Efectividad de los miniplatos inestables para la mejora del equilibrio en pacientes geriátricos institucionalizados con síndrome de desequilibrio posterior. Ensayo clínico aleatorizado / Effectiveness of unstable mini-boards to improve balance in institutionalised elderly people diagnosed with backward disequilibrium syndrome. Randomised controlled trial

Introducción y objetivos: El síndrome de desequilibrio posterior es un problema común entre los adultos mayores que los predispone a sufrir caídas. El objetivo del estudio es comprobar si el tratamiento con miniplatos inestables propuesto mejora la marcha y el equilibrio en pacientes geriátricos institucionalizados y diagnosticados de síndrome de desequilibrio posterior. Materiales y métodos: Ensayo clínico controlado aleatorizado, con ciego simple y 2 grupos. Los participantes fueron ancianos institucionalizados de entre 68 y 97 años diagnosticados de síndrome de desequilibrio posterior (n=77). La intervención consistió en un protocolo de ejercicios de propiocepción y equilibrio durante 12 semanas. El grupo control recibió el tratamiento habitual que venía recibiendo en el centro hasta el momento. La medición de resultados se basó en la escala del test Timed Up and Go (TUG), cuyos resultados se registraron al inicio y a las 6, 8 y 12 semanas de la intervención. Resultados: Se obtuvo una muestra equilibrada respecto a todos los factores del análisis de 48 individuos para el grupo de miniplatos y 29 para el grupo control. El tratamiento con miniplatos ofreció como media una disminución en el TUG de 2,80s respecto al método de tratamiento habitual. Conclusiones: Los miniplatos se han mostrado como un método más eficaz que el tratamiento convencional, siendo mayor la mejora del equilibrio. La mejora del tiempo de ejecución del TUG es satisfactoria dadas las características de la población diana. Las puntuaciones bajas de partida en el test TUG han condicionado una menor capacidad de mejora del equilibrio

Introduction and objectives: Backward disequilibrium syndrome is a postural disorder that involves a posterior shift of a person's centre of gravity relative to their base of support, which increases falling risks. This study aimed to determine whether a specific protocol with the use of unstable mini-boards can improve balance and motion in institutionalised elderly people diagnosed with backward disequilibrium syndrome. Materials and methods: Single-blinded, 2-group, randomised controlled clinical trial. The patients were institutionalised adults, aged between 68 and 97, diagnosed with backward disequilibrium syndrome (n=77). The intervention group underwent a specific 12-week proprioception and balance exercise programme. The control group continued receiving the treatment they had been receiving so far. Outcomes were assessed using the Timed Up and Go (TUG) scale, at baseline, weeks 6, 8 and 12. Results: Size was 48 for the intervention group and 29 for the control group, which was considered well-balanced, for all the analysis factors. The results showed a mean reduction of 2.80s for the TUG in the intervention group in comparison with the control group. Conclusions: The use of mini-boards proved to be a more effective method of treatment than conventional therapy, achieving greater improvements in balance. Results for TUG were satisfactory, given the characteristics of the target population. The low baseline TUG ratings determined less capacity to improve balance

Diferencias en el espacio acromio-humeral medido ecográficamente en el dolor de hombro del deportista lanzador / Differences in acromio-humeral space measured by ultrasonography in overhead athlete shoulder pain

