No función primaria del injerto hepático: 18 años de experiencia del Hospital Nacional Guillermo Almenara Irigoyen - EsSalud / Primary non function of hepatic allograft: 18 years' experience of Guillermo Almenara Irigoyen National Hospital - EsSalud

RESUMEN Introducción : La no función primaria del injerto (NFPI) después del trasplante hepático es la falla aguda del injerto, en ausencia de algún factor causal, como trombosis aguda de arteria hepática o vena porta. Objetivos : Describir las características perioperatorias de los pacientes trasplantados de Hígado que presentaron NFPI en el Departamento de Trasplantes del Hospital Guillermo Almenara Irigoyen. Materiales y métodos : Estudio retrospectivo, descriptivo y transversal. Desde marzo del 2000 a marzo del 2018 se realizaron 249 Trasplantes de hígado. La NFPI fue definida con los criterios de OPTN/UNOS, se manifiesta por aumento de transaminasas (>3 000 UI/ml), coagulopatía (INR >2,5), niveles altos de lactato (>4 mEq/l), PH en acidosis: PH arterial ≤7,30 y/o PH venoso ≤7,25 e inestabilidad hemodinámica que requiere soporte con drogas vasoactivas; puede llevar a la muerte sin retrasplante de emergencia. Resultados : Se diagnosticaron 8 pacientes con NFPI siendo una prevalencia de 3,7% de 216 trasplantes de hígado en adultos, la edad de los receptores fue 51,5±8,45 años, score de MELD basal 13,13±3,8 (rango 6-18). Las características de los donantes, la edad fue 38,5±14,48, todos ABO idénticos al receptor, la distribución geográfica: 7 de Lima metropolitana y 1 en Tacna. La causa de muerte encefálica 75% ACV Hemorrágico y 25% TEC grave. Respecto a factores transoperatorios el TIF 431±143 min [265 - 645 min], y TIC 81,8±46 min [57- 195 min], La estancia en UCI hasta el deceso del paciente fue 11,13±9,3 días (rango 2-31 días), el 12,5% fue retrasplantado. Conclusiones : La prevalencia de NFPI en nuestro centro después del trasplante hepático es 3,7% similar a las series reportadas por otros centros, y se asocia con mortalidad alta sin retrasplante hepático.

ABSTRACT Introduction : The primary nonfunction of the graft (PNF) after liver transplantation is acute graft failure, in the absence of some causal factor, such as acute thrombosis of the hepatic artery or portal vein. Objectives : Describe the perioperative characteristics of Liver transplant patients who presented NFPI in the Transplant Department of the Guillermo Almenara Irigoyen Hospital. Materials and methods : Retrospective, descriptive and cross-sectional study. From March 2000 to March 2018; 249 liver transplants were performed. The PNF was defined with y he criteria of OPTN/UNOS, manifested by increased transaminases (>3,000 UI/ml), coagulopathy (INR >2.5), high lactate levels (>4 mEq/l), PH in acidosis: PH arterial ≤7.30 and/or venous ≤7.25 and hemodynamic instability that requires support with vasoactive drugs. It can lead to death without emergency retransplantation. Results : 8 patient with PNF were diagnosed with a prevalence of 3.7%, the age of recipients was 51.5±8.45 years, the base MELD score 13.13±3.8 (range 6-18). The characteristics of the donors, the age was 38.5±14.48 years, all ABO identical to the recipients, the geographical distribution: 7 of metropolitan Lima and 1 in Tacna. The cause of encephalic death 75% hemorrhagic DCV and 25% severe TEC. Regarding transoperative factors, the CIT 431±143 min [265 - 645 min], and WIT 81.8±46 min [57- 195 min], the stay in the ICU until the death of the patients was 11.13±9.3 days (range 2-31 days), 12.5% was retransplant. Conclusions : The prevalence of PNF after liver transplant in our center is 3.7%. Similar to the series reported by other center, and is associated with high mortality without retransplantation.

