Suarez-Moreno R.M.,Hospital Of Especialidades |
Hernandez-Ramirez D.A.,Hospital Of Oncologia |
Madrazo-Navarro M.,Hospital Of Especialidades |
Salazar-Lozano C.R.,Hospital Of Especialidades |
And 2 more authors.
Cirugia y Cirujanos | Year: 2010
Background: Tuberculosis is frequently the form of presentation of human immunodeficiency virus (HIV) infection even in patients who have not developed acquired immune deficiency syndrome (AIDS). Nevertheless, pancreatic affection is uncommon. Tuberculosis of the pancreas (TBP) is a clinical rarity and mimics pancreatic carcinoma both clinically and radiologically. Clinical case: We present the case of a 42-year-old man with a 5-day evolution of moderate abdominal pain in the right lower quadrant and fever and vomiting without diarrhea. The patient had no history of abdominal surgery. CT scan revealed a heterogeneously enhancing, multicystic structure in the pancreatic head. Due to suspicion of malignancy, a pancreatoduodenectomy was performed with pathological result of pancreatic tuberculosis. The patient was discharged on the 10 th postoperative day without surgical complications. He died 10 months later of Pneumocystis jirovecii pneumonia. By that time he had a positive serum HIV antibodies test. Conclusions: TBP diagnosis can be missed or significantly delayed because it is often not suspected prior to laparotomy unless there is evidence of pulmonary tuberculosis. TBP should be considered in the differential diagnosis of a mass in the head of the pancreas. The response to early antituberculosis treatment is very effective. Pancreatic tuberculosis, acquired immunodeficiency deficiency syndrome.
Efficacy of bolus epidural analgesia with bupivacaine-fentanyl in patients undergoing abdominal surgery [Eficacia de la analgesia epidural en bolo con bupivacaína-fentanyl en pacientes sometidos a cirugía abdominal]
Brito-Guraieb G.,Hospital Angeles Metropolitano |
Xospa-Aleman T.J.,La Salle University at Cuauhtémoc
Revista Mexicana de Anestesiologia | Year: 2015
Background: Postoperative epidural analgesia is the administration of local anesthetic with or without opioid in the epidural space to keep the individual free from pain. Method: clinical, comparative, controlled, prospective, randomized study, patients after hysterectomy and open cholecystectomy Tula Regional Hospital, the period from March to June 2013. 40 patients were selected without importing age, randomly distributed into five groups were selected depending on the concentration of bupivacaine administered by epidural catheter 0.120%, 0.130%, 0.150%, 0.170% and 0.20% more 50 μg fentanyl recovering, at 6, 12 and 24 hours, 20 minutes after administration of each dose was evaluated pain by visual analog scale, and vital signs were taken. Results: The concentrations of bupivacaine 0.120%, 0.130% and 0.150% more fentanyl 50 μg maintained patients had moderate pain, while 0.170% bupivacaine and 0.20% more fentanyl 50 μg remained without pain in patients throughout the study. Conclusions: Epidural analgesia bolus is effective in patients undergoing open abdominal surgery in hospitals with limited resources, accelerates recovery, reduces costs for the patient and the institution. © 2015, Colegio Mexicano de Anestesiologia A.C. All rights reserved.
