Search

Aim Describe the use of botulinum toxin A (BT) and preoperative progressive pneumoperitoneum (PPP) in a loss of domain inguinoscrotal hernia following our hospital's protocol. Material and methods Single case report of a 60-year-old male, with loss of domain bilateral inguinoscrotal hernia. We performed prehabilitation with respiratory physiotherapy (RP), BT and PPP. We applied BT 30 days before surgery, injecting a total of 500U in 12 sites of abdominal wall: 4 in the lateral abdominal muscle and 2 of them in each rectus abdominis. We calculated, using the Tanaka index, the ratio between the abdominal cavity volume (ACV) and the hernia volume (HV), which was 32%, as well as the amount of pneumoperitoneum to insufflate, which according to our protocol is HV x3 + 100cc. The PPP catheter was placed 10 days before repair, insufflating a total of 6.900cc within seven consecutive days of catheter placement. Results With the application of prehabilitation (BT, RP, PPP) we achieve a lengthening of 18.5 cm and a decrease of 27 mm of the thickness as well as an increase in the volume of the abdominal cavity of×4.200cc. Afterwards, a hernioplasty with Stoppa and bilateral Litchenstein technique was performed. as well as a scrotoplasty and circumcision for the patient's phimosis in collaboration with Plastic and Urology services. The surgical procedure was performed without complications. After 7 months there is no hernia recurrence. Conclusions BT and PPP help to repair the inguinoscrotal hernia, avoiding the mayor surgical techniques like component separation diminishing morbidity.

Aim show our technique for abdominal wall graft retrieval minimizing warm ischemia time. Material and methods a video report of an abdominal wall graft retrieval (full-thickness) from a female brain death donor. Results better graft perfusion with a lower picnosis in the studied cells. Lower tissue damage in both full-thickness and isolated fascia grafts. Surgical technique: An “house-flap” incision is done as opposed to a conventional cross-line laparotomy. The flap is extended until the inguinal ligament, divided afterwards to gain easier access to the femoral vessels. After abdominal organ dissection, the common iliac arteries are dissected from close to the aortic bifurcation up to the femoral vessels, beyond the origin of the inferior epigastric arteries. After cannulation of the aorta, cava vein and inferior mesenteric vein for the intraabdominal organs, both common iliac arteries are cannulated beyond the origin of external iliac artery. To achieve optimal perfusion of the rectus fascia we have to clamp the artery distal to the origin of the inferior epigastric artery (usually at the level of the femoral artery). The abdominal wall graft perfusion is done simultaneously with all the abdominal organs. Afterwards, we cover the graft with cold pads to avoid direct contact between the ice and the graft. A closure of the donor abdominal wall must be ensured after removing the wall graft. Conclusions our technique has showed better pathological outcomes than those previously published with a lower warm ischemia time of the abdominal wall graft.

Incisional hernias are a well-known complicationafter liver transplantation, with an incidence of up to 15%. Conventional closure techniques such as synthetic or biological meshes do not have proper results, probably due to a variety of factors including tension in a definitive wall closure and the use of immunosuppressive drugs that can cause necrosis and wound infection. Alternative techniques such as a complete abdominal fascia transplantation can sometimes be needed. We present the case of a 57-year-old man with a history of liver transplantation due to HCV Cirrhosis, Portal Thrombosis and Pulmonary Hypertension. The patient developed a hernia of the Mercedes scar with a large fascial defect that caused him pain and obstructive symptoms. Surgical intervention was performed for hernia repair. During surgery, a large aponeurotic defect was identified with a ring of 25×15cm associated with an adhesion syndrome within the hernial sac. During surgery, the hernial sac was released, followed by release of the anterior aponeurosis and peritoneal closure. An abdominal wall transplant was performed from a 56-year-old donor after the graft had been preserved for 10 days in Celsior® at 4°. The fascial graft was placed to cover the abdominal wall defect and sutured to the edges of the recipient's fascia, using 4 interrupted 2-0 polypropylene non absorbable stitches. This patient's loss of domain of the abdominal cavity, associated with the existing vascular complications, were more than sufficient reasons to choose this technique. The patient's postoperative course was uneventful, but developed bulging during follow-up, without any additional complications.

