[Organ and tissue donation and transplantation: three health care centers' attitude]. / Actitud hacia la donación y el trasplante de órganos y tejidos de tres instituciones de salud.

OBJECTIVE: To assess the knowledge and attitude towards organ donation within health professionals in different institutions of Nuevo Leon. METHODS: A prospective, open, observational, descriptive study of parallel groups, through application of a survey formulated by the Hospital Universitario (HU) "Dr. José Eleuterio González". We applied 208 surveys in the HU (n = 100) and other institutions like IMSS, ISSTE (n = 108). RESULTS: From all the participants, 86% had a positive attitude towards organ donation, associated to a higher education, and information regarding organ donation received by other health professionals. Though having a positive attitude toward organ donation, 14% of health professionals don't support it due to being afraid of not receiving medical assistance, knowing their status of donators, religious reasons, and fear of organ trafficking. CONCLUSIONS: Our study shows that, even within the health professionals, there is a need for information regarding organ donation. A well-instructed health professional shows a higher interest in organ donation; this could have a positive impact in the attitude of the population toward organ donation, as well as in the obtainment of organs inside the medical institutions.

Anaphylaxis as an Unusual Cause of Shock in the Trauma Setting: A Case Report.

Anaphylactic shock is the most severe form of an acute systemic allergic reaction and can be potentially lethal if left untreated. Here, we present the case of a 51-year-old male with no significant medical history, who arrived at our hospital's emergency trauma bay following a motor vehicle accident caused by a sudden onset of malaise while driving. Upon arrival, the patient's airway was patent, but he reported a sensation of a foreign body in his larynx. He also had an oxygen saturation of 88%, although no abnormal breath sounds were auscultated. The patient was also hypotensive and tachycardic, with no favorable response after crystalloid administration. He had no neurological alterations but was diaphoretic, with hives spreading across his trunk and all four extremities. Upon further interrogation, we identified that he had consumed diclofenac, a non-steroidal anti-inflammatory drug (NSAID), 45 minutes before the driving incident. Prompt recognition and management of the anaphylactic shock were initiated alongside the assessment and treatment of the traumatic injuries. This case highlights the importance of considering unusual causes of shock in trauma patients. It underscores the need for a comprehensive approach to patient care in trauma settings, where multiple etiologies of shock should be considered and managed simultaneously.

Gastrointestinal Cytomegalovirus Infection in a Transplantation Recipient With a Negative Serum Viral Load: Case Report.

BACKGROUND: Kidney transplant recipients are vulnerable to infections, especially cytomegalovirus (CMV) disease. It is recommended that clinicians plan their prophylaxis and therapeutic regimens based on viral load testing. OBJECTIVE: CMV viral load monitoring testing provides useful information for identifying virologic response and possible antiviral resistance. Due to the paucity of medical literature on guiding viral therapy in cases of CMV tissue disease with nondetectable serum viral load, we intend to provide physicians with evidence on how to guide medical therapy in these cases. CASE REPORT: A 49-year-old Hispanic male recipient of a kidney transplant from a cadaver donor presented to the emergency department with anorexia, asthenia, diarrhea, weight loss, and supraclavicular and mediastinal adenomegalies at 2 months post-transplantation. Both patients were serum IgG- and IgM-positive for CMV, which classified them as intermediate risk for developing CMV disease or tissue-invasive disease (donor-positive/recipient-positive [D+/R+]). The patient was induced with basiliximab and methylprednisolone and received maintenance therapy with tacrolimus, mycophenolic acid, and prednisone. Real-time polymerase chain reaction analyses were performed due to suspicion for BK virus, B19 parvovirus, Epstein-Barr virus, and CMV, with an undetectable viral load for all. A biopsy specimen taken from the gastrointestinal tract confirmed CMV infection, which was corroborated through immunocytochemistry. CONCLUSIONS: Histopathologic testing is a possible option for patients with CMV tissue disease symptoms but no detectable serum viral load. Clinical observation is fundamental when viral monitoring is difficult.

5-Year management and outcomes of penetrating neck injury in a trauma center. Penetrating neck injury.

