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We report a patient who was diagnosed sigmoid colon cancer associated with liver metastases in segment III. The patient underwent laparoscopic surgery where the sigmoid colon resection and hepatic metastasectomy were performed in a “one staged” surgical procedure. The pathological results showed moderately differentiated tubular adenocarcinoma in sigmoid colon, tubular adenocarcinoma metastases also in liver. Oncological surgical results were obtained with free edges of neoplasia, R0 Surgery, T3N0M1. After the optimal surgical results, the patient is handled by oncology for adjuvant treatment. We report here the sequence of events and a review of the literature.

Background: The program "Chile grows with you" is a part of the Chilean social protection system oriented to decrease social inequities from pregnancy (a socially secure pregnancy) to four years of age, directed to the poorest 40% of the population., Aim: To determine the incidence of social vulnerability and its determinants, starting at the gestation period., Material and Methods: Data was obtained from anonymous secondary data based on the records of the first assessment of pregnant women and from social protection surveys, provided by the Ministry of Planning and Cooperation., Results: The incidence of social vulnerability was high. However there was a disparity between the figures obtained from the social protection records and the survey carried out during the first assessment of pregnant women (91 and 27% respectively). The psychosocial risk was higher among vulnerable women (42% compared to 28% among women not considered vulnerable). This risk was associated with lack of family support, depressive symptoms, gender violence, substance abuse and maternity conflicts. Working conditions were precarious with a low level of social security, there were habitability problems, disability, dependency, female householders and a mean income below the threshold of poverty., Conclusions: Among vulnerable families, there are adverse determinants that attempt against a socially secure pregnancy and integral development of children.

Objective: To compare the costs and quality of cervical cancer screening between a non-governmental organization (NGO) and a Ministry of Health clinic., Material and Methods: A quantitative and qualitative cross-sectional study was conducted between April and July 1999, in two healthcare clinics in Cuernavaca, Morelos, Mexico. Cervical cancer screening production processes were compared along four components: a) Pap smear collection; b) its transportation to the cytology center; c) analysis and interpretation; and d) notification of results. The framework developed by Bruce was used for assessing the quality of care. The framework includes users' perceptions on information received and waiting times, as well as providers' perceptions of space and equipment availability., Results: The unitary cost of the production process in the public clinic ($144 pesos or US$15.5) was 26% higher than in the NGO ($114 pesos or US$12.3). Women attending NGO services reported a higher satisfaction with the quality of care than those who attended the public clinic. The waiting time prior to screening and the time each woman has to wait to receive test results were the main sources of insatisfaction., Conclusions: Analysis of costs and quality of care results suggest that NGOs should be considered as an alternative in the provision of cervical cancer screening. The English version of this paper is available at: http://www.insp.mx/salud/index.html

Objective: To know the prevalence of adrenal insufficiency (AI) in our patients with acquired immunodeficiency syndrome (AIDS) and to compare the clinical manifestations with those reported in previous series in the literature., Patients and Methods: Retrospective study with review of clinical records of patients with AIDS diagnosed of AI (plasma cortisol after synthetic ACTH < 18 micrograms/dl) in our hospital for a period of 6 and a half years., Results: Eleven out of 65 patients (17%) with the hormonal study performed were diagnosed of AI. The prevalence of AI in our patients with AIDS was 1.66%. The response of plasma cortisol to synthetic ACTH was abnormal in the 11 patients (mean increase: 1.89 micrograms/dl). Nine out of the 11 patients had a decreased basal plasma cortisol level (mean: 4.75 micrograms/dl). Basal plasma ACTH levels were increased (mean: 638.9 pg/ml) in seven out of nine patients. Patients were severely immunosuppressed (mean CD4: 21/microliter). While the clinical course was subacute (mean: 5.1 weeks), nine out of the eleven patients developed an adrenal crisis which required emergency therapy. Ten patients had an opportunist infection--M. tuberculosis (3), M. avium-intracellulare (3), Cytomegalovirus (3), histoplasmosis (1)--which could involve the adrenal glands in ten patients. All patients responded to treatment but their mean survival was 5.6 weeks., Conclusions: Although the prevalence of AI in our patients with AIDS was low (1.66%), it is important to be aware of the disease and to order a basal plasma cortisol value after synthetic ACTH, as treatment improves the life quality of patients if AI is confirmed, despite a short survival time.

The epidemiological study of post-traumatic epilepsy after 10 years of follow-up on the island of Mallorca is reported. The double prospective and retrospective method was used for patient selection. Prospectively, 23,082 isolated head injuries were studied in the Hospital of Son Dureta in Palma de Mallorca between the years 1980 to 1988. Retrospectively, 663 epileptics proceeding from different data bases of different centers were studied. Two hundred and twelve post-traumatic epilepsies of certain etiology were identified. Results are discussed with regard to age, sex and latency time found. Special emphasis is made in that benign cerebral concussion is not causing seizures. A prevalence of 4% of post traumatic epilepsy is found in the population of risk head injuries, and post-traumatic epilepsy represents 7% of the total of the casuist of epileptic patients.

The number of human cases with hydatidosis in the Province de Río Negro in the period 1969-1983 was determined by a retrospective exam of the registers at the Provincial Ministry of Health. From 1216 cases the yearly numbers between 59.4 in 1969-78 and 124.4 cases between 1979-83. This implies a yearly of 3.24 X 10,000 and with the most frequent localization in the liver. The average days of hospitalization was 29.2 per patient. The highest correspond to the southern departments of the Province 6.57 X 10,000 in the 40 Sanitary Zone. Eighty two and thirty five per cent of the cases had immunological confirmation with DD5, before surgery. The census allowed us to determine that rates of prevalence were in school children 1.09%, in conscripts, 0.28% and in adult settlers 2.58%. The average of positive serological cases in the province, was 0.77%. The yearly number of cases diagnoses is estimated in 4% of the existent carriers and is the highest in the world. The followup and control of children who had surgery, allowed us to detect that 30% of the cases presented new hydatid cyst before the 5 year lapse. Different factors put Río Negro with the highest rates of denounced human hydatidosis. These are related to living conditions around cattle farms and the socio economics and educational factors, which are analyzed in this paper. Modifications in the Programme for the control of hydatidosis has been put into action by the sanitary authorities.