Objetivo: Observar la implicación que tiene el espacio subacromial medido ecográficamente, y si existen diferencias entre el acromio great trocanter (AGT) y el acromio humeral distance (AHD) en deportistas con dolor de hombro. Material y método: Se ha realizado un estudio observacional, transversal y comparativo sobre la relación del espacio subacromial y el dolor del hombro del deportista lanzador. Se ha seleccionado a 81 deportistas hombres que utilizan los miembros superiores en su práctica deportiva. Se les practicó una ecografía del hombro obteniendo imágenes de la distancia AGT y la distancia AHD. La muestra se dividió en 2 grupos en función del dolor durante la práctica deportiva. Resultados: No se encontraron diferencias estadísticamente significativas en AHD, AGT, diferencia en la AHD entre el grupo sin dolor (GsD) y el grupo con dolor (GD). Sin embargo, se obtuvieron diferencias significativas para la edad (p = 0,010; IC del 95%,-8,41; -1) y para la diferencia en la AGT (p = 0,039; IC del 95%, 0,068-2,654). Se encontró una correlación significativa (GsD, p = 0,007; GD, p = 0,013) entre la AGT y la AHD aunque con una dependencia moderada (GsD r = 0,395; GD r = 0,412). Conclusiones: La distancia AGT es significativamente menor en los sujetos con dolor de hombro y la distancia AHD tiene tendencia a estar disminuida en presencia de dolor. A su vez, la edad es un factor predisponente del dolor de hombro en deportistas. Por lo que se recomienda el estudio de estos valores como dato complementario en la valoración ecográfica del conflicto subacromial

Objective: To observe the involvement of the subacromial space measured by ultrasound and if there are any differences between AGT (Acromio Great Trocanter) and AHD (Acromio Humeral Distance) in the group of patients with and without shoulder pain. Material and method: An observational, cross-sectional and comparative study on the relationship of subacromial space and shoulder pain in overhead sportmen was performed. A total of 81 sportmen who used their Upper Limbs in their sport were selected. A shoulder ultrasound that obtained images of AGT distance and distance AHD was performed. The sample was divided into two groups based on pain during sports. Results: No statistically significant differences were found in the AHD, AGT, the AHD or a difference between the no pain group (NPG) and the pain group (PG). However, significant differences for age (P = 0.010; CI 95% -8.41 -1) and for the AGT (p = 0.039; CI 95% 0.068 - 2.654) were obtained. A significant correlation (PG, P = 0.013; NPG, P = 0.007) was found between AGT and AHD with moderate dependence (NPG r = 0.395; PG r = 0.412). Conclusions: The AGT distance is significantly lower in subjects with shoulder pain and AHD distance tends to be decreased in the presence of pain. Age is also a predisposing factor of shoulder pain in sportmen. That is why the study of these values as additional data on the ultrasound assessment of subacromial impingement is recommended

Zinc and copper changes in serum and urine after aerobic endurance and muscular strength exercise.

AIM: The role of zinc and copper has been shown essential in the scope of physical exercise. The outcomes of the studies about changes in the concentrations of these elements in blood, in physical effort situations, are sometimes discordant and seem to be related with the type of the exercise done. The purpose of the study was to determine the changes of zinc and copper in serum and urine produced by two kinds of exercise, designing two tests involving different types of physical exertion, which have been defined as aerobic endurance (AE) and muscular strength (MS). METHODS: The study was designed to assess the variations of both elements in two types of exercise: AE, participants: 22 subjects, consisted of run for 40 minutes with a heart rate intensity of ±5 beats per minute from the anaerobic threshold (AnT). MS, participants: 16 subjects, consisted of performing a circuit of 8 different exercises, applying 40% of maximum peak force, until exhaustion. RESULTS: The serum concentration of Zn decreases in both exercises, being statistically significant in the MS (P<0.001). Cu concentration increases significantly in AE (P=0.002) as well as in MS (P<0.001). Urine concentrations of both elements increases after exercise in the two cases (P<0.05 in AE; P<0.001 in MS), the variation of Zn is correlated with proteinuria generated which appears after physical exertion (r=0.59). CONCLUSION: Findings suggest that changes of Zn and Cu in serum and urine are related to the type of exercise performed, which are higher when there is a big impact on muscular tissues.

Perioperative chemotherapy for resectable gastroesophageal cancer: a single-center experience.