BACKGROUND: Penetrating neck injuries represent 5-10% of all traumatic injuries, these bring with them a high rate of morbidity and mortality due to vital structures that could be injured in this area. The aim of this study was to determine the epidemiological and clinical characteristics of penetrating neck injuries. METHODS: This was a retrospective, unicentric and descriptive study that included all patients who underwent neck exploration surgery. RESULTS: A total of 70 neck exploration cases were reviewed, 34 (49%) didn't had any injury. Thirty (43%) had at least one hard sign, 42 (60%) patients showed at least one soft sign. Statistical analysis showed only surgical time (252±199.5 vs. 155±76.4; p=0.020) and transfusions (1.87±3 vs. 0.4±0.856; p=0.013) were statistically significant. We report a mortality of 2 (3%) patients. CONCLUSIONS: Our prevalence of neck surgical exploration without vascular injury was slightly higher (49% vs. 40%) than literature. We highlight the importance of not performing neck explorations in all patients who present a penetrating injury. We did not obtain differences between groups for hard signs and soft signs. We were not able to identify whether or not there would be an injury based on clinical characteristics. Imaging studies should be performed to avoid unnecessary neck explorations; however, depending on the clinical scenario some surgery cannot be avoided.

Symptom attribution and stress level in patients with medically unexplained symptoms in a Mexican emergency department.

Background: Patients who come to the emergency department are different from those seen in outpatient clinics. The former suffer greater stress. Aim: Establish an association between the attribution of the symptoms (psychosocial or organic) by the patient and the level of perceived stress in patients with Medically Unexplained Physical Symptoms (MUS) in an emergency department. Methods: A correlational cross-sectional study was conducted in 138 patients with MUS in the emergency department of a 3rd level public hospital where the psychosocial or organic attribution of nonspecific symptom(s) by patients and the perceived stress were measured with validated scales. Bivariate analysis was performed with Chi square for categorical variables, and a Spearman correlation, p <0.05. Results: 75% of patients with psychosocial attribution have higher stress compared to patients with organic symptom attribution (25%). In Spearman's correlation, a medium but statistically significant correlation was obtained. Conclusions: The psychosocial attribution of the patient's complaint might coexist in MUS patients with higher level of perceived stress by the patients. Health professionals might need to address both psychosocial attributions and stress in MUS patients.

[Kidney transplantation. Experience at the University Hospital José González, UANL in Monterrey, Mexico]. / Trasplante renal. Experiencia en el Hospital Universitario José E. González, UANL, en Monterrey, México.

BACKGROUND: In patients with end-stage renal disease, successful renal allotransplantation improves the quality of life and increases survival as compared with long-term dialysis treatment. OBJECTIVE: To show our experience, effectiveness and results of renal transplantations at the University Hospital of UANL. MATERIAL AND METHODS: A retrospective study of renal transplantation performed at University Hospital of UANL was done. The transplant cases from 1967 to July 2001 and January 2003 to June 2011 were included. RESULTS: 280 kidney transplants were performed in 264 patients, 146 men and 118 women; 201 from deceased donor and 79 from living donor. The patient survival at 1, 3, and 5 years was 98.8, 85.9 and 85.9%, respectively. The graft survival at 1, 3, and 5 years, censored for death with functioning graft, was 98.8, 85.7 and 74.9%, respectively. CONCLUSIONS: Our results, in this population with unfavorable socioeconomic conditions, are comparable to those obtained in other institutions.

Presentation, management and evolution of patients with abdominal gunshot wound. A decade of violence in Mexico.

BACKGROUND: Traumatic injuries represent 9.6% of the global surface of the disease and represent the third most common cause of death in adults and adolescents. Patients were admitted to the hospital presenting traumatic injuries, penetrating abdominal traumatism remains a major cause of morbidity and mortality. OBJECTIVE: To analyze the presentation, handling and development of patient's gunshot wound. METHOD: Retrospective, descriptive, observational study. It was reviewed from 2010-2015 in the statistics department of the University Hospital Dr. José E. González all patients diagnosed with firearm projectile injury in abdomen. RESULTS: Were admitted above an average of 1.22 ± 0.51 lesions, on a Glasgow coma scale of 13.59 ± 2.5, oxygen saturation of 96.2 ± 2.09, heart rate of 94.4 ± 20, respiratory rate of 22 ± 6 and shock degree of 1.5 ± 0.80. CONCLUSION: Vital signs and specific characteristics of the lesion are essential and useful for the prediction of mortality due to abdominal traumatism by firearm projectile, in addition to the quantification of wounds and associated organic lesions, these are being evaluated both as a whole and separately.