Functional magnetic resonance in the clinical diagnosis of attention deficit hyperactivity/impulsivity disorder in children: An exploratory proposal [Resonancia magnética funcional en el diagnóstico clínico del déficit de atención y de la agresión impulsiva infantil: Una propuesta exploratoria]
Mercadillo R.E.,National Autonomous University of Mexico |
Sanchez-Rey A.E.,Hospital Angeles Metropolitano |
Sanchez-Cortazar J.,Hospital Angeles Metropolitano |
Ramirez E.,Hospital Angeles Metropolitano |
Barrios F.A.,National Autonomous University of Mexico
Salud Mental | Year: 2011
Attention deficit disorder (ADD) refers to a neurobehavioral condition commonly initiated in childhood. Its clinical diagnosis involves poor attention, distractibility, difficulties to inhibit motor behaviors and cognitive impulsivity. It is suggested that ADD is classified in two general types correlated with different neurocognitive qualities. One is manifested in executive frontal dysfunctions (ADD). In the other type dominates hyperactivity/ impulsivity (ADHD) and it is associated with deficiencies in working memory and alterations in the dorsolateral prefrontal cortex. Results obtained by using electroencephalography, event-related potential paradigms and voxel brain morphometry suggest anomalies in the brain structure and function correlated with ADD, particularly in the frontal, parietal and temporal cortices, in addition to regions involved in the fronto-estriatal connections. On the other hand, functional magnetic resonance imaging (fMRI) constitutes a technique to obtain brain images which can be interpreted as regions and networks of neural activity elicited during the performance of a cognitive process. Based on the information that the ADD patients are susceptible to cognitive interferences, some researches have applied the classical and the counting versions of the Stroop task paradigms in fMRI. In comparison with control subjects, adult patients show alack of neural activation in the anterior cingulated cortex. Nevertheless, results in children are more controversial and attribute neurobiological and social factors in the ADD etiology. The anterior cingulated cortex and prefrontal region of the human brain conform the execution system of attention and their function is essential for emotional processes. The neurocognitive relation between attention and emotion involves the influence of the affective system in the alert and execution systems of attention through reciprocal connections between limbic and frontal regions, which permit a mnemonic and affective valuation of the attended environment. Understanding the relations between attention and emotion is essential in basic and clinical approaches, due to the co-morbidity of ADD with some emotional disorders, such as the oppositional defiant disorder, anxiety and impulsive aggression, the last one elicited by uncontrolled experiences of anger. In this sense, some studies describe that the metabolic brain activity correlated with the experience of anger is manifested in the frontal, anterior cingulated and insular cortices and the temporal pole. Clinical situations require individualized decisions on the immediate and emergent treatment of one case. Furthermore, when the clinical case refers to a behavioral disorder probably related with neurobiological dysfunctions, a comparison of test with control subjects is necessary. In this sense, the present work constitutes an fMRI study designed to evaluate neurological functional alterations in a child patient diagnosed with ADHD, with persistent severe impulsive aggression behaviors that required a swift evaluation to enhance the diagnosis and treatment proposed by other clinical techniques. Besides the patient, three infant participants were evaluated. One of them was diagnosed with ADD but did not manifest aggressive or impulsive behaviors and was not under any pharmacological treatment. The other two healthy children had no neurological and psychiatric disorders history. All the participants presented similar intellectual coefficient and performed the same cognitive and emotional tests. In the case of the patient, test were applied in two conditions: under the proposed pharmacological treatment and without medication. The attention test consisted in a version of the counting Stroop task in Spanish language, presented in a block design through the EPrime software. Subjects practiced the task in a personal computer before the functional image acquisition and were trained to answer by using a bottom response system that will be used in the scanner. For the emotional-anger paradigm, children were interviewed about scenes and situations of their personal experience which elicited anger and calm. Situations were ordered and planned in a block design to be executed in the magnetic resonance instrument. During the functional images acquisition children listened to the situations conducted by imaginery techniques. Functional images were acquired in a 1.5 T G.E. instrument in the Magnetic Resonance Unit of the Hospital Ángeles Metropolitano in Mexico City. Data were analyzed by using the SPM 5 software applying a contrast using FWE with p < 0.05. Brain coordinates obtained in SPM 5 were converted