BACKGROUNDS: Multimodal treatment for locally advanced gastric cancer has been reported to improve disease-free survival when compared to surgery alone. We aimed to clarify the efficacy and safety of perioperative chemotherapy for locally advanced gastric cancer patients treated in daily clinical practice. METHODS: Patients diagnosed with locally advanced gastric cancer were treated with perioperative chemotherapy and surgery. The primary end point was the complete resection (R0) rate. Secondary end points were disease-free survival (DFS), overall survival (OS), toxicity, radiological response rate, pathological response rate and downstaging rate. We also looked for prognostic and predictive factors for DFS, OS, pathological complete response and the R0 rate. RESULTS: Forty patients were found eligible for this retrospective analysis. At diagnosis, 52.5% of patients were classified as stage II and 47.5% were stage III. Forty percent of patients completed three preoperative cycles and three postoperative cycles. A tolerable toxicity related to chemotherapy was found. Thirty-nine patients underwent surgery: 80% reached a complete resection (R0), down-staging was detected in 57.5% and 17.5% had a pathologically complete response. The median time of disease-free survival was 34.05 months (95%CI 25.6-42.4), and the median time of overall survival was 39.01 months (95%CI 30.8-47.1). We found that the presence of comorbidities were independent predictive factors for the pathologic response, while the chemotherapy schedule and the clinical response could independently predict a complete resection. CONCLUSIONS: Our results support that perioperative chemotherapy for locally advanced gastric cancer can be safely delivered in daily clinical practice, obtaining an improvement of the pathologic response and the complete resection of gastric cancer.

Disminución del dolor en cervicalgias mediante la aplicación de microcorrientes / Decrease in cervical pain using microcurrents

De manera general pretendemos comprobar la efectividad de las microcorrientes ante el dolor y específicamente en las cervicalgias. Un total de 20 pacientes con cervicalgia aguda o crónica han sido tratados en consulta con la tecnología de microcorrientes exclusivamente. La valoración del dolor ha sido realizada mediante la escala analógica visual (EVA) por autoevaluación antes y después del tratamiento completo. El valor medio de la EVA antes del tratamiento fue de 65,45 y el valor medio postratamiento fue de 21,90. La duración media del tratamiento fue de 3,5 semanas. Los resultados de este estudio están en consonancia con los publicados en otros países sobre aplicaciones de las microcorrientes en esta patología. Existen pocas publicaciones sobre aplicaciones de microcorrientes. Las ventajas observadas en el estudio con esta tecnología son rapidez de recuperación funcional del paciente, ausencia de efectos secundarios y contraindicaciones, facilidad de aplicación y sensación agradable para el paciente, así como una muy buena relación beneficio/coste. El conjunto de observaciones apoya la realización de estudios más rigurosos con esta tecnología (AU)

We aim to verify the effectiveness of microcurrents in pain, specifically in cervical pain. A total of 20 patients with acute or chronic neck pain have been treated in the outpatient clinic with microcurrent technology exclusively. Pain assessment was performed using the visual analogue scale (VAS) for self-assessment before and after the full treatment. The mean VAS before treatment was 65.45 and the average post-treatment was 21.90. Mean treatment duration was 3.5 weeks. The results of this study are consistent with the studies published in other countries on applications of microcurrents in this condition. There are few publications on applications of microcurrents. The benefits observed in the study with this technology are rapid functional recovery of the patient, no side effects or contraindications, ease of application and good feeling for the patient as well as a very good cost/benefit ratio. The set of observations supports carrying out more rigorous studies with this technology (AU)

Actitud ante lesiones destructivas mediofaciales en pacientes que esnifan cocaína / Attitude to nasal cocaine abusers with midline destructive lesions

