Resumen: Introducción: el quiloperitoneo es una complicación extremadamente rara y poco reportada del bypass gástrico en Y de Roux (BGYR). Es la presencia de un líquido lechoso, con alto contenido graso (triglicéridos > 110 mg/dL), secundario a obstrucción y pérdida del flujo linfático. Material y métodos: este artículo reporta cinco casos de pacientes operados BGYR por laparoscopia que fueron reoperados por sospecha de obstrucción intestinal, y en quienes se encontró quiloperitoneo como hallazgo intraoperatorio. Resultados: la presencia de hernia interna por defecto en el espacio yeyunal se encontró en los cinco pacientes. El resultado del examen citoquímico del líquido libre encontrado durante la cirugía confirmó el diagnóstico de quiloperitoneo. El diagnóstico se asoció a presentación obstructiva en todos los pacientes, resolviéndose con la reducción de la hernia y corrección del defecto mesentérico. Conclusión: el quiloperitoneo es una complicación rara en pacientes con hernia interna con BGYR, con pocos casos reportados en la literatura. Aunque se considera una complicación poco común, puede ser un indicador de hernias internas cuando el diagnóstico no es concluyente y bien puede resolverse durante la laparoscopia diagnóstica reduciendo la hernia interna y cerrando el defecto del mesenterio.

Abstract: Introduction: chyloperitoneum is an infrequent and under-reported complication of Roux-en-Y gastric bypass (RYGB). It is the presence of a milky liquid with a high-fat content (triglycerides > 110 mg/dL), secondary to obstruction and loss of lymphatic flow. Material and methods: this article reports five cases of patients undergoing RYGB by laparoscopy who were reoperated for suspected intestinal obstruction and in whom chyloperitoneum was found as an intraoperative finding. Results: the presence of an internal hernia by a defect in the jejunal space was found in the five patients. The result of the cytochemical examination of free fluid found during diagnostic surgery for chyloperitoneum. The diagnosis was associated with an obstructive presentation in all patients, resolving with the reduction of the hernia and correction of the mesenteric defect. Conclusion: chyloperitoneum is a rare complication in patients with internal hernia with RYGB, with few cases reported in the literature. Although it is considered a rare complication, it can indicate internal hernias when the diagnosis is inconclusive. It may well be resolved during diagnostic laparoscopy by reducing the internal hernia and closing the mesenteric defect.

Resumen: Las neoplasias apendiculares primarias son una entidad rara. Existen algunas variedades histológicas malignas, las que representan aproximadamente de 0.5 a 1% de las neoplasias intestinales. El linfoma apendicular corresponde con apenas 0.015% de las neoplasias primarias del apéndice cecal. Se presentan dos casos de pacientes con linfoma de Burkitt apendicular. Ambos casos con un cuadro de abdomen agudo con irritación peritoneal y que por laparoscopia exploradora se identifica un cuadro apendicular complicado y en el segundo caso con piocolecisto agregado. En ambos casos el reporte histopatológico y de inmunohistoquímica reveló linfoma de Burkitt. Esta entidad se presenta en su mayor proporción como apendicitis aguda y debido a su poca frecuencia se suele diagnosticar después del resultado histopatológico.

Abstract: Appendicular neoplasms are a rare entity. There are several histological varieties, malignant ones represent approximately 0.5 to 1% of intestinal neoplasms.2 Appendicular lymphoma corresponds to only 0.015% of primary neoplasms of the cecal appendix. Two cases of patients with appendicular Burkitt’s lymphoma are presented. Both cases with acute abdomen with peritoneal irritation and that by exploratory laparoscopy identified the complicated appendicular disease and in the second case with added pyocholecyst. In both cases, the histopathological report and immunohistochemistry showed Burkitt’s lymphoma. This entity presents in its greater proportion as acute appendicitis and due to the rarity of its frequency, it is usually diagnosed after a histopathological result.

Resumen: La tuberculosis es una enfermedad infecciosa endémica en México, la cual es causada por Mycobacterium tuberculosis, un bacilo ácido-alcohol resistente. La principal afección orgánica es a nivel pulmonar; sin embargo, se ha reportado que hasta 25% de los casos pueden tener una afección extrapulmonar, ya sea por diseminación linfática o hematógena, y en casos aislados como primoinfección extrapulmonar. Presentamos el caso de un masculino de 62 años de edad con un cuadro de dolor abdominal de siete días de evolución asociado con melena, en la que se documentaron múltiples perforaciones ileales en el borde antimesentérico con diagnóstico histológico de tuberculosis intestinal. Esta entidad debe sospecharse en pacientes con tratamiento inmunosupresor crónico y deben realizarse medidas de escrutinio de manera preventiva.

