatobiliary scintigraphy in the follow-up of patients with biliary reconstruction]. / Utilidad del colangiogamagrama en el seguimiento de pacientes con reconstrucción de vía biliar.

BACKGROUND: The relevance of biliary tract injury patients is not only related to diagnosis and treatment but also to follow-up for the possibility of late complications and medical and legal aspects. Hepatobiliary scintigraphy has played a principal roll in diagnosis of many hepatobiliary diseases. METHODS: We carried out a descriptive and retrospective study. Included were all patients with biliary tract injuries who underwent biliary reconstruction and liver biopsy. Clinical, laboratory exams and hepatobiliary scintigraphy follow-up was done. RESULTS: From January 2001 to december 2009 one hundred patients, sixty-five women and thirty-five men were registered. According to Strasberg's classification we had 13 % type E1, 17 % type E2, 38 % type E3 and 32 % type E4. All of them underwent biliary tract reconstruction, eighty-four Hepp-Couinaud type and sixteen conventional jejunum-hepatic anastomosis (Roux-Y). Liver biopsy demonstrated twelve patients with inflammation, forty-nine with cholestasis, nineteen with ductular proliferation and nineteen with fibrosis. When we compare pathologic results of liver biopsy with pre and postoperatively hepatobiliary scintigraphy we found significance in those patients with cholestasis and ductular proliferation in hepatobiliary scintigraphy elimination step, but none in those with inflammation and fibrosis. CONCLUSIONS: Hepatobiliary scintigraphy is an adequate study to the follow-up of patients who underwent hepatobiliary reconstruction been more significative in patients with cholestasis and ductular proliferation.

Introducción: la importancia de casos de lesión de vía biliar no solo involucra el diagnóstico y el tratamiento oportuno, sino también el seguimiento a largo plazo por la posibilidad de complicaciones tardías y los aspectos médico-legales. La medicina nuclear ha desempeñado un papel importante en el diagnóstico de múltiples enfermedades hepatobiliares. Métodos: estudio observacional, retrospectivo, transversal y analítico. Revisión de pacientes con lesión de vía biliar y sometidos a reconstrucción bilio-digestiva y biopsia hepática en la cirugía. Seguimiento clínico, con laboratorio y colangiogamagrama. Resultados: de enero de 2001 a diciembre de 2009 se evaluaron cien pacientes, treinta y cinco hombres y sesenta y cinco mujeres con edad promedio de 38.8 años. Los tipos de lesión de acuerdo con la Clasificación de Strasberg fueron: Tipo E1 (13 %); Tipo E2 (17 %); Tipo E3 (38 %), y Tipo E4 (32 %). Todos los pacientes fueron sometidos a cirugía reconstructiva de la vía biliar, 84 con técnica de Hepp-Couinaud y 16 pacientes con técnica convencional de hepático-yeyuno anastomosis en Y de Roux. Por biopsia hepática, doce pacientes con inflamación, cuarenta nueve colestasis, diecinueve ductopenias y diecinueve fibrosis. Conclusiones: la colangiogamagrafía, es un estudio adecuado en el seguimiento al valorar la captación y eliminación, su mejor utilidad es en pacientes con resultado histopatológico de colestasis y ductopenia.

[Bilateral and synchronous testicular teratoma: a case report and literature review]. / Teratoma testicular bilateral sincrónico: reporte de un caso y revisión de la literatura.

