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Unlabelled: The methods used for the study of the small bowel are not ideal. Double-balloon enteroscopy is a new alternative with therapeutic potential., Objective: Evaluate the utility, efficacy and safety of double-balloon enteroscopy in Mexico., Material and Methods: Adult patients seen in the Hospital de Especialidades Centro Médico Nacional Siglo XXI, Mexico City who were being studied for: chronic diarrhea, obscure gastrointestinal hemorrhage, weight-loss and chronic anemia were included in the study. Anterograde (oral) and retrograde (anal) approaches were used and study time, findings and complications were evaluated., Results: Thirty-one enteroscopies were performed, 15 were anterograde, 8 retrograde and 8 were performed via both routes, in 23 patients studied between February and October, 2004; 10 of them were women and 13 men with ages ranging from 25 to 80 years. Fourteen patients were sedated and 9 patients were anesthetized. Study time varied form 55 to 90 minutes. With the anterograde route the ileum was reached in 56.6% of cases, 39.1% the jejunum and only in one patient (4.3%) the whole intestine was explored. With the retrograde route in 62.5% of cases the jejunum was explored and 37.5% the ileum. Four patients with obscure gastrointestinal bleeding and 1 patient with chronic anemia had vascular ecstasies, and in 40% of patients there was no identifiable cause. In 2 patients with intestinal stenosis biopsies revealed intestinal lymphoma in one and ischemic injury in another one. The adverse effects were mild and transitoru., Conclusions: Double-balloon enteroscopy is a safe diagnostic and therapeutic method that is useful in cases of obscure hemorrhage, chronic anemia; small bowel pathology was found in 64.7% of cases.

The role played by the cardiac sympathetic fibers in the pulmonary depressor reflex was analyzed in twenty dogs. The selective perfusion with homologous blood of the inferior lobar vessels of the left lung with pressures of 40 to 60 mmHg decreased the spontaneous background discharges recorded from the left superior or inferior cardiac sympathetic nerves. This decrease was maximal at perfusion pressure of 80-100 mmHg. Following the decrease in the sympathetic discharges, the systolic and diastolic systemic arterial blood pressure decrease about 10 per cent. The changes were reversible when the perfusion pressure was returned to the control. The intravenous injection of atropine sulphate did not change either the systemic hypotension or the responses of the sympathetic efferent discharges induced by elevation of the pressure in the vascular bed of the lung lobe. Thus, it is believed that the systemic arterial blood pressure during this reflex may have fallen due to a diminution of the vascular tone caused by a decrease in the sympathetic efferent discharges. After transection of the vagus nerve ipsilateral to the tested lobe, the reduction of the sympathetic discharges as well as the decrease of the systemic arterial blood pressure were no longer observed. Our results further substantiate the concept that the vagus nerve is the afferent pathway for the pulmonary depressor reflex, and it may be concluded that during this reflex the sympathetic efferent activities are inhibited.

As therapy for leukemia and lymphoma has improved, secondary pulmonary disease has become a major cause of death. In this review of 225 patients with leukemia or lymphoma, six possibly preventable deaths resulted because progressive pulmonary infiltrates were treated without tissue diagnosis. Four other patients died of undiagnosed second primary lung tumors. When pulmonary infiltrates were diagnosed by open lung biopsy examination, appropriate therapy in nine patients resulted in seven survivals from potentially lethal infections. Of six patient with either primary lung tumor, leukemic infiltrate, or lymphomatous nodule, bronchoscopy and brush biopsy examination revealed bronchogenic tumors, leading to appropriate surgical therapy and survival in three. In three others, bronchoscopy and mediastinoscopy suggested exacerbation of the primary disease, which was treated satisfactorily by radiotherapy. Thus, when pulmonary disease develops in patients with leukemia or lymphoma, aggressive therapy based on tissue diagnosis may avert untimely death.

Subendocardial ischemia with consequent subendocardial necrosis is a frequent cause of death after cardiopulmonary bypass. The problem is caused by an inequity in the oxygen requirements of the subendocardium and the available blood supply. We have developed a means of detecting ischemia early in the postperfusion period. Using an analogue computer, we determine the endocardial viability ratio (EVR). This value may decrease before either systemic or central venous pressure changes. Thus the ratio can reflect early the danger of subendocardial ischemia. Another advantage is that equipment now common in coronary care units can be used to determine the EVR.