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Introduction: Non-medical staff members in hospitals are highly credible at population level, and are a source of opinion even though they do not have sufficient medical training., Objectives: To analyse the attitudes of non-medical professionals of Spanish and Latin American hospitals towards organ donation and identify the factors that influence these attitudes., Material and Method: Through the "Proyecto Colaborativo Internacional Donante" (International Collaborative Donor Project), a stratified random sample was selected from non-medical services of eleven hospitals: 3 Spanish (n=277), 5 Mexican (n=632), 2 Cuban (n=42) and 1 Costa Rican (n=101)., Results: Of the 1052 professionals surveyed, 72% (n=754) were in favour of donating an organ after death. By country, 98% of Cubans, 80% of Mexicans, 66% of Costa Ricans and 52% of Spanish were in favour (P<.001). The most influential variables were: 1) country, with results being more positive in Mexico (odds ratio [OR]=2.197), 2) believing in the possibility that they will require a transplant (OR=2.202), 3) having discussed the issue with their family (OR=3.23), 4) the positive attitude of their partner towards donation (OR=3.322), 5) not being concerned about possible mutilation of their body after donation (OR=3.378), 6) preferring options other than burial (OR=2.525), 7) accepting an autopsy (OR=2.958)., Conclusions: The attitude of non-medical staff members of hospitals towards the donation of their own organs varies greatly depending on the country of the respondent. Psychosocial factors that influence these attitudes are similar to those described at the population level.

We analyzed the Mexican legal framework, identifying the vectors that characterize quality and control in gastrointestinal surgery. Quality is contemplated in the health protection rights determined according to the Mexican Constitution, established in the general health law and included as a specific goal in the actual National Development Plan and Health Sector Plan. Quality control implies planning, verification and application of corrective measures. Mexico has implemented several quality strategies such as certification of hospitals and regulatory agreements by the General Salubrity Council, creation of the National Health Quality Committee, generation of Clinical Practice Guidelines and the Certification of Medical Specialties, among others. Quality control in gastrointestinal surgery must begin at the time of medical education and continue during professional activities of surgeons, encouraging multidisciplinary teamwork, knowledge, abilities, attitudes, values and skills that promote homogeneous, safe and quality health services for the Mexican population.

Background: Primary solid tumors of the greater omentum are extremely rare. Lipomas, leiomyomas, fibromas, and neurofibromas have been described as benign tumors of the greater omentum, but angiofibrolipomas have not., Clinical Case: We present the case of a 39-year-old male with a 3-day evolution of right lower quadrant abdominal pain associated with nausea and vomiting. McBurney, Psoas, Obturator and Markle signs were all positive. Laboratory analysis revealed leukocytosis and bandemia. Abdominal ultrasound showed free fluid and an undefined mass suggestive of complicated acute appendicitis. Emergency midline laparotomy demonstrated a tumor of the greater omentum with areas of ischemia, necrosis and hemorrhage. Histological exam revealed angiofibrolipoma of the greater omentum., Conclusions: Angiofibrolipoma of the greater omentum may present as a surgical emergency due to torsion. When a tumor of the omentum is found during surgery, complete excision is the treatment of choice when a definitive histology result is received.

Purpose: The purpose of our study was to evaluate the possibility of the reduction of peritoneal adhesions to a polypropylene mesh with fibrin glue., Methods: Forty Wistar rats were assigned to two treatment groups: Group 1) hernioplasty with polypropylene mesh plus fibrin glue sealant, and Group 2) hernioplasty with polypropylene mesh without fibrin glue sealant. The variables evaluated were: presence and density of adhesion, organs or abdominal structures adhered to the polypropylene mesh, inflammatory tissular reaction and cell recount., Results: Group 1 presented a statistically lower adhesion percentage than Group 2 (40% versus 100%, P = 0.0003). The mean areas of mesh patch surfaces covered with adhesions were statistically different between Groups 1 and 2 (0.67 +/- 0.65 cm2 versus 1.60 +/- 0.51 cm2; P = 0.00001). Twelve rats presented with adhesions in Group 1; eleven were adhesions to the epiploon and one to the colon. In Group 2 there were 16 adhesions to the epiploon, 2 to the colon, 1 to the small intestine and 1 to the stomach. Tissular reaction comparison showed a significant difference (21 +/- 4.9 versus 17 +/- 4.1; P = 0.006)., Conclusions: Fibrin glue sealant significantly reduced the frequency and severity of intra-abdominal adhesions.

