Free fatty acids reduce metabolic stress and favor a stable production of heterologous proteins in Pichia pastoris

ABSTRACT The growth of yeasts in culture media can be affected by many factors. For example, methanol can be metabolized by other pathways to produce ethanol, which acts as an inhibitor of the heterologous protein production pathway; oxygen concentration can generate aerobic or anaerobic environments and affects the fermentation rate; and temperature affects the central carbon metabolism and stress response protein folding. The main goal of this study was determine the implication of free fatty acids on the production of heterologous proteins in different culture conditions in cultures of Pichia pastoris. We evaluated cell viability using propidium iodide by flow cytometry and thiobarbituric acid reactive substances to measure cell membrane damage. The results indicate that the use of low temperatures and low methanol concentrations favors the decrease in lipid peroxidation in the transition phase from glycerol to methanol. In addition, a temperature of 14 ºC + 1%M provided the most stable viability. By contrast, the temperature of 18 ºC + 1.5%M favored the production of a higher antibody fragment concentration. In summary, these results demonstrate that the decrease in lipid peroxidation is related to an increased production of free fatty acids.

Mecanismos fisiopatológicos implicados en el síndrome compartimental abdominal / Patho-physiological Mechanisms Involved in Abdominal Compartment Syndrome

La hipertensión intra-abdominal y el síndrome compartimental abdominal son entidades frecuentes en los pacientes graves, las cuales cursan con una alta mortalidad. El presente trabajo tuvo como objetivo explicar la etiopatogenia del síndrome compartimental abdominal, así como describir los mecanismos fisiopatológicos involucrados en dicha patología. Para ello se consultó un total de 25 fuentes bibliográficas, entre ellas artículos de revistas, libros y otras, accedidas por medio de los principales gestores de la información. Se concluyó que el síndrome compartimental abdominal es propiciado por la disminución de la distensibilidad de la pared abdominal, el aumento del volumen intra-abdominal o una combinación de ambas, y que además se produce compresión directa de los órganos por la hipertensión intra-abdominal, el edema, isquemia secundaria al descenso del flujo sanguíneo, alteración de la función y composición de la microbiota intestinal, llegando a causar tardíamente el síndrome de disfunción múltiple orgánica.

Intra-abdominal hypertension and compartment syndrome are frequent entities in severely ill patients and result in a high mortality. This work is aimed at explaining the ethiopathogenesis of compartment abdominal syndrome, so as describing pathophysilogical mechanisms involved in this pathology. For that, a total of 25 bibliographic resources were reviewed, among them journals, books and others, consulted through the main information agents. It was concluded that the compartment syndrome is caused by the decrease of the abdominal wall distensibility and the increase of intraabdominal volumen or a combination of both. In addition it is produced by the direct organ compression by intra-abdominal hypertension, edema, ischemia secundary to blood flow decreasing, disturbances of the function and composition of the intestinal microbiota, all which later causes a multiple organ disfunction.

Carbon metabolism influenced for promoters and temperature used in the heterologous protein production using Pichia pastoris yeast

Abstract Nowadays, it is necessary to search for different high-scale production strategies to produce recombinant proteins of economic interest. Only a few microorganisms are industrially relevant for recombinant protein production: methylotrophic yeasts are known to use methanol efficiently as the sole carbon and energy source. Pichia pastoris is a methylotrophic yeast characterized as being an economical, fast and effective system for heterologous protein expression. Many factors can affect both the product and the production, including the promoter, carbon source, pH, production volume, temperature, and many others; but to control all of them most of the time is difficult and this depends on the initial selection of each variable. Therefore, this review focuses on the selection of the best promoter in the recombination process, considering different inductors, and the temperature as a culture medium variable in methylotrophic Pichia pastoris yeast. The goal is to understand the effects associated with different factors that influence its cell metabolism and to reach the construction of an expression system that fulfills the requirements of the yeast, presenting an optimal growth and development in batch, fed-batch or continuous cultures, and at the same time improve its yield in heterologous protein production.

