Hipoxemia nocturna después de cirugía abdominal: factores asociados y rol de la oxigenoterapia / Nocturnal hypoxemia after abdominal surgery: associated factors and usefulness of oxygen therapy

Fifteen elective patients (6 M, 9 F, 51+-8 years old) scheduled for laparotomy (n=8) or laparoscopy (n=7) were studied. Ventilatory parameters and pulse oximetry were measured pre and postoperatively. Patients were randomly assigned to receive oxygen by nasal cannula either during the first or the second postoperative night. PONH (Sat2 85) developed in seven patients (47 per cent)of which four had undergone laparoscopic surgery. PONH was more frequent in mildly obese patients and those presenting preoperative hypoxemia (p=0.03). Peak flow was lower in patients presenting PONH (p=0.04). In five patients, PONH was associated with significant tachycardia. Oxygen administration was associated with a higher SatO2 and prevented PONH in 6/7 patients. PONH is a common event in patients older than 40 years scheduled for open or laparascopic abdominal surgery, and develops more frequently in those with preoperative nocturnal hypoxemia and greater ventilatory impairment. PONH can be prevented, most of the time, with oxygen administration

Monitorización intraoperatoria del pH intramucoso gástrico / Intrasurgical monitorization of the gastric intramucosal pH

Eighteen patients subjected to abdominal surgery were studied. All received general anesthesia and hemodynamic parameters were maintained within 20 percent of basal values. A tononeter was placed in the stomach after induction of anesthesia. Arterial blood gases and samples from the tonometer were obtained 30 minutes after induction and at 2 hours of surgery. Intramucosal pH was calculated using Henderson-Haselbach equations. Basal gastric mucosal pH was 7.4ñ0.1 and did not change during surgery. Two patients had a pH persistently below 7.35 without hemodynamic alterations or systemic acidosis. Gastric mucosal pH is not modified by abdominal surgery and some patients have low values despite the absence of hemodynamic derangement

Valor pronóstico de tres clasificaciones utilizadas en cáncer colorrectal con compromiso ganglionar / Prognostic value of 3 classifications uses in colorectal cancer with ganglionar compromise

Existen varias clasificaciones para la etapificación del cáncer colorrectal que tiene valor pronóstico, luego de resecciones con intención curativa. La más utilizada y punto de referencia para las demás, es la de Dukes. En ésta se incluye a todos los pacientes con compromiso ganglionar habría subgrupos de enfermos con distinto pronóstico. Para analizar el valor actual de la clasificación Dukes, se revisaron entre los años 1975 y 1985. En forma paralela un grupo de patológos revisó el material histológico de estos pacientes seleccionando a aquellos cob metástasis ganglionares. De esta forma se constituyó un grupo de 94 enfermos quienes fueron etapificados utilizando 3 clasificaciones actualmente en uso en cáncer colorrectal (Dukes C, Astler y Coller C1, C2 y GITSG C1, C2). El promedio de ganglios examinados en las piezas operatorias y el promedio de metástasis ganglionares por pieza operatoria fue 12,6 y 2,9 respectivamente. Se observó una relación entre las metástasis ganglionares y el grado de invasión de tumor en la pared, ya que en un 89 por ciento de los enfermos el tumor comprometía todas las túnicas del colon. En el análisis de sobrevida a 5 años se debe destacar la presencia de 3 poblaciones de enfermos con pronósticos muy diferentes: Astler y Coller C1= 85 por ciento, Dukes C= 47 por ciento y GITSG C2= 30 por ciento. Se concluye que el grupo de pacientes con metástasis ganglionares (Dukes) es muy amplio incluyendo subgrupos de pacientes con pronóstico distinto

Traslocación bacteriana en un modelo de autotrasplante de intestino delgado en perros / Bacterial translocation in a small intestine auto transplantation model in dogs

Sepsis is the commonest complication of small bowel transplantation. These infections are presumibly caused by bacterial translocation, due to splachnic ischemia. To study bacterial translocation in the inmediate postoperative period after small bowel transplantation in dogs and to relate it to splanchnic ischemia. Three groups of dogs were studied. In group A (n=6) spontaneous episodes of splanchnic schemia were monitored in the first 18 hrs of the postoperative period. In group B (n=5) a 60 min ischemia was induced by superior mesenteric artery occlusion, 2 hours after small bowel transplantation. In group C (n=5) a 60 min ischemia was induced by occlusion of mesenteric vein, 2 hrs after transplantation. Bacterial translocation was assessed through bacterial cultures from the mesenteric vein and splanchnic ischemia with intramucosal pH measurement (a pH<7.2 was considered indicative of ischemia). 28 of 83 cultures were positive, specially for Gram negative bacilli. The incidence of positive cultures was 14 percent for group A, 17 percent for group B and 79 percent for group C (p<0.01 cpmpared to groups A and b). The higher incidence of bacterial translocation occurred during the first 2 hours after transplantation, when the lower intramucosal pH recording were obtained. The percentage of positive cultures was 39 percent during periods of ischemia, compared to 24 percent during periods without ischemia (p=NS). Bacterial translocation occurs during the first 2 hours after intestinal transplantation in concomitance with the lower intramucosal pH readings

Ileostomías: indicaciones y resultados / Ileostomy: indication and results

Se evalúa nuestra experiencia con 100 ileostomías realizadas en 81 pacientes. Ileostomías terminales son 41 y 59 en asa. La colitis ulcerosa en 34 pacientes (42%), fue el diagnóstico más frecuente como indicación de una ileostomía. La ileostomía terminal se asoció principalmente a colectomías subtotales con conservación del recto en el 85,4% de los casos. La ileostomía en asa fue indicada con mayor frecuencia para proteger un reservorio ileal en 21 pacientes (35,6%) y una anastomosis colorrectal baja en 16 (27,1%). Las complicaciones más frecuentes fueron la infección de la herida operatoria y las alteraciones hidroelectrolíticas. De las 41 ileostomías terminales se reconstituyó el tránsito en 29, y de las 59 ileostomías en asa se han cerrado 46. Fallecieron 4 pacientes (4,9%), ninguno secundario a complicaciones de la ileostomía