Trombosis venosa portal en pacientes sometidos a trasplante de hígado

Introducción: La trombosis venosa portal (TVP) es frecuente en los pacientes con cirrosis hepática, sometidos a trasplante hepático (TH); en nuestro medio, esta es la primera publicación con énfasis en resultados y estrategias quirúrgicas. Objetivo: Revisar la casuística del Hospital Nacional Guillermo Almenara Irigoyen, determinar características, tipos de TVP y el manejo quirúrgico. Materiales y métodos: Se analizaron las historias clínicas de los pacientes cirróticos sometidos a TH, que presentaron TVP, entre marzo 2000 a junio 2018. En dicho lapso se realizaron 255 trasplantes hepáticos en 239 pacientes, 229 adultos y 26 pediátricos; éstos últimos fueron excluidos. Resultados: Encontramos 27 pacientes con TVP (12,2%), diagnosticados en pre y durante el TH, ninguno de etiología maligna; las etiologías más frecuentes de la cirrosis fueron esteatohepatitis no alcohólica (37,4%), esteatohepatitis alcohólica (22%), hepatitis autoinmune (HAI) (11%), virus de hepatitis B (VHB) (7,4%) y otros (11,5%). Según la clasificación de Yerdel, encontramos: Grado I: 10 (37%), Grado II: 10 (37%), Grado III: 4 (15%) y Grado IV: 3 (11%). Las estrategias quirúrgicas empleadas fueron: trombectomía en 23 (85,2%); hemitransposición cavoportal en 2 (7,4%), anastomosis reno-portal con interposición de injerto venoso en 1 (3,7%) y la trombo-venectomía mas interposición de injerto venoso 1 (3,7%). En 2 casos se presentaron re-TVP (7,5%). Observamos que la TVP disminuyó la supervivencia del paciente posterior al TH: Al año (81,2%), 3 años (78,4%) y 5 años (78,4%) comparado con pacientes sin TVP 1 año (84,6%) 3 años (82,3%) y 5 años (82,3%). Conclusiones: Los pacientes cirróticos con TVP estuvieron clínicamente más descompensados, la supervivencia disminuyo a mayor grado de TVP. La conducta quirúrgica fue similar a otros centros trasplantadores; el diagnóstico temprano fue esencial para tomar una conducta quirúrgica anticipada y disminuir la morbimortalidad posterior al trasplante hepático.

Introduction: Portal venous thrombosis (PVT) is common in patients with liver cirrhosis, undergoing liver transplantation (LT); in our setting, this is the first publication with an emphasis on results and surgical strategies. Objective: Was to review the case history of the Guillermo Almenara Irigoyen National Hospital, determine characteristics, types of PVT and surgical management. Materials and methods: We analyzed patients undergoing LT who presented PVT between March 2000 and Jun 2018. Of 255 liver transplants in 239 patients, 229 adults and 26 pediatric, these last were excluded. Results: We found 27 patients had PVT (12.2%) diagnosed in pre and during LT, none with malignant PVT, the most frequent etiologies of cirrhosis were non-alcoholic steatohepatitis (37.4%), alcoholic steatohepatitis (22%), autoimmune hepatitis (AIH) (11%), virus B hepatitis (VBH) (7.4%) and others (11.5%). According to PVT grade: Yerdel I in ten patients (37%), Yerdel II in te patients (37%), Yerdel III in four patients (15%) and Yerdel IV in three patients (11%). Surgical strategy used: thrombectomy in 23 cases (85.2%), hemitransposition cavoportal in 2 cases (7.4%), reno-porto anastomosis with interposition of venous graft in 1 case (3.7%) and thrombectomy with interposition of venous graft in 1 case (3.7%). The re - PVT was present in two cases (7.5%). The PVT decreased patient survival after LT 1 year (81.2%), 3 years (78.4%) and 5 years (78.4%) compared with patients without PVT 1 year (84.6%) 3 years (82.3%) and 5 years (82.3%) respectively. Conclusions: Cirrhosis with PVT was clinically more unbalanced, survival decreased to a higher degree of PVT. Surgical behavior similar to other transplant centers. Early diagnosis is essential to take early surgical action and decrease morbidity and mortality after LT.