Carbon metabolism influenced for promoters and temperature used in the heterologous protein production using Pichia pastoris yeast

Abstract Nowadays, it is necessary to search for different high-scale production strategies to produce recombinant proteins of economic interest. Only a few microorganisms are industrially relevant for recombinant protein production: methylotrophic yeasts are known to use methanol efficiently as the sole carbon and energy source. Pichia pastoris is a methylotrophic yeast characterized as being an economical, fast and effective system for heterologous protein expression. Many factors can affect both the product and the production, including the promoter, carbon source, pH, production volume, temperature, and many others; but to control all of them most of the time is difficult and this depends on the initial selection of each variable. Therefore, this review focuses on the selection of the best promoter in the recombination process, considering different inductors, and the temperature as a culture medium variable in methylotrophic Pichia pastoris yeast. The goal is to understand the effects associated with different factors that influence its cell metabolism and to reach the construction of an expression system that fulfills the requirements of the yeast, presenting an optimal growth and development in batch, fed-batch or continuous cultures, and at the same time improve its yield in heterologous protein production.

Racismo e julgamento social na internet: crianças e jovens negros como alvos / Racism and social judgment on internet: black children and young people as targets

Este estudo teve como objetivo avaliar o preconceito racial, emitido na internet, contra crianças e jovens negros em conflito com a Lei, mediante o julgamento social atribuído. Para tanto, selecionaram-se notícias que retratam a apreensão de jovens negros, acusados ou suspeitos de terem cometido roubos. Foram analisados, por meio do software IRAMUTEQ, 879 comentários sobre essas notícias, os quais constituíram um único corpus submetido a uma Classificação Hierárquica Descendente (CHD) e a Análises de Similitude. A CHD reteve 83,32% dos segmentos de texto, dividindo o corpus em três classes. Os resultados indicaram expressivo preconceito racial contra crianças e jovens negros, estigmatizando-os e legitimando as suas mortes. Significativamente, predomina nos comentários a concepção dos jovens como uma ameaça à ordem social, responsabilizando a ausência dos pais, a permissividade da Lei e as pessoas envolvidas com a promoção de Direitos Humanos. Em síntese, o estudo traz contribuições para a análise do preconceito racial na internet contra jovens negros em conflito com a lei, possibilitando avaliar expressões do preconceito e da discriminação racial no Brasil.

This study aims to evaluate the racial prejudice, issued over the internet, against black children in conflict with the law, through the attributed social judgment. Therefore, reports were selected that portray the apprehension of young black people, accused or suspected of having committed robberies. Through IRAMUTEQ software, 879 comments on the news were analyzed which constituted a single corpus submitted to a Descending Hierarchical Classification (DHC) and Similitude Analysis. The DHC retained 83,32% of the text segments, dividing the corpus into three classes. The results indicated expressive racial prejudice against black children and young people, stigmatizing them and legitimizing their deaths. Significantly, it predominates on the comments the concept of young people as a threat to the social order, blaming the absence of the parents, the permissiveness of the law and the people involved in the promotion of Human Rights. In summary, this study brings contributions to the analysis of racial prejudice over the internet against young black people in conflict with the law, making it possible to evaluate expressions of prejudice and racial discrimination in Brazil.

Complementing firewood with alternative energy sources in Rio Pardo Watershed, Brazil / Fontes alternativas para energia em complementação a lenha na Bacia Hidrográfica do Rio Pardo, Brasil

ABSTRACT: Wood is the primary energy source for grains and Tobacco drying in the Rio Pardo Watershed (RPW). The amount of firewood produced in the RPW is not enough to supply the demand. Recently, an automatized supply system was introduced in the region enabling the use of sawdust and pellets. In this context, this study aims to compare firewood, sawdust and pellets as energy sources for Tobacco curing in air-forced curing systems. Energetic density was used to estimate the biomass consumption in Tobacco curing. The consumption of biomass is lower for pellet, followed by firewood and sawdust. Pellets and sawdust could complement firewood in the region; however, research is necessary to ascertain the economic feasibility.

RESUMO: A madeira é fonte fundamental de energia na secagem da produção agrícola na Bacia Hidrográfica do Rio Pardo. A lenha disponível na região não é suficiente para suprir a demanda. Recentemente, um sistema de alimentação automatizado possibilitou o uso de materiais como serragem e pellets na secagem da produção. Portanto, nesse estudo comparou-se a energia consumida na cura do tabaco para lenha, serragem e pellets em unidades de cura de ar-forçado. A densidade energética foi utilizada para estimar o consumo de biomassa das fontes de energia utilizadas na cura do tabaco. Constatou-se que o consumo de biomassa é menor para o pellet, seguido da lenha e por último a serragem. Serragem e pellets podem ser alternativas energéticas na região. No entanto, estudos são necessários para afirmar se há viabilidade econômica.