La cocaína esnifada es muy agresiva para el septum nasal y, si se consume de forma habitual, puede ocasionar destrucción de mucosa, cartílago e incluso hueso. Si nos encontramos ante un paciente con necrosis de línea media facial, antes de establecer la cocaína como agente causal, debemos hacer un diagnóstico diferencial con una serie de procesos que producen un cuadro clínico similar. Debemos descartar procesos sistémicos, neoplásicos e infecciosos. El tratamiento será inicialmente conservador, si bien es fundamental el cese del consumo. Cuando el paciente lleve un tiempo razonable de abstinencia, se puede plantear la cirugía (AU)

Chronic inhalation of cocaine can damage nasal septum with destruction of mucosa, cartilage and even bone. When we see a patient with midline nasal necrosis, we have to do a differencial diagnosis with systemic, neoplastic and infectious process. The treatment will be conservative at the beginning. The most important is to stop of using the drug. Surgery can be consider after some time of absence (AU)

Pancreatitis crónica autoinmune: una entidad de difícil diagnóstico diferencial / Chronic autoimmune pancreatitis: an entity of difficult differential diagnosis

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Clinical value of CEA and CA125 regarding relapse and metastasis in resectable non-small cell lung cancer.

BACKGROUND: The aim of the present study was to evaluate the value of serum Carcinoembryonic Antigen (CEA) and CA125 antigen assay for monitoring the activity of non-small cell lung cancer (NSCLC) after curative surgical resection. PATIENTS AND METHODS: Serum CEA and CA 125 were determined preoperatively and at every postoperative visit, in 113 patients with NSCLC (TNM stages I, II, IIIA). Both markers were assayed by magnetic particle enzyme immunoassay. RESULTS: Tumor recurrence was more frequent in patients with preoperative CA 125 levels above the cut-off (15 U/ml) (28 out of 47) (59.5%) than in those with low values (18 out of 66) (27.2%) (p < 0.001). The 36-month disease-free survival was lower for patients with elevated CA 125 (37%) than among those with low levels (72%) (p = 0.006). High CA 125 was an independent predictor of the risk of postoperative recurrence (Hazard Ratio: 3.02)(95% CI: 1.41-6.49). No relationship was detected between preoperative serum CEA and risk of recurrence. High preoperative CA125 indicated elevated risk for disseminated recurrence (Hazard Ratio: 7) (95% CI: 2.39-20.51), but not for locoregional failure. No significance was detected for CEA, either in locoregional or disseminated recurrence. Forty-six subjects (40.7%) developed tumor recurrence. At the diagnosis of relapse, serum CEA was elevated in 16 patients (34.7%) and CA125 in 26 (56.5%). Sensitivity was higher in the case of disseminated recurrence (63% for CA125 and 43.3% for CEA) and decreased in locoregional relapse (43.7% for CA125 and 18.7% for CEA). The specificity was 97% for CEA and 59% for CA125. CONCLUSION: Serum CA125 is a useful prognostic marker in NSCLC. The predictive information is especially useful to estimate the risk of disseminated recurrence. Serial determinations of CEA and CA125 during the postoperative follow-up do not show enough sensitivity/specificity to recommend their use for diagnosis of tumor relapse.

Intrinsic defects explain altered proliferative responses of T lymphocytes and HVS-derived T-cell lines in gastric adenocarcinoma.

We have taken advantage of a recently described technique of transformation and immortalization of T lymphocytes using the lymphotropic Herpesvirus saimiri, to achieve long-lasting T-cell lines from gastric cancer patients and healthy volunteers. Blood samples were drawn and T lymphocytes were transformed. Once sustained growth was observed, lines were subjected to phenotypic and functional analyses, and the results compared with freshly isolated peripheral blood mononuclear cells. Cytofluorometric analysis revealed that CD3 and CD45 were found at lower proportion in primary cells from patients than from control individuals (54% vs 75%, p<0.001, 90% vs 96%, p<0.05, respectively), and in HVS-derived T-cell lines (90% vs 98%, p<0.05, 97% vs 100%, p<0.05, respectively). Proliferative analyses showed that primary isolated cells were unable to respond adequately to CD3-, CD2-, and PHA-mediated stimulation, as compared to controls. Similarly, T-cell lines from patients proliferated to a lesser extent when CD3- and CD2-mediated stimuli were considered, especially when simultaneous stimulation via CD3 and CD2 molecules was carried out (47,824 counts per minute [cpm] vs 121,478 cpm, p<0.05). Altogether these results show that the defects reported in T cells from patients with cancer are not exclusively due to tumour-derived factors, since the alterations persist in long-lasting, HVS-transformed, T-cell lines, suggesting that this model seems a suitable one to disclose them.