Background: Ureteropyelic obstruction is the most frequent congenital cause of obstructive uropathy in the newborn. Its repair is based on surgical procedures and has a very high rate of relapse of secondary stenosis to fibrosis (5-12%) in open repair and 10-20% in endo-urological pyeloplasties. Hyaluronic acid has demonstrated therapeutic utility in modulating the healing process and its effect in scar formation from ureteropyelic anastomosis is determined., Methods: An experimental, controlled, comparative, double blind study was performed. Sample n = 20 per protocol with d = 26%, alpha = 0.05, beta = 0.80. Two groups of Wistar rats, 4 months of age and weighing between 250 and 350 g, were used. Under general anesthesia, Vision 12 x was used and bevel section was realized in the left ureteropyelic union and end-to-end anastomosis with Vicryl 7-0. Experimental group was treated with 25 microg of hyaluronic acid and group B was treated with placebo. The rats were reoperated on the 15th day and adherences in cavity were quantified. To quantify the degree of fibrosis, samples of ureteropyelic anastomosis tissue were dyed with Masson Trichrome and observed microscopically. Inferential statistics were used with a = 0.05., Results: Macroscopic: there were adherences in 75 % of group A and 90 % of the group B (p >0.05). Microscopic: anastomotic fibrosis in group A (534 +/- 292 micro) was significantly lower (p = 0.043) than that of group B (728 +/- 295 micro)., Conclusions: Hyaluronic acid plays a role in diminishing the formation of fibrosis from ureteropyelic anastomosis in an animal model.

AFLP was used to analyze the genetic diversity among Ochrobactrum strains. AFLP patterns showed a great genomic variability that separated the samples into three distinct clusters. Ochrobactrum intermedium was found to be closely related to Brucella abortus S99.

Introduction: Diabetic retinopathy (DR) it is the main cause of preventable blindness in productive-age adults. The rate of progression to blindness from DR differs among countries and populations., Material and Methods: In order to report the incidence and progression of DR after 12 years of follow-up in a cohort (n = 100) of adult patients with diabetes mellitus type 2 (DM2) in Leon, Guanajuato, Mexico, we designed an open population cohort study from April 1992 to July 2004. Main variables studied longitudinally were incidence and progression of DR, fasting blood glucose, glycated hemoglobin and associated clinical parameters., Results: Mean age was 54 +/- (SD) 9.2 years and the time since DM2 diagnosis was 9 +/- 6 years. Incidence rates at 3, 6 and 12 years were 23, 48 and 71%, respectively; and for progression were 56, 70 and 74%, respectively. The 12-year proliferative DR incidence and progression were 14.3 and 32%, respectively. Mean fasting blood glucose levels were 193 mg/dL and for glycated hemoglobin 11%. Mortality was 45%, half attributable to acute myocardial infarction., Discussion: Diabetic retinopathy in our population has a high incidence that doubled in 3 years, and has an accelerated progression toward more severe forms. Incidence and progression are higher than that reported in white non-Hispanics. It should be high priority in our country to (a) prevent diabetes mellitus, (b) improve its metabolic control, (c) establish RD diagnostic programs and (d) give appropriate treatment.

More than 500,000 new medical articles are published every year and available time to keep updated is scarcer every day. Nowadays, the task of selecting useful, consistent, and relevant information for clinicians is a priority in many major medical journals. This review has the aim of gathering the results of the most important findings in clinical medicine in the last few years. It is focused on results from randomized clinical trials and well-designed observational research. Findings were included preferentially if they showed solid results, and we avoided as much as possible including only preliminary data, or results that included only non-clinical outcomes. Some of the most relevant findings reported here include the significant benefit of statins in patients with coronary artery disease even with mean cholesterol level. It also provides a substantial review of the most significant trials assessing the effectiveness of IIb/IIIa receptor blockers. In gastroenterology many advances have been made in the H. pylori eradication, and the finding that the cure of H. pylori infection may be followed by gastroesophageal reflux disease. Some new antivirals have shown encouraging results in patients with chronic hepatitis. In the infectious disease arena, the late breaking trials in anti-retroviral disease are discussed, as well as the new trends regarding antibiotic resistance. This review approaches also the role of leukotriene modifiers in the treatment of asthma and discusses the benefit of using methylprednisolone in patients with adult respiratory distress syndrome, among many other advances in internal medicine.