Potential medicinal use of forest species of the Deciduous Seasonal Forest from Atlantic Forest Biome, South Brazil

The current paper focuses on potential medicinal use of forest species from Deciduous Seasonal Forest in central region of Rio Grande do Sul State, South Brazil. Floristic and phytosociological surveys were carried out in 2011 and 2012. Results were compared with the available information in scientific literature about popular knowledge and biological/pharmacological evidences. Each species was classified in use categories to diseases, symptoms our disorders based on the International Statistical Classification of Diseases and Related Health Problems (ICD). In 2011, we found a total of 31 species, 77,4% of them with medicinal use. In 2012, we found 33 species,72,7% of them with medicinal use. The species most frequently mentioned were Casearia sylvestris, Eugenia uniflora, Cabralea canjerana, Luehea divaricata, Parapiptadenia rigida and Vitex megapotamica. The main species with biological/pharmacological properties were C. sylvestris, E. uniflora, L. divaricata, V. megapotamica and Zanthoxylum rhoifolium. We concluded that there is a considerable potential for medicinal purposes to forest species from Deciduous Seasonal Forest in the study region. We recommend further studies mainly about the species Prunus myrtifolia, Zanthoxylum rhoifolium, Cabralea canjerana and Casearia sylvestris which presented references to antitumoral properties.

Evaluación de percepciones de residentes de Medicina Interna sobre las instancias de aprendizaje durante la Residencia: un estudio de corte transversal / Internal Medicine residents´ perceptions of education in the Residency Program: a cross-sectional study

Introducción: la Residencia de Medicina Interna del Hospital Italiano de Buenos Aires posee una larga trayectoria en la formación de médicos clínicos e internistas. Existe bibliografía que sugiere que las percepciones de los residentes no son consistentes con las de aquellos encargados de organizar y evaluar los programas de residencia. Nuestro objetivo es conocer las percepciones de los residentes acerca de cuáles son las instancias formativas que mejor contribuyen a la generación de conocimiento. Materiales: estudio de corte transversal utilizando una encuesta virtual que fue enviada a todos los Residentes de Medicina Interna del Hospital Italiano de Buenos Aires. Se recolectaron datos generales de los residentes y año de residencia. Posteriormente se evaluaron las diferentes instancias involucradas en el aprendizaje: pases de guardia, recorrida de internación, pases de ambulatorio, pases de internación, ateneos y, por último, los cursos superiores universitarios. Resultados: la actividad individual más reconocida por su papel en el aprendizaje fue la discusión de los pacientes durante la recorrida (18% de los residentes). En contrapartida, la participación en cursos superiores universitarios no fue elegida como estrategia útil desde el punto de vista individual. Específicamente respecto de la utilidad de los pases de guardia (realizados por los residentes de primer año y los jefes de residentes), gran parte de los participantes optó por el pase de la tarde como el momento de mayor utilidad para el aprendizaje. Conclusión: los residentes consideran que los pases de guardia de la tarde, los pases de internación y ambulatorios y los ateneos de internación son los momentos más propicios y eficaces para la adquisición de nuevo conocimiento. Dichos datos pueden resultar de utilidad en la planificación de diversas instancias educativas y servir como base para estudios similares en poblaciones disímiles. (AU)

Introduction: the Internal Medicine Program at the Hospital Italiano de Buenos Aires has long term experience in training medical physicians. There is mounting evidence suggesting that residents' perceptions about their education are not consistent with the ones of who are responsible for designing and evaluating residency programs. Our goal is to evaluate residents' perceptions on the instances that contribute the most to their training. Methods: we conducted a cross-sectional study using an online survey offered to all Internal Medicine Residents at Hospital Italiano de Buenos Aires, Argentina. Baseline characteristics of each resident were collected. We subsequently assessed residents' perceptions of different instances of the residency program: residents´ morning and evening rounds, patients´ rounds, case discussions with staff physicians, grand rounds and postgraduate courses. Results: overall, the activity that was perceived as the most relevant for their education was the residents' evening rounds (18% of the residents). Conversely, participation in postgraduate courses was not selected as an important learning resource individually. Most residents highlighted the importance of patient discussion with their chief resident during morning and evening rounds. Conclusion: residents systematically prefer patient discussion on medical rounds rather than lectures and courses. This information might prove useful in the future so as to improve Internal Medicine residency programs. (AU)