Abstract: Tuberculosis is an endemic infectious disease in Mexico, caused by Mycobacterium tuberculosis, an acid-fast stain-positive bacillus. The most common clinical scenarios are pulmonary affections. However, it has been reported that up to 25% of the cases may present as an extrapulmonary disease, either due to lymphatic or hematogenous dissemination, and isolated cases have been reported as an extrapulmonary primary infection. We present the case of a 62-year-old male with a 7-day history of abdominal pain associated with melena, in which multiple ileal perforations were documented in the anti-mesenteric border with a histological diagnosis of intestinal tuberculosis. This entity should be suspected in patients with chronic immunosuppressive treatment and special screening should be performed to prevent these clinical scenarios.

Abstract: Nesidioblastosis is a rare pathology of the endocrine pancreas that causes hypoglycemia due to endogenous hyperinsulinism. It is a hyperplasia of the islets of Langerhans with a hypertrophy of the βeta cells. Treatment options in most cases are distal pancreatectomy. A 64-year-old male with multiple long-term hypoglycemic events. A diagnostic protocol was performed, evidencing the suggestive presence related to insulinoma. It is decided to perform distal pancreatectomy by laparoscopy. A pancreatic fragment with pancreatic islet hyperplasia and isolated endocrine cells was reported. In immunohistochemistry with positivity for synaptophysin and chromogranin confirming the diagnosis of diffuse nesidioblastosis. The patient was discharged without complications and with adequate metabolic control and without episodes of hypoglycemia. This is how nesidioblastosis represents a diagnostic challenge in the patient with hyper insulinemic hypoglycemia refractory to medical management.

Resumen: La nesidioblastosis es una patología del páncreas endocrino poco frecuente que origina cuadros de hipoglucemia por hiperinsulinismo endógeno. Se trata de una hiperplasia de los islotes de Langerhans con una hipertrofia de las células β. Las opciones de tratamiento en la mayoría de los casos es la pancreatectomía distal. Hombre de 64 años que presenta múltiples eventos de hipoglucemia de larga evolución. Se realizó protocolo diagnóstico evidenciándose la presencia sugestiva relacionada con insulinoma. Se decide realizar pancreatectomía distal por laparoscopia. Se informó de un fragmento pancreático con hiperplasia de islotes pancreáticos y células endócrinas aisladas. En la inmunohistoquímica con positividad para sinaptofisina y cromogranina que confirma el diagnóstico de nesidioblastosis difusa. El paciente fue egresado sin complicaciones y con adecuado control metabólico y sin episodios de hipoglucemia. Es así como la nesidioblastosis representa un reto diagnóstico en el paciente con hipoglucemia hiperinsulinémica refractaria a manejo médico.

Abstract: Specific care took place at the Hospital Ángeles Pedregal General Surgery Area as soon as the COVID-19 was declared as a pandemic to take care of patients, medical personnel and paramedics in the surgical areas reorganizing the operational surgery steps. Objective: To describe if the implemented measures in the General Surgery operational service during the COVID-19 pandemic correspond to the international recommendations, and if these were beneficially reflected in the intra-hospital quality care. Material and methods: A descriptive and registry study was made including different variables and procedures depending of the pandemic in Mexico. 133 for phase 1, 48 for phase 2 and 60 for phase 3, this compared retrospectively to the operation of the service before the pandemic. Results: Notable reduction of the elective priority surgical urgency procedures, in major proportion using laparoscopic methods as well as a reduction of number of days of the patients at the hospital. Conclusion: With the operative measures taken, it was possible to have a safe practice, both inside and outside of the surgical room for the patient and the intra-hospital personnel with favorable results in our care center.

