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BACKGROUND: Fecal incontinence is defined as an involuntary bowel movement through the anal canal in inadequate time and place. There are different types of therapies for the management of fecal incontinence, being biofeedback therapy one of the most effective techniques. The aim of this study was to evaluate the necessary number of sessions of biofeedback electromyographyc therapy to achieve the maximum sphincteric complex contraction. METHODS: Descriptive, retrospective and longitudinal study. 65 patients with fecal incontinence were included. Weekly electromyographyc biofeedback therapies were applied, with a maximum of 6, in which the sphincteric complex contraction was measured. A two ways Friedman analysis was made to determine the significant differences between the sessions. RESULTS: A total of 65 patients were evaluated for fecal incontinence. The values for pelvic floor contraction were significantly higher in the third session, and did not show any significant difference in posterior sessions. CONCLUSION: The maximum contraction of the sphicnteric complex was achieved in the third weekly biofeedback session, without any significant differences in the posterior sessions.

Introducción: el origen anómalo de la arteria coronaria izquierda del seno coronario derecho (ACAOS) se caracteriza porque la arteria coronaria principal izquierda se origina anómalamente del seno de valsalva aórtico coronario derecho y cuyo trayecto puede seguir cuatro diferentes caminos hacia el lado izquierdo del corazón. Caso clínico: masculino de 73 años de edad, que ingresó al hospital por dolor precordial de tipo opresivo, intensidad 10/10 con irradiación a brazo izquierdo y cuello, acompañado de diaforesis y nausea. El diagnóstico fue de un síndrome isquémico coronario agudo sometido a terapia trombolítica Su evolución posterior fue no satisfactoria debido a diferentes complicaciones que lo llevaron a la muerte. Conclusiones: el diagnóstico del origen anómalo de la arteria coronaria izquierda del seno opuesto (ACAOS), se establece únicamente a través de métodos de diagnósticos como la angiotomografía computada cardiaca o un cateterismo cardiaco como parte del abordaje de un síndrome isquémico coronario agudo que permiten establecer las características morfológicas de las arterias coronarias como las diferentes variantes anatómicas y sus características particulares respecto a las estructuras adyacentes.

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INTRODUCTION: One-third of the world's population is infected with tuberculosis (TB), with intestinal TB representing the sixth most common presentation of extrapulmonary TB. The diagnosis of intestinal TB is a challenge for physicians due to its diverse clinical manifestations that mimic other infectious, autoimmune, and neoplastic disorders, and is thus rarely considered as the causative agent of disease. PRESENTATION OF CASE: We present a 55-year-old male with no relevant familial history, who presented due to a loss of 10kg of weight in 2 months accompanied by nocturnal diaphoresis and continuous abdominal distension. DISCUSSION: The incidence and the severity of intestinal TB are increased in immunosuppressed patients and more rapidly progress due to deficient immune response. However, our immunocompetent had severe progression resulting in surgery less than a month after the diagnosis was made. CONCLUSION: While the diagnosis of intestinal TB, and specifically colonic TB, is difficult and is almost never the first diagnosis entertained outside the immunocompromised population, we present a rare case in which the disease presents in an immunocompetent patient.

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OBJECTIVE: The purpose of the study was to evaluate the effect of the pulsed electromagnetic fields (PEMF) and its possible modulation of the placebo effect in migraine. DESIGN: Placebo-controlled, randomized, double-blind, cross-over clinical trial. SETTING: Government third level hospital. INTERVENTIONS: Patients with migraine were included. PEMF were applied to the wrist with a bracelet. MAIN OUTCOME MEASURES: Frequency and intensity of the migraine attacks at baseline and during treatment were recorded. Also, we valuated the possible influence of gender and the presence of aura in the PEMF and placebo responses. RESULTS: Eighteen patients (fifteen women, 30±2 years old) were included. Migraine frequency and intensity was reduced with both PEMF and placebo to a similar extent in the whole population. However, in responders to placebo, migraine intensity was reduced to a median of 100% with the placebo and to 60% with the PEMF, while in non-responders there was only a slight effect of both treatments. Our results do not suggest an influence of gender or presence of aura in the outcomes. CONCLUSIONS: Treatment with PEMF may not alter either migraine intensity or frequency compared to baseline, but may reduce the response to placebo in migraine patients.

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INTRODUCTION: There are few studies regarding the clinical characteristics of Miller Fisher syndrome (MFS) in the Latin-American population. METHODS: A retrospective analysis was made of the clinical characteristics, neurophysiology, treatment and prognosis of MFS patients between 1995 and 2005. RESULTS: Nineteen MFS cases were documented, 12 of which did not receive immunosuppressive therapy. In both groups, the mean age was 36 years, 84% were male; onset in spring and fall was also predominant (73%), and antecedents of respiratory disease were found (79%). The mean duration of infectious symptoms was 7 days (1-11 days), and the mean interval between the onset of the infection and neurological symptoms was 7 days (1-30 days). The principal sign of onset was diplopia (63%). The mean delay between the onset of neurological symptoms and the beginning of recovery from ataxia, ophthalmoplegia and areflexia was 10 (1-30 days), 11 (1-30 days) and 14 (4-45 days) days, respectively, and the mean delay of the disappearance of ataxia, ophthalmoplegia and areflexia was 35 (10-121 days), 93 (18-244 days) and 64 (10-650 days) days, respectively. There was no significant difference between the group that received immunosuppression and the one that did not. DISCUSSION: The natural course of MSF is characterized by excellent recovery; there were no differences between the two groups.

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