ANTECEDENTES: Las lesiones traumáticas representan el 9.6% de la carga global de la enfermedad y son la tercera causa más común de muerte en adultos y adolescentes. Entre los pacientes ingresados en el hospital con lesiones traumáticas, el traumatismo penetrante abdominal sigue siendo una importante causa de morbilidad y mortalidad. OBJETIVO: Analizar la presentación, el manejo y la evolución de los pacientes con herida por proyectil de arma de fuego en el abdomen. MÉTODO: Estudio retrospectivo, descriptivo y observacional. Se revisaron todos los pacientes con diagnóstico de herida por proyectil de arma de fuego en el abdomen en el departamento de estadística del Hospital Universitario Dr. José E. González durante los años 2010-2015. RESULTADOS: Del total, 21 (9.1%) pacientes eran del sexo femenino y 229 (90.9%) del sexo masculino. Se ingresaron con un promedio de 1.22 ± 0.51 lesiones, con una puntuación en la Escala de coma de Glasgow de 13.59 ± 2.5, saturación de oxígeno de 96.2 ± 2.09, frecuencia cardiaca de 94.4 ± 20, frecuencia respiratoria de 22 ± 6 y grado de choque de 1.5 ± 0.80. CONCLUSIÓN: Los signos vitales y las características específicas de la lesión son esenciales y útiles para la predicción de la mortalidad por traumatismo abdominal por proyectil de arma de fuego, además de la cuantificación de heridas y lesiones orgánicas asociadas, siendo evaluadas estas tanto en un todo como por separado.

Hepatic epithelioid hemangioendothelioma: a diagnostic challenge of vascular tumors.

Epitheloid hemangioendothelioma is a very rare tumor, with a variable presentation and unpredictable clinical behavior. The etiology and the triggering risk factors have not been specified. Unlike other primary liver tumors, it does not arise in the background of chronic liver disease. The approach is challenging due to the spectrum of possibilities and the need for immunohistochemistry to establish the definitive diagnosis. The information available so far is limited due to the few published cases, this favors that the therapeutic options are few or that there is insufficient evidence to standardize them when the lesion is not resectable.

El hemangioendotelioma epiteloide es un tumor muy infrecuente, con una presentación variable y un comportamiento clínico impredecible. No se han precisado la etiología ni los factores de riesgo desencadenantes. A diferencia de otros tumores hepáticos primarios, no surge en el contexto de una enfermedad crónica del hígado. El abordaje es un reto debido al espectro de posibilidades y la necesidad de inmunohistoquímica para establecer el diagnóstico definitivo. La información disponible hasta el momento es limitada por los escasos casos publicados, lo que favorece que las opciones terapéuticas sean pocas o no exista la evidencia suficiente para estandarizarlas cuando la lesión no sea resecable.

Complications and treatment to liver wound by gunshot. A retrospective approach.