to the Talairach Deamond system in order to obtain the Brodmann areas related to those coordinates. During the performance of the counting Stroop task, the patient with ADHD under medication manifested activation in frontal areas, but not during the medication suspension trial. Frontal activity identified in this patient in the treatment trial was similar to that identified in the unaggressive ADD patient. In both cases, ADHD without medication and ADD, a lack of activity was identified in the anterior cingulate cortex (ACC). Nevertheless, activation in ACC, in parietal and temporal regions was present in the aggressive patient under treatment but not in the suspension condition. These results may suggest that an inadequate attention process distort the environment stimuli, which is necessary for the subject's correct affective evaluation of the situation. During the experience of anger, the patient under treatment manifested activity in the parahippocampal region, as well as in the anterior and posterior cingulate cortices. Results discussed in this work agree with those previously reported and offer cues to complement the diagnosis and treatment of ADD/ADHD and their relations with emotional disorders. Particularly, the design used here could be used for the analysis and evaluation of some pharmacological and behavioral treatments clinically applied in ADD. In addition, it helps to understand the participation of multipotential brain regions and neural networks involved in several cognitive processes, such as attention, working memory and emotion. Finally, we proposed some ideas to interpret these results using fMRI and ADD: 1. It is necessary a consensual and standard integration of neuropsychological tests which identify different cognitive qualities of ADD. 2. The selection of children samples to study the neurobiology of ADD must include several variables associated with its etiology, such as parental relations, social and scholar environments. 3. Experimental paradigms could be designed to be performed using different neuroimaging techniques, such as fMRI or event-related potential. Thus, the results of the same test can be used to complement different approaches. 4. Results obtained by fMRI must not be understood in a phrenologycal and deterministic approach, but as brain region activations indicating dynamic neural networks.
Mucino-Ortega E.,Hospital Angeles Metropolitano |
Galindo-Suarez R.M.,Hospital Angeles Metropolitano |
Diaz-Ponce H.,Hospital Angeles Metropolitano |
Walter-Tordecillas M.A.,Hospital Angeles Metropolitano
Ginecologia y Obstetricia de Mexico | Year: 2012
Background: Poorly managed postoperative pain has a negative impact in healing patients and costs of care. Methods: A model to estimate economic and health consequences of parecoxib 40 mg and morphine 12 mg regarding ketorolac 30 mg, on the management of postoperative pain in gynecologic laparotomy surgery from the perspective of the Mexican Social Security Institute (IMSS) was developed. A systematic review to identify the proportion of patients that rated their analgesic treatment as "excellent" or "good" in the Patient Global Evaluation of Study Medication, 12 hours after administration of the analgesic (responders), was performed. The patients who rated "fair" or "poor" their treatment were administered additional 4 mg of morphine. Costs in the model correspond to the acquisition costs of analgesics in which the institution would incur. Results: The proportion and cost per responder were: morphine: 14.44% and$ 192.79, ketorolac: 32.44% and $34.82, parecoxib: 35.51% and $121.25.Treatment with morphine was more expensive and less effective than both, ketorolac and parecoxib, while the cost per additional percent point of responders with parecoxib (compared to ketorolac) was $ 28.15. For the management of postoperative pain, ketorolac and parecoxib are more effective and less expensive than morphine, additionally parecoxib would be an alternative for patients with contraindication to ketorolac use. Conclusion: The management of postoperative pain with parecoxib is more effective and, in the context of IMSS, less expensive than morphine, also constitutes an alternative with a reasonable incremental cost compared to ketorolac.
Larracilla Alegre J.,Hospital Angeles Metropolitano
Revista Mexicana de Pediatria | Year: 2011
In this paper is done an historical review of the clinical studies done in infants with acute diarrhea, treated only by of voluntary oral rehydration: since the first outcome in 1959 in 508 dehydrated infants with diarrhea, to others published in recent years with similar findings. All of this contribution, among others, supported the decision of the WHO for the development of a oral serum and the use of oral rehydration solution in all the world.
Godinez-Baca L.E.,Hospital Angeles Metropolitano |
Luna-Perez D.,Hospital Angeles Metropolitano
Revista Mexicana de Cardiologia | Year: 2016
Myocarditis is an inflammatory myocardial disease, often due to autoimmune or infectious causes, among them; viral etiology is the most frequent. However, influenza AH1N1 related myocarditis is rare. We report the case of a young patient with influenza AH1N1 pneumonia and secondary myocarditis.