There are several diagnostic methods for Helicobacter pylori infection, some of them need an endoscopic procedure and biopsy to be performed (invasive) like the rapid urease test, culture and histology. Recently non invasive, specific, sensible, easy to perform and patient's well accepted methods had been developed known as breath test, based on the hydrolysis of labelled urea by Helicobacter pylori urease enzyme, to release ammonia and bicarbonate. Labelled CO2 reaches the bloodstream and the lungs, from where can be collected into the breath for quantification. Labelled urea has to options: 13C stable, non-radioactive and 14C unstable, radioactive. Breath test with 13C is based on the atomic mass difference between 12C and 13C and it is necessary a mass spectrometer and 40 minutes to perform it. Breath test with 14C has 1 uCi (one micro-curie) of radioactivity (1/300 of total radiation received in one year from the environment); the test takes 10 minutes and the samples are read in a beta counter. Both non-invasive tests had demonstrated sensitivity and specificity comparable to established "gold standards" for Helicobacter pylori infection diagnosis.

Objective: To inform a patient with penetrating thoracic trauma and diaphragm injury that produced stomach herniation, being reduced the hernia and repaired the injury by laparoscopy though abdominal route with excellent result., Report: 17-years-old male, hemodynamically stable with penetrating injury in the fifth left intercostal space, at the level of the middle auxiliary line, pneumothorax and left diaphragmatic hernia. Treatment. A pleurostomy tube was inserted. By laparoscopy 600 mL of free blood in abdominal cavity were aspired, the stomach hernia was reduced and the diaphragmatic repair was performed with nylon 3-0 running suture. The evolution was excellent, being integrated to his work at the twentieth postoperative day., Commentary: Our case supports that laparoscopic surgery is at therapeutic alternative in select cases of trauma.

Unlabelled: The Refeeding Syndrome is conformed by a series of clinical manifestations related to electrolytic alterations associated with the restarting of the nutritive contribution both enteral and parenteral., Aim: To detect the Refeeding Syndrome incidence in malnourished patients who required nutritional, enteral or endovenous support and its relationship with mortality., Material and Methods: A cohort study was performed in the service of Nutritional Support of the IMSS (Social Security Mexican Institute) Specialties Hospital CMN León, from June 1995 to May 1996. All patients with mild and severe malnutrition were included, they received endovenous or enteral nutritious support for more than 7 days, without presenting previous electrolytic unbalance. Serum potassium, phosphorous, and magnesium levels were determined before starting the nutritious support and also on the 3rd, 7th, and 10th days. Descriptive statistics, Student's t and Z test were used, with a 5% significance level., Results: 148 patients with total nutritional support, 23 (16%) of them with restrained malnutrition and 65 (44%) with severe deficit. 54 men and 34 women with an average age of 51.6 +/- 19.4 years. Nineteen patients were eliminated due to a nutrition period of less than 7 days, and other 19 were also eliminated for presenting electrolytic alterations before the nutritive support started. An incidence of 48% of electrolytic alterations compatible with the refeeding syndrome was the result in the remaining 50 patients. The alterations were: hypomagnesemia 13/24, hypokalemia 12/24 and hypophosphatemia 4/24; in 55% of the cases the syndrome appeared at the third day of administration. Hospital sojourn of patients with the syndrome was 26.7 +/- 18 days vs 15.3 +/- 7 (p < 0.05) of those who did not present it. 15 patients died, 5 of them had electrolytic alterations before nutrition, 7 (29%) with refeeding syndrome and 3 (12%) did not presented it (p = 0.059)., Conclusions: Refeeding Syndrome is a frequent entity in malnourished patients submitted to enteral or parenteral nutrition; at least in this study it was of 48%; its presence was followed by a longer hospital stay and a higher mortality rate.

Background: Reflux Esophagitis is a common complaint from the upper gastrointestinal tract with a figured out prevalence of about 2%. Therapeutic results in this pathology have been unsatisfactory., Aim: To compare lansoprazole and omeprazole therapeutic effects in patients with reflux esophagitis., Materials and Methods: A clinical, double-blinded, balanced survey was randomly designed with patients who would daily receive 30 mg lansoprazole (Group A) or 20 mg omeprazole (Group B) during a 4-week period. All patients were submitted to endoscopy and biopsy both at the beginning and at the end of the survey., Results: Ten patients in each group were treated without any significant differences in sex, age, nicotinism, alcoholism, AINES ingestion, development time, pain regurgitations, pyrrosis, hematemesis, dysphagia, melena, nausea or vomiting, and esophagitis degree. A complete cure in 8/10 (omeprazole) and 7/10 (lansoprazole) patients was obtained (p = n.s.). However, the histological results of the biopsy at the end of the four-week period proved to be a failure in 4/10 (omeprazole) and in 5/10 (lansoprazole) patients (p = n.s.). The endoscopy and clinical result at the end of the study were similarly effective; but not so the histological damage to the esophagus, which continues to be important., Conclusions: The use of bomb inhibitors in esophagitis by reflux is advisable. Future surveys must assess the average time of treatment for the disappearance of the histologic lesion.