INTRODUCCIÓN: Un trauma penetrante puede dañar una variedad de órganos. Dado que el hígado es un órgano sólido inelástico, no tiene la tolerancia al estiramiento necesaria para hacer frente a una herida por proyectil de arma de fuego (GSW). MÉTODOS: Este fue un estudio retrospectivo, observacional y descriptivo de 53 registros clínicos de pacientes ingresados en el Departamento de Cirugía por trauma hepático (LT) por un GSW. RESULTADOS: Del total de historias clínicas analizadas, el 89% de los pacientes presentaron una lesión asociada con LT. La lesión orgánica asociada más frecuente fue la torácica, específicamente la lesión pulmonar, en el 58%. El predictor más importante de mortalidad fue una estancia en la unidad de cuidados intensivos (UCI), que aumentó el riesgo unas 21 veces. CONCLUSIÓN: Una estadía en la UCI, seguida de la presencia de fracturas, fue el predictor más importante de mortalidad. Se necesitan nuevas medidas de pronóstico para contrarrestar las variables que ha creado el aumento de GSW, además de disminuir el tiempo de espera desde el evento traumático hasta el tratamiento relevante. INTRODUCTION: A penetrating trauma can damage a variety of organs. Since the liver is an inelastic solid organ, it does not have the necessary stretch tolerance to cope with a gunshot wound (GSW). METHODS: This was a retrospective, observational, and descriptive study of 53 clinical records of patients admitted to the Department of Surgery for liver trauma (LT) by a GSW. RESULTS: Of the total clinical records analyzed, 89% of the patients presented a lesion associated with LT. The most common associated organic lesion was thoracic, specifically lung injury, in 58%. The most important predictor of mortality was a stay in the intensive care unit (ICU), which increased the risk about 21 times. CONCLUSION: A stay in the ICU, followed by the presence of fractures, was the most important predictor of mortality. New prognostic measures are needed to counteract the variables that the increase in GSWs has created, in addition to decreasing the waiting time from the traumatic event to relevant treatment.

Endoscopic retrograde cholangiopancreatography for treatment biliopleural fistulas.

BACKGROUND: Biliopleural fistula is a rare communication between the biliary system and the pleural space secondary to ruptured hydatid cysts, hepatobiliary surgeries or penetrating wounds. There is not so much of the subject in the literature, so there is no standardized protocol for its management. OBJECTIVE: The objective of this work is to determine advantages and disadvantages of the use of ERCP as a conservative initial treatment for biliopleural fistulas. METHOD: Our retrospective study included patients with a diagnosis of biliopleural fistula who underwent ERCP as initial treatment, older than 18 years in a period from August 2016 to August 2019. RESULTS: Eight patients with a diagnosis of biliopleural fistula were included, 75% men and 25% women with a mean age of 24.5 years; the traumatic etiology was predominant in our group (89%), the diagnosis was made between days 3 and 14 after chest tube placement and we were successful in treating the fistula with ERCP in 87.5% of our patients. CONCLUSIONS: The use of ERCP as initial treatment for biliopleural fistula should be considered as the initial tool in the algorithm of management of this entity.

ANTECEDENTES: La fístula biliopleural es una comunicación poco frecuente entre el sistema biliar y el espacio pleural secundario a ruptura de quistes hidatídicos, cirugías hepatobiliares o heridas penetrantes Existe poco sobre el tema en la literatura por lo que no existe un protocolo estandarizado para su manejo. OBJETIVO: El objetivo de este trabajo es determinar ventajas y desventajas del uso de CPRE como tratamiento inicial conservador para fístulas biliopleurales. MÉTODO: Nuestro estudio retrospectivo incluyó pacientes con diagnóstico de fístula biliopleural quienes fueron sometidos a CPRE como tratamiento inicial, mayores de 18 años en un período de Agosto de 2016 a Agosto de 2019. RESULTADOS: Se incluyeron 8 pacientes con diagnístico de fístula biliopleural, 75% hombres y 25% mujeres con una media de edad de 24.5 años; la etiología traumática fue a predominante en nuestro grupo (89%), el diagnóstico se realizó entre los días 3 y 14 post colocación de sonda torácica y obtuvimos éxito en el tratamiento de la fístula con CPRE en el 87.5% de nuestros pacientes. CONCLUSIONES: El uso de CPRE como tratamiento inicial para fístula biliopleural debe ser considerada como la herramienta inicial en el algoritmo de manejo de esta entidad.

Prognosis of mortality and evolution in pancreatoduodenal trauma in patients with wound by projectile of firearm.

