Baja morbilidad en niños operados de nefrectomía con técnica laparoscópica transperitoneal de 3 puertos

ResumenAntecedentesAunque la nefrectomía laparoscópica actualmente se considera el estándar de oro en la cirugía renal del adulto, aún existe controversia de su papel en la población pediátrica. La nefrectomía laparoscópica ha demostrado ser un procedimiento efectivo y seguro comparado con el abordaje abierto.ObjetivoPresentar una serie de casos de pacientes pediátricos con diversas enfermedades renales, tratados con nefrectomía laparoscópica transperitoneal.Materiales y métodosIncluye 22 pacientes pediátricos sometidos a nefrectomía laparoscópica transperitoneal. Todos los casos se realizaron vía laparoscópica con abordaje transperitoneal usando 3 puertos.ResultadosTodos los riñones se removieron satisfactoriamente. El promedio de tiempo operatorio fue de 142min. En 21 de los 22 casos no hubo complicaciones que requirieran conversión cirugía abierta. Se inició dieta y deambulación el mismo día de la cirugía en todos los pacientes y se dio de alta a 20 de los 21 pacientes sin conversión a los 2 días postoperatorios.ConclusionesEn nuestra serie de casos reportamos el abordaje transperitoneal laparoscópico para nefrectomía usando una técnica con 3 puertos que puede ser usada con seguridad en la población pediátrica con los mismos resultados y seguridad que otros procedimientos laparoscópicos. Es una excelente alternativa a la cirugía abierta tradicional y debe ser considerada para disminuir el riesgo quirúrgico.AbstractBackgroundEven though laparoscopic nephrectomy is considered the gold standard in renal surgery in the adult, its role in the pediatric population is still a subject of debate. Laparoscopic nephrectomy has been shown to be a safe and effective procedure, compared with the open approach.AimTo present a case series of pediatric patients with different renal pathologies treated through transperitoneal laparoscopic nephrectomy.Material and methodsTwenty-two pediatric patients that underwent transperitoneal laparoscopic nephrectomy were included in the study. All of the cases underwent the 3-port transperitoneal laparoscopic approach.ResultsAll the kidneys were satisfactorily removed and the mean surgery duration was 142 min. There were no complications requiring conversion to open surgery in 21 of the 22 cases. Oral diet and ambulation were begun the same day of the surgery for all patients. Twenty of the 21 patients that did not require conversion were released on the second postoperative day.ConclusionsWe report herein on the transperitoneal laparoscopic approach for nephrectomy with the 3-port technique. It can be performed in the pediatric population with the same results and safety as other laparoscopic procedures and is an excellent alternative to traditional open surgery. This procedure should be considered for reducing surgical risk

Effect of antispasmodic agents, alone or in combination, in the treatment of Irritable Bowel Syndrome: Systematic review and meta-analysis

Introduction: Irritable bowel syndrome (IBS) is characterized by recurrent abdominal pain, bloating, and changes in bowel habit. Aims: To determine the clinical effectiveness of the antispasmodic agents available in Mexico for the treatment of IBS. Methods: We carried out a systematic review and meta-analysis of randomized controlled clinical trials on antispasmodic agents for IBS treatment. Clinical trials identified from January 1960 to May 2011 were searched for in MEDLINE, the Cochrane Library, and in the ClinicalTrials.gov registry. Treatment response was evaluated by global improvement of symptoms or abdominal pain, abdominal distention/bloating, and frequency of adverse events. The effect of antispasmodics vs placebo was expressed in OR and 95% CI. Results: Twenty-seven studies were identified, 23 of which fulfilled inclusion criteria. The studied agents were pinaverium bromide, mebeverine, otilonium, trimebutine, alverine, hyoscine, alverine/simethicone, pinaverium/simethicone, fenoverine, and dicyclomine. A total of 2585 patients were included in the meta-analysis. Global improvement was 1.55 (CI 95%: 1.33 to 1.83). Otilonium and the alverine/simethicone combination produced significant values in global improvement while the pinaverium/simethicone combination showed improvement in bloating. As for pain, 2394 patients were included with an OR of 1.52 (IC 95%: 1.28 a 1.80), favoring antispasmodics. Conclusions: Antispasmodics were more effective than placebo in IBS, without any significant adverse events. The addition of simethicone improved the properties of the antispasmodic agents, as seen with the alverine/simethicone and pinaverium/simethicone combinations

Anti-carbamylated protein antibodies positivity and disease activity in Hispanic patients with established rheumatoid arthritis: An observational study