Abdominal compartment syndrome is a potentially life-threatening condition seen in critically ill patients. Several techniques have been described for abdominal wall closure after a damage control laparotomy to achieve static and dynamic support without leading to abdominal hypertension. Aim To describe short termn results after a modified Chevrel technique for midline incisional hernia repair in patients with abdominal hypertension. Materials and Methods We perfomed a modified Chevrel as an abdominal wall closure technique in 9 patients between January 2016 and January 2022. The inclusion criteria were patients surgical intervened from gastrointestinal diseases and postoperative complications who suffered from varying degrees of abdominal hypertension. We consider this surgical approach in symptomatic patients with intrabdominal pressures exceeding 20mmHg who were stable enough to undergo surgery. Results Nine patients were treated with this technique (6 male and 3 female). Their BMI ranged from morbidly obese to severe underweight. The main reasons why only one side of the fascia could be used were: The presence of a stoma, intrabdominal drains and inverted T-scars from previous surgeries. The use of mesh was dismissed in 6 of the patients (66.7%) because they required subsequent abdominal surgeries. None of the patients developed hernia recurrence, although we did have one case of bulging, one hematoma and one case of seroma. Our results are limited by a 33% mortality within the first two years. Conclusions The modified Chevrel technique can be used as an urgent surgical tool for closing midline defect in patients undergoing compartimental syndrome and abdominal hypertension.

Abdominal compartment syndrome is a pontentially life-threatening condition seen in critically ill patients, and most often caused by acute pancreatitis, postoperative abdominal vacular thrombosis or mesenteric ischemia. A descompressive laparotomy is sometimes required, often resulting in hernias, and subsequent definitive wall closure is challenging. Aim This study aims to describe short term results after a modified Chevrel technique for midline incisional repair in patients witch abdominal hypertension. Materials & Methods We performed a modified Chevrel as an abdominal closure technique in 9 patients between January 2016 and January 2022. All patients presented varying degrees of abdominal hypertension. Results Nine patients were treated with new technique (6 male and 3 female), all of whom had conditions that precluded unfolding the contralateral side as a means for closure. The reasons for this were diverse, including presence of ileostomies, intra-abdominal drainages, Kher tubes or an inverted T scar from previous transplant. The use of mesh was initially dismissed in 6 of the patients (66.7%) because they required subsequent abdominal surgeries. None of the patients developed a hernia, although two died 6 months after the procedure. Only one patient developed buldging. A decrease in intrabdominal pressure was achieved in all patients. Conclusion The modified Chevrel technique can be used as a closure option for midline ventral hernias in cases where the entire abdominal wall cannot be used.

With the aging population, there is a need to develop intergenerational activities to promoting healthy aging. “Age XXL” was an intergenerational project in Portugal where older adults attending an...

Objective: To determine the effectiveness of a 13-week individual reminiscence therapy (RT) intervention on cognition, memory, executive function, mood, and quality of life of people with Alzheimer’s disease and vascular dementia. Method: Non-protocolized analysis using data from a larger multicenter, single-blind, randomized, parallel two-arm RCT of RT for people with neurocognitive disorders. A sample of 148 people with probable Alzheimer’s disease or vascular dementia attending 23 Portuguese institutions providing care and support services for older adults were selected. Intervention group (n = 74) received 26 individual RT sessions, twice a week for 13 weeks. Control group (n = 74) maintained their treatment as usual. Outcomes were global cognitive function (MMSE), memory (MAT), executive function (FAB), mood (GDS-15), and self-reported quality of life (QoL-AD). All participants were assessed at baseline (T0) and 15 weeks later (T1). Results: The results showed a significant effect of the intervention on global cognition (Group X Time interaction F(1, 128) = 10.542, p = .001, ηp2 = .076), memory (F(1,128) = 9.881, p = .002, ηp2 = .072), and quality of life (F(1,128) = 0.181, p = .671, ηp2 = .001), with medium effect sizes. A small effect on executive function (F(1,127) = 11.118, p = .001, ηp2 = .080) was also found. No effects were found on depressive symptoms (F(1,128) = 0.181, p = .671, ηp2 = .001). Conclusion: Individual RT may have beneficial effects on cognition and quality of life of people with Alzheimer’s disease or vascular dementia.