Síndrome hepatopulmonar y trasplante hepático: experiencia en el departamento de trasplantes del Hospital Nacional Guillermo Almenara Irigoyen - EsSalud / Hepatopulmonar syndrome and liver transplantation: experience in the transplantation department of the Guillermo Almenara Irigoyen National Hospital - EsSalud

Introducción: El síndrome hepatopulmonar (SHP) es una complicación grave de la enfermedad hepática, la cual se caracteriza por la presencia de vasodilatación intrapulmonar e hipoxemia progresiva, siendo el trasplante de hígado el único tratamiento efectivo. Objetivo: Mostrar nuestros resultados de los pacientes con síndrome hepatopulmonar sometidos a trasplante hepático. Materiales y métodos: Estudio retrospectivo, descriptivo y trasversal. Desde marzo del 2000 a diciembre del 2016 se realizaron 226 trasplantes de hígado. Del total, se excluyeron a 25 pacientes: 12 retrasplantes, 9 trasplantes dobles higadoriñon, 2 trasplantes con falla hepática aguda, 2 trasplantes en pacientes no cirróticos. De los 201 pacientes con diagnóstico pretrasplante de cirrosis hepática, 19 tuvieron criterios de SHP; quienes fueron distribuidos según edad, sexo, nivel de hipoxemia (pO2), score CHILD, score MELD. La reversibilidad de la hipoxemia post trasplante se midió con una cutt off de p0(2) >75 mmHg. Resultados: La prevalencia del SHP en nuestra serie fue 9,45%. La edad promedio fue 41 años (14-65); la relación M/F de 1,65. El 78,94% (15/19) fueron adultos. 89,5% (17/19) fueron score de CHILD B y C, y el 68,4% tuvieron SHP severo y muy severo. En el 94,11% de los pacientes se demostró reversibilidad del SHP. La tasa de mortalidad temprana en los pacientes con SHP fue 10,4%. Conclusiones: La prevalencia del SHP fue del 9,45%. Los pacientes trasplantados con y sin SHP tuvieron similar sobrevida.

Introduction: Hepatopulmonary syndrome (HPS) is a serious complication of liver disease, which is characterized by the presence of intrapulmonary vasodilation and progressive hypoxemia. Liver transplantation is the only effective treatment. Objective: To show our results of patients with hepatopulmonary syndrome undergoing liver transplantation. Materials and methods: Retrospective, descriptive and cross-sectional study. From March 2000 to December 2016; 226 liver transplants were performed. Of the total, 25 patients were excluded: 12 retransplantation, 9 liver-kidney combined transplants, 2 transplants for acute liver failure, 2 transplants in non-cirrhotic patients. Of the 201 patients with pretransplant diagnosis of liver cirrhosis, 19 filled criteria for SHP; who were distributed according to age, sex, hypoxemia level (pO2), Child-Pugh score and MELD score. The reversibility hypoxemia after liver trasplantation was measured with a cut-off of p0(2) >75 mmHg. Results: The prevalence of SHP in our series was 9.45%. The average age was 41 years (14-65); the M / F ratio of 1.65. The 78.94% (15/19) were adults. 89.5% (17/19) were Score of Child-Pugh B and C, and 68.4% had severe and very severe SHP. In 94.11% of patients, reversibility SHP founded. The early mortality rate (30 days) in patients with SHP was 10.4%. Conclusions: The prevalence of HPS in our series was 9.45%. Transplanted patients with and without SHP had similar survival.

