Cristaloides balanceados para ressuscitação do choque séptico / Balanced crystalloids for septic shock resuscitation

RESUMO A administração de fluidos em tempo adequado é crucial para a manutenção da perfusão tissular nos pacientes com choque séptico. Entretanto, a questão da escolha do fluido a ser utilizado para ressuscitação no choque séptico ainda é um assunto em debate. É crescente o corpo de evidência que sugere que o tipo, a quantidade e o momento da administração de fluidos durante a evolução da sepse podem afetar os desfechos do paciente. Os cristaloides têm sido recomendados como fluidos a serem administrados em primeira linha na ressuscitação do choque. No entanto, à luz da natureza inconclusiva da literatura disponível, não se podem fazer recomendações definitivas quanto à solução cristaloide mais apropriada. A ressuscitação de pacientes críticos sépticos e não sépticos com cristaloides não balanceados, principalmente a solução salina a 0,9%, tem sido associada a uma maior incidência de desordens do equilíbrio ácido-base e a distúrbios eletrolíticos, além de poder se associar à maior incidência de lesão renal aguda, à maior necessidade de terapia de substituição renal e à mortalidade. Foi proposto o uso de soluções cristaloides balanceadas como uma alternativa às soluções de cristaloides não balanceados, para mitigar seus efeitos deletérios. Entretanto, a segurança e a eficácia dos cristaloides balanceados para ressuscitação do choque séptico necessitam ser mais bem exploradas em estudos clínicos bem delineados, randomizados e controlados, multicêntricos e pragmáticos.

ABSTRACT Timely fluid administration is crucial to maintain tissue perfusion in septic shock patients. However, the question concerning which fluid should be used for septic shock resuscitation remains a matter of debate. A growing body of evidence suggests that the type, amount and timing of fluid administration during the course of sepsis may affect patient outcomes. Crystalloids have been recommended as the first-line fluids for septic shock resuscitation. Nevertheless, given the inconclusive nature of the available literature, no definitive recommendations about the most appropriate crystalloid solution can be made. Resuscitation of septic and non-septic critically ill patients with unbalanced crystalloids, mainly 0.9% saline, has been associated with a higher incidence of acid-base balance and electrolyte disorders and might be associated with a higher incidence of acute kidney injury. This can result in greater demand for renal replacement therapy and increased mortality. Balanced crystalloids have been proposed as an alternative to unbalanced solutions in order to mitigate their detrimental effects. Nevertheless, the safety and effectiveness of balanced crystalloids for septic shock resuscitation need to be further addressed in a well-designed, multicenter, pragmatic, randomized controlled trial.

Colloids versus crystalloids in objective-guided fluid therapy, systematic review and meta-analysis. Too early or too late to draw conclusions / Coloides versus cristaloides em fluidoterapia guiada por objetivos, revisão sistemática e metanálise. Demasiadamente cedo ou demasiadamente tarde para obter conclusões / Coloides versus cristaloides en fluidoterapia guiada por objetivos, revisión sistemática y metaanálisis. Demasiado pronto o demasiado tarde para obtener conclusiones

Several clinical trials on Goal directed fluid therapy (GDFT) were carried out, many of those using colloids in order to optimize the preload. After the decision of European Medicines Agency, there is such controversy regarding its use, benefits, and possible contribution to renal failure. The objective of this systematic review and meta-analysis is to compare the use of last-generation colloids, derived from corn, with crystalloids in GDFT to determine associated complications and mortality.

Foram feitos múltiplos ensaios clínicos em fluidoterapia guiada por objetivos (FGO), muitos deles com o uso de coloides para aprimoramento da pré-carga. Após a decisão da Agência Europeia de Medicamentos, existe ainda controvérsia sobre seu uso, seus benefícios e sua possível contribuição para a falência renal. O objetivo desta revisão sistemática e metanálise é comparar o uso de coloides de última geração, derivados de milho, com cristaloides em FGO para determinar as complicações e a mortalidade associadas.

Se han realizado múltiples ensayos clínicos en fluidoterapia guiada por objetivos (FGO), muchos de ellos con el uso de coloides para la optimización de la precarga. Tras la decisión de la Agencia Europea del Medicamento, existe cierta controversia en cuanto a su utilización, beneficios y su posible contribución al fallo renal. El objetivo de esta revisión sistemática y metaanálisis es comparar el uso de coloides de última generación, derivados del maíz, con cristaloides en FGO para determinar las complicaciones y la mortalidad asociadas.

