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In 2003 a pilot study was carried out in the rural area of the Bolivian Department of La Paz aiming at the identification of dietary patterns among a group of secondary school adolescents who have little or scarce contact with the urban centres. The study consisted of a food intake survey (24 h recall), the measurement of anthropometrics and sociodemographic information. Nine percent was the global prevalence of overweight, although it was more present in girls. No statistically significant differences were found between nutrients in the diets of boys and girls. The energy intake was distributed in the five usual eating times as follows: 22% breakfast, 20% break time at school, 24% lunch, 12% tea time and 22% dinner. Furthermore, the anthropometric measures of boys were compared with their urban counterparts, where the differences were only significant with students in private schools. The present study can be used for the formulation of nutritional policies in Bolivia.

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BACKGROUND: Although laparoscopic appendectomy has some advantages over open appendectomy, some reports do show more postoperative intraabdominal abscesses. METHODS: A retrospective review of complicated appendicitis managed surgically by eight surgical groups from six countries was undertaken. Among 3,433 patients with appendicitis, 1,017 (29.5%) had complicated appendicitis, which included perforated or gangrenous appendicitis with or without localized or disseminated peritonitis. There were 74 preoperative abscesses (7.4%) and 5 small bowel obstructions. RESULTS: One patient died. There were 29 postoperative intraabdominal abscesses (2.8%) and 112 mostly minor complications. Conversion to laparotomy was necessary for 28 patients (2.7%). The surgical time ranged from 32 to 132 min (mean, 62 min), and the hospital stay ranged from 1 to 18 days (mean, 3.5 days). CONCLUSIONS: The morbidity rates, particularly for intraabdominal abscesses, were less for laparoscopic appendectomy in complicated appendicitis than those reported in the literature for open appendectomy, whereas operating times and hospital stays were similar.

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Acute epiploic appendagitis is not as rare as previously thought; but, since the presenting signs and symptoms are not specific, preoperative diagnosis has been rarely made. At the present time, a laparoscopic exploration of the peritoneal cavity will establish the correct diagnosis, and the treatment can be provided during the same procedure. Herein, a case of a 63-year-old female patient with acute abdominal syndrome caused by a necrotic epiploic appendix that was successfully diagnosed and treated laparoscopically is described. A review of the literature is made, as well.

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Reusable microinstruments are used in a modification of the three-port technique for laparoscopic appendectomy and other pelvic procedures; the method is described herein. Fifty-seven consecutive patients were operated upon using this technique. There was no mortality; there were two minor complications and no conversions to laparotomy. Pain medication needs were minimal in all patients, and the cosmetic results were excellent. The use of microinstruments for pelvic laparoscopic procedures is safe and cost-effective using the technical modifications described.

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With the laparoscopic approach, bilateral and complex groin defects can be corrected simultaneously by applying a preperitoneal mesh that covers the entire posterior wall of the groin, using a technique similar to the one described by Stoppa. We present our series of hernias repaired by the transabdominal preperitoneal laparoscopic approach with the Stoppa-type technique. The report consists of 78 cases of bilateral defects, of which 60% were indirect bilateral hernias, 23% direct bilateral, and 17% combined defects; 28.5% were recurrent hernias. Only minor complications were observed (hematomas and urinary retention) in some patients, but all resolved spontaneously. Three recurrences (0.7%) have been seen to this date. This method is recommended as the method of choice for complex groin defects.

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A partial pneumothorax developed in a patient undergoing laparoscopic truncal vagotomy when a small pleural laceration was accidentally produced. Changes in oxygen saturation and PETCO2 were immediately detected by the anesthesiologist and measures were taken to maintain the patient's ventilatory stability. The pleural laceration was repaired laparoscopically, and the pneumothorax was corrected by ventilatory manipulation, avoiding the placement of a chest tube. The procedure was completed uneventfully. Literature about the causes of pneumothorax during laparoscopic procedures as well as preventive and therapy viewed.