Recurrencia de hepatitis autoinmune post trasplante hepático: experiencia de 15 años en el Perú / Autoimmune hepatitis recurrence after liver transplantation: 15 years experience in Peru

Introducción: La recurrencia de la hepatitis autoinmune (HAI) luego del trasplante hepático se presenta entre el 8-68%. En nuestra experiencia las enfermedades autoinmunes del hígado son una indicación principal de trasplante hepático. Objetivo: Determinar la recurrencia de la HAI en 15 años de experiencia y evaluar los factores de riesgo asociados a la recurrencia de HAI. Materiales y métodos: Estudio retrospectivo, descriptivo y trasversal. Desde marzo del 2000 a diciembre del 2015 se realizaron 200 trasplantes en 190 pacientes, algunos de los fueron diagnosticados de cirrosis hepática por HAI. Aquellos pacientes en quienes se detectó una duplicación de los valores normales de aminotranferasa (TGP-TGO <2 VN) en 2 mediciones consecutivas fueron sometidos a biopsia hepática. El diagnostico se realizó por criterio histológico. Resultados: El 19% de trasplantes hepáticos fue por HAI. La edad promedio fue 35 años (con valores extremos de 16 y 64 años); la relación de feminidad fue de 2,2; el subtipo de HAI más frecuente fue el tipo 1 (89%). La recurrencia histológica HAI se evidenció en 11 pacientes (31%). La media de seguimiento fue de 54 meses (con valores extremos de 8 y 169 meses). Conclusiones: En nuestra experiencia la HAI es la indicación más frecuente de trasplante hepático 19%. La recurrencia post trasplante de HAI fue 31%. No se encontró asociación entre el grado de severidad de la actividad histológica en el explante ni en el tipo de HLA en la presentación de la recurrencia.

Introduction: The recurrence of autoimmune hepatitis (HAI) following liver transplantation occurs between 8-68%. In our experience, autoimmune liver diseases are a major indication of liver transplantation. Objective: To determine the recurrence of autoimmune hepatitis in 15 years of experience and to evaluate the risk factors associated with the recurrence of HAI. Materials and methods: Retrospective, descriptive and cross-sectional study. From March 2000 to December 2015; 200 transplants were performed on 190 liver transplants; 36 patients were diagnosed for hepatic cirrhosis by HAI and underwent liver biopsy if transaminase (TGP-TGO >2 ULN) in 2 consecutive measurements. The diagnosis was made by histological criteria. Results: The indication for hepatic transplantation for HAI was 19%. Mean age was 35 years (range 16-64 years) relationship between Sex F / M 2.2, the most common HAI subtype is type 1 (89%). The HAI histological recurrence was 31% (11/36). The mean follow-up was 54 months (range 8-169 months). Conclusions: Autoimmune hepatitis is the most frequent indication of liver transplantation in our experience, accounting for 19%. The recurrence of post-transplant HAI was 31%. No association was found between the degree of severity of histological activity in the explants and the type of HLA in the presentation of the recurrence.

Sugammadex and fast-track anesthesia for pediatric cardiac surgery in a developing country

Objective: There are several physiologic advantages to early tracheal extubation and spontaneous ventilation following surgery for congenital heart disease [CHD]. In order for early tracheal extubation to be feasible, effective reversal of neuromuscular blockade is mandatory. Sugammadex reverses neuromuscular blockade with a mechanism that differs from acetylcholinesterase inhibitors. We aimed to study the effect of sugammadex on the fast track extubation

Methodology: We retrospectively reviewed our experience with the use of sugammadex to reverse neuromuscular blockade following cardiac surgery for CHD in infants and children, during a pediatric cardiac surgical trip of Heart Care International to Tuxtla, Mexico. Demographic data collected included age, weight, type of CHD, and the surgical procedure. Intraoperative data included sugammadex dose, outcome [successful tracheal extubation], and adverse effects, which could be attributed to sugammadex. Sugammadex was administered to 14 patients, who ranged in age from 1 to 16 years of age and in weight from 7.6 to 57.7 kilograms. Statistical analysis was done

Results: All 14 patients underwent successful tracheal extubation in the operating room within 15 min of completion of the surgical procedure. No patient required reintubation of the trachea during the postoperative course. No adverse effects related to sugammadex were noted

Conclusions: Our preliminary experience demonstrates that sugammadex effectively reverses neuromuscular blockade and allows for early tracheal extubation in pediatric patients following surgery for repair of CHD. Prompt and effective reversal of neuromuscular blockade allows for effective fasttracking with early tracheal extubation