Análise econômica da produção de Acacia mearnsii De Wild e carvão vegetal no Vale do Caí e Taquari, Rio Grande do Sul / Economic analysis of Acacia mearnsii De Wild production and charcoal in the Valley of Caí and Taquari, Rio Grande do Sul, Brazil

O estudo objetivou analisar a viabilidade econômica da produção de acácia-negra e carvão vegetal em Brochier, Maratá, Paverama e Poço das Antas. Os subsídios foram obtidos com aplicação de questionários in loco. Os critérios econômicos utilizados foram: Valor Presente Líquido (VPL), Valor Presente Líquido Infinito (VPL inf.). Valor Anual Equivalente (VAE), Valor Esperado da Terra (VET), Relação Benefício Custo (B/C), Taxa Interna de Retorno (TIR) e Custo Médio de Produção (CMPr). A taxa média de atratividade utilizada foi de 6,8% a.a. Os dados de produção de madeira foram oriundos de SCHNEIDER et al. (2000). Assim, o plantio de acácia-negra consorciada com milho mostrou-se viável, apresentando maior atratividade no Índice de Sítio 18: VPL de R$ 2529,22 ha-1, VET de R$ 384,91 ha-1, VPL infinito de R$ 506,37 ha-1, TIR de 18,91% e CMPr de R$ 36,44 m-3. A produção de carvão vegetal mostrou-se mais viável nos fornos Brochier (CMPr de R$ 0,32 m-3 e B/C de 1,94).

The study aimed to analyze the feasibility and the economic production of black wattle and charcoal in Brochier, Maratá, Paverama and Poço das Antas Rio Grande do Sul, Brazil. Subsidies were obtained with in loco questionnaires . The economic criteria used were: Net Present Value (NPV), Infinite Net Present Value (NPV inf.), Annual Equivalent Value (VAE), Expected Value of Earth (VET), Benefit Cost Ratio (B/C), internal rate of return (IRR) and average cost of production (CMPr). The average rate of attractiveness used was 6.8% p.a. The wood production data obtained was from SCHNEIDER et al. (2000). Thus, planting black acacia intercropped with maize proved to be viable, showing greater attractiveness in the 18 place index : NPV of R$ 2529,22 ha-1 VET of R$ 384.91 ha-1, VPL inf. of R$ 506.37 ha-1, TIR of 18.91% and CMPr of R$ 36.44 m-3. Charcoal production proved to be more feasible in the ovens Brochier (CMPr of R$ 0,32 m-3 and B/C of 1,94).

Biomarkers to evaluate the effects of temperature and methanol on recombinant Pichia pastoris

Pichia pastoris is methylotrophic yeast used as an efficient expression system for heterologous protein production. In order to evaluate the effects of temperature (10 and 30 °C) and methanol (1 and 3% (v/v)) on genetically-modified Pichia pastoris, different biomarkers were evaluated: Heat stress (HSF-1 and Hsp70), oxidative stress (OGG1 and TBARS) and antioxidant (GLR). Three yeast cultures were performed: 3X = 3% methanol-10 °C, 4X = 3% methanol-30 °C, and 5X = 1% methanol-10°C. The expression level of HIF-1α, HSF-1, HSP-70 and HSP-90 biomarkers were measured by Western blot and in situ detection was performed by immunocytochemistry. Ours results show that at 3% methanol -30 °C there is an increase of mitochondrial OGG1 (mtOGG1), Glutathione Reductase (GLR) and TBARS. In addition, there was a cytosolic expression of HSF-1 and HSP-70, which indicates a deprotection against nucleolar fragmentation (apoptosis). On the other hand, at 3% methanol -10 °C and 1% and at methanol -10 °C conditions there was nuclear expression of OGG1, lower levels of TBARS and lower expression of GLR, cytosolic expression of HSF-1 and nuclear expression HSP-70. In conclusion, our results suggest that 3% methanol-30 °C is a condition that induces a strong oxidative stress and risk factors of apoptosis in modified-genetically P. pastoris.