BACKGROUND: The wounds caused by the firearm projectile are published to date in a public health problem in the world. As an example, we mentioned the injuries caused by firearms are the first cause of death in the age group between 1 to 19 years in the United States, as in Mexico. OBJECTIVE: Analysis of the prognostic factors of mortality and evaluation of the evolution in patients with TPD due to abdominal HPPAF. METHOD: Retrospective, observational, descriptive study. Helped by 49 clinical files of patients who were admitted to the department of surgery of the University Hospital José Eleuterio González, between 2011 to 2015 and whose diagnosis was due to pancreatic trauma (TP), duodenal trauma (TD) or pancreatoduodenal trauma (TPD) by wounds caused by the firearm projectile. RESULTS: During a collection period of 5 years, a total of 49 clinical records applicable to the study were obtained according to the inclusion criteria, of which 36 (73%) suffered only from TD, 37 (75%) from TP and 24 (49%) about TPD. Significant differences were obtained for mortality associated with TD and TPD, but not for TP. The most affected organ as a lesion associated with a TPD was the liver, followed by thoracic structures and the stomach. The most significant risk factor for mortality was a prolonged stay in the intensive care unit. CONCLUSIONS: Data obtained are consistent with those consulted, providing new reproducible statistics for future studies regarding the increasing violence in our country and around the world.

ANTECEDENTES: Las heridas por proyectil de arma de fuego constituyen un problema de salud pública en el mundo. Como ejemplo mencionamos que este tipo de lesiones son la primera causa de muerte en el grupo de edad de 1 a 19 años en los EE.UU., al igual que en México. OBJETIVO: Análisis de los factores pronósticos de mortalidad y evaluación de la evolución en pacientes con TPD por HPPAF abdominal. MÉTODO: Estudio retrospectivo, observacional y descriptivo, realizado con 49 expedientes clínicos de pacientes que fueron admitidos en el departamento de cirugía del Hospital Universitario José Eleuterio González entre los años 2011 y 2015, cuyo diagnostico fue herida por proyectil de arma de fuego con trauma pancreático (TP), duodenal (TD) o pancreatoduodenal (TPD). RESULTADOS: Durante un periodo de recolección de 5 años se obtuvieron 49 expedientes clínicos aplicables al estudio según los criterios de inclusión, de los cuales 36 pacientes (73%) sufrieron únicamente TD, 37 (75%) TP y 24 (49%) TPD. Se obtuvieron diferencias significativas para la mortalidad asociada a TD y TPD, pero no para TP. El órgano más afectado como lesión asociada a un TPD fue el hígado, seguido de las estructuras torácicas y el estómago. El factor de riesgo para mortalidad más significativo fue una estancia prolongada en la unidad de cuidados intensivos. CONCLUSIONES: Los datos conseguidos concuerdan con los consultados, otorgando nueva estadística reproducible para futuros estudios respecto a la violencia creciente en nuestro país y alrededor del mundo.

Prognostic factors for survival and surgical complications in Whipple's pancreatoduodenectomy during a 10-year experience.

BACKGROUND: Periampullary neoplasms account for over 30,000 cancer-related deaths per year in the United States. Pancreaticoduodenectomy (PD) is considered the surgical standard and is the only curative treatment option for these pathologies. OBJECTIVE: The objective of this study was to report the prognostic factors in survival and surgical complications in PD. MATERIALS AND METHODS: A total of 178 cases are reported, several variables were reviewed and the same surgical technique was used by the same surgeon. RESULTS: A total of 151 PD were reviewed. The most common initial symptoms were jaundice, 111 (73%), abdominal pain, 20 (13%), and oral intolerance, 10 (6%). Poor prognostic factors for survival were the presence of a previous pathology, days of hospitalization, positive margins, and weight loss. DISCUSSION: With the experience gained, a decrease in surgical time, intraoperative bleeding, and transfusions performed was achieved. Our complication rate remained at 20%, lower than that reported in literature. CONCLUSION: PD is the only option of cure for patients with pancreatic and periampullary tumors. This procedure has been linked to high morbidity and mortality even in high-volume centers. A pancreatic fistula is the most feared complication; therefore, multiple pancreatojejunostomy techniques have been described in literature. It is important to continue reporting these cases to reach a consensus on this technique.