Perioperative management of a patient with glutaric aciduria: a case report and literature review

Glutaric aciduria type-1 [GA-1] is an autosomal recessive metabolic disorder due to the deficiency of the enzyme glutaryl-CoA dehydrogenase. The enzymatic defect leads to secondary damage to the central nervous system due to the accumulation of glutaric acid. Progressive neurologic effects with spasticity and orthopedic deformities necessitate frequent surgical and anesthetic care. We present a 13-year-old girl with glutaric academia type-1 who required anesthetic care for posterior spinal fusion. Previous reports of anesthetic care for these patients are reviewed, the end-organ involvement discussed, and options for anesthetic care presented

Peripheral regional anesthesia in infants and children: an update

Peripheral regional anesthesia in children has had a recent surge in popularity among pediatric anesthesia providers. The increased prevalence is at least in part explained by the proliferation of ultrasonography in the perioperative arena. Ultrasound-guided peripheral nerve block techniques have given pediatric anesthesiologists confidence to approach the diminutive structures that are in close approximation to sensitive areas. The three major categories of pediatric peripheral nerve blocks are upper extremity, truncal, and lower extremity. The indications, ultrasound anatomy, ultrasound-guided technique, and potential complications of the nerve blocks in each category are reviewed

Correlation between average retinal nerve fiber layer thickness and rim area of the spectral-domain OCT with the Humphrey visual field index in eyes with glaucoma

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the correlation between the average retinal nerve fiber layer (RNFL) thickness and optic nerve head rim area (RA) measured with a spectral-domain optical coherence tomography (OCT) with the visual field index (VFI) using the Humphrey Visual Field Analyzer in glaucoma patients.<br /><strong>METHODS:</strong> Eighty-five consecutive patients diagnosed with glaucoma underwent spectral-domain OCT of the optic disc and Humphrey perimetry. A glaucoma specialist confirmed the presence of glaucomatous optic neuropathy based on findings in the optic nerve head photographs, OCT measurements of the RNFL and optic disc, and standard automated perimetry. The correlation of the average RNFL thickness and rim area with the VFI was determined using the Spearman's correlation coefficient analysis.<br /><strong>RESULTS:</strong> A total of 121 glaucomatous eyes of 85 patients were included in the study. There were 47 males and 38 females, ages ranging from 12 to 94 years. The average RNFL thickness, RA, and VFI were 67.9 ± 12.3 ?m, 0.65 ± 0.3 mm2, and 56 ± 32%, respectively. The average RNFL thickness (r = 0.35) showed a stronger positive correlation with VFI than RA (r = 0.15), but the difference was not statistically significant.<br /><strong>CONCLUSION:</strong> The average RNFL thickness and rim area of the spectral-domain OCT demonstrated a positive correlation with the VFI of the Humphrey Visual Field Analyzer. The OCT parameters, exemplified by average RNFL and RA, were not good indicators for VFI.</p>

Comparação de métodos analíticos para determinação do teor de gordura em queijos

Métodos analíticos destinados aos produtos lácteos são diversos, com pouca especificidade para cada tipo de derivado. Diferentes queijos apresentam grandes variações de composição centesimal; o teor de gordura figura entre os parâmetros com maior variação, influenciado pelas características da matéria-prima, do processo de fabricação ou da maturação. Nesse contexto, métodos para determinação de gordura em queijos são genéricos e podem não expressar com precisão seus valores reais.

Perioperative care of a patient with neuronal ceroid lipofuscinoses

The neuronal ceroid lipofuscinoses [NCL] are a group of inherited, autosomal recessive, and progressive neurodegenerative diseases, which result from an enzymatic defect or the deficiency of a transmembrane protein, leading to the accumulation of lipopigments [lipofuscin] in various tissues. NCL results in the impairment of function in several end-organs including the central nervous system with loss of cognitive and motor function, myoclonus, and intractable seizures. Additional involvement includes the cardiovascular system with arrhythmias and bradycardia as well as impairment of thermoregulation leading to perioperative hypothermia. Given the complexity of the end-organ involvement and the progressive nature of the disorder, the anesthetic care of such patients can be challenging. Till date, there are a limited number of reports regarding the anesthetic management of patients with NCL. We present an 18-year-old patient with NCL who required anesthetic care during replacement of a vagal nerve stimulator. Previous reports of anesthetic care for these patients are reviewed, the end-organ involvement of NCL discussed, and options for anesthetic care presented

Transversus abdominis blockade: ready for use in the pediatric population?

