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We presented a case of a 64-year-old female patient with a history of gastric bypass that presented with bowel obstruction due to a bezoar. She arrived at the emergency department, referring to severe abdominal pain, nausea, and vomiting. Abdominal X-ray reported gastric distention and hydro-air levels. CT scan reported swirling of the mesentery vessels and a collapsed intestinal loop, mimicking an internal hernia. Laparotomy was accomplished, which shows obstruction at 60 cm from the ileocecal valve. An enterolithotomy was performed, and a 6 × 6 cm phytobezoar was extracted. The patient had a satisfactory postoperative outcome, discharging her home on the fourth postoperative day. On a 12 month-follow up, the patient is doing well with no further complications. Gastric bypass continues to be one of the most performed bariatric procedures with low complication rates. It is important to note that not all intestinal obstructions in postoperative bariatric surgeries are due to internal hernias or adhesions. The differential diagnosis of intestinal obstruction due to bezoar must be present in patients who underwent bariatric surgery. Nutritional counseling is essential for the follow-up of patients, emphasizing fluid intake and slow chewing, as well as the use of absorbable materials for suture during the surgery.

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BACKGROUND/AIMS: Image-enhanced endoscopy (IEE) can differentiate neoplastic from non-neoplastic colorectal lesions through indirect analysis of pit patterns and microvascular architecture. We evaluated the accuracy of Flexible Spectral Imaging Color Enhancement (FICE) in differentiating neoplastic from non-neoplastic lesions and observer agreement in the analysis of capillary pattern of colorectal lesions. METHODS: A prospective double-blind trial was conducted in two referral endoscopy centers. Vascular pattern was analyzed by IEE with magnification. Lesions were divided into two groups and examined separately by two experts. Examiners, blinded to each other's interpretations, switched groups and the lesions were reviewed. After 60 days, lesions were reevaluated. RESULTS: In total, 76 patients were referred to colonoscopy for colon cancer screening. Of 100 colorectal lesions, 88 were neoplastic (73 tubular adenomas, 10 tubulovillous adenomas, 1 villous adenoma, 2 serrated adenomas, 2 adenocarcinomas) and 12 were non-neoplastic (hyperplastic polyps). Mean diameter of the lesions was 6.7 mm. Examiners 1 and 2 had 95 % accuracy. The interobserver kappa coefficient was 0.80 and the intraobserver kappa coefficient was 0.88 for examiner 1 and 0.73 for examiner 2. CONCLUSION: IEE with magnification is effective for real-time predictive histological diagnosis of colorectal lesions, with inter- and intraobserver agreement ranging from good to excellent.

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There is accumulative evidence on the multiple functions of the intestinal microflora in relation to the homeostasis of the host. At first considered as a simple mutualism, today this relationship proves to be essential to the health and to pathologic processes, particularly metabolic (eg, obesity) and gastrointestinal (eg, inflammatory bowel disease and functional disorders). The first studies were conducted on the microbiota from fecal material cultured anaerobically. With the advent of molecular biology, it has become possible to determine qualitative and quantitatively the dominant, subdominant and transients species. In recent years, there were advances in the understanding of the relationship betwen the microbiota and the host, as well as among the microorganisms in their respective niches. These advances result from translational integration of microbiology with specialities such as molecular biology, cell phisiology, immunology and ecology. There are few studies on the spatial distribution of the microflora in the gut. Unravelling the topography of the microflora in mammals is a way to validate new animal models for the study of microflora.

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Objetivo: gestionar la creación y puesta en marcha de una red de apoyo intersectorial, cuyo fin es brindar soporte y contribuir a la solución de la problemática de las familias. Materiales y Métodos: estudio descriptivo, llevado a cabo en 42 familias, 15 líderes comunitarios y representantes de 8 instituciones y 11 trabajadores del centro de salud de un barrio de estratos 1 y 2 de la ciudad de Bucaramanga. Se aplicó un formato de valoración por dominios de la Asociación Norteamericana de Diagnósticos de Enfermería (NANDA) para identificar la problemática de las familias. El procesamiento de los datos, se realizó en Excel mediante la obtención de frecuencias y promedios para su posterior análisis. Resultados: se logró la creación y puesta en marcha de la red de apoyo, conformada por ocho instituciones del sector,con la cual se abordaron problemáticas como: inasistencia a programas de promoción y prevención, drogadicción, violencia intrafamiliar, embarazos en adolescentes. Conclusiones: la articulación interinstitucional y la conformación de redes de apoyo logran mejores efectos a nivel económico, social, espiritual, físico y psicológico, contribuyendo a la salud familiar. Asimismo, contribuye al desarrollo personal, profesional, liderazgo y construcción del conocimiento, propios de enfermería familiar como eje de abordaje en la salud pública.