ANTECEDENTES: Las neoplasias periampulares suponen más de 30.000 muertes relacionadas con el cáncer por año en los EE.UU. La pancreaticoduodenectomía (PD) se considera el estándar quirúrgico y es la única opción de tratamiento curativo para esta enfermedad. OBJETIVO: Reportar los factores de pronóstico en la supervivencia y las complicaciones quirúrgicas de la PD. ­. MÉTODO: Se reportaron 178 casos; se revisaron varias variables y se utilizó la misma técnica quirúrgica por el mismo cirujano. RESULTADOS: Se revisaron 151 DP. Los síntomas iniciales más comunes fueron ictericia (111; 73%), dolor abdominal (20; 13%) e intolerancia oral (10; 6%). Los factores de pronóstico para la supervivencia fueron la presencia de patología previa, los días de hospitalización, los márgenes positivos y la pérdida de peso. DISCUSIÓN: Con la experiencia adquirida, se logró una disminución del tiempo quirúrgico, del sangrado intraoperatorio y de las transfusiones realizadas. Nuestra tasa de complicaciones se mantuvo en un 20%, inferior a la reportada en la literatura. CONCLUSIÓN: La PD es la única opción de curación para los pacientes con tumores pancreáticos y periampulares. Este procedimiento se ha relacionado con una alta morbilidad y mortalidad incluso en centros de alto volumen. La fístula pancreática es la complicación más temida, por lo que se han descrito numerosas técnicas de pancreatoyeyunostomía. Es importante seguir informando de estos casos para llegar a un consenso sobre esta técnica.

Mumps outbreak with high complication rates among residents in a university teaching hospital.

According to the US Advisory Committee on Immunization Practices recommendations, only health care personnel (HCP) with adequate evidence of immunity should be exposed to patients with a suspected diagnosis of mumps. Here we report a hospital-outbreak scenario among medical residents with no previous vaccination record against mumps who had a high rate of complications. We also describe the importance and impact of full and proper vaccination, as well as isolation, of HCP in stopping the outbreak and, finally, review opportunities for improving the safety of HCP.

Modulation of Remote Ischemic Preconditioning by Proinflammatory Cytokines in Renal Transplant Recipients.

AIM: Remote ischemic preconditioning (RIPC) has been used as a strategy to reduce acute renal injury and ischemia-reperfusion injury (IRI) in renal transplantation (RT) with controversial results. OBJECTIVE: To determine if RIPC modifies IRI in cadaveric RT recipients through inflammatory mediators and graft function. METHODS: Twenty-nine RT recipients were studied, 12 in the control group (CG) and 17 in the RIPC group. RIPC which was performed on donors using a pneumatic tourniquet placed on both thighs for 10 min followed by the determination of IL-1, IL-6, TNF-α, VEGF, and ICAM-1, and hematological and biochemical parameters in different phases of RT. RESULTS: Serum creatinine levels were significantly lower in the RIPC group versus the CG at 15 and 30 days; however, the estimated glomerular filtration rate (eGFR) showed no significant difference in any phase between either group, only TNF-α showed significantly higher values in the RIPC group versus the CG in almost all phases of the study, meanwhile IL6 was increased at 72 hours (hr) and 30 days, IL1 at 72 hr and 15 days and ICAM-1 post reperfusion, contrary to this VEGF showed a decrease at 7 and 15 days. CONCLUSION: RIPC did not improve eGFR or serum creatinine; however, it modifies the inflammatory response in RT recipients.

[Posttransplant relapse in non viral hepatopathies]. / Recidiva postrasplante de hepatopatías no virales.

OBJECTIVE: We describe the recurrence of non-viral liver disease after orthotopic liver transplantation (OLT). METHODS AND RESULTS: We studied 39 patients who received an OLT for non-viral chronic liver disease. Six (15.3%) of these patients presented disease recurrence after OLT, one following alcohol abuse, 3 presented autoimmune liver disease [2 received an OLT for primary biliary cirrhosis and recurred as autoimmune hepatitis (AIH) one patient had cryptogenic cirrhosis before OLT and recurred as AIH]. One patient showed recurrence of a non-alcoholic steatohepatitis (NASH). One patient received an OLT for cirrhosis secondary to the use of metothrexate and post OLT developed secondary biliary cirrhosis due to a choledocal stenosis in the anastomotic site. CONCLUSIONS: All patients described here displayed long term recurrence (after 11 months post OLT). The recurrence of alcoholism was 8.3% among patients transplanted for this condition. AIH was observed in 30% of cases and NASH in 20%. All three patients with autoimmune liver disease recurred with a different autoimmune disease post OLT.