Postoperative pain and the associated potential adverse effects have been a major concern for the anesthesiologists since the advent of the practice of anesthesiology. The optimal means of providing postoperative analgesia in the pediatric patient has been a challenging task, and various combinations have been tried to lessen the side effects. Regional techniques in pediatric population have seen some crests in popularity in the past but the use of ultrasound and MRI guidance has added precision in the techniques and boosted confidence of the anesthesiologists. Transversus abdominis plane or TAP block has now made its way into the pediatric population and this editorial provided a supplementary source of information to the a review article and two case reports on similar topic in this issue of Anesthesia, Pain and Intensive Care

Transversus abdominis plane block for placement of a paracentesis catheter with failed fontan physiology

Despite the successful palliation of patients with complex CHD, long term consequences may occur related to the chronically elevated venous pressures or failing ventricular function following total cavopulmonary anastomosis in patients with single ventricle anatomy. We present a 33-year-old adult woman with Fontan physiology who presented with recurrent ascites requiring insertion of a tunneled abdominal drain. Given her co-morbid conditions, the procedure was accomplished using a transversus abdominis plane [TAP] block placed with ultrasound guidance. Although generally used for the provision of postoperative analgesia following lower abdominal procedures, the TAP block may also be used in specific scenarios instead of general anesthesia in high risk patients. The anatomy of the TAP block is reviewed, its perioperative applications discussed, and its potential use instead of general anesthesia presented

10 años de trasplante hepático en el Perú / 10 years of liver transplantation in Peru

El artículo revisa la experiencia única en el Perú de 10 años de trasplantes realizada por el departamento de trasplantes del Hospital Nacional Guillermo Almenara Irigoyen (HNGAI), describiendo la historia, resultados quirúrgicos en adultos y niños, retrasplantes, trasplantes combinados hígado-riñon, las diferentes complicaciones encontradas y toda la experiencia recogida en los 72 trasplantes realizados hasta la presentación de este artículo.

The article reviews the experience in 10 years of hepatic transplants performed by The Transplant Department of the National Hospital Guillermo Almenara Irigoyen (HNGAI), describing the history, surgical outcomes in adults and children, retransplantation, combined liver-kidney transplants, complications in 72 transplants performed at the time of submission of the article.

[Molecular blood genotyping in patients with Thalassemia major in Tehran adult thalassemic clinic]

Blood typing by serologic methods after transfusion has limitations due to presence of donor red cells in recipients. Accurate determination of red blood cells [RBCs] antigens is very important in multitransfused patients including beta-thalassemics and sickle cell anemics. So, the aim of this study was to evaluate DNA- based methods as supplement to the hemagglutination technique to determine the red blood cell [RBC] antigen profile of multitransfused patients with beta- thalassemia. DNA was extracted from peripheral blood of 20 apparently normal people and 44 patients including 35 with beta- thalassemia [out of whom 19 had clinical evidence of delayed hemolytic transfusion reaction], 8 with thalassemia intermedia [out of whom 2 had hemolytic reaction], and one with sickle cell thalassemia. RHD/ RHC/ RHc/ RHE/ RHe/ JKA/ JKB/ FYA/ FYB/ KELL1/ KELL2 alleles were determined by PCR and were then compared with the hemagglutination method. Phenotype and genotype results were the same in all controls. The phenotypes and genotypes of 53 blood antigens of 26 patients were incompatible. Most of the discrepancies [19 cases] occurred in the Rh system, and fifteen in the Duffy and Kidd systems. The results show that screening platelet concentrates for bacterial contamination is necessary for blood transfusion centers and hospital blood banks. Blood typing by serologic method was not accurate in this study but genotyping could determine true blood groups in multitransfused patients and help in selection of RBCs without alloimmunized antigens in future transfusion attempts. Specificity, sensitivity, positive and negative predictive values of hemagglutination method for RhD antigen had good values in comparison to the molecular method. This might be due to pre- transfusion determination of RhD for thalassemic patients so as to receive Rh- matched blood units. It seems pre-transfusion blood typing of Rh and Kell antigens, which are the cause of hemolytic reactions, in comparison to the molecular method could be cost effective. In addition, typing of Rh and Kell antigens in some regular blood donors could be helpdul for selecting antigen-negative RBCs for transfusion dependent patients