Principios de la resección endoscópica transuretral de próstata de alta performance (de 90 a 170 grs) / Principles of endoscopic transurethral resection high performance (90 to 170 grs)

Desde que aparecieron los tratamientos médicos efectivos en el adenoma de próstata, tales como las nuevas generaciones de .-bloqueantes en las que han desaparecido sus principales inconvenientes y el Finasteride y sobre todo desde que se popularizo su uso conjunto, los tratamientos quirúrgicos se han visto muy disminuidos en su indicación por parte de los urólogos, a expensa de los tratamientos farmacológico. Pero esta situación ha traído consigo nuevos retos, pues si bien una importante cantidad de pacientes no ha necesitado tratamiento quirúrgico, muchos de ellos o no responden al tratamiento o con el tiempo se hacen refractarios al mismo no dejando otra solución que la cirugía. Desde hace muchos años la resección endoscópica-transuretral es el Gold Standard para el tratamiento quirúrgico de la Hipertrofia Benigna de la próstata. Pero en la actualidad, merced a que el tamaño de la glándula prostática que requiere cirugía es mayor que el que nos enfrentábamos con anterioridad y tratando de no volver a épocas y técnicas quirúrgicas que se consideraban superadas, se revisó todas las posibilidades tecnológicas para que la RTU con sus ya reconocidas ventajas pueda continuar siento la opción quirúrgica de elección.

Since the effective medical treatments appeared in the adenoma of prostate, such as the new generations of .-blockers in those that their main inconveniences and the Finasteride have disappeared and mainly since have popularizes their combined use, the surgical treatments have been very diminished, to the expense of the pharmacological treatments, in their indication on the part of the urologist. But this situation had brought new challenges, because although an important quantity of patients has not needed surgical treatment, many of them or they don't respond to the treatment or with the time they become refractory to the same one not leaving another solution except the surgery. For many years the transurethral endoscope resection is the Standard Gold for the surgical treatment of the Benign Hypertrophy of the prostate. But at the present time, thanks to that the size of the gland prostatic that requires surgery is, bigger than the one that we faced previously and trying not to return to times and technical surgical that were considered overcome, we revise all the technological possibilities so that the RTU with their grateful advantages can already continue, I believe he the surgical option to be election.

Impact of Plasma-Lyte pH 7.4 on acid-base status and hemodynamics in a model of controlled hemorrhagic shock

OBJECTIVE: Intravenous infusion of crystalloid solutions is a cornerstone of the treatment of hemorrhagic shock. However, crystalloid solutions can have variable metabolic acid-base effects, perpetuating or even aggravating shock-induced metabolic acidosis. The aim of this study was to compare, in a controlled volume-driven porcine model of hemorrhagic shock, the effects of three different crystalloid solutions on the hemodynamics and acid-base balance. METHODS: Controlled hemorrhagic shock (40 percent of the total blood volume was removed) was induced in 18 animals, which were then treated with normal saline (0.9 percent NaCl), Lactated Ringer's Solution or Plasma-Lyte pH 7.4, in a blinded fashion (n = 6 for each group). Using a predefined protocol, the animals received three times the volume of blood removed. RESULTS: The three different crystalloid infusions were equally capable of reversing the hemorrhage-induced low cardiac output and anuria. The Lactated Ringer's Solution and Plasma-Lyte pH 7.4 infusions resulted in an increased standard base excess and a decreased serum chloride level, whereas treatment with normal saline resulted in a decreased standard base excess and an increased serum chloride level. The Plasma-Lyte pH 7.4 infusions did not change the level of the unmeasured anions. CONCLUSION: Although the three tested crystalloid solutions were equally able to attenuate the hemodynamic and tissue perfusion disturbances, only the normal saline induced hyperchloremia and metabolic acidosis.

Use of albumin as a risk factor for hospital mortality among burn patients in Brazil: non-concurrent cohort study / Uso de albumina como fator de risco para mortalidade intra-hospitalar em pacientes portadores de queimaduras no Brasil: coorte histórica não concorrente

CONTEXT AND OBJECTIVE: Among burn patients, it is common to use colloidal substances under the justification that it is necessary to correct the oncotic pressure of the plasma, thereby reducing the edema in the burnt area and the hypotension. The aim here was to assess the risk of hospital mortality, comparing the use of albumin and crystalloid solutions for these patients. DESIGN AND SETTING: Non-concurrent historical cohort study at Faculdade de Medicina de Marília; within the Postgraduate program on Internal and Therapeutic Medicine, Universidade Federal de São Paulo; and at the Brazilian Cochrane Center. METHODS: Burn patients hospitalized between 2000 and 2001, with registration in the Hospital Information System, who received albumin, were compared with those who received other types of volume replacement. The primary outcome was the hospital mortality rate. The data were collected from files within the Datasus software. RESULTS: 39,684 patients were included: 24,116 patients with moderate burns and 15,566 patients with major burns. Among the men treated with albumin, the odds ratio for the risk of death was 20.58 (95 percent confidence interval, CI: 11.28-37.54) for moderate burns and 6.24 (CI 5.22-7.45) for major burns. Among the women, this risk was 40.97 for moderate burns (CI 21.71-77.30) and 7.35 for major burns (CI 5.99-9.01). The strength of the association between the use of albumin and the risk of death was maintained for the other characteristics studied, with statistical significance. CONCLUSION: The use of albumin among patients with moderate and major burns was associated with considerably increased mortality.