[Osteoma and exostosis of the external auditory meatus: a clinical diagnosis]. / Osteoma y exóstosis del conducto auditivo externo: un diagnóstico clínico.

Proliferative osseous lesions usually found in the external ear are exostoses and osteomata. In other sites they are clearly different entities, but in this location histopathologic differential features are not so reliable in the study of the specimens. An occlusive osteomata is shown, with the typical clinical presentation demonstrated in a multiplanar CT. Microscopically, the lesion consisted of mature bone trabeculae, separated by medular spaces with fibrovascular tissue, characteristic features of osteomata. However, in the most superficial areas, lines of bone apposition, like those in exostoses, were found. A literature review confirms the lack of specificity of the histopathologic study, so diagnosis is based on clinical data.

Intraductal pancreatic carcinoma associated with pancreas divisum.

OBJECTIVE: we report the case of a 36 years old man with a pancreatic cancer associated to a pancreas divisum presenting as acute and relapsing recurrent pancreatitis. The coexistence of intraductal carcinoma and pancreas divisum is uncommon as let us do analyze its clinical, radiological and therapeutical features. CONCLUSIONS: 1. Pancreatic duct obstruction and pancreas divisum as congenital anomaly may be consider potential etiologies for pancreatic cancer. 2. Widespread use of magnetic resonance xholangiopancreatography and endoscopic retrograde xholangiopancreatography examinations together with brush cytology smears will allow more accurate approach to tumor diagnosis and management. 3. The use of pancreatoscopy in patients suffering from chronic pancreatitis may reveal helpful to discover intraductal neoplasms otherwise misdiagnosed.

Carcinoma pancreático intraductal asociado con páncreas divisum / Intraductal pancreatic carcinoma associated with pancreas divisum

Objetivo: presentar un caso de páncreas divisum con episodios recurrentes de pancreatitis aguda en el seno de una pancreatitis crónica, asociado a un carcinoma intraductal. La incidencia infrecuente de esta asociación sirve de vehículo para la discusión de la misma y exposición de sus parámetros diagnósticos y terapeúticos. Conclusiones: 1. La obstrucción del conducto pancreático y el páncreas divisum como alteración anatómica congénita puede ser un factor predisponente para la aparición de un carcinoma de páncreas.2. El empleo de la resonancia magnética nuclear y la colangiopancreatografía retrógrada endoscópica como pautas diagnósticas de imagen, y la utilización de la citología por cepillado permiten un diagnóstico diferencial y aproximan una pauta terapéutica correcta.3. Probablemente el empleo de la pancreatoscopia de manera habitual en pacientes con pancreatitis crónica pueda diagnosticar este tipo de tumores intraductales inadvertidos para otros procedimientos diagnósticos (AU)

Preoperatively irradiated rectal carcinoma: analysis of the histopathologic response and predictive value of proliferating cell nuclear antigen immunostaining.