Non-pharmacological intervention options, including individual reminiscence therapy (iRT), have been effective in improving cognitive functioning, mood, and quality of life (QoL) in persons with neurocognitive disorders (NCD).A 13-week randomized trial intervention utilizing iRT was conducted on older adults with NCD. We explored predictors of participants with positive and non-positive intervention responses using responder analysis, an analytic strategy that focuses on contributors to intervention response.Re-analysis of a published single-blind, multicentre, randomised controlled trial on 251 older adult residents with NCD from residential facilities across Portugal. Participants received 13 weeks of biweekly iRT (26 sessions) or treatment/programming as usual. Outcomes included global cognition (Minimental State Examination), memory (MAT), executive functioning (FAB), depressive symptoms (GDS-15), and QoL (QoL-AD).There were more responders in the intervention than the control group on all five criteria, with significant differences for cognition (p = 0.001; f = 0.202; NNT = 5) and memory (p = 0.004; f = 0.184; NNT = 6). At baseline, intervention responders vs non-responders had: higher QoL-AD scores (30.23 vs 25.57; p0.001; d = -0.774) for cognition; lower FAB scores (1.41 vs -2.12; p0.001; d = 0.928) for executive functioning; higher GDS-15 scores for the depressive symptoms (7.57 vs 4.91; p0.001; d = -0.845), and for QoL (6.81 vs 5.33; p = 0.013; d = -0.443).The iRT intervention showed high response rates for cognition and memory. Those with worse executive dysfunction, mood, and QoL, benefitted most from the intervention for those respective outcomes. Therefore, the presented iRT has beneficial effects for people with NCD, with mood and QoL as important influential factors.Ensayo aleatorio de terapia de reminiscencia individual para adultos mayores con deterioro cognitivo: un análisis de respuesta de tres meses.Introducción. La terapia de reminiscencia individual (iTR) ha demostrado mejorar la cognición, el estado de ánimo y la calidad de vida (CdV) de personas con trastornos neurocognitivos (TNC). Objetivo. Se exploraron los predictores de la respuesta positiva a la iTR utilizando el análisis de respuesta, una estrategia analítica de los factores que contribuyen a una respuesta a la intervención. Pacientes y métodos. Reanálisis de un ensayo controlado aleatorizado de 251 adultos mayores portugueses con TNC. Los participantes recibieron dos sesiones de iTR durante 13 semanas (26 sesiones) o el tratamiento habitual. Las variables analizadas fueron la cognición global (Minimental State Examination), la memoria (test de alteración de la memoria), el funcionamiento ejecutivo –batería de evaluación frontal (FAB)–, los síntomas depresivos –escala de depresión geriátrica-15 (GDS-15)– y la CdV –escala de calidad de vida en la enfermedad de Alzheimer (QOL-AD)–. Resultados. Hubo más respondedores en el grupo de intervención que en el de control en los cinco criterios, con diferencias significativas para cognición (p = 0,001; f = 0,202; número necesario para tratar = 5) y memoria (p = 0,004; f = 0,184; número necesario para tratar = 6). En la línea de base, los respondedores tenían: puntuaciones más altas de QOL-AD (30,23 frente a 25,57; p menor de 0,001; d = –0,774) para la cognición; puntuaciones FAB más bajas (1,41 frente a –2,12; p menor de 0,001; d = 0,928) para el funcionamiento ejecutivo; y mayores puntuaciones en la GDS-15 para los síntomas depresivos (7,57 frente a 4,91; p menor de 0,001; d = –0,845) y para la CdV (6,81 frente a 5,33; p = 0,013; d = –0,443). Conclusiones. La iTR mostró altas tasas de respuesta para la cognición y la memoria. Los que tienen peor función ejecutiva, estado de ánimo y CdV se beneficiaron más de la intervención para esas respectivas variables. La iTR tiene efectos beneficiosos en los TNC, con el estado de ánimo y la CdV como factores influyentes.

Cognitive stimulation is a recommended therapy with positive effects on the cognitive performance of older adults with neurocognitive disorders. However, there are few one-on-one, long-term interventions applied by professionals. The aim of the present study was to determine the effectiveness of 47-week individual cognitive stimulation (iCS) interventions on cognition, mood, instrumental activities of daily living, and quality of life in older adults, with neurocognitive disorders using a single-blind, randomized, parallel two-arm RCT. A sample of 59 older adults with neurocognitive disorders (predominantly Alzheimer's disease), who were non-institutionalized but socially vulnerable, was selected. The intervention group (n = 30) received 47 iCS weekly sessions. The control group (n = 29) maintained their baseline treatments. Outcomes were global cognitive function, cognitive impairment, mood, instrumental activities of daily living, and self-reported quality of life. All participants were assessed at baseline, 25 weeks, and 50 weeks. The results showed a significant effect of the intervention on MMSE, MoCA, GDS-15. Individual cognitive stimulation may have beneficial effects on the cognitive function and mood of older adults with cognitive impairment.