HSF-1, HIF-1and HSP90 expression on recombinant Pichia pastoris under fed-batch fermentation

Pichia pastoris is a methylotrophic yeast used as an efficient expression system for heterologous protein production as compared to other expression systems. Considering that every cell must respond to environmental changes to survive and differentiate, determination of endogenous protein related to heat stress responses and hypoxia, it would necessary to establish the temperature and methanol concentration conditions for optimal growth. The aim of this study is characterize the culture conditions through the putative biomarkers in different conditions of temperature and methanol concentration. Three yeast cultures were performed: 3X = 3% methanol -10 °C, 4X = 3% methanol -30 °C, and 5X = 1% methanol -10 °C. The expression level of HIF-1α, HSF-1, HSP-70 and HSP-90 biomarkers were measured by Western blot and in situ detection was performed by immunocytochemistry. The western blot results of HIF-1α and HSP-90 did not indicate statistically significant in the culture conditions studied. Respect to biomarkers location, HIF-1α and HSP-90 presented differences between cultures. In conclusion, the results suggest the cultures in a hypoxic condition produce a high density and yeast cells smaller. Beside the high density would not necessary related with a high production of recombinant proteins in modified-genetically P. pastoris.

Applications of recombinant Pichia pastoris in the healthcare industry

Since the 1970s, the establishment and development of the biotech industry has improved exponentially, allowing the commercial production of biopharmaceutical proteins. Nowadays, new recombinant protein production is considered a multibillion-dollar market, in which about 25% of commercial pharmaceuticals are biopharmaceuticals. But to achieve a competitive production process is not an easy task. Any production process has to be highly productive, efficient and economic. Despite that the perfect host is still not discovered, several research groups have chosen Pichia pastoris as expression system for the production of their protein because of its many features. The attempt of this review is to embrace several research lines that have adopted Pichia pastoris as their expression system to produce a protein on an industrial scale in the health care industry.

Acclimatization to chronic intermittent hypoxia in mine workers: a challenge to mountain medicine in Chile

In the past two decades, Chile has developed intense mining activity in the Andes mountain range, whose altitude is over 4,000 meters above sea level. It is estimated that a workforce population of over 55,000 is exposed to high altitude hypobaric hypoxia. The miners work under shift systems which vary from 4 to 20 days at the worksite followed by rest days at sea level, in a cycle repeated for several years. This Chronic Intermittent Hypoxia (CIH) constitutes an unusual condition for workers involving a series of changes at the physiological, cellular and molecular levels attempting to compensate for the decrease in the environmental partial pressure of oxygen (PO2). The mine worker must become acclimatized to CIH, and consequently undergoes an acute acclimatization process when he reaches the worksite and an acute reverse process when he reaches sea level. We have observed that after a period of 3 to 8 years of CIH exposure workers acclimatize well, and evidence from our studies and those of others indicates that CIH induces acute and chronic multisystem adjustments which are effective in offsetting the reduced availability of oxygen at high altitudes. The aims of this review are to summarize findings of the physiological responses to CIH exposure, highlighting outstanding issues in the field.

Recombinants proteins for industrial uses: utilization of Pichia pastoris expression system

The innovation in industrial process with impact in the efficient production is the major challenge for actual industry. A high numerous of enzymes are utilized in at different level of process; the search for new alternatives with better characteristic has become a field of study of great interest, the recombinant protein achievement in a different host system is an alternative widely assessed for production of this. The microorganism Pichia pastoris has been used like a successful expression system in diverse areas, improved the yield and extraction-recovery of the product expressed. The reported of diverse authors in the production of enzymes with different application in industry is varied, in this review the different industry areas and the characteristic of the enzymes produced are detailed.