OBJECTIVES: To investigate the relationship between the histopathologic effects of preoperative chemoradiotherapy in rectal cancer and the proteins, proliferating cell nuclear antigen (PCNA) and p53. METHODS: Samples from 73 tumors were examined. The histopathologic effects observed in the resected specimens induced by preoperative chemoradiotherapy were correlated with the inmunohistochemical expression of PCNA and p53 in biopsies obtained by rectoscopy before chemoradiotherapy. RESULTS: Thirty-five tumors showed a high PCNA index (48%). Nuclear accumulation of p53 protein was detected in 53 tumors (72%). Specimens were assigned one of four grades based on the amount of residual viable tumor. Three neoplasms (4%) showed complete regression; 8 other carcinomas (11%) showed only small numbers of tumor cells scattered within the field of stromal reaction. In these cases, it was considered that the tumor had responded significantly to radiotherapy. Tumors with a high PCNA index responded to chemoradiotherapy more frequently (8/35; 72%) than tumors with a low index (3/38; 43%) (p = 0.07). p53-negative tumors responded more frequently (4/20; 20%) than positive tumors (7/53; 13.2%) (p = 0.50). When pathologic and immunohistochemical characteristics of the tumors were included in a logistic regression model, only high PCNA index (odds ratio 5.35, 95% confidence interval 1.07-26.7) (p = 0.04) was significantly associated with the histologic response to preoperative chemoradiotherapy. CONCLUSION: High proliferative activity of rectal cancer, as determined by PCNA immunostaining, is predictive of the response to preoperative chemoradiotherapy.

Osteoma y exóstosis del conducto auditivo externo: un diagnóstico clínico / Osteoma and exostosis of the external auditory meatus: a clinical diagnosis

Las lesiones proliferativas óseas que habitualmente se presentan en el oído externo son la exóstosis y el osteoma. En otras partes del organismo son entidades claramente diferenciadas, pero en esta localización las diferencias histopatológicas no son tan constantes en el estudio de las piezas resecadas. Presentamos un osteoma oclusivo, típico desde el punto de vista clínico, demostrado mediante TC multiplanar. Microscópicamente, la lesión estaba formada por trabéculas óseas maduras de hueso compacto, separadas por espacios medulares con tejido fibrovascular, rasgos característicos de los osteomas. Sin embargo, en las áreas más superficiales, se observaron líneas de aposición ósea indistinguibles de las exóstosis. La revisión de la literatura nos confirma la falta de especificidad del análisis histopatológico convencional, siendo por tanto los datos clínicos la base del diagnóstico diferencial (AU)

Proliferative osseous lesions usually found in the external ear are exostoses and osteomata. In other sites they are clearly different entities, but in this location histopathologic differential features are not so reliable in the study of the specimens. An occlusive osteomata is shown, with the typical clinical presentation demonstrated in a multiplanar CT. Microscopically, the lesion consisted of mature bone trabeculae, separated by medular spaces with fibrovascular tissue, characteristic features of osteomata. However, in the most superficial areas, lines of bone apposition, like those in exostoses, were found. A literature review confirms the lack of specificity of the histopathologic study, so diagnosis is based on clinical data (AU)

Signos predictivos de dolor discógeno lumbar: correlación de la RM con la discografía / Signs predictive of lumbar disk pain: correlation between mri and discography

Objetivo: Correlacionar los hallazgos de la resonancia magnética (RM) con la discografía para determinar el valor predictivo de distintos signos de RM en la identificación del espacio lumbar degenerado sintomático. Material y método: Se han evaluado 61 discos en 37 pacientes tributarios de tratamiento quirúrgico por enfermedad discal degenerativa. Se evaluó la RM de todos los pacientes, valorando los siguientes parámetros: señal del disco en T2, altura discal, cambios en la esponjosa subcondral, morfología discal y señal de alta intensidad en el ánulus posterior. La discografía fue positiva cuando desencadenó dolor típico y concordante. Resultados: La pérdida de altura discal y los cambios en la esponjosa subcondral descritos por Modic se mostraron como señales con una elevada especificidad (100 por ciento y 91 por ciento), pero con escasa sensibilidad diagnóstica (24 por ciento y 37 por ciento). La disminución de la señal en T2 fue el signo radiológico con mayor sensibilidad. Las zonas de alta intensidad presentaron una especificidad del 79 por ciento, una sensibilidad del 15 por ciento y un valor predictivo positivo del 71 por ciento. Conclusiones: Los cambios tipo Modic, y la pérdida de altura discal evidente tienen mayor especificidad y valor predictivo positivo (VPP) que las zonas de alta intensidad. Las zonas de alta intensidad no son un signo predictor fiable de dolor discal. La escasa sensibilidad de la mayoría de los signos radiológicos hace que en la actualidad, la resonancia magnética no pueda reemplazar a la discografía en la identificación de los discos lumbares degenerados sintomáticos. (AU)