Reminiscence therapy (RT) is a form of cognitive stimulation therapy that incorporates discussion of past activities, events, and experiences to stimulate individual memories; it has had some success in treating persons with neurocognitive disorders. This research aims to evaluate the ability of individual RT, using a simple reminiscence format, to improve the overall cognitive function, memory, executive functions, emotional status, and quality of life in older adults with neurocognitive disorders who received social care and support services. A multicenter randomized controlled trial was completed in the Azores archipelago (an independent region of Portugal) using repeated measures (pre-intervention, post-intervention, and follow-up). The intervention group underwent individual RT sessions, twice weekly for 13 weeks, while the control group completed regular activities administered as part of their program. Results did not reveal any significant differences between the intervention and control groups. While results did not reveal significant effects, a number of historical and contextual factors are considered as possible explanations for the lack of effects—namely, data collection occurring during the COVID-19 global pandemic, participant cohort effects, and therapist heterogeneity.

We have seen an increase in the prevalence of mental disorders in Portugal. Despite this fact, the mental health care network is limited with no known home-based cognitive stimulation programs available. The aim of this study was to determine the effectiveness of an eight-month one-on-one cognitive stimulation intervention program in improving cognition, executive function and mood in adults with psychotic disorders (e.g., schizophrenia, delusional disorder). An uncontrolled repeated measures design was applied to 20 adults diagnosed with mental disorders who participated in 35 one-on-one sessions at home, conducted weekly, with 45 minutes each. Independent evaluators assessed cognitive status (MoCA), executive functions (FAB) and depressive symptoms (BDI). There was a significant effect of the intervention on cognitive status (d = 0.59), executive functions (d = 0.76) and depressive symptoms (d = 0.43). The results support sound effectiveness, viability and acceptability of the intervention in this mental health population.

Cognitive stimulation may be beneficial in slowing the progression of mild neurocognitive disorder (NCD), but the results of existing research are inconsistent. Furthermore, there are no long-term interventions nor individual (one-on-one) interventions applied by professionals. Objetive. The aim of this study was to assess the efficacy of a long-term individual cognitive stimulation intervention on people with mild NCD.A pre-post test design with a non-equivalent control group was conducted. A total of 82 participants with mild NCD were assigned to a cognitive stimulation intervention group or to a control group. The intervention consisted of 88 individual format sessions of approximately 45 minutes, twice per week. Independent evaluators assessed cognition, depressive symptomatology and autonomy level in activities of daily living at pre-intervention, intra-intervention (6 months) and post-intervention (12 months).At intra- and post-intervention, significant improvement on cognition and depressive symptomatology in the intervention group compared to the control group were found. Younger participants and those with better cognitive function and status in pre-intervention achieved better results. Adherence to the intervention was high.Results suggest the efficacy of long-term individual cognitive intervention in people with mild NCD, which could delay the progression towards a major NCD.Efecto de la intervención de estimulación cognitiva individual de larga duración para personas con trastorno neurocognitivo leve.Introducción. La estimulación cognitiva puede ser beneficiosa para ralentizar la progresión del trastorno neurocognitivo (TNC) leve, pero los resultados de las investigaciones existentes son inconsistentes. Además, no existen intervenciones a largo plazo ni intervenciones individuales (uno a uno) aplicadas por profesionales. Objetivo. El objetivo de este estudio fue evaluar la eficacia de una intervención de estimulación cognitiva individual de larga duración para personas con TNC leve. Pacientes y métodos. Se llevó a cabo un diseño pretest-postest con un grupo control no equivalente. Un total de 82 participantes con TNC leve fueron asignados a un grupo de intervención de estimulación cognitiva o a un grupo control. La intervención consistió en 88 sesiones de formato individual de aproximadamente 45 minutos, dos veces por semana. Evaluadores independientes evaluaron la cognición, la sintomatología depresiva y el nivel de autonomía en las actividades de la vida diaria en la preintervención (línea base), la intraintervención (seis meses) y la postintervención (12 meses). Resultados. En la intra- y la postintervención, se encontró una mejora significativa en la cognición y la sintomatología depresiva en el grupo de intervención en comparación con el grupo control. Los participantes más jóvenes y los que tenían una mejor función y estado cognitivo en la preintervención obtuvieron mejores resultados. La adhesión a la intervención fue alta. Conclusiones. Los resultados sugieren la eficacia de una intervención cognitiva individual de larga duración para personas con TNC leve, que podría retrasar la progresión hacia un TNC mayor.