Melatonin Protects the Heart, Lungs and Kidneys from Oxidative Stress under Intermittent Hypobaric Hypoxia in Rats

Melatonin (N-acetyl-5-methoxytryptamine) is the main secretory product of the pineal gland in all mammals including humans, but it is also produced in other organs. It has been previously demonstrated to be a powerful organ-protective substance under oxidative stress conditions. The aim of this study was to evaluate the protective effect of melatonin in several organs such as heart, lung, kidney, and of the reproductive system, such as testis and epididymis in animals exposed to intermittent hypobaric hypoxia and therefore exposed to oxidative stress and analyzed by lipid peroxidation. Ten-week-old male Wistar rats were divided into 6 groups for 96 hours during 32 days under: 1) Normobaric conditions, 2) plus physiologic solution, 3) plus melatonin, 4) intermittent hypobaric hypoxia, 5 plus physiologic solution and 6) plus melatonin. The animals were injected with melatonin (10 mg/kg body weight) at an interval of 96 hours during 32 days. Results indicated that melatonin decreased lipid peroxidation in heart, kidneys and lung under intermittent hypobaric hypoxia conditions. However, it did not exhibit any protective effect in liver, testis, epididymis and sperm count.

Utilidade da ecocardiografia transeofageana durante hipotensão arterial grave em cirurgia não cardíaca / Utility of transesophageal echocardiography during severe hypotension in non-cardiac surgery / Utilidad de la ecocardiografía transeofageana durante hipotensión arterial severa en cirugía no cardiaca

JUSTIFICATIVA E OBJETIVOS: Hipotensão arterial grave e refratária é uma ocorrência perioperatória rara em cirurgias não cardíacas, mas a determinação de sua etiologia é essencial para o tratamento bem-sucedido. MÉTODOS: Adultos submetidos a cirurgias não cardíacas foram incluídos prospectivamente neste estudo. Hipotensão arterial grave foi definida como uma queda de 30 por cento em relação à pressão arterial sistólica basal que não respondeu à administração adequada de fluidos e efedrina, de acordo com critérios do anestesiologista. Uma sonda multiplanar de ecocardiografia transesofageana (ETE) foi inserida antes de qualquer outro monitoramento hemodinâmico invasivo. RESULTADOS: Quarenta e dois adultos (68 ± 12 anos) foram incluídos neste estudo, 84 por cento durante a cirurgia não cardíaca eletiva. Cirurgias abdominais (abertas e laparoscópicas), torácicas e ortopédicas foram as mais frequentes. Em todos os pacientes, a ETE foi útil para a determinação da etiologia da hipotensão arterial grave. Hipovolemia foi diagnosticada em 18 pacientes (42 por cento). Baixa fração de ejeção (FE < 30 por cento) foi detectada em cinco casos, tendo sido tratada com sucesso pela administração de fármacos vasoativos. Obstrução dinâmica da via de saída do ventrículo esquerdo associada a movimento sistólico anterior (MAS) da válvula mitral foi diagnosticada em cinco pacientes; em outros seis, foi detectada embolia grave durante cirurgia dos quadris e joelhos. Isquemia miocárdica causando hipotensão arterial persistente foi detectada em cinco pacientes; em três pacientes, o tamponamento cardíaco foi a causa da hipotensão arterial grave. Dois pacientes morreram; ambos apresentavam isquemia miocárdica grave. CONCLUSÕES: Ecocardiografia transesofageana perioperatória foi realizada rapidamente e demonstrou ser uma técnica útil no contexto de hipotensão arterial durante cirurgia não cardíaca. O coração e os grandes vasos puderam ser observados diretamente e avaliados ...

BACKGROUND AND OBJECTIVES: Severe and refractory hypotension is an infrequent perioperative situation during non-cardiac surgery, but determining its etiology is essential for successful management and therapy. METHODS: Adults undergoing non-cardiac surgery were prospectively enrolled in this study. Severe hypotension was defined as a drop from 30 percent of baseline systolic arterial pressure unresponsive to adequate fluids administration and to ephedrine, according to the anasthesiologist criteria. A multiplanar transesophageal echocardiography (TEE) probe was inserted, prior to any other invasive hemodynamic monitor. RESULTS: Forty two adults (68 ± 12 years) were studied, 84 percent during elective non-cardiac surgery. Abdominal (open and laparoscopic), thoracic and orthopaedic surgeries were performed most frequently. In all patients, TEE was useful for determining the etiology of severe hypotension. Hypovolemia was diagnosed in 18 patients (42 percent). Low ejection fraction (EF < 30 percent) was detected in 5 cases and was successfully treated with vasoactive drugs. Dynamic left ventricular outflow tract obstruction, associated with systolic anterior motion of the mitral valve, was diagnosed in 5 patients; in another 6 patients severe embolism was detected during hip and knee surgery. Myocardial ischemia causing persistent hypotension was detected in 5 patients; in 3 patients, cardiac tamponade was the etiology of severe hypotension. Two patients died; both had severe myocardial ischemia. CONCLUSIONS: Perioperative TEE was performed quickly, proving to be a useful technique in the context of hypotension during non-cardiac surgery. The heart and great vessels could be observed directly and functionally evaluated. Thus, the etiology of severe hypotension could be easily determined and managed.

