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Background Acute pseudo-obstruction of the colon is a disorder characterised by an increase in intra-luminal pressure that leads to ischaemia and necrosis of the intestinal wall. The mechanism that produces the lesion is unknown, although it has been associated with: trauma, anaesthesia, or drugs that alter the autonomic nervous system. The pathophysiology of medication induced colon toxicity can progress to a perforated colon and potentially death. Objetive Present a case of a colonic pseudo-obstruction in a patient with polyfarmacy as the only risk factor and to review the medical literature related to the treatment of this pathology. Clinical case The case is presented of a 67 year old woman with colonic pseudo-obstruction who presented with diffuse abdominal pain and distension. The pain progressed and reached an intensity of 8/10, and was accompanied by fever and tachycardia. There was evidence of free intraperitoneal air in the radiological studies. The only risk factor was the use of multiple drugs. The colonic pseudo-obstruction progressed to intestinal perforation, requiring surgical treatment, which resolved the problem successfully. Conclusion It is important to consider drug interaction in patients with multiple diseases, as it may develop complications that can be avoided if detected on time.

ResumenAntecedentesLa pseudo-obstrucción colónica aguda se caracteriza por la dilatación masiva del colon, con aumento de la presión intraluminal que condiciona isquemia y necrosis de la pared intestinal. No se conoce el mecanismo que produce la lesión, aunque se ha asociado con: traumatismo, anestesia o agentes farmacológicos que alteran el sistema nervioso autónomo. La patofisiología de la toxicidad colónica por fármacos puede progresar hasta la perforación colónica y potencialmente a la muerte.ObjetivoComunicar el caso de una paciente con polifarmacia como único factor de riesgo para la pseudo-obstrucción colónica, y presentar la revisión de la bibliografía médica relacionada con el tratamiento.Caso clínicoPresentamos el caso de una mujer de 67 años con distensión y dolor abdominal difuso, progresivo de intensidad 8/10 por pseudo-obstrucción colónica, acompañado de febrícula y taquicardia. En los estudios de gabinete se observó aire libre en cavidad. El único factor de riesgo que tenía la paciente fue el uso de múltiples fármacos. El cuadro de pseudo-obstrucción evolucionó hasta la perforación intestinal, que requirió tratamiento quirúrgico, con resultado exitoso.ConclusiónEs importante tener en cuenta las interacciones farmacológicas en los pacientes con múltiples enfermedades, ya que pueden condicionar complicaciones como la perforación colónica, que de ser detectadas a tiempo se podrían evitar.AbstractBackgroundAcute pseudo-obstruction of the colon is a disorder characterised by an increase in intra-luminal pressure that leads to ischaemia and necrosis of the intestinal wall. The mechanism that produces the lesion is unknown, although it has been associated with: trauma, anaesthesia, or drugs that alter the autonomic nervous system. The pathophysiology of medication induced colon toxicity can progress to a perforated colon and potentially death.ObjetivePresent a case of a colonic pseudo-obstruction in a patient with polyfarmacy as the only risk factor and to review the medical literature related to the treatment of this pathology.Clinical caseThe case is presented of a 67 year old woman with colonic pseudo-obstruction who presented with diffuse abdominal pain and distension. The pain progressed and reached an intensity of 8/10, and was accompanied by fever and tachycardia. There was evidence of free intraperitoneal air in the radiological studies. The only risk factor was the use of multiple drugs. The colonic pseudo-obstruction progressed to intestinal perforation, requiring surgical treatment, which resolved the problem successfully.ConclusionIt is important to consider drug interaction in patients with multiple diseases, as it may develop complications that can be avoided if detected on time.

This study was aimed to establish the construct validity of a video-tracking system based on orthogonal cameras approach for assessment of laparoscopic psychomotor skills in training environments. The camera-tracking system consists of two webcams placed in orthogonal configuration at a distance of 13.5 cm. The orthogonal cameras employ a color segmentation algorithm to register the 3D motions of the laparoscopic instruments using colored tapes placed on the distal end. For construct validity, 31 participants (4 experts and 27 residents) performed three training tasks in a laparoscopic box trainer with the built-in orthogonal cameras system. Eleven motion-related parameters were used to evaluate their performance. Statistical analysis was performed, and results between two groups were compared using a Mann–Whitney U-test. Construct validity results showed statistical differences in almost all motion-related parameters for assessment of laparoscopic technical skills. Results demonstrated that the orthogonal video-based tracking system was able to differentiate laparoscopic experience between experts and trainees surgeons. The orthogonal cameras system was successfully validated in a laparoscopic box trainer. This video-based tracking system was able to distinguish performance between experts and trainees surgeons, showing its potential as a reliable tool to assess laparoscopic psychomotor skills. The orthogonal cameras allow incorporating the advantages of this video motion-tracking technology with the benefits of the traditional laparoscopic box trainers, creating realistic haptic feedback and allowing the evaluation of psychomotor skills of the surgeons.

The first laparoscopic cholecystectomy carried out in 1985 generated a great enthusiasm about the new surgical technique; however, it was evident that educational techniques required improvement because this new procedure presented a higher prevalence of injuries in the biliary tract than conventional surgery. Minimally invasive surgery has a number of advantages over open surgery. Some of these advantages allowed the use of technology in order to generate experts, evaluate them objectively, document the process in video, assess their competence and use simulators to improve overall surgical education.

