Disfunción cognitiva postoperatoria / Postoperative cognitive dysfunction

Cognitive function may decline after surgical procedures. Cognitive postoperative dysfunction (CPOD) is subtle and requires neuropsychological test for diagnosis. Multifactorial in origin, its cause is unknown but associated with different risk factors, which especially affects origin people submitted to extense surgery. CPOD is transient, but in some cases is prolonged and is associated with an increase in mortality and permanente disability. The aging population and the increase of elderly patients requiring surgery a cause of concern. Clinical studies are required to recognize preventive and therapeutic measures to reduce CPOD in the future. (AU)

Déficit de vitamina D. Revisión epidemiológica actual / Vitamin D deficiency. Current epidemiological review

Vitamin D is a liposoluble hormone that exists in two molecular forms. Ergocalciferol (vitamin D-2) and colecalciferol (vitamin D-3). Vitamin D-3 is produced in the skin by the action of UV-B radiation. Both forms are metabolized by the liver to 25-hydroxy-Vit D (25OHD) and later in the kidney to the active form 1,25-dihydroxy-Vit D. This form promotes bone mineralization by intestinal absorption of calcium and phosphate. Normal levels of 25OHD are associated with less fracture, normal neuromuscular and immune function and possibly have a preventive effect on certain types of cancer. The Endocrine Society's Clinical Practice Guidelines recommends that optimal plasma levels of 25OHD are above 30 ng/ml, insufficiency between 21 and 29 ng/ml and deficiency below 20 ng/ml. The prevalence rate of 25OHD deficit is about 2 to 90% in different populations. Risk factors of Vitamin D deficit like year season, skin pigmentation, sunlight exposition, use of sunblock and inadecuate Vitamin D ingestion, together with different measurement techniques explain the variability of results between epidemiological studies. An important risk group is the health professionals that are not exposed to sunlight. There are no studies that describe the prevalence in this population in Chile. (AU)

Revascularización miocárdica en un paciente con calcificación de la aorta ascendente y arco aórtico: aorta de porcelana / Myocardial revascularization in a patient with calcification of ascending aorta and aortic arch: porcelain aorta

El hallazgo de una aorta ascendente intensamente calcificada (aorta de porcelana) durante la cirugía de revascularización miocárdica ofrece dificultades tanto en la decisión de llevar a cabo la cirugía como en la elevada frecuencia de complicación neurológica que esta condición acarrea. Se presenta el caso de un paciente de 59 años operado de urgencia por una angina posinfarto miocárdico grave y en quien se encontró una aorta ascendente y arco aórtico totalmente calcificados. Enfrentados a esta situación se decidió efectuar una revascularización miocárdica utilizando perfusión arterial por vía femoral, cánula única cavoatrial y uso de un drenaje aurículo ventricular. Así, enfriando a 25º C y durante fibrilación ventricular espontánea se construyeron anastomosis distales con vena safena a la arteria circunfleja y arteria mamaria interna (AMI) a la arteria descendente anterior. Luego de defibrilar el corazón se efectuó la anastomosis venosa terminolateral a la AMI. El paciente fue retirado de bomba con bajo apoyo y completó un postopertorio sin incidentes. Una ecocardiografía transesofágica postoperatoria reveló la extensión y magnitud de la aterosclerosis en la aorta

Oxigenación extracorpórea de membrana en síndrome de distrés respiratorio del adulto: experiencia en 2 pacientes / Extracorporeal oxygenation of membrane in adult distress respiratory syndrome: experience in 2 patients

We report 2 female patients with adult respiratory distress syndrome and severe respiratory failure in whom extracorporeal membrane oxygenation was used. Its indication was due to a bad response to conventional tretament with mechanical ventilation and high levels of positive end expiratory pressure. A 2.0 or 2.2 m2 membrane oxygenator in a veno-venous circuit with systemic anticoagulation was used, maintaining mechanical ventilation. In the first patient, the procedure was done early and was succesful, increasing hemoglobin saturation from 39 to 87 percent. The patient was withdrawn from the procedure 48 hours later and died one week later due to a septic shock. The second patient was connected to the procedure after three weeks of respiratory distress syndrome and no increase in arterial oxygenation was achieved. The patient died due to an intracraneal hemorrhage, probably hastened by systemic anticoagulation. The real benefits of extracorporeal membrane oxygenation are not defined yet