With notable increases in older adult populations, as well as with the associated cognitive impairments that can accompany aging, there is significant importance in identifying strategies to promote cognitive health. The current study explored the implementation of a positive reminiscence program (REMPOS), a non-pharmacological cognitive therapy that has been previously structured, defined, and tested in a Spanish sample. We sought to improve the quality of life of institutionalized older adults with healthy aging, mild cognitive impairment, and Alzheimer’s disease by utilizing this protocol in these samples. A randomized design with a pre-post measure was conducted over a three-month period. Two types of interventions were used: the experimental groups received REMPOS, and the control groups underwent their regular daily institutional programming with cognitive stimulation techniques. After the intervention, the three experimental groups showed higher cognitive functioning, decreased depressive symptomatology (except for the MCI group) and higher evocation of specific positive memories (except for the MCI group). This study supports the effectiveness of REMPOS and reminiscence therapy, with regard to both cognitive and mood factors in cognitively impaired older adults.

Background: The literature suggests that reminiscence therapy (RT) is one of the non-pharmacological treatments with better evidence for older people with neurocognitive disorders (NCD). RT stimulates neuroplasticity and cognitive reserve, and it may have a protective effect on the person with NCD.Objective: To describe in detail the structure and contents of an individual RT intervention protocol applied to older people with NCD.Methodology: Identification of the phases prior to the design of the intervention protocol.Results: Individual RT intervention protocol, in a mixed format, consisting of 26 sessions, twice a week, of approximately 50 minutes each, conducted by trained therapists.Conclusion: The detailed individual RT program can be adequately implemented and replicated, and it may delay the progression of NCD.

Objectives To evaluate the effectiveness of a 13-week individual reminiscence therapy (RT) intervention to improve the overall cognitive function, memory, executive function, mood and quality of life (QoL) of people with neurocognitive disorders. Methods A single-blind, multicentre, randomised parallel two-arm controlled trial recruited 251 people with neurocognitive disorders attending 24 institutions providing care and support services for older adults in Portugal. The primary outcome measure was cognitive function (Mini-Mental State Examination [MMSE]). Secondary outcomes were memory (Memory Alteration Test [MAT]), executive function (Frontal Assessment Battery [FAB]), mood (Geriatric Depression Scale-15 [GDS-15]) and self-reported QoL-Alzheimer's disease AD). Participants in the intervention group (n = 131) received 26 individual RT sessions, twice a week, over the course of 13 weeks. Participants in the control group (n = 120) maintained their treatment as usual. Results Intention-to-treat analysis showed that, at endpoint assessment, the intervention group had significantly improved in relation to the control group in MMSE (mean difference 1.84, 95% CI [0.80, 2.89], p = .001, d = .44), MAT (mean difference 2.82, 95% CI [0.72, 4.91], p = .009, d = .34) and QoL-AD (mean difference 1.78, 95% CI [0.17, 3.39], p = .031, d = .28). Non-significant improvements were found on FAB (mean difference 0.74, 95% CI [-0.04, 1.52], p = .062, d = .24) and GDS-15 (mean difference -0.63, 95% CI [-1.45, 0.19], p = .130, d = .19). Conclusions For people with neurocognitive disorders attending social care and support services, the individual RT designed for this trial should be considered an intervention with the potential to improve cognition, memory and QoL.

Resumen Introduccion y objetivos La endometriosis es una enfermedad con una incidencia que puede llegar al 50% en mujeres en edad fertil. La endometriosis apendicular se presenta en el 1% de estas pacientes, con una clinica variable: su presentacion mas frecuente es la propia de una apendicitis. El objetivo del estudio es describir y analizar las caracteristicas clinicas y anatomopatologicas de los casos de endometriosis apendicular de los ultimos 10 anos en el Hospital 12 de Octubre. Pacientes y metodos Presentamos el estudio retrospectivo de los casos de endometriosis apendicular de nuestro centro en los ultimos 10 anos. Resultados Encontramos 22 casos de endometriosis apendicular de un total de 7.051 piezas. La mediana de edad de las pacientes fue de 38,5 anos, con 3 pacientes fuera de edad fertil. El inicio fue un abdomen agudo en 16 pacientes; hasta en 10 casos se requirio la realizacion de 2 pruebas de imagen. La endometriosis apendicular fue sospechada en tan solo 2 pacientes. El abordaje laparoscopico fue la tecnica de preferencia en los casos cronicos o dudosos. En 6 de las piezas aparecio una apendicitis concomitante. Conclusiones La endometriosis apendicular presenta un dificil diagnostico preoperatorio y debe ser tenida en cuenta en el diagnostico diferencial de la apendicitis aguda y considerar que puede ocurrir fuera de la edad fertil.

