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BACKGROUND: We present the first results of our program, which is characterized by its acceptance of any candidate with chronic renal failure. Therefore, we serve all patients, regardless of their social security and socioeconomic status. METHODS: We conducted a retrospective, descriptive, cross-sectional study describing the characteristics of patients who received kidney transplants in the period from 2008 to 2015. Descriptive statistics were used to evaluate our findings. RESULTS: A total of 708 transplants were performed, with 377 (53%) involving a living donor and 331 (47%) involving deceased donors. The patients' mean age was 26 years (±12.7 SD), with a range of 5 to 69 years. Of these patients, 488 were male (68.9%), and 423 (59.7%) had no social security. The replacement therapy prior to transplantation was peritoneal dialysis in 40% of cases, hemodialysis in 57% of cases, and 3% of patients had no prior therapy. The blood group distribution was 436 (61%) type O; 177 (25%) type A; 78 (11%) type B; and 8 (1%) type AB. The average hospital stay for a living donor transplant was 9 days and 13 days in the case of a deceased donor. CONCLUSIONS: This study describes the basic clinical and epidemiological characteristics of our transplant population. These results can be used as a basis for future descriptive and prospective studies at our institution or in other inter-agency and national projects. We also highlight the rapid development of the kidney transplant program at the Bajio Regional High Specialty Hospital.

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BACKGROUND: Today, antireflux surgery has an established position in the management of gastroesophageal reflux disease. Some case series have shown good short-term results, but there is still little information regarding long-term results. Studies have recently focused on evaluating residual symptomatology and its impact on quality of life. OBJECTIVES: To determine the postoperative quality of life and degree of satisfaction in patients that underwent laparoscopic Nissen fundoplication. PATIENTS AND METHODS: A total of 100 patients (59 women and 41 men) were studied after having undergone laparoscopic Nissen fundoplication. The variables analyzed were level of satisfaction, gastrointestinal quality of life index (GIQLI), residual symptoms, and the Visick scale. RESULTS: No variation was found in relation to sex; 49 men and 51 women participated in the study. The mean age was 49 years. The degree of satisfaction encountered was: satisfactory in 81 patients, moderate in 3, and bad in 2 patients. More than 90% of the patients would undergo the surgery again or recommend it. The Carlsson score showed improvement at the end of the study (p<0.05). In relation to the GIQLI, a median of 100.61 points±21.624 was obtained. Abdominal bloating, regurgitation, and early satiety were the most frequent residual symptoms. The effect on lifestyle measured by the Visick scale was excellent. CONCLUSIONS: The level of satisfaction and quality of life obtained were comparable with reported standards; and the residual symptoms after antireflux surgery were easily controlled.

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OBJECTIVES: To determine among adult patients with type-2 diabetes mellitus the proportion diagnosed with diabetic polyneuropathy (DPN) by clinical evaluation and by the Hoffmann reflex (H-reflex). In addition, the predictive value of the H-reflex in the diagnosis of DPN was evaluated. METHODS: Studies were carried out on 150 adult patients referred for neuropathy screening. Diagnostic criteria for DPN were at least two abnormalities in clinical neurophysiological examinations and electrophysiological testing (H-reflex and nerve conduction velocity). Logistic regression analysis was performed to identify unique contributions of study characteristics to positive versus negative outcomes. RESULTS: H-reflex was absent in 39.3% (59/150) and latency was prolonged in 43.3% (65/150) of patients. Ulnar nerve motor branch nerve conduction showed prolonged latency in 9.3% (14/150) of patients. Logistic regression analysis indicated that the H-reflex was significantly associated with positive outcomes. CONCLUSION: The H-reflex could have a predictive value in DPN, providing more quantitative information regarding diagnosis than conventional nerve conduction studies.

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BACKGROUND: The use of open tension-free techniques in hernia surgery seems to be superior to those techniques that apply tension to the suture line. However, the cost-effectiveness of tension vs. tension-free repairs has not been investigated before. METHODS: This study is a cost-effectiveness analysis within a randomized controlled clinical trial that compared open-tension (OT) versus mesh-plug tension-free (MPTF) hernia repair, with a 2-year follow-up for each patient. Between July 2002 and June 2003, 106 patients with inguinal hernia were randomized to either procedure. Main outcome measures included average surgical time, time to full recovery, pain visual analog scale, amount of analgesics required, off-work time, hospital stay, and heath-care costs. RESULTS: The average cost was $885.15 (95% CI $843.56-$926.74) and $837.66 (95% CI $796.42-878.89) USD for the OT and the MPTF herniorrhaphy, respectively (P < 0.05). Average yearly savings with the MPTF repair were calculated as $7,598.84 USD. Surgery time, time to full recovery, pain visual-analog scale, use of analgesics, off-work time, and hospital stay were significantly lower for the MPTF repair. Disability-adjusted life-years were reduced 56% with the MPTF repair, which represented a total savings of $12,656.60 USD with this procedure. CONCLUSION: This controlled clinical trial demonstrates that the MPTF technique significantly decreases care costs in patients operated on for inguinal hernias.