Objective: To evaluate the use of octreotide together with the conservative handling in the treatment of patients with external gastrointestinal fistulae., Material and Methods: Clinical essay in postsurgical gastrointestinal fistulae carriers assisted during a 54-month period. They were randomly distributed in two groups: group A was treated with conventional handling and group B was additionally treated with octreotide., Results: 44 women and 55 men with an average age of 50 +/- 19 years old were treated. The following table summarizes the result variables. [table: see text], Conclusion: The use of octreotide is recommendable, for it was useful in diminishing both the closing time of the fistula and the time the nutritional support the patient requires. Mortality still continues to be very increased (because of sepsis), by which the phrase "primum non nocere" takes a relevant place since this pathology is greatly preventable.

Introduction: Severe acute pancreatitis is an ailment with a higher than 60% mortality. The nutritional support is a fundamental part of the treatment in these patients with the aim of ameliorating traumatic metabolic response., Aim: To compare total effectiveness of parenteral nutrition and enteral nutrition through jejunostomy in postoperated patients for acute pancreatitis., Material and Methods: A clinically controlled, longitudinal, prospective, experimental and at random survey was performed with our hospital's nutritional supportive service (which is a reference center) in a 16-month period. Patients postoperated on for severe pancreatitis were included (3 or more of Ranson's criteria), the ones who died before the first week were excluded. Group I was treated with total parenteral nutrition, and group II with enteral nutrition via jejunostomy through a silicon catheter placed at transoperative. The result variables were summed up at the beginning and every week for a 3-week period. The hipotheses were contrasted with Student's " t " test with a tail for independent samples of a 5% significance level., Results: Groups I and II were integrated by 12 and 10 patients respectively. Sex and ages were similar. Urine nitrogen was kept high in both groups, being group I the highest (ns). Nitrogen balance was kept close to neutrality in both groups (ns). Serum albumin levels were slightly increased in both groups (ns). The creatinine/size index showed loss of progressive muscular mass in both groups, being group II the lowest (p < 0,05). Total lymphocyte count depletion level improved from mild to normal in both groups, but being this more important in group II (p < 0,05). Global mortality was 40%., Conclusions: Enteral nutrition was as effective as parenteral in these patients, having the advantage of being less expensive, easier to handle and with a lesser rate of septic complications. We consider that this must be the nutritional method of choice if there are contra indications for its use.

This study aims to establish the frequency of diabetic retinopathy (DR) in patients with diabetes mellitus (DM) type II in Leon, Guanajuato, Mexico, as well as the opportunity for their diagnosis. A prospective study was carried out in a sample of 100 patients. DR was stratified using the classification of the Early Treatment Diabetic Retinopathy Study Research Group and diagnosed in 42 per cent of the sample. The evolution time of diabetes in this group was different from that of the group without RD (p < 0.0001). A direct proportional and significant relationship between the duration of DM and an increasing severity of DR was found. Opportune diagnosis was made in 70 per cent of the cases with DR. In 81 per cent of the 42 patients with DR, no previous diagnosis was made. This study shows a high proportion of RD without diagnosis. The intensification of educational strategies for the opportune detection and early treatment of DR is recommended.

A prospective randomized double blind study was carried out on 60 patients undergoing elective gastrointestinal endoscopy. Patients in group A were sedated with diazepam (0.15 mg/kg) and those in group B received midazolam (0.10 mg/kg). There were no differences between the groups in age, sex, previous drug intake, level of anxiety prior to the procedure and from the endoscopist point of view the easiness to perform the studies. The group of patients who received midazolam (B) showed a significantly greater sedation, had less pain in the site of injection, their retrograde amnesia was more effective and tolerated much better the overall procedure (p < 0.05). There were no complications in either group. The cost per dosage was 2:1 greater with midazolam. It is concluded that midazolam has some advantages over diazepam used for sedation of patients undergoing gastrointestinal endoscopy. The time for recovery and cost are its disadvantages.

This paper describes a case of cutaneous amebiasis of the face in a 17-month-old girl. About four weeks prior to admission she had diarrhea with high suspicion of intestinal amebiasis. Fifteen days later she presented with edema of the right lower eyelid and epiphora. There was a vesicle in the inner angle of the eye which spontaneously drained, causing loss of the underlying tissue. The ulcer developed rapidly, destroying periorbital tissue. Both cytology and biopsy of the ulceration border showed abundant trophozoites of Entamoeba histolytica. Treatment was specific therapy and surgery.