[Variación estacional de las amputaciones en un hospital universitario de Monterrey, México (2009-2012)]. / Seasonality variation of amputations in a university hospital from Monterrey, Mexico (2009-2012).

ANTECEDENTES: Una de las principales complicaciones de la diabetes mellitus es la amputación de alguna extremidad. En todo el mundo, la prevalencia de amputaciones asociadas a la diabetes es muy variada y tiene un impacto considerable en la calidad de vida del paciente. OBJETIVO: Analizar la frecuencia de las amputaciones en el Hospital Universitario Dr. José E. González y evaluar si se presenta un patrón estacional. MÉTODO: Se realizó un estudio retrospectivo de 2009 a 2012, en el que se revisaron los expedientes de pacientes diabéticos que se sometieron a amputación. La estacionalidad se analizó con la bondad de ajuste de ji al cuadrado. RESULTADOS: Se analizaron 456 amputaciones. Los resultados muestran que febrero es el mes que presenta la mayor frecuencia de amputaciones. La estación anual con mayor número de amputaciones fue el invierno. CONCLUSIONES: Las amputaciones en pacientes diabéticos del área metropolitana de Monterrey presentan un patrón estacional, siendo los meses de invierno los de mayor frecuencia. BACKGROUND: The amputation of an extremity is a main complication of Diabetes mellitus. Worldwide the prevalence of amputations associated with diabetes mellitus is variable and had a considerable impact in the quality of life. OBJECTIVE: Analyze the frequency of amputations in the University Hospital, Dr José E González and evaluate if a seasonal pattern is present. METHOD: A retrospective analysis from 2009 to 2012 was carried out. Clinical files of diabetic patients undergoing to amputation were studied. The seasonality was evaluated with a chi square goodness of fit. RESULTS: A total of 456 amputations were studied. Results shown that February was the month with highest frequency of amputations while winter was the annual season with highest frequency of amputations. CONCLUSIONS: Amputations of diabetic patients from Metropolitan Monterrey Mexico show a seasonal pattern being the winter months those that present highest frequency.

[Preacondicionamiento isquémico remoto sobre viabilidad del injerto hepático]. / Remote ischemic preconditioning in liver graft viability.

ANTECEDENTES: El preacondicionamiento isquémico remoto (PIR) en trasplante hepático ha sido sugerido en el ámbito experimental como estrategia para disminuir la lesión por isquemia- reperfusión. OBJETIVO: Evaluar el efecto del PIR sobre el injerto hepático en donante cadáver y el impacto de diversos mediadores inflamatorios en este proceso. MÉTODO: Se incluyeron 10 receptores de trasplante hepático, 5 controles y 5 con PIR, el cual fue realizado en los donantes cadavéricos mediante la aplicación de un torniquete neumático en ambos muslos por 10 minutos seguido de 10 minutos de reperfusión. Se determinaron interleucina (IL)-1, IL-6, factor de necrosis tumoral alfa (FNT-α), factor de crecimiento endotelial vascular (FCEV) y molécula de adhesión intracelular (ICAM)-1, parámetros hematológicos y bioquímicos en diversas fases del trasplante hepático. RESULTADOS: Se observó un aumento significativo de la aspartato aminotransferasa (AST), la alanino aminotransferasa (ALT) y la fosfatasa alcalina en las fases tempranas tras el trasplante hepático, y a las 72 horas los sujetos con PIR mostraron mejor respuesta, con recuperación de plaquetas, que persistió hasta los 3 meses en este grupo. La IL-6 participa en las fases tempranas de la lesión por isquemia- reperfusión, contrario al FNT-α, que se incrementa hasta el día 7, mientras que la ICAM-1 aumentó en todas las fases. CONCLUSIONES: En este estudio piloto, el PIR disminuyó el daño por lesión por isquemia- reperfusión, aunque el mayor efecto se observó después de 72 horas. BACKGROUND: Remote ischemic preconditioning (RIP) in liver transplantation has been suggested experimentally as a strategy to reduce ischemia-reperfusion injury. OBJECTIVE: Evaluate the effect of RIP on liver graft in cadaveric donors and the impact of various inflammatory mediators in this process. METHOD: Ten liver transplantation recipients, 5 controls and 5 PIR, were made in the cadaver donors by applying a pneumatic tourniquet in the upper third of both thighs for a period of 10 minutes followed by 10 minutes reperfusion. The determination of interleukine (IL)-1, IL-6, tumor necrosis factor alpha (TNF-α), vascular endothelial growth factor (VEGF), intracellular adhesion molecule (ICAM)-1 was performed as well as hematological and biochemical parameters at various stages of liver transplantation. RESULTS: Significant increase of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase in the early stages of post-liver transplantation were observed, after 72 hours subjects who received liver transplantation subjected to RIP they showed a better response, which was also evident in platelet recovery, which persisted until phase 3 months in this group. IL-6 appears to participate in the early stages of the ischemia-reperfusion injury, contrary to TNF-α that increases until day 7 while ICAM-1 was increased in all phases. CONCLUSIONS: In this pilot study the PIR decreased the damage by ischemia-reperfusion injury, although the greatest effect was observed after 72 hours.