Biochemical study of freshwater fish Catla catla with reference to mercury chloride

Toxic activity of mercury chloride was tested in vivo on fresh water fish Catla catla. Acute toxicity tests were conducted to measure the impact of toxicity on the fishes within a short period at the various concentrations of HgCl[2] [0.1, 0.5, 1, 1.5, 2, 2.5 and 3mg/L]. The protein and carbohydrate were estimated using Anthrone by standard methods and enzymes such as Na[+]-K[+], Mg[2+] and Ca[2+] adenoxide triphosphatases were determined caloriemetrically. Depletion of protein was observed at all exposure periods. The biochemical estimation values of carbohydrates in muscle, intestine and brain showed significant values with P<0.05. The activity of Mg [2+] adenoxide triphosphatases in muscle, intestine and brain was studied and the maximum depletion was observed at 96h, 72h and 72h, respectively. Regarding activity of Ca [2+] adenoxide triphosphatases in muscle, the maximum depletion of this enzyme activity in muscle was observed at all exposure periods, except 96h. In intestine, enzyme activity was gradually decreased in all exposure and an increase was found during 96h. In brain, the enzyme activity was observed at all exposure periods except 96h

effects of polysorbate surfactants on the structure of mucus glycoproteins

A dynamic oscillatory technique was used to assess the effect of polysorbate non-ionic surfactants on mucus rheology. Adherent mucus gel was scraped from the surface mucosa of pig stomachs and purified by gel exclusion chromatography followed by ultrafiltration and gelation. Rheological measurements of this gel were carried out on a Carri-Med Controlled Stress Rheometer. Appropriate volumes of surfactant solution were added to weighed samples of mucus gel so that a final concentration of 20 mM surfactant was achieved in a gel containing 8% w/w solids content. Polysorbate 20 [PS20], polysorbate 40 [PS40], polysorbate 60 [PS60] and polysorbate 80 [PS80] all decreased both storage [elastic] modulus G' and loss [viscous] modulus G" significantly at 10 Hz [P<0.05, ANOVA]. The extent of rheological changes induced by the four polysorbates could be ranked as: PS80>PS20>PS60>PS40. The mechanisms by which surfactants disturb the mucus structure are not fully understood, nonetheless, they could possibly affect the mucus gel properties by causing depletion of the glycoprotein constituents such as non-mucin proteins and mucin associated lipids. This might lead to the conclusion that polysorbates, by reducing the viscoelasticity of mucus gel could alleviate its barrier properties and facilitate the diffusion of concomitantly administered drugs via mucus gel

La influencia del pericardio en la patofisiología de la disfunción ventricular en el infarto agudo del ventrículo derecho: estudio experimental / The role of the pericardium in the pathophysiology of ventricular dysfunction in experimental acute right ventricular infarction