JUSTIFICATIVA Y OBJETIVOS: La hipotensión arterial severa y refractaria es una incidencia rara en Cirugías no cardiacas, pero determinar su etiología es esencial para el tratamiento exitoso. MÉTODOS: Adultos sometidos a cirugías no cardiacas que fueron incluidos prospectivamente en este estudio. La hipotensión arterial severa fue definida como una caída de un 30 por ciento con relación a la presión arterial sistólica basal que no respondió a la administración adecuada de fluidos y efedrina, de acuerdo con critérios del anestesiólogo. Una sonda multiplanar de ecocardiografía transesofageana (ETE) se insertó antes de cualqueir otro monitoreo hemodinámico invasivo. RESULTADOS: Cuarenta y dos adultos (68 ± 12 años) se incluyeron en este estudio, 84 por ciento durante la Cirugía no cardiaca electiva. Cirugías abdominales (abiertas y laparoscópicas), torácicas y ortopédicas fueron las más frecuentes. En todos los pacientes, la ETE fue útil para la determinación de la etiología de la hipotensión arterial severa. La Hipovolemia fue diagnosticada en 18 pacientes (42 por ciento). Una baja fracción de eyección (FE < 30 por ciento), fue detectada en cinco casos, y fue tratada exitosamente con la administración de fármacos vasoactivos. Se diagnosticó la obstrución dinámica de la vía de salida del ventrículo izquierdo asociada al movimento sistólico anterior (MAS), de la válvula mitral en cinco pacientes; en otros seis, fue detectada embolia severa durante cirugía de caderas y rodillas. La Isquemia miocárdica causando hipotensión arterial persistente se detectó en cinco pacientes; en tres pacientes, el taponamiento cardíaco fue la causa de la hipotensión arterial severa. Dos pacientes fallecieron y ambos presentaban isquemia miocárdica severa. CONCLUSIONES: La Ecocardiografia transesofageana perioperatoria fue realizada rápidamente y demostró ser una técnica útil en el contexto de la hipotensión arterial durante la cirugía no cardiaca. El corazón y ...

Ecocardiografía transesofágica intraoperatoria: utilidad en la monitorización cardiovascular durante la cirugía abdominal / Intraoperative transesophageal echocardiography: usefulness for cardiovascular monitoring during abdominal surgery

Antecedentes: la ecocardiografía transesofágica (ETE) puede ser un sistema útil de monitorización cardiovascular intraoperatoria durante una cirugía no cardíaca, con la ventaja de ser una técnica mínimamente invasiva que brinda información anatómica y funcional sobre el corazón y sus grandes vasos en tiempo real. Objetivo: Evaluar la utilidad de ETE intraoperatoria en el manejo hemodinámico de pacientes con alto riesgo cardiovascular sometidos a cirugía abdominal. Lugar: Servicio de Anestesiología de Hospital Clínico Universitario. Diseño: Estudio prospectivo de casos clínicos. Población: Adultos portadores de patología cardiovascular sometidos a cirugía abdominal. Método: Se monitorizaron pacientes con ETE utilizando transductor multiplanar, describiéndose características y tipos de cirugías. Para objetivar la utilidad clínica, al finalizar la monitorización se clasificó a cada paciente en uno de los siguientes grupos: 1= ETE sin utilidad, 2 = la ETE cambió el manejo de volúmenes y fármacos, 3 = nuevo diagnóstico y 4 = la ETE fue sustituta del catéter de arteria pulmonar. Resultados: De un total de 98 pacientes estudiados, solo 2 (2 por ciento) fueron clasificados en el grupo 1; 45 pacientes (51 por ciento), en el grupo 2; 21 (24 por ciento) en el grupo 3 y 30 (34 por ciento) en el grupo 4. No hubo complicaciones con la técnica. Conclusiones: La ETE durante el intraoperatorio de cirugía abdominal permitió al anestesiólogo manejar mejor, en forma adecuada y segura el estado hemodinámico de pacientes con riesgo cardiovascular, ya que las imágenes y mediciones obtenidas fueron de alta calidad y sencillas de obtener en tiempo real.