Goal: To manage the creation and implementation of a network of cross sector support, which aims to provide support and contribute to the solution of the problems of families. Materials and Methods: A descriptive study was conducted in 42 families, 15 community leaders and representatives of eight institutions and 11 health center workers in a district of 1 and 2 statuses in the city of Bucaramanga. It was used the Format for valuation domains of the American Association of Nursing Diagnoses (NANDA) to identify the problems of families. The data processing was performed in Excel by obtaining frequencies and averages for further analysis. Results: Absence from promotion and prevention programs, drug addiction, domestic violence, teen pregnancy: the creation and implementation of the support network, consisting of eight institutions in the sector, which addressed issues as was achieved. Conclusions: interagency coordination and the creation of support networks achieve better effects in economic, social, spiritual, physical and psychological level, contributing to family health. It also contributes to personal, professional, leadership and knowledge. building, typical of family nursing as axis approach to public health.

Objetivo: Gerenciar a criação e implementação de uma rede de apoio intersetorial, que visa dar apoio e contribuir para a solução dos problemas das famílias. Materiais e Métodos: Estudo descritivo, realizado em 42 famílias, 15 líderes comunitários e representantes de oito instituições e 11 trabalhadores de centros de saúde no distrito de níveis 1 e 2, na cidade de Bucaramanga. Formato foi utilizada para domínios de avaliação da Associação Americana de Diagnósticos de Enfermagem (NANDA) para identificar os problemas das famílias. O processamento dos dados foi realizada no Excel através da obtenção de freqüências e médias para análise posterior. Resultados: Ausência de programas de promoção e prevenção, toxicodependência, violência doméstica, gravidez na adolescência: a criação e implementação da rede de apoio, constituída por oito instituições do setor, que abordou temas como foi conseguido. Conclusões: a coordenação interinstitucional ea criação de redes de apoio alcançar melhores efeitos em nível econômico, social, espiritual, física e psicológica, contribuindo para a saúde da família. Também contribui para a pessoal, profissional, liderança e construção do conhecimento, típico de enfermagem de família como eixo abordagem à saúde pública.

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Introduction There is growing interest in beating heart cardiac surgery (mainly myocardial revascularization) without aortic cross-clamping and, if possible, without the use of a cardiopulmonary bypass (CPB) pump, since better results can be obtained with this procedure than with conventional myocardial protection techniques using cardioplegic solutions. This led us to considerer mitral valve replacement (MVR) with beating heart and continuous coronary perfusion as a surgical option at the Cardiology and Cardiovascular Surgery Institute (ICCCV) in Havana, Cuba. Objective To assess the safety and potential benefits of beating heart MVR with continuous coronary perfusion compared to the conventional cardioplegic arrested heart MVR procedure. Methods A randomized, controlled intervention study was conducted with a sample of 64 patients referred to the ICCCV for isolated MVR between January 2001 and December 2002. Patients were randomly divided into 2 groups: control group A and study group B. Each group received a specific myocardial protection technique during surgery. Group A underwent MVR using the arrested heart technique with administration of a cold crystalloid cardioplegic solution and with moderately hypothermic CPB. Group B underwent MVR using the beating heart technique with normothermic CPB and continuous coronary perfusion. The following variables were assessed: serum enzyme (CK and CK-MB) and lactate concentrations; duration of aortic cross clamping, CPB, mechanical ventilation support, drainage, postoperative bleeding, stay in the surgical intensive care unit (SICU), and total operation time; amount of blood lost, blood adminstered, and postoperative complications. Quantitative variables were determined using Wilcoxon-Mann-Whitney add Student's t-tests. Results Differences between the two techniques were not found to be statistically significant, which suggests that both are equally safe. However, the differences found are clinically important and favor the beating heart technique, since patients who underwent beating heart MVR had lower serum concentrations of total CK, CK-MB and lactate; less total blood loss, and less need for transfusion. They also required less time on mechanical ventilation support in the SICU, spent fewer days in the hospital, and presented fewer postoperative complications compared to patients who underwent arrested heart MVR. Conclusion The beating heart technique with continuous coronary perfusion proved to be as safe as the conventional arrested heart technique with cardioplegic solutions for MVR surgery in patients with low surgical risk. This procedure is recommended as an alternative method of myocardial protection for this type of surgery in Cuba and may be considered as an option in other limited-resource settings.

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Se realiza un análisis de los resultados ecocardiográficos obtenidos en un grupo de 261 pacientes de comunicación interauricular aislada, de comunicación interventricular aislada y de persistencia del conducto arterioso aislada, en los cuales se realizó ecocardiograma bidimensional con pulso Doppler, registrado en papel del modo M y ecocardiograma contrastado. Se hace un breve resumen histórico de este método de investigación no invasivo en nuestro país. Se comentan los aspectos técnios y metodológicos y se muestran los resultados típicos en las distintas cardiopatías presentadas. Se indica que del análisis de los resultados obtenidos se infiere para el médico práctico la necesidad de utilizar las enormes posibilidades diagnósticas que nos brinda esta técnica no invasiva en el estudio del corazón y los grandes vasos

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