Modifications to Rives technique for midline incisional hernia repair.

Between 1990 and 1997, 284 patients were treated in our hospital for abdominal hernias. In the original group, 239 patients (84.15%) had midline hernia, and 45 (15.8%) had lateral hernia. A total of 152 midline hernia patients (63.5%) were treated using our variant of Rives technique. In all these cases, preperitoneal and retromuscular polypropylene mesh was used as a reinforcement and was subsequently attached by means of absorbable sutures to the external border of the rectus muscles. There were no deaths. A total of 42 of all patients operated on (27.6%) suffered from long-term postoperative pain. In seven cases (4.6%) it was necessary to remove the prosthesis because of chronic infection, and there were two recurrences in patients in whom the prosthesis had to be removed. In our experience, the Rives technique is a suitable and safe treatment for the repair of midline incisional hernias. The use of absorbable sutures and fixation of the mesh to the external oblique aponeurosis can reduce the original problems of abdominal pain and unaesthetic skin scars.

Tratamiento quirúrgico del enterocele mediante la resección del saco peritoneal y reparación protésica del espacio rectovaginal. Estudio prospectivo y validación de una nueva técnica quirúrgica / Surgical treatment of enterocele by resection of the peritoneal sack and prosthetic repair of the rectovaginal pouch. Prospective study and validation of a new surgical technique

Introducción. El tratamiento quirúrgico del enterocele constituye actualmente un tema de debate, no habiéndose conseguido la unificación de criterios en cuanto a la idoneidad de su vía de abordaje y tratamiento. La idea de este estudio prospectivo es evaluar los resultados del tratamiento quirúrgico del enterocele, mediante una nueva técnica diseñada personalmente y consistente en la resección del saco peritoneal redundante y la reparación protésica del espacio rectovaginal. Material y métodos. Se estudian 13 pacientes diagnosticadas de enterocele entre junio 1997 y diciembre de 2000, mediante exploración clínica y posterior confirmación con proctografía de evacuación. Se realiza en todos los casos la extirpación del saco peritoneal redundante colocando una prótesis de polipropileno anclada en el espacio interrectovaginal. La edad media de las pacientes fue de 64 años (rango 54-86). Se analiza en todas ellas el grado de enterocele, las alteraciones en la defecación, la asociación con otras enfermedades del suelo pélvico, así como la posible repercusión de las mismas en la clínica del enterocele. Resultados. La tolerancia a la malla de polipropileno fue perfecta en todos los casos, no observándose infecciones de la malla que nos obligaran a su extracción. La obliteración del espacio rectovaginal fue completa en todos los casos, como se comprobó en las proctografias de evacuación realizadas en los controles posteriores. Los grados de enterocele mayor tuvieron mejor respuesta clínica a la mayoría de los parámetros estudiados, que los grados menores de enterocele, no obstante en todas ellas los síntomas fueron menores que antes de la cirugía. Conclusiones. En pacientes con malestar pélvico y alteraciones en la defecación, el enterocele puede ser considerado como un importante factor. El estudio proctográfico y el grado de enterocele es fundamental a la hora de plantearnos un tratamiento quirúrgico. La resección del saco peritoneal redundante del enterocele y la posterior colocación de una malla protésica de polipropileno parece ser un tratamiento adecuado para estas pacientes (AU)