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Surgical specimens must often be extracted during laparoscopic surgery. Although the technologic advances in this field are amazing, simple measures may sometimes work even better than very sophisticated instruments. This is true of the reclosable plastic bags with zipper-type closure that we use for retrieving surgical specimens from the abdominal cavity in order to protect it as well as the abdominal wall. The bags are cheap, offer no problems for sterilization, are easy to obtain, and are available in many sizes. They are very simple to handle, making it easy to slip in the specimen and then extract it from the abdominal cavity. We describe our experience with these bags and a technique for manipulating them.

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A case is presented of a male patient that presented with intestinal obstruction in the early postoperative period of a transabdominal preperitoneal inguinal repair (TAPP) that was diagnosed and repaired successfully using laparoscopy. Whenever a total extraperitoneal procedure (TEP) cannot be performed, the peritoneal closure of the TAPP should be done water-tight using interrupted stitches of absorbable monofilament sutures.

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BACKGROUND: Peritonitis continues to be an important cause of morbidity and mortality and often an etiologic diagnosis is unclear. To evaluate the efficacy and safety of laparoscopy the authors analyzed their 5-year experience with this modality of treatment. METHODS: A review was made of 107 consecutive nonselected laparoscopic procedures performed between October 1990 and November 1995. The diagnosis was established by clinical, laboratory, and imaging findings and confirmed by laparoscopy and/or laparotomy. RESULTS: An etiologic diagnosis was unclear in 35% of the cases and was established in all by laparoscopy; 94 patients (87.9%) were successfully treated by laparoscopy while 13 (12.1%) required conversion. Mortality was 4.6%; 14% had postoperative complications and 7.4% had reoperations. CONCLUSIONS: Laparoscopic surgery is safe and very efficient in the diagnosis and treatment of patients with peritonitis. In most instances a definitive treatment can be carried out without conversion and has the additional and well-known advantages of minimally invasive surgery.

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Although postoperative pain has been reduced significantly since the advent of laparoscopic surgery, many patients still complain of moderate abdominal and shoulder pain during the first 48 to 72 h after surgery. In this study, the effect of subdiaphragmatic instillation of bupivacaine after laparoscopic cholecystectomy was investigated. The evaluation of postoperative pain was done according to a numerical verbal scale and the dose of analgesia required. The results showed a considerable reduction of postoperative pain during the first 48 h after surgery in patients who received bupivacaine instillation. Although the literature shows certain controversy as to the effects of similar methods, our study concludes that instillation of a long-acting anesthetic, such as bupivacaine, into the subdiaphragmatic space after laparoscopic procedures is effective in postoperative pain reduction.

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We present a case of a perforated duodenal ulcer in an elderly malnourished, septic, diabetic patient with abnormal renal function. This patient was treated successfully with laparoscopic surgery. We suggest that similar cases can be treated by this method.

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We have studied the genomic organization of cellular myc (c-myc) proto-oncogene in 48 human primary breast tumors. Two types of alterations (amplification and rearrangement) were observed in 27 (56%) of the tumors studied. The c-myc proto-oncogene appeared to be amplified 2- to 15-fold in the DNA of 20 tumors (41%). Non-germ line c-myc-related fragments (rearrangements) of variable size were detected in 7 primary breast tumors (6 malignant, 1 benign); 4 of these tumors presented both rearrangement and amplification, and the other 3 presented rearrangement only. The majority of the tumors analyzed were invasive ductal adenocarcinomas; 58% of these showed c-myc locus genetic alterations. Although the c-myc alterations described here do not appear to correlate with the aggressive behavior of primary breast tumors, they seem to be associated with development of breast carcinoma.

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Se comunica un caso de la variedad recidivante de manos y pies de la epidermolisis ampollar simple. Se realiza el estudio con microscopio electronico y se discuten las caracteristicas relevantes de esta enfermedad

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Se comunica un caso de la variedad recidivante de manos y pies de la epidermolisis ampollar simple. Se realiza el estudio con microscopio electronico y se discuten las caracteristicas relevantes de esta enfermedad

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