"Con la realización de la primera colecistectomía laparoscópica en 1985 se generó un entusiasmo por este tipo de cirugía; la aparición de lesiones de la vía biliar en una frecuencia mayor a la esperada en la cirugía convencional, obligó a una reflexión y a la necesidad de mejorar las técnicas educativas. La cirugía de mínima invasión tiene ventajas comparada con la cirugía abierta, algunas de ellas permitieron la aplicación de la tecnología en la educación quirúrgica como la necesidad de generar expertos, la evaluación objetiva de los mismos, la videodocumentación, la medición de competencias y el empleo de simuladores fueron algunas de las ventajas técnicas para una mejor educación quirúrgica."

To analyze presentation, diagnosis and treatment of islet cell tumors at the ABC Medical Center.Medical records of the 7 patients with endocrine tumors diagnosed between 1995 and 2005 were reviewed and analyzed, with emphasis to clinical, biochemical and radiological characteristics, surgical treatment and outcome.There were 3 insulinomas, 1 gastrinoma, 1 VIPoma, and 2 non-functioning tumors. All insulinomas presented the Whipple's triad. The tumor was localized before surgery in 2 cases. In all patients intraoperative ultrasound confirmed the tumor and enucleation was performed in all three. The patient with gastrinoma was diagnosed by endoscopy in the presence of metastatic disease, therefore no surgical treatment was performed. The patient with VIPoma, presented the typical secretory diarrhea. A tumor in the pancreatic head was found and it was resected by pancreaticoduodenectomy. Histology revealed a malignant lesion. Both non functioning tumors were found by imaging studies, one benign tumor was treated by central pancreatectomy and the other was malignant and underwent distal en-block pancreatectomy. Immunohistochemistry was positive for VIP in the benign lesion. Two of the 3 malignant tumors have died and one is alive with recurrent disease.Distribution of islet cell tumors in our series followed the usual patterns. In all functioning lesions hormonal production was identified before surgery. Imaging studies localized the tumor in 7 of the 8 patients. Surgical resection cured all benign tumors.

Since the first laparoscopic cholecystectomy in 1988, the management of gall-bladder disease has changed importantly. This technique was rapidly popularized in the U.S. as well as in Europe. Multiple studies have proved its feasibility, safeness and great advantages.Analyze usefulness and recent advances of endoscopic surgery in the management of gallbladder disease.We did a review of the recent medical literature to determine the actual status of laparoscopic cholecystectomy.Laparoscopic cholecystectomy is the most common surgical procedure performed in the digestive tract. During the year 2001, 1,100,000 cholecystectomies were done in the U.S., 85% were done laparoscopically. In Mexico cholecystectomy in government hospitals is done laparoscopically in 50% of the cases, while in private hospitals it reaches 90%. There are multiple prospective controlled studies showing superiority of laparoscopic cholecystectomy in times of recovery, costs, return to normal activity, pain, morbidity, esthetics among other advantages.Laparoscopic cholecystectomy is the gold standard for the treatment of the great majority of cases of gallbladder disease, nevertheless in developing countries open cholecystectomy is still done frequently.

Laparoscopic surgery has a great application for the treatment of different pathologies of the gastrointestinal tract. In the management of gastroesophageal reflux disease it is not a exception, since its introduction in 1991 this technique has evolved constantly.Analyze and evaluate indications, surgical technique and long term results of laparoscopic surgery as a treatment for gastro-esophageal reflux disease.In this review paper we analyze literature to evaluate the current status of laparoscopic surgery and its application to the treatment of gastro-esophageal reflux disease. Besides we briefly report long term results from authors experience.Indications for laparoscopic treatment of patients with gastroesophageal reflux disease include patients with moderate to severe erosive esophagitis, patients with non-typical symptoms in which a 24 hours pH measurement shows these symptoms are correlated with gastroesophageal reflux and those who do not tolerate medical treatment, also Barrett's disease is considered a relative indication. Laparoscopic surgery has increased the number of patients treated surgically because it is well tolerated. Long term results in terms of controlling gastroesophageal reflux must be superior to 90% with a low complication rate.Laparoscopic surgery for the treatment of gastroesophageal reflux disease has shown better recovery, hospital stay, return to daily activities and global morbidity, which our group has been able to reproduce. Selection criteria must be strict with an adequate long term follow up.

The use of ERCP with endoscopic esphincterotomy (ES) for the management of choledocholithiasis has replaced almost completely common bile duct exploration in the era of laparoscopic cholecystectomy. Once the procedure is completed it is followed by laparoscopic cholecystectomy in the same hospitalization. During the last few years, the development of new technology and equipment with possibilities of minimal invasive procedures and diagnosis, as well as the ongoing surgical skills has allowed surgeons to solve the problem of choledocholithiasis in one minimal invasive procedure, decreasing effectively morbidity with a high success rate, changing again ERCP with ES as a complement and not as a substitute for surgery. Nevertheless the initial step in the use of these techniques require of a special technical support and what is most important capacitation to achieve the desire objectives. Transcystic technique seems to be the most promising and choledochotomy with primary closure in cases that cannot be solved with the transcystic approach. Regardless of the approach the surgeon must be familiar with both and increasingly with the use of the endoscope in order to provide patients with advantages of minimal invasive surgery and all its advantages. We also discuss our series of 81 patients operated on with laparoscopic surgery with a high rate of success, low morbidity and mortality.