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PURPOSE: Less than 450 cases of femoral hernias containing the vermiform appendix have been published since De Garengeot's first description. A laparoscopic treatment option opened 15 years ago seems reliable and safe. A literature review of all the patients who have benefited from this new therapeutic alternative is presented. METHODS: A systematic review using the German Society of Surgery's recommendations was performed for De Garengeot's hernias totally treated laparoscopically. Keywords searched included "De Garengeot hernia" OR "femoral hernia appendix" OR "crural hernia appendix." RESULTS: Only 29 out of 225 De Garengeot hernia's manuscripts were identified describing patients entirely treated laparoscopically: 25 patients by a transabdominal preperitoneal hernia repair (TAPP) and 4 patients by a total extraperitoneal (TEP) procedure; 85.1% were females. The mean age was 71 years. Twenty-two patients had pre-operative imaging tests, sonography (2), computed tomography (14), or both (6). Nevertheless, only 56% had a preoperative diagnosis. Twenty-one cases required urgent treatment, while programmed surgery was possible in 7 instances. An appendix-sparing procedure could be done in 16% of the TAPPs. No postoperative complications occurred. The median hospital stay was 2.5 days. CONCLUSIONS: The best surgical approach for a De Garengeot's hernia is not defined, and many critical questions remain unanswered. A better understanding of the diagnosis and treatment of this peculiar hernia will supply guidelines for clinicians who may encounter it hereafter. A fully laparoscopic approach seems perfectly safe and feasible for this entity, and it could be considered the first-line alternative if enough expertise is available.

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BACKGROUND: Albumin, along with other proteins, is abnormally eliminated via the urine during early stages of diabetic nephropathy. Moreover, endothelial dysfunction (ED) accompanying early diabetic nephropathy may develop even before microalbuminuria is detectable. Transferrin has a molecular weight comparable to albumin, whereas transferrinuria and microalbuminuria in a 24-h urine sample may comparably reflect early diabetic nephropathy. Whereas transferrin metabolism is related with ED during very early diabetic nephropathy has not been elucidated yet. This case-control study aimed to evaluate the relation between ED and urine transferrin, even before early diabetic nephropathy is present. METHODS: Patients were enrolled from two study sites in Mexico City: Ticomán General Hospital (healthy controls); and a Specialized Clinic for the Management of the Diabetic Patient (cases). All patients provided written informed consent. The primary endpoint was the correlation between urinary transferrin concentration and ED measured in type 2 diabetic patients without albuminuria. ED was evaluated by ultrasonographic validated measurements, which included carotid intima-media thickness (CIMT) and flow mediated dilation (FMD). Plasma biomarkers included glycated hemoglobin, creatinine, cholesterol and triglycerides, as well as urine albumin, transferrin and evidence of urinary tract infection. RESULTS: Sixty patients with type 2 Diabetes Mellitus (t2DM; n = 30) or without t2DM (n = 30), both negative for microalbuminuria, were recruited. The group with t2DM were older, with higher values of HbA1c and higher ED. This group also showed significant differences in urine transferrin and urine/plasma transferrin ratio, as compared with healthy controls (14.4 vs. 18.7 mg/mL, p = 0.04, and 74.2 vs. 49.5; p = 0.01; respectively). Moreover, urine transferrin correlated with higher CIMT values (r = 0.37, p = 0.04), being particularly significant for t2DM population. CIMT also correlated with time from t2DM diagnosis (r = 0.48, p < 0.001) and HbA1c (r = 0.48; p < 0.001). CONCLUSION: Urine transferrin correlated with subclinical atherogenesis in patients with t2DM without renal failure, suggesting its potential to identify cardiovascular risk in patients at very early nephropathy stage without microalbuminuria.

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Cd1-xZnxTe (0 ≤ x ≤ 0.1) ingots were obtained by Bridgman's method using two different speeds in order to find the optimal conditions for single-crystalline growth. Crystalline quality was studied by chemical etching, the elemental composition by wavelength dispersive spectroscopy (WDS), tellurium (Te) precipitates/inclusions concentration by differential scanning calorimetry (DSC), optical transmission by Fourier transformed infrared spectrometry (FTIR), and band gap energy (Egap) by photoluminescence (PL). It was observed that the ingots grown at a lower speed were those of the best crystalline quality, having at most three grains of different crystallographic orientation. The average dislocations density in all of them were similar and correspond to materials of good quality. EPMA results indicated that the homogeneity in the composition was excellent in the ingots central part. The concentration of Te precipitates/inclusions in all ingots was below the instrument (DSC) detection limit, 0.25% wt/wt. In the case of wafers from Cd0.96Zn0.04Te and Cd0.90Zn0.10Te ingots, the optical transmission was better than that of commercial materials and varied between 60% and 70%, while for pure CdTe, the transmission range was between 50% and 55%, the latter being decreased by the presence of Te precipitates/inclusions. The band gap energy Eg of different wafers was experimentally obtained by PL measurements at 76 K. We observed that Eg increased with the Zn concentration of the wafers, following a linear regression comparable to those proposed in the literature, and consistent with the results obtained with other techniques.