Para obtener mayor información de la función del pericardio en el Infarto Agudo del Ventrículo Derecho (IAVD) se estudiaron las curvas de función ventricular (CFV) y la relación de las presiones diastólicas finales ventriculares (R-Pd2V, VD: VI) en un modelo canino. Estos se dividieron en: Grupo A (N = 12): Basal (B), IAVD, Postpericardiectomía (PP). La CFV derecha (D) B se comportó como parábola y su punto de flexión (PF) estuvo en 13 ñ 2 mmHg de Pd2V. En el IAVD la CFVD se ubicó abajo y a la derecha de la CFVD B (p < 0.05) y el PF se desplazó a 18 ñ 2 mmHg p < 0.05), PP la CFVD se desplazó arriba y a la izquierda de la CFVD IAVD (p = NS). La R- Pd2V VD: VI B fue: 0.75, en IAVD: 0.91 y PP: 0.84 (p = NS). Grupo B (N = 12): Basal (B), Postpericardiectomía (PP) e IAVD. La CFVD PP se desplazó arriba y a la izquierda de la CFVD B (p < 0.05) y el PF fue = 10 ñ 2 mmHg. En IAVD la CFVD se ubicó abajo y a la derecha de la CFVD PP (p < 0.05) y la R-Pd2V, VD:VI fue de 0.45 PP, y con el IAVD se igualaron (0.95) significativamente (p < 0.05). Conclusiones: En la génesis del gasto cardiaco (GC) bajo del IAVD se demostró el papel restrictivo parcial del pericardio, ya que la igualdad de la R-Pd2V se debe también a isquemia. El PF de la CFVD con IAVD (18 + 2 mmHg) es la cifra límite para la infusión de volumen en el IAVD experimental. A reserva de validarse en el hombre este dato puede ser útil para el manejo de la precarga en el humano con IAVD e hipotensión sistémica o GC bajo.

Esteatohepatitis no alcohólica: reporte de los primeros casos de HNGAI - Essalud / NASH: report of the first cases at the Guillermo Almenara Hospital

Se describen los hallazogs clínicos bioquímicos e histológicos, encontrados en nueve pacientes del Servicio de Gastroenterología del Hospital Nacional Guillermo Almenara Irigoyen - EsSalud, con diagnóstico de esteatohepatitis no alcohólica (NASH) en el periodo comprendido desde enero 1996 hasta abril 1998. No hubo diferencias significativas en relación a predominio de sexo (5 varones y 4 mujeres). Cinco pacientes eran obesos, 2 pacientes tenían diabetes mellitus, 5 pacientes tenían hiperlipidemia y un paciente tomaba prednisona por más de 2 años. Solamente 2 pacientes eran asintomáticos al momento del estudio; mientras que 4 pacientes presentaban discomfort abdominal, 2 pacientes dolor en hipocondrio derecho 5 pacientes referían fatiga y hepatomegalia en 5 pacientes. Todos los pacientes presentaban incremento de transaminasas al momento del examen. Todos los pacientes presentaban incremento de transaminasas al momento del examen. Todos los pacientes tenían esteatohepatitis a la histología con diferentes combinaciones de injuria hepática, fibrosis y cirrosis en 3 pacientes. se compararon y se analizaron nuestros resultados con lo descrito por otros autores.

Incidencia del transtorno de estres postraumático en pacientes atendidos en el servicio de urgencias del Hospital Regional Simón Bolívar con herida toracoabdominal por arma de fuego y/o cortopunzante / Post traumatic stress disorder in firearm wound or steelarm wound in thorax and/or abdomen

El trastorno del estrés postraumático (TSPT) es una entidad nosológica clasificada desde 1980 por el DSM III, asociado a eventos traumáticos extraordinarios para el paciente y se presenta al cabo de mínimo 6 horas. El estudio abarca una muestra de 31 pacientes, seleccionados por haber sufrido herida por arma de fuego o cortopunzante en tórax y/o abdomen, de los cuales 16 cumplieron los criterios para el DSM III-R para el TSPT. Se encontró que el criterio que mas se cumplía en la población estudiada era el criterio referente a revivir el evento (26 pacientes) (criterio B). El item que más cumplieron los 31 pacientes fué el referido a alteración psicológica ante situaciones similares al evento (criterio B4) correspondiendo al 100 por ciento de población estudiada; de los pacientes que desarrollaron el TSPT todos presentaron hipervigilancia con una significancia estadística (p<0.0001). El estudio permite mostrar que el TSPT si se presenta en nuestra población además permite sugerir que los pacientes con las características establecidas para el presente estudio ameritan un control psicológico a mediano plazo como mínimo