Objectives We aimed to determine the prevalence of anti-carbamylated protein (anti-CarP) antibodies in Mexican Hispanics with established rheumatoid arthritis (RA) and to assess their relationship with disease activity. Methods A cohort study was conducted in 278 patients with established RA during an 18-month follow-up. We measured IgG/IgM/IgA rheumatoid factor (RF), IgG anticitrullinated protein antibodies (ACPA) and IgG/IgM/IgA anti-CarP antibodies using enzyme-linked immunosorbent assay (ELISA). For disease activity, we performed the 28-joint disease activity score with erythrocyte sedimentation rate (DAS28-ESR). Repeated measures one-way ANOVA was used to test the association between anti-CarP IgG antibody status and longitudinal DAS28-ESR scores. Patients were evaluated at baseline and at 6, 12, and 18 months during follow-up. Results Anti-CarP IgG antibodies were positive in 47.8% of patients and, accounting for all isotypes, in 9.5% of patients with negative RF and ACPA. Triple antibody positivity was present in 42.6% of patients in our sample. Anti-CarP IgG antibody positivity did not show statistically significant differences in mean DAS28-ESR when compared to anti-CarP IgG antibody negative patients at baseline, 6, 12 or 18 months. Conclusion Anti-CarP IgG antibodies are not associated to a higher disease activity in Hispanic patients with established RA. Our findings suggest that the clinical value of measuring anti-CarP antibodies in RA diminishes over time.Transplantation and autoimmunit

Recommendations for the medical treatment of rheumatoid artritis [Recommendaciones para el tratamiento médico de la artritis reumatoide]

[No abstract available

Guidelines for the treatment of ankylosing spndylitis and its effect in Mexican rheumatology [Fundamentos para el tratamiento de la espondilitis anquilosante y su efecto en la reumatología mexicana]

We describe the guidelines for the current treatment of ankylosing spondylitis with an emphasis on the role and outlook of the Mexican rheumatologic community. The topics we analyze include: epidemiological as well as professional, financial, health status, and quality of life aspects. We propose to acknowledge that axial spondyloarthritis is the earliest form of ankylosing spondylitis. Finally we carry out a review of the literature supporting current therapeutic recommendations. Regarding the latter, we approached the ASAS/EULAR recommendations for the treatment of ankylosing spondylitis and their level of agreement with Mexican and other countries' rheumatologists. Finally, we analyzed the recommendations to start tumor necrosis alpha blockers among patients with ankylosing spondylitis

Guidelines in RA treatment: Concepts on safety and recomendations using anti-TNF-α inhibitors [Recomendaciones para el tratamiento médico de la artritis reumatoide: Actualización sobre la seguridad de los antagonistas del factor de necrosis tumoral alfa]

Recommendations for the use of Disease-Modifying Antirheumatic Drugs (DMARD) with both conventional and biological agents in Rheumatoid Arthritis (RA) must be based on their safety profile, adverse effects, risks, and advantages. With the purpose of presenting the most updated information about the safety of tumor necrosis factor alpha (TNFα) antagonists, in this article we summarize the literature published during the last three years about this sort of biological agents in specific clinical situations, such as risk of developing infections, cancer, cardiovascular diseases, and autoimmunity; as well as their administration to patients who will undergo surgical procedures, pregnant and/or breast-feeding women, and patients who need immunizations. Likewise, in this analysis we offer specific recommendations, based on evidence, for the best anti-TNF-alfa management

Guidelines for the treatment of ankylosing spndylitis and its effect in Mexican rheumatology [Fundamentos para el tratamiento de la espondilitis anquilosante y su efecto en la reumatología mexicana]

We describe the guidelines for the current treatment of ankylosing spondylitis with an emphasis on the role and outlook of the Mexican rheumatologic community. The topics we analyze include: epidemiological as well as professional, financial, health status, and quality of life aspects. We propose to acknowledge that axial spondyloarthritis is the earliest form of ankylosing spondylitis. Finally we carry out a review of the literature supporting current therapeutic recommendations. Regarding the latter, we approached the ASAS/EULAR recommendations for the treatment of ankylosing spondylitis and their level of agreement with Mexican and other countries' rheumatologists. Finally, we analyzed the recommendations to start tumor necrosis alpha blockers among patients with ankylosing spondylitis

Guidelines in RA treatment: Concepts on safety and recomendations using anti-TNF-? inhibitors [Recomendaciones para el tratamiento médico de la artritis reumatoide: Actualización sobre la seguridad de los antagonistas del factor de necrosis tumoral alfa]

Recommendations for the use of Disease-Modifying Antirheumatic Drugs (DMARD) with both conventional and biological agents in Rheumatoid Arthritis (RA) must be based on their safety profile, adverse effects, risks, and advantages. With the purpose of presenting the most updated information about the safety of tumor necrosis factor alpha (TNF?) antagonists, in this article we summarize the literature published during the last three years about this sort of biological agents in specific clinical situations, such as risk of developing infections, cancer, cardiovascular diseases, and autoimmunity; as well as their administration to patients who will undergo surgical procedures, pregnant and/or breast-feeding women, and patients who need immunizations. Likewise, in this analysis we offer specific recommendations, based on evidence, for the best anti-TNF-alfa management