Backgroung: Intraoperative transesophageal echocardiography (TEE) is a minimally invasive technique that can be helpful for cardiovascular monitoring during non-cardiac surgery, because it provides real time anatomical and functional information of the heart and great vessels. Objective: Evaluation of the utility of TEE during abdominal surgery in high-risk cardiovascular patients. Site of application: Anesthesiology Department of University Hospital. Design: Prospective Study of patients. Population: Adults with cardiovascular pathology subjected to abdominal surgery. Method: Patients were monitored with TEE. At the end of surgery each patient was classified in one of the following groups: group: 1 = TEE no utility, 2 = TEE useful for volume and drug guidance; 3 = new diagnosis and 4 = TEE was a substitute for the pulmonary artery catheter. Results: 98 patients were studied. Only two cases were classified in group 1, 45 patients (51 per cent) in group 2, 21 patients (21,5 per cent) in group 3 and 30 patients (30,5 per cent) in group 4. There were no complications following the use of TEE. Conclusions: Intraoperative TEE during abdominal surgery allowed the anesthesiologist a safe and adequate hemodynamic management of high-risk cardiovascular patients. TEE provided high quality and easy to obtain images and measurements in real time.

Antecedentes: A ecocardiografia transesofágica (ETE) pode ser um sistema útil de monitoramento cardiovascular intraoperatório durante uma cirurgia nao cardiaca, com a vantagem de ser uma técnica minimamente invasiva que proporciona informação anatómica e funcional em tempo real sobre o coração e seus grandes vasos. Objetivo: Avaliar a utilidade da ETE intraoperatória no manejo hemodinamico de pacientes com alto risco cardiovascular submetidos à cirurgia abdominal. Lugar: Serviço de Anestesiologia do Hospital Clínico Universitário. Desenho: Estudo prospectivo de casos clínicos. População: Adultos portadores de patología cardiovascular submetidos à círurgia abdominal. Método: Foram monitorizados pacientes com ETE utilizando transductor multiplanar, sendo descritas características e tipos de cirurgias. Finalizado o monitoramento, e a fim de ponderar a utilidade clínica, cada paciente foi classificado em um dos seguintes grupos: 1 = ETE sem utilidade, 2 = a ETE mudou o manejo de volumes e fármacos, 3 = novo diagnóstico e 4 = a ETE substituiu o cateter da artéria pulmonar. Resultados: De 98 pacientes estudados, somente 2 (2 por cento) foram classificados no grupo 1; 45 pacientes (51 por cento), no grupo 2; 21 (24 por cento) no grupo 3 e 30 (34 por cento) no grupo 4. Não houve complicações com a técnica. Conclusoes: Com a ETE, o anestesiologista conseguiu manejar melhor, de forma adequada e segura o estado hemodinamico de pacientes com risco cardiovascular durante o intraoperatório de cirurgia abdominal, pois as imagens e medições foram de alta qualidade e simples de se obter em tempo real.

O tratamento cirúrgico do pé valgo pela técnica do alongamento do calcâneo / Elongation of os calcis in the treatment of planovalgus feet

Os autores analisaram os resultados do tratamento cirúrgico do pé plano valgo pela técnica do "alongamento do calcâneo", descrita por Evans, em 10 pacientes (18 pés), todos revistos após a maturidade esquelética, com um tempo médio de seguimento de 11 anos e seis meses. Após análise clínica e radiográfica, concluíram que as correções obtidas tendem a manter-se estáveis com o crescimento e que os melhores resultados aconteceram nos casos operados antes do aparecimento do "bico" talar anterior na radiografia em perfil, assim como, na projeçäo radiográfica, houve normalizaçäo pós-operatória da "queda" da coluna medial do pé