Godinez-Baca L.E.,Hospital Angeles Metropolitano |
Luna-Perez D.,Hospital Angeles Metropolitano
Revista Mexicana de Cardiologia | Year: 2016
Introduction: Sinus of Valsalva aneurysm (SVA) is an uncommon pathology that may be either acquired or congenital, whose main complication is rupture, that leads to acute congestive heart failure. Case report: We present the case of a 28-year-old man with Valsalva sinus rupture into the right cavities and severe heart failure with successful surgical correction. Conclusions: Surgical repair is the treatment of choice for SVA, with low operative risk and good long-term outcome.
PubMed | Hospital Angeles Metropolitano
Type: Journal Article | Journal: Ginecologia y obstetricia de Mexico | Year: 2013
Poorly managed postoperative pain has a negative impact in healing patients and costs of care.A model to estimate economic and health consequences of parecoxib 40 mg and morphine 12 mg regarding ketorolac 30 mg, on the management of postoperative pain in gynecologic laparotomy surgery from the perspective of the Mexican Social Security Institute (IMSS) was developed. A systematic review to identify the proportion of patients that rated their analgesic treatment as excellent or good in the Patient Global Evaluation of Study Medication, 12 hours after administration of the analgesic (responders), was performed. The patients who rated fair or poor their treatment were administered additional 4 mg of morphine. Costs in the model correspond to the acquisition costs of analgesics in which the institution would incur.The proportion and cost per responder were: morphine: 14.44% and $192.79, ketorolac: 32.44% and $34.82, parecoxib: 35.51% and $121.25.Treatment with morphine was more expensive and less effective than both, ketorolac and parecoxib, while the cost per additional percent point of responders with parecoxib (compared to ketorolac) was $28.15. For the management of postoperative pain, ketorolac and parecoxib are more effective and less expensive than morphine, additionally parecoxib would be an alternative for patients with contraindication to ketorolac use.The management of postoperative pain with parecoxib is more effective and, in the context of IMSS, less expensive than morphine, also constitutes an alternative with a reasonable incremental cost compared to ketorolac.
PubMed | Hospital Angeles Metropolitano
Type: Case Reports | Journal: Cirugia y cirujanos | Year: 2014
Churg-Strauss is a rare, idiopathic, hypereosinophilic disease characterized by blood, tissue, and systemic vasculitis in patients with a history of asthma or allergic rhinitis. Gastrointestinal manifestations of Churg Strauss appear in a 31-45% of the patients according to some series of studies, abdominal pain being the most frequent symptom followed by diarrhea and bleeding.Male patient with a history of asthma who presents abdominal pain apparently due to acute appendicitis. During the hospital stay the study protocol is complemented, confirmating the diagnosis of Churg Strauss syndrome with intestinal manifestations.Churg Strauss syndrome is a rare vasculitis that may present with intestinal manifestations so it is important to take into consideration the differential diagnosis. There are few cases in the literature associated with this syndrome and acute abdomen, all of them on the poor prognosis of this association.
PubMed | Instituto Nacional Of Neurologia Y Neurocirugia and Hospital Angeles Metropolitano
Type: | Journal: Cirugia y cirujanos | Year: 2016
Positioning during neurosurgical procedures is a challenge for surgical teams even if precautions are taken, the mechanisms underlying peripheral nerve injury (elongation, compression or ischaemia) are latent and it is important to know the frequency of occurrence in our environment.To analyze the frequency of peripheral nerve injury secondary to surgical positioning.Prospective study including 163 patients scheduled for neurosurgical procedures. Four groups: supine, lateral, ventral and park bench were analyzed by neurological exploration in order to detect injury and relate with risk factors already described.In this study 112 patients were included, two patients who were under park bench position experienced paresthesias in ulnar region of less than 24 hours duration; statistically significant correlation with body weight greater than 85kg.The incidence of peripheral nerve injury is low, understanding the mechanisms that may originate it helps towards prevention and early detection of complications.