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PURPOSE: The purpose of our study was to evaluate the possibility of the reduction of peritoneal adhesions to a polypropylene mesh with fibrin glue. METHODS: Forty Wistar rats were assigned to two treatment groups: Group 1) hernioplasty with polypropylene mesh plus fibrin glue sealant, and Group 2) hernioplasty with polypropylene mesh without fibrin glue sealant. The variables evaluated were: presence and density of adhesion, organs or abdominal structures adhered to the polypropylene mesh, inflammatory tissular reaction and cell recount. RESULTS: Group 1 presented a statistically lower adhesion percentage than Group 2 (40% versus 100%, P = 0.0003). The mean areas of mesh patch surfaces covered with adhesions were statistically different between Groups 1 and 2 (0.67 +/- 0.65 cm2 versus 1.60 +/- 0.51 cm2; P = 0.00001). Twelve rats presented with adhesions in Group 1; eleven were adhesions to the epiploon and one to the colon. In Group 2 there were 16 adhesions to the epiploon, 2 to the colon, 1 to the small intestine and 1 to the stomach. Tissular reaction comparison showed a significant difference (21 +/- 4.9 versus 17 +/- 4.1; P = 0.006). CONCLUSIONS: Fibrin glue sealant significantly reduced the frequency and severity of intra-abdominal adhesions.

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PURPOSE: The purpose of this study is to compare the safety and complications of direct trocar insertion without pneumoperitoneum (DTI) with Veress needle (VN) in laparoscopic cholecystectomy (LC). METHODS: We studied 84 patients admitted to our hospital for LC, in a random simple blind design, 42 patients were assigned to DTI and 42 to VN. The variables analysed were : procedure complications, laparoscope insertion time and duration of surgery. RESULTS: Complication percentages between the groups were significantly different (DTI 2.3% versus VN 23.8%, p = 0.009). The duration of surgery between the two groups was also significantly different (DTI 56+/-31 versus VN 71+/-28 minutes, p < 0.02). Finally, laparoscope insertion time between the two techniques was significantly different (DTI 1.5+/-0.5 versus VN 3.0+/-0.4 minutes p < 0.001). CONCLUSIONS: Our results show DTI to be a safe, efficient, rapid and easily-learned alternative technique, reducing the number of procedure-related complications.

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Inguinal herniorraphy is one of the most common surgeries performed. Avoiding hernia recurrence is a primary concern. Hence, it is necessary to analyze the predictive factors of postoperative complications and recurrence. To compare the predictive factors of postoperative complications and recurrences of hernias among three tension-free open herniorraphy techniques. Five hundred and fifty-one inguinal hernia patients, operated on with one of three tension-free anterior approach herniorraphy techniques, were included in a cohort study. The three techniques were: Lichtenstein (n=214), Mesh-Plug (n=201) and Prolene Hernia System (PHS, n=136). The patients were evaluated at 15 days, 1 month, 6 months and then every year up to 5 years after hernioplasty. The variables evaluated were recurrences and postoperative complications. Relative risk was estimated from a univariate analysis of the presumable risk values, after which a multivariate analysis was carried out. Complications [n=27, (4.9%)] were more frequently associated with incarcerated hernia, a coexisting disease at the time of operation, hospitalization longer than 1 day, previous herniorraphy, a herniary ring larger than 4.5 cm and a history of postoperative complications. Recurrence was greater for the Mesh-Plug group [n=5 (2.5%), RR: 4.35 (CI: 0.85-22.23)] than for the Lichtenstein [n=2 (0.9%), RR: 0.63 (0.06-3.87)] and PHS [n=0 (0%), RR de 0 (0-2.39)] groups. The presence of coexisting disease during hernioplasty, incarcerated hernia and an extended hospital stay are predictive factors for hernia complications. Previous herniorraphy, a herniary ring larger than 4.5 cm and postoperative complications are predictive factors for hernia recurrence.

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