[Incidence of bacteria from cultures of bile and gallbladder wall of laparoscopic cholecystectomy patients in the University Hospital "Dr. José Eleuterio González"]. / Identificación de flora bacteriana en cultivos de bilis y pared de vesícula biliar de pacientes sometidos a colecistectomía laparoscópica en el Hospital Universitario «Dr. José Eleuterio González¼.

BACKGROUND: Through experience it has been accepted that bile in normal conditions remains sterile. Bactibilia is a common finding in individuals at high risk or with complicated cholecystolithiasis, however few data prevails about the prevalence of bactibilia in patients operated on for uncomplicated laparoscopic cholecystectomy. There is s common usage of preoperative and postoperative antibiotics in the different patients without the existence of any actual bacteriologic and epidemiologic evidence. MATERIAL AND METHODS: 183 patients with diagnosis of cholecystolithiasis postoperated of laparoscopic cholecystectomy had their bile sent to bacteriology. RESULTS: Bactibilia was identified in 31.95% of the cultures of mild cholecystitis and in 35.71% for moderate (p<.0001). A total of 125 negative cultures were obtained (68.3) and 58 positive (31.69%) with a prevalence of enterobacteria group (43.10%) and Enterococcus (27.58). CONCLUSIONS: Comparing the groups according to severity there is a significant difference with regard to the presence of bactibilia, in addition to the bacterial groups cultivated. Fluoroquinolones and metronidazole is an option for the treatment of patients with the suspicion of bactibilia. The use of antibiotics is not justified in patients at low risk.

[Impact of telmisartan on glomerular filtration in laparoscopic surgery. A double blinded randomised controlled study]. / Impacto de telmisartán en la filtración glomerular en cirugía laparoscópica. Estudio aleatorizado doble ciego.

BACKGROUND: Laparoscopic surgery has begun to replace a great number of procedures that were previously practiced using open or conventional techniques. This is due to the minimal invasion, small incisions, and short time recovery. However, it has come to knowledge, that the increase in intra-abdominal pressure due to carbon dioxide pneumoperitoneum during laparoscopic surgery causes cardiovascular, respiratory, endocrine, and renal alterations. OBJECTIVE: To evaluate the nephroprotective effect of telmisartan, an angiotensin II AT1 receptor antagonist, on glomerular filtration in laparoscopic surgery. MATERIAL AND METHODS: Analytical prospective, randomised, double-blind study was conducted on patients undergoing elective laparoscopic cholecystectomy. They were randomised into 2 groups, with the treatment group receiving a single dose of 40mg telmisartan orally 2hours prior to surgery, and the placebo group. RESULTS: There were 20 patients in each group (n=40), with a mean age of 32.65 years in the treatment group. Plasma creatinine did not show any significant change in the different time lapse in which blood samples were taken, but creatinine clearance at the end of surgery (196.415±56.507 vs. 150.1995±75.081; p=0.034), and at 2 h postoperative period (162.105±44.756 vs. 113.235±31.228; p≤0.001) was statistically significant, which supports an increase in renal function in the telmisartan group. CONCLUSION: The use of telmisartan, an angiotensin II AT1 receptor antagonist, offers renal protection during laparoscopic surgery.