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Background and Objectives: Less than 300 cases of a De Garengeot's hernia have been published. This rare femoral hernia with the vermiform appendix included appears almost exclusively on the right side, mainly in females, and it generally debuts as an incarcerated femoral hernia. Although most of the times there is a concomitant appendicitis, clinical signs of peritonitis are absent. The wide use of radiologic exams has not favored its preoperative diagnosis, but been usually found incidentally during a surgical emergency. The best surgical approach to a De Garengeot's hernia is not totally defined and many critical questions still remain unanswered. Open surgery is considered the standard treatment procedure, but since the emergence of laparoscopy for incarcerated hernias, this is certainly an option. Methods: We report the successful laparoscopic management of an 83-year-old woman who had been operated on her right inguinal hernia, with a Rutkow-Robbins' technique, 4 months earlier. She had noticed the protrusion of a lump in her right inguinal region for 2 months. Radiological studies were not conclusive. With a miss diagnosis of a recurrent incarcerated inguinal hernia, a minimal invasive endoscopic approach was performed. A representative case of this fully laparoscopic TAPP procedure is presented. Results: The patient made an uninterrupted recovery. She left the hospital the day after in a stable condition and has enjoyed good health since. Conclusion: A fully laparoscopic TAPP approach seems perfectly safe and feasible to treat this entity, and could be considered the first line alternative when enough expertise is available.

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INTRODUCTION: Primary retroperitoneal parasitic leiomyoma (PRPL) with inguinal extension is a diagnostic-therapeutic challenge due to its uncertain etiopathogenesis and because it has been considered unresectable according to customary surgical techniques in some instances. The abdominoinguinal incision described by Karakousis in the 1980s allows a safe and radical approach for lower quadrants abdominopelvic tumors. OBJECTIVES: We present the case of a rare PRPL satisfactorily treated through Karakousis's approach. PRESENTATION OF CASE: A 35-year-old woman was referred from the Gynecology Service to our Unit. She suffered from a pelvic tumor with left inguinal extension. Initially, it was diagnosed as a retroperitoneal sarcomatous tumor as any digestive and/or gynecological origins of the pelvic tumor were excluded. A radical oncologic excision with permanent neuro-vascular control was undertaken using a left Karakousis's abdominoinguinal approach. The final anatomopathological report was PRPL. The patient was discharged after 8 days. She is disease-free 18 months later. DISCUSSION: PRPL variant could be related to remnant embryogenic cells of the ducts of Wolf and Müller. Karakousis's approach allowed an en-bloc ilioinguinal removal of the tumor in continuity, with permanent control of the aorto-ileo-femoral axis, the sparing of the neuro-vascular package, and ensured a total abdominal wall restoration. CONCLUSIONS: PRPL is a rare extrauterine entity probably derived from remnant embryogenic cells. The absence of clinical guidelines recommend an individualized treatment of these patients. Karakousis's abdominoinguinal approach should be present in any surgeon's armamentarium as the resectability-rate of tumors of the lower quadrant of the abdomen increases up to 95%.

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INTRODUCTION: FDG PET/CT is believed to be crucial in oncology, but its limited specificity represents a challenge. Prosthetic meshes used for repair abdominal defects may lead to false-positives FDG PET/CT uptake, over staging malignancies and inducing inappropriate treatments. A false-positive FDG PET/CT uptake mimicking metastatic disease during the follow-up of a previously treated metastatic melanoma patient is presented.

