Variaciones vasculares en cavidad abdominal y de vías urinarias: presentación de caso / Vascular variations in urinary tract and abdominal cavity: case report

Se presenta un raro caso de múltiples variaciones en la cavidad abdominal de un espécimen cadavérico de 50 años de género masculino, del laboratorio de anatomía de la Universidad Industrial de Santander (Bucaramanga-Colombia). Se observó variaciones arteriales (arteria renal adicional derecha y origen de la rama hepática derecha desde la arteria mesentérica superior), venosa (vena renal derecha adicional) y de vía urinaria (doble uréter en el lado derecho). Estas diversas variantes anatómicas además de suscitar interés académico, deben ser consideradas y descritas correctamente por los clínicos durante la realización de procedimientos quirúrgicos, radiológicos y de imágenes diagnósticas en la cavidad abdominal.

Here we present a rare case of multiple abdominal cavity variations in a 50-year-old male cadaveric specimen of the anatomy laboratory of the Universidad Industrial de Santander (Bucaramanga, Colombia). The anatomical dissection revealed arterial variations (right additional renal artery and origin of the right hepatic branch from the superior mesenteric artery), venous (right additional renal vein) and urinary tract (duplicated ureter on the right side). These multiple anatomic variations in addition to raising academic interest, should be considered and described correctly by clinicians while performing surgical, radiological and imaging procedures in the abdominal cavity.

Evaluation of the effect of allopurinol as a protective factor in post ischemia and reperfusion inflammation in Wistar rats

PURPOSE: To investigate the potential protective effect of allopurinol on reperfusion injury by determining the inflammatory response through the measurement of tumor necrosis factor-alpha (TNF-alpha). METHODS: Sixty rats were distributed into two groups: control and allopurinol and each group was divided into three subgroups, ischemia for two hours, ischemia for three hours and ischemia simulation. Allopurinol group rats received 100mg/kg dose of allopurinol, whereas control group rats received an equivalent dose of saline. Clamping of the infrarenal aorta was performed for two or three hours depending on the subgroup. Ischemia simulation subgroups did not suffer ischemia, just aortic dissection, and maintenance for three hours. After 72 hours of reperfusion, blood was collected by cardiac puncture for TNF-alpha measurement. RESULTS: Allopurinol reduced TNF-alpha significantly (p <0.001) when compared to the matching control subgroups (control X allopurinol in ischemia for two hours and for three hours). CONCLUSION: Allopurinol reduced the concentrations of serum TNF-alpha when used at different times of ischemia followed by reperfusion, which might indicate reduction of the inflammation provoked by the reperfusion injury.

Desarrollo de un modelo experimental de hipertensión intra-abdominal / Development of an experimental model of intra-abdominal hypertension

Objetivos: Desarrollar un modelo porcino experimental de hipertensión intra-abdominal. Estudiar los efectos de la hipertensión intra-abdominal sobre la macro-hemodinamia, parámetros ventilatorios y perfusión esplácnica. Métodos: Se sometió a anestesia y ventilación mecánica a un grupo de 5 cerdos machos. Se realizó monitorización hemodinámica invasiva. Se sometió a los animales a una laparotomía para cateterizar la vena porta e instalar un tonómetro intrayeyunal, y se elevó la presión intra-abdominal a 15 mmHg infundiendo manitol 7,5 por ciento a la cavidad abdominal. Una hora después se volvieron a realizar mediciones y posteriormente se realizaron incrementos sucesivos de la presión intra-abdominal a niveles de 25 y 35 mmHg. Resultados: La hipertensión intra-abdominal produjo una disminución del gasto cardíaco (p <0,001) con aumento de la presión venosa central (p <0,001) y la presión de oclusión en la arteria pulmonar (p=0,073). Existió un incremento significativo en las presiones pico y meseta de la vía aérea, asociado a una reducción de la distensibilidad toraco-pulmonar (p <0,001). De los parámetros de perfusión regional el pH intramucoso fue el más precoz y sensible en detectar hipoperfusión esplácnica(p=0,04). El lactato arterial y venoso portal no tuvieron una buena correlación con el aumento de la presión intra-abdominal(p=NS). Conclusiones: El modelo presenta cambios hemodinámicos, ventilatorios y de perfusión esplácnica reproducibles que son concordantes con los observados en el SCA y constituye un instrumento valioso para futuros estudios de intervención terapéutica.

Medición de presión intrabdominal por método intravesical: validación de la técnica en humanos / Intra-abdominal pressure measurement using intravesical method: validation of the technique in humans

Currently the compartmental abdominal syndrome is recognized as a relevant clinical picture in the context of the critical surgical patient. For an adequate diagnosis and handling of the picture, measurement of the pressure in the mentioned compartment, the abdomen is fundamental. Several methods have been applied with this objetive, where the most utilized is that of intra-vesical measurement. The objetive of our study is the validation of the technique of intra-vesical measure of pressure in humans. Patients that are to undergo laparoscopic surgery were included. Intra-abdominal pressure was measured via intra-peritoneal de Veres needle technique associated to a CO2 insufflator performing increasing pressure curve up to tha safe limit of (18 mmHg. Parallely the intra-vesical pressure was measured with a three-way N°18 Foley probe (latex, Kendall), adjusting the secondary way to a pressure transducer. 20 patients were evaluated, with a total of 220 measurements. Through linear regression method a strong positive correlation was observed between de Veres needle and Foley probe with r = 0.713, P=0,00001. The method seems valid with a projected line of y = 4.77 + 0.69x, for a 95 per cent confidence interval. There were two cases where, clearly for the observer, there was no correlation, in one of them due to multiple previous surgeries (it was even necessary to change to open surgery) and in another case it was an obese patient (IMC 29.56). We come to the conclusion that measurement of intravesical pressure as a method for evaluating the intra-abdominal pressure is adequate on humans, considering a lower sensitivity to the changes in abdominal pressure, therefore the clinical conduct in the particular case must be taken with several measurements and associated to the relevant symptomatology described for the abdominal compartmental syndrome. We also recommend precaution on obese patients and those with multiple previous surgeries.