Resumen: Desde que el COVID-19 fue declarado pandemia, el Servicio de Cirugía General del Hospital Ángeles Pedregal adoptó medidas específicas para el cuidado de los pacientes, del personal médico y paramédico dentro de las áreas quirúrgicas mediante una reorganización en la operatividad de las cirugías. Objetivo: Describir si las medidas implementadas en la operatividad del Servicio de Cirugía General durante la pandemia corresponden a las recomendaciones internacionales y si éstas se vieron reflejadas benéficamente en la calidad de atención intrahospitalaria. Material y métodos: Estudio descriptivo en el que se incluyeron diferentes variables y se registraron de forma consecutiva los procedimientos quirúrgicos que, dependiendo de la fase de la pandemia en México, fueron 133 para la fase uno, para la fase dos 48 y para la fase tres 60, esto comparado de manera retrospectiva con la operatividad quirúrgica antes de la pandemia. Resultados: Disminución notable de los procedimientos quirúrgicos electivos con prioridad para la cirugía de urgencia, se realizó en mayor proporción cirugía laparoscópica, así como reducción de los días de estancia intrahospitalaria. Conclusión: Con las medidas operativas adoptadas se pudo tener una práctica segura dentro y fuera del quirófano, reduciendo notablemente el riesgo de contagio con resultados favorables en nuestro centro.

Abstract Background: Maximal oxygen uptake (VO2max) and both first (VT1) and second (VT2) thresholds have been used as reference points for exercise prescription in different populations. Objective: We aimed to test the hypothesis that exercise prescription, based on VTs determined by treadmill cardiopulmonary exercise testing (CPET), is influenced by the rate of increase in treadmill workload. Methods: Nine healthy individuals underwent two CPETs, followed by two sessions of submaximal exercise, both in randomized order. For the “speed” protocol, there was an increment of 0.1 to 0.3 km.h-1 every 15s. The “grade” incremental protocol increased 1% every 30s and 0.1 km.h-1 every 45s. This was followed by submaximal exercise sessions lasting 40min at an intensity corresponding to heart rate (HR) between the VT1 and VT2. Results: The “speed” protocol resulted in higher VT1 (p = 0.01) and VT2 (p = 0.02) when compared to the “grade” incremental protocol, but there was no effect on VO2max. The target HR for the submaximal exercise sessions was higher in the “speed” protocol compared to the “grade” incremental protocol (p < 0.01) and remained stable during the two steady-state exercise sessions. Blood lactate remained stable during the submaximal exercise sessions, with higher values observed during the “speed” protocol than those “grade” incremental protocol (p < 0.01). Conclusions: Compared to a grade-based protocol, a speed-based protocol resulted in higher VT1 and VT2, which significantly affected cardiorespiratory and metabolic responses to prescribed exercise intensity in healthy young adults.

Abstract: Introduction: Physical training programs (PTP) have shown several beneficial effects for patients with cardiovascular disease (CVD), particularly by increasing survival and quality of life. Physiological response during the effort and recovery phases of an exercise testing, is one of the strongest prognostic markers among patients with CVD. A reasonable mechanism that explains those training effects on survival is through the adaptations seen on heart rate recovery (HRR) and oxygen uptake kinetics at the post-exertional phase (RVO2). Objective: Compare the HRR and RVO2 values before and after a PTP in patients with CVD. Methods: We studied a cohort of patients included in a cardiac rehabilitation program, whom performed a cardiopulmonary exercise testing (CPX). Then, risk stratification and an individualized exercise training program were performed. The exercise training program included 20 sessions of aerobic exercise, 30 min a day, five times a week, at moderate intensity. Finally, a second CPX was performed. Results: A total of 215 patients were included. Peak oxygen uptake values rose 2.2 ± 5.2 ml/kg/min (p < 0.001), HRR increased 1.6 ± 10 bpm (p < 0.05) and RVO2 improved −21 ± 98 s (p < 0.001). A post-hoc analysis show that the percentage of maximum heart rate remained statistically associated with HRR increment. Furthermore, diabetes and sedentarism were strongly related to RVO2 improvement. No correlation between HRR and RVO2 was found (R2 = 0.002). Conclusion: Physical exercise was associated with a beneficial effect on HRR and RVO2. Nevertheless, both variables were statistically unrelated.