There is evidence to suggest that cognitive stimulation produces cognitive benefits in people with mild neurocognitive disorder. However, the effect has been previously demonstrated to be minimal to moderate and the effect of long-term individual interventions, namely on specific cognitive domains, is unknown.To assess the efficacy, feasibility and acceptability of a long-term individual cognitive stimulation intervention for patients with mild neurocognitive disorder.Patients (n = 30) with mild neurocognitive disorder were assigned to a cognitive stimulation intervention group (n = 15) or to a control group (n = 15). The intervention consisted of 88 individual sessions, approximately 45 minutes long, with two sessions per week. External evaluators assessed the level of alteration in cognitive performance, depressive symptoms and the level of independence in the performance of basic activities of daily living.After the intervention, a significant improvement was found in the intervention group compared to the control group in overall cognitive performance (d = 0.83), specifically in the language domain (d until 1.50). There were also lower depressive symptoms in the intervention group compared to the control group (d = 0.93). Only 6.7% of the participants dropped out the study, with participants attending a mean of 83 ± 12.1 sessions.The results support the efficacy, feasibility and acceptability of the intervention for mild neurocognitive disorder and justify a randomized controlled trial of the program with a larger sample.Programa de estimulacion cognitiva individual de larga duracion para personas con trastorno neurocognitivo leve: estudio piloto.Introduccion. Existen evidencias que sugieren que la estimulacion cognitiva produce beneficios cognitivos en personas con trastorno neurocognitivo leve. Sin embargo, el tamaño del efecto encontrado es de pequeño a moderado, y se desconoce el efecto de las intervenciones individuales de larga duracion y, mas concretamente, sobre dominios cognitivos especificos. Objetivo. Evaluar la eficacia, viabilidad y aceptabilidad de una intervencion de estimulacion cognitiva individual de larga duracion para personas con trastorno neurocognitivo leve. Pacientes y metodos. Un total de 30 personas con trastorno neurocognitivo leve fueron asignadas a un grupo de intervencion de estimulacion cognitiva (n = 15) o a un grupo control (n = 15). La intervencion consistio en 88 sesiones individuales de unos 45 minutos, con una periodicidad de dos veces por semana. Evaluadores independientes valoraron el nivel de rendimiento cognitivo, los sintomas depresivos y el nivel de autonomia en la realizacion de actividades basicas de la vida diaria. Resultados. Tras la intervencion, se encontro una mejoria significativa en el grupo de intervencion en comparacion con el grupo control en el rendimiento cognitivo global (d = 0,83), concretamente en el dominio del lenguaje (d hasta 1,50), y una menor sintomatologia depresiva en el grupo de intervencion en comparacion con el control (d = 0,93). Solo un 6,7% de los participantes abandono el estudio, asistiendo a un promedio de 83 ± 12,1 sesiones. Conclusiones. Los resultados apoyan la eficacia, viabilidad y aceptabilidad de la intervencion, y justifican la realizacion de un ensayo controlado aleatorizado aplicado a una muestra mayor.

Introduccion. La estimulacion cognitiva puede ser beneficiosa para ralentizar la progresion del trastorno neurocognitivo (TNC) leve, pero los resultados de las investigaciones existentes son inconsistentes. Ademas, no existen intervenciones a largo plazo ni intervenciones individuales (uno a uno) aplicadas por profesionales. Objetivo. El objetivo de este estudio fue evaluar la eficacia de una intervencion de estimulacion cognitiva individual de larga duracion para personas con TNC leve. Pacientes y metodos. Se llevo a cabo un diseno pretest-postest con un grupo control no equivalente. Un total de 82 participantes con TNC leve fueron asignados a un grupo de intervencion de estimulacion cognitiva o a un grupo control. La intervencion consistio en 88 sesiones de formato individual de aproximadamente 45 minutos, dos veces por semana. Evaluadores independientes evaluaron la cognicion, la sintomatologia depresiva y el nivel de autonomia en las actividades de la vida diaria en la preintervencion (linea base), la intraintervencion (seis meses) y la postintervencion (12 meses). Resultados. En la intra- y la postintervencion, se encontro una mejora significativa en la cognicion y la sintomatologia depresiva en el grupo de intervencion en comparacion con el grupo control. Los participantes mas jovenes y los que tenian una mejor funcion y estado cognitivo en la preintervencion obtuvieron mejores resultados. La adhesion a la intervencion fue alta. Conclusiones. Los resultados sugieren la eficacia de una intervencion cognitiva individual de larga duracion para personas con TNC leve, que podria retrasar la progresion hacia un TNC mayor.