BACKGROUND: Testicular germ-cell carcinoma is the most frequent neoplasm in males aged 15 to 35 years old. It is bilateral in 2% to 3%, and synchronous in 20% to 25% of the cases. CLINICAL CASE: The case is presented of a 19 year-old male, with abdominal pain. Physical examination revealed abdominal mass in the umbilical region, and the computed tomography scan showed a retroperitoneal tumour, with α-fetoprotein, lactate dehydrogenase, and human chorionic gonadotropin above limits. Testicular ultrasound showed bilateral lesions. Exploratory laparotomy was performed, identifying an unresectable retroperitoneal tumour. Biopsies were taken, reporting mixed germ cell tumour composed of choriocarcinoma and embryonal carcinoma. Six cycles of chemotherapy were given, based on bleomycin, etoposide and cisplatin, with partial tumour response. Later on, the patient underwent bilateral radical orchiectomy, with pathology reporting a synchronous bilateral testicular teratoma. A second line of chemotherapy was given, based on vincristine, etoposide, ifosfamide and cisplatinum. Nevertheless, the disease progressed, with metastatic dissemination and the patient died. DISCUSSION: Germ cells tumours can present in primary extra-gonadal locations. It is difficult to distinguish a retroperitoneum primary germ cell tumour from metastatic disease of a clinically undetected gonadal tumour or one that has regressed, like the situation described in the case presented. CONCLUSIONS: Ninety percent of patients diagnosed with germ cell tumours can be cured. However, delay in diagnosis correlates with an advanced clinical stage and poor prognosis.

[Experience of the surgical management of the esophageal achalasia in a tertiary care hospital]. / Experiencia del manejo quirúrgico de la acalasia esofágica en un hospital de alta especialidad.

INTRODUCTION: Achalasia is a primary esophageal motor disorder. The most common symptoms are: dysphagia, chest pain, reflux and weight loss. The esophageal manometry is the standard for diagnosis. The aim of this paper is to determine the effectiveness of the surgical management in patients with achalasia in a tertiary care hospital. METHODS: A case series consisting of achalasia patients, treated surgically between January and December of 2011. Clinical charts were reviewed to obtain data and registries of the type of surgical procedure, morbidity and mortality. RESULTS: Fourteen patients were identified, with an average age of 49.1 years. The most common symptoms were: dysphagia, vomiting, weight loss and pyrosis. Eight open approaches were performed and six by laparoscopy, with an average length of cardiomyotomy of 9.4 cm. Eleven patients received an antireflux procedure. The effectiveness of procedures performed was 85.7 %. CONCLUSIONS: Surgical management offered at this tertiary care hospital does not differ from that reported in other case series, giving effectiveness and safety for patients with achalasia.

Introducción: la acalasia es un trastorno motor primario del esófago. La sintomatología más frecuente es la disfagia, dolor torácico, reflujo y pérdida de peso. La manometría esofágica es el estándar para su diagnóstico. El objetivo de este trabajo fue determinar la eficacia del manejo quirúrgico de los pacientes con acalasia en nuestro centro hospitalario. Métodos: se realizó un estudio de serie de casos en el que se incluyeron pacientes con acalasia tratados de manera quirúrgica entre enero y diciembre de 2011. Se revisaron los expedientes para obtener los datos y registros del tipo de procedimiento quirúrgico realizado, morbilidad y mortalidad. Resultados: se incluyeron 14 pacientes con edad promedio de 49.1 años. Los síntomas predominantes fueron: disfagia, vómito, pérdida de peso y pirosis. Se realizaron ocho abordajes abiertos y seis laparoscópicos, con una longitud media de cardiomiotomía de 9.4 cm. Once pacientes recibieron un procedimiento antirreflujo concomitante. La efectividad de los procedimientos realizados fue del 85.7 %. Conclusiones: el manejo quirúrgico ofrecido en nuestro centro no difiere de lo reportado en otras series de caso, lo que otorga efectividad y seguridad a los pacientes tratados con acalasia.

Implementation of intensity modulated radiotherapy for prostate cancer in a private radiotherapy service in Mexico.

Intensity modulated radiation therapy (IMRT) allows physicians to deliver higher conformal doses to the tumour, while avoiding adjacent structures. As a result the probability of tumour control is higher and toxicity may be reduced. However, implementation of IMRT is highly complex and requires a rigorous quality assurance (QA) program both before and during treatment. The present article describes the process of implementing IMRT for localized prostate cancer in a radiation therapy department. In our experience, IMRT implementation requires careful planning due to the need to simultaneously implement specialized software, multifaceted QA programs, and training of the multidisciplinary team. Establishing standardized protocols and ensuring close collaboration between a multidisciplinary team is challenging but essential.