Resumen: Introducción: Los programas de entrenamiento físico han demostrado efectos benéficos en pacientes con enfermedad cardiovascular, particularmente debido al aumento de la supervivencia y calidad de vida. La respuesta fisiológica durante la prueba de esfuerzo cardiopulmonar tanto en las fases de ejercicio como de recuperación son de los principales marcadores pronósticos debido a la adaptación en la recuperación de la frecuencia cardiaca (RFC) y la cinética de recuperación de oxígeno en la fase de postesfuerzo (RVO2). Objetivo: Comparar los valores de RFC y RVO2 antes y después de un programa de entrenamiento físico. Métodos: Se estudió una cohorte de pacientes incluidos en un programa de rehabilitación cardiaca, que hayan realizado una prueba de esfuerzo cardiopulmonar. El programa de entrenamiento consistió en 20 sesiones de ejercicio aeróbico de 30 min diarios, 5 veces a la semana de intensidad moderada. Por último, se realizó una segunda prueba de esfuerzo cardiopulmonar. Resultados: Se incluyeron 215 pacientes. El consumo pico de oxígeno aumentó en 2.2 ± 5.2 ml/kg/min (p < 0.001), la RFC se incrementó 1.6 ± 10 lpm (p < 0.05) y mejoró la RVO2 −21 ± 98 seg (p < 0.001). En el análisis post-hoc se observó que el porcentaje de la frecuencia cardiaca máxima se mantuvo asociado con el incremento de la RFC. Por otra parte, la diabetes y el sedentarismo estuvieron fuertemente asociados con la mejora de la RVO2. No se observó correlación entre RFC y RVO2 (R2 = 0.002). Conclusiones: El ejercicio físico se asoció con un efecto benéfico sobre la RFC y la RVO2. Sin embargo, ambas variables no se relacionaron estadísticamente.

Resumo Este artigo aborda a produção científica do intelectual e cientista social cubano Fernando Ortiz em sua faceta de historiador. Considerando a proposta historiográfica recente de uma "Atlantic History", ou "história atlântica", o trabalho examina como, décadas antes disso, Ortiz havia sido pioneiro de uma história cultural que tomava o espaço geográfico e social do mundo Atlântico como marco necessário para a interpretação do passado cubano e hispano-americano. O trabalho esboça a trajetória geral do autor tomando por base sua obra tardia. A teoria da transculturação proposta por ele nega tanto o determinismo racial como a definição somática de raça. Tal teoria é central para a maneira como Ortiz examina a contribuição africana para a cultura cubana - e, de modo geral, para a cultura de todo o litoral ocidental do oceano Atlântico - no contexto de sua busca de uma história cultural latino-americanista construída à luz das ciência sociais.

Abstract This article concerns the scientific writings of the Cuban intellectual and social scientist Fernando Ortiz, in what pertains to his facet as a historian. Considering the recent historiographical proposal for an 'Atlantic History', the article examines how, decades before, Ortiz had pioneered a cultural history that set the interpretation of the Cuban and Hispano-American past against the backdrop of the geographical and social space of the Atlantic world. The article outlines Ortiz's career, focusing on his later work. The theory of transculturation proposed by the author denies both racial determinism and the somatic definition of race. This theory is central to the way Ortiz examines the African contribution to Cuban culture, and, more generally, to the culture of the western Atlantic seaboard in the context of his search for a Latin-Americanist cultural history anchored in the social sciences.

This article explores a decisive moment in the construction of historiographical discourse in the River Plate: that of Romanticism, marked by the reception of topics and concepts forged in the course of philosophical, political and social debates in Europe during the 1820s and 1830s. It emphasizes the importance, in the River Plate, of a certain Geschichtsphilosophie for the crystallization of a historical discourse which emphasized general interpretation and the identification of “general laws” of historical development . The main hypotheses are: a) that reference to the “nation” as the basic object of historical discourse first appeared in the works analyzed here; b) that the effort to articulate a “national history” had as its precondition the fact of having been produced in exile, a situation that also conditioned its subject-matter. This article emphasizes the role historical context exercises in the historical reconstruction of the meanings of political, social and historiographical discourse.

Este trabajo explora un momento decisivo en la construcción del discurso historiográfico rioplatense – el romántico – marcado por la recepción de un conjunto de tópicos y conceptos acuñados en el transcurso de los debates filosóficos, políticos y sociales europeos de las décadas de 1820 y 1830. Enfatiza la importancia de cierta “Geschichtsphilosophie” para la cristalización de un discurso histórico que privilegiaba la interpretación general y la identificación de “leyes generales” del desarrollo histórico. Las hipótesis centrales son: a) que la referencia a la “nación” como sujeto privilegiado del relato histórico apareció por primera vez en las obras aquí analizadas; b) que ese esfuerzo por articular una historia de la “nación” tuvo como condición de posibilidad y como condicionante de sus contenidos el hecho de haberse producido en el exilio. Este artículo enfatiza el rol del contexto histórico para la reconstrucción histórica de los significados del discurso político, social e historiográfico.