Resumen Fundamento y objetivo Los dispositivos intrauterinos (DIU), constituyen el 23% del uso general de las medidas contraceptivas reversibles en todo el mundo. Entre las complicaciones mas graves secundarias a su uso, destacan la perforacion uterina y la migracion del dispositivo. Material y metodo Se presenta un caso de migracion de DIU a traves de pared rectal en una mujer de 40 anos, que acude al servicio de urgencias por dolor brusco y rectorragia. A la exploracion fisica se objetiva el componente horizontal del DIU saliendo a traves del orificio anal y mediante tacto rectal se palpa el componente vertical alojado en recto; localizacion que se verifica mediante la realizacion de una TC abdominopelvica. En este caso, se realizo una extraccion colonoscopica del cuerpo extrano. Conclusiones En general, cuando una perforacion es identificada, se recomienda la extraccion del dispositivo lo antes posible. Para ello se pueden usar tecnicas endoscopicas o quirurgicas, en funcion de la localizacion, por lo que cada caso debe ser individualizado.

Children are one of the groups with the highest mortality rate on the waiting list for LT. Primary closure of the abdominal wall is often impossible in the pediatric population, due to a size mismatch between a large graft and a small recipient. We present a retrospective cohort study of six pediatric patients, who underwent delayed abdominal wall closure with a biological mesh after LT, and in whom early closure was impossible. A non-cross-linked porcine-derived acellular dermal matrix (Strattice(™) Reconstructive Tissue Matrix; LifeCell Corp, Bridgewater, NJ, USA) was used in all of the cases of the series. After a mean follow-up of 26 months (21-32 months), all patients were asymptomatic, with a functional abdominal wall after physical examination. Non-cross-linked porcine-derived acellular dermal matrix (Strattice(™) ) is a good alternative for delayed abdominal wall closure after pediatric LT. Randomized controlled trials are necessary to determine the best moment and the best technique for abdominal wall closure.

Introduccion. Existen evidencias que sugieren que la estimulacion cognitiva produce beneficios cognitivos en personas con trastorno neurocognitivo leve. Sin embargo, el tamano del efecto encontrado es de pequeno a moderado, y se desconoce el efecto de las intervenciones individuales de larga duracion y, mas concretamente, sobre dominios cognitivos especificos. Objetivo. Evaluar la eficacia, viabilidad y aceptabilidad de una intervencion de estimulacion cognitiva individual de larga duracion para personas con trastorno neurocognitivo leve. Pacientes y metodos. Un total de 30 personas con trastorno neurocognitivo leve fueron asignadas a un grupo de intervencion de estimulacion cognitiva (n = 15) o a un grupo control (n = 15). La intervencion consistio en 88 sesiones individuales de unos 45 minutos, con una periodicidad de dos veces por semana. Evaluadores independientes valoraron el nivel de rendimiento cognitivo, los sintomas depresivos y el nivel de autonomia en la realizacion de actividades basicas de la vida diaria. Resultados. Tras la intervencion, se encontro una mejoria significativa en el grupo de intervencion en comparacion con el grupo control en el rendimiento cognitivo global (d = 0,83), concretamente en el dominio del lenguaje (d hasta 1,50), y una menor sintomatologia depresiva en el grupo de intervencion en comparacion con el control (d = 0,93). Solo un 6,7% de los participantes abandono el estudio, asistiendo a un promedio de 83 ± 12,1 sesiones. Conclusiones. Los resultados apoyan la eficacia, viabilidad y aceptabilidad de la intervencion, y justifican la realizacion de un ensayo controlado aleatorizado aplicado a una muestra mayor