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INTRODUCTION: Melanoma is a health problem world-wide. Its incidence has tripled in the last decade. The main cause of death in melanoma patients is widespread metastases. It can metastasize to almost every organ. However, melanoma skeletal muscle metastases (MSMM) are exceptional, and only two cases of MSMM to rectus abdominis muscles have been previously published. Regardless of all new advances seen in melanoma therapy, cure for most MSMM is still elusive. Surgical approaches are still not well defined. PRESENTATION OF CASE: A 35-year-old woman had been previously operated of an ulcerated scapular melanoma (Clark level III, Breslow 2.3mm) in January 2014. Subsequently she underwent a sentinel lymph node which resulted negative. Twenty months later, a CT scan revealed a well-enhanced nodule of 25mm in the right rectus abdominis, without any other metastases. The PET-CT uptake was pathologic (SUV maximum of 13.16). An ultrasound-guided biopsy confirmed it was a metastatic melanoma. A radical compartmental resection of the right rectus abdominis muscle was performed. The abdominal wall was reconstructed with two polypropylene meshes buried preperitoneally. The final histologic diagnosis of the specimen proved to be a metastasis of melanoma. DISCUSSION: Surgery is the only potentially curative therapy for patients with isolated MSMM. The ultimate goal of negative resection margins, in order to avoid local recurrences, is paramount in those difficult cases. CONCLUSION: Radical compartmental surgery should be considered for selected stage IV melanoma patients whose disease could be amenable to complete resection, in order to extend median survival.

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Introducción. Se realizó el estudio para determinar la relación entre la condición ambiental y las variables fisiológicas (temperatura rectal y frecuencia respiratoria) en bovinos cruzados cebú x europeo en los meses de julio, septiembre y noviembre de 1998. Material y métodos. Para ello se estudiaron cinco ranchos, dos localizados en la zona costera con clima BS0 y tres en la zona oriente con clima regional AW1. En cada uno se seleccionaron cinco animales, se realizó la toma de las variables fisiológicos a las 6, 10, 14 y 18 horas. Se determinó la temperatura, humedad, temperatura de bulbo negro al sol y sombra cada hora de las 6 a las 18 horas.Resultados. Los resultados indican una diferencia en las condiciones térmicas del ambiente en ambas regiones, así como en la frecuencia respiratoria y temperatura rectal. Los cambios en la condición ambiental, provocaron cambios en las variables fisiológicas. Los cambios microclimáticos por hora aparentemente tuvieron efecto sobre las variables fisiológicas de los animales criados en ambas regiones. Se observó una relación entre los cambios en la condición ambiental por mes y hora con las variables fisiológicas. De las dos zonas geográficas únicamente los animales criados en la zona oriente rebasaron los límites normales en la frecuencia respiratoria. Discusión. Esta variación sugiere que el animal pone en marcha el proceso de disipación térmica evaporativa como compensación a la reducida eficiencia de pérdida de calor sensible, lo que le permite mantener la temperatura corporal dentro de los límites fisiológicos.

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Se utilizaron 25 vacas Holstein y sus crías para evaluar el efecto del amamantamiento restringido (AR) y de la crianza artificial (CA) sobre el comportamiento productivo, reproductivo y sanitario en un hato bovino de doble propósito, en el sureste de México. En el grupo AR los becerros mamaron la leche residual durante 30 minutos después de cada ordeño por la mañana y por la tarde, hasta la edad de 180 días. Los becerros del grupo CA se separaron de las madres a los dos días de edad, se les alojó en jaulas individuales y se les alimentó con leche obtenida de sus respectivas madres hasta los 90 días de edad. Los becerros del grupo AR tuvieron un peso significativamante mayor que los de CA a los 90 días de edad (84 kg vs 75 kg, P< 0.05). El crecimiento posterior no fue diferente en ambos grupos y la diferencia de peso a los 90 días se mantuvo hasta los 120 días. El total de leche ordeñada no se vio afectado por el amamantamiento (P> 0.05), aunque el total de leche vendible, producida a los 120 días, fue mayor en las vacas que amamantaban (P< 0.01). En el grupo AR los intervalos parto-primer servicio y parto-concepción durante los primeros 180 días posparto fueron significativamente mayores (P< 0.01 y P< 0.05 respectivamante) en relación al grupo CA. Las proporciones de vaca servidas y gestantes hasta los 120 0 180 días posparto fueron significativamente menores en el grupo AR en comparación con el CA (P < 0.01). Las vacas del grupo AR registraron mayores pérdidas de peso hasta los 120 días posparto, y dentro de cada grupo, las vacas que parieron con mayor peso ciclaron y fueron servidas en mayor proporción en comparación con aquellas cuyo peso al parto fue menor. Las vacas y becerros del grupo AR presentaron menos problemas de salud (incidencia de mantitis y diarreas) que las del sistema CA (P< 0.05). En conclusión, el sistema AR resultó ventajoso en cuanto al crecimiento de los becerros, a la producción de leche de las vacas, y a la salud tanto de los becerros como de las madres; sin embargo, las vacas del grupo AR perdieron más peso durante el posparto y tuvieron un comportamiento reproductivo más bajo en comparación con las del grupo CA, situación que es desfavorable para la eficiencia de los sistemas de doble propósito

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