Lesions produced in the graft mucosa due to harvesting, storage, and implantation must be graduated to assess the subsequent protocolized biopsy specimens. The aim is to identify type and intensity of graft mucosal lesions observed immediately after implantation. Congestion, hemorrhage, microthrombi, neutrophilic infiltrates, shortening of villi, epithelial detachment, erosion, and crypt loss were separately evaluated by two pathologists in mucosal biopsy specimens from 13 grafts. Each change was assessed as normal, mild, moderate, or severe and by splintering the summation of points a global score was designed. Cold ischemia time was registered. Correlation between the pathologists' evaluations and between final preservation injury degree and cold ischemia time was determined using the "index of correlation rho (ρ)" (Spearman's test). The same changes were assessed in 19 biopsy specimens from day 2 to day 6 (3.6 ± 1.1) to determine their evolution. Congestion was found in 7 biopsy specimens, microthrombi in 2, hemorrhage in 4, neutrophils in 6, villous atrophy in 8, epithelial detachment in 9, erosions in 2 and/or crypt loss in 2. The maximum degree of preservation injury was expressed as intense congestion and hemorrhage associated with epithelial detachment and villous atrophy. The global preservation score was grade 3 in 2 cases, grade 2 in 5, grade 1 in 2, and grade 0 in 4. There was positive correlation (ρ = 0.915) in the evaluation between pathologists (P .01), total agreement in 9 biopsy specimens, and partial agreement (only 1 point disagreement) in 4. Mean cold ischemia time was 327 ± 101 min. (135-480). There was positive correlation (ρ = 0.694) between preservation score and cold ischemia time (P .01). In the follow-up biopsy procedures, histological injury decreased by at least one grade in every case. Additionally, karyorrhexis was observed in 3 grafts and very occasional apoptosis in 2 others. This scale achieves good reproducibility and allows graduate preservation injury in intestinal transplantation.

Background Surgical complications in multivisceral transplantation (MVT) are frequent and always severe. Those related to technical issues are relevant as they have implications not only on the graft but also on patient survival. The aim of this study was to review our case-based data and experience with 5 MVT performed since December 2004. Case Report A 38 year-old woman presented with ultra-short bowel syndrome due to massive ischemia also affecting the celiac trunk. She also had moderate to severe hepatitis/steatosis with some degree of fibrosis on liver biopsy, due to long-term home parenteral nutrition (HPN). An MVT was carried out in September 2010 including the liver, stomach, pancreatoduodenal complex with the spleen, and small bowel. The postoperative course was complicated by a leak from the pyloromiotomy, requiring reoperation on postoperative day 13. She also had central line catheter infection and renal impairment, requiring renal replacement therapy, and was discharged on postoperative day 150. Fifteen days later she was hospitalized because of severe abdominal pain associated with an abdominal mass. Computed tomography showed an aortic donor graft pseudoaneurysm, so we decided to operate on the patient. A complete resection of the pseudoaneurysm using an interposed polytetrafluoroethylene graft was performed. Six months after the MVT, the patient died due to sepsis, despite a functional graft and complete digestive autonomy. Conclusions Although this complication is rare, surgical complications in MVT are severe and may seriously impair graft and patient survival.

Background: The effect of angiotensin converting enzyme inhibitors (ACEls) on 1.25-dihydroxyvitamin D [1.25-(OH)2D] levels has not been studied. The purpose of this study is to assess the relationship between 1.25-dihydroxyvitamin D levels and I/D angiotensin-converting enzyme polymorphism (ACE) in hypertensive patients. Materials and Methods: The study included 60 individuals (31 females and 29 males) with systolic and/or diastolic hypertension. The 25-hydroxyvitamin D levels were measured by HPLC and the 1.25-(OH) 2 D was determined by RIA. ACE polymorphism was analyzed by Polymerase Chain Reaction (PCR) using a modification of the original method described by Rigat. Results: Treatment with ACEIs produced an increase in total calcium (p = 0.003) and a decrease in the 1.25-(DH) 2 D (p = 0.0001). No relationship between final calcium and 1.25-(OH) 2 D (r=-0.171, p=0.198) was observed. When the effects of enalapril and quinapril were analyzed separately, the results were similar. When the patients were divided according to genotype, the decrease in 1.25-(OH) 2 D was observed only in patients with D allele, genotype Ins/Del (69±23 vs. 48±19, p=0.021 ) and in those of genotype Del/Del (64±19 vs. 17, p = 0.004). Conclusion: The ACE inhibitors in combination with the presence of the DD genotype decrease the level of 1.25-(DH) 2 D. There was no difference between enalapril and quinapril treated groups.