CONTEXTO E OBJETIVO: Em pacientes queimados é comum o uso de substâncias coloidais sob justificativa de que é necessário corrigir a pressão oncótica do plasma, reduzindo o edema na área queimada e a hipotensão. O objetivo foi avaliar o risco de mortalidade hospitalar, comparando o uso de albumina e soluções cristaloides para esses pacientes. TIPO DE ESTUDO E LOCAL: Estudo coorte histórico não concorrente na Faculdade de Medicina de Marília, no Programa de Pós-Graduação em Medicina Interna e Terapêutica da Universidade Federal de São Paulo e no Centro Cochrane do Brasil. MÉTODOS: Pacientes queimados hospitalizados entre 2000 e 2001, registrados no Sistema de Informações Hospitalares e que receberam albumina foram comparados com aqueles que receberam outros tipos de reposição volêmica. O desfecho primário foi a taxa de mortalidade hospitalar. Os dados foram coletados dos arquivos do programa Datasus. RESULTADOS: Foram incluídos 39.684 pacientes: sendo 24.116 pacientes com queimaduras moderadas e 15.566 pacientes com queimaduras graves. Entre os homens tratados com albumina, o odds ratio para o risco de morte foi 20,58 (intervalo de confiança IC 95 por cento 11,28-37,54) para queimaduras moderadas e 6,24 (IC 5,22-7,45) para queimaduras graves. Entre as mulheres, esse risco foi de 40,97 para queimaduras moderadas (IC 21,71-77,30) e 7,35 para queimaduras graves (IC 5,99-9,01). A força da associação entre o uso de albumina e o risco de morte foi mantida para as outras características estudadas, com significância estatística. CONCLUSÃO: O uso de albumina entre pacientes com queimaduras moderadas e graves foi associado a aumento considerável da mortalidade.

Comparison of the effects of lactated Ringer solution with and without hydroxyethyl starch fluid resuscitation on gut edema during severe splanchnic ischemia

The type of fluid used during resuscitation may have an important impact on tissue edema. We evaluated the impact of two different regimens of fluid resuscitation on hemodynamics and on lung and intestinal edema during splanchnic hypoperfusion in rabbits. The study included 16 female New Zealand rabbits (2.9 to 3.3 kg body weight, aged 8 to 12 months) with splanchnic ischemia induced by ligation of the superior mesenteric artery. The animals were randomized into two experimental groups: group I (N = 9) received 12 mL·kg-1·h-1 lactated Ringer solution and 20 mL/kg 6 percent hydroxyethyl starch solution; group II (N = 7) received 36 mL·kg-1·h-1 lactated Ringer solution and 20 mL/kg 0.9 percent saline. A segment from the ileum was isolated to be perfused. A tonometric catheter was placed in a second gut segment. Superior mesenteric artery (Q SMA) and aortic (Qaorta) flows were measured using ultrasonic flow probes. After 4 h of fluid resuscitation, tissue specimens were immediately removed for estimations of gut and lung edema. There were no differences in global and regional perfusion variables, lung wet-to-dry weight ratios and oxygenation indices between groups. Gut wet-to-dry weight ratio was significantly lower in the crystalloid/colloid-treated group (4.9 ± 1.5) than in the crystalloid-treated group (7.3 ± 2.4) (P < 0.05). In this model of intestinal ischemia, fluid resuscitation with crystalloids caused more gut edema than a combination of crystalloids and colloids.

Experimental antegrade enema: effects on water, electrolyte and acid-base balances with different solutions

PURPOSE: To study the effects on the water, electrolyte, and acid-base balances in rabbits submitted to antegrade enema with different solutions through appendicostomy. METHODS: Forty male New Zealand rabbits were submitted to appendicostomy, and distributed in 4 groups, according to the antegrade enema solution: PEG group, polyethylene glycol electrolyte solution (n=10); ISS group, isotonic saline solution (n=10); GS group, glycerin solution (n=10); SPS group, sodium phosphate solution (n=10). After being weighed, arterial blood gas analysis, red blood count, creatinine and electrolytes were measured at 4 times: preoperatively (T1); day 6 postop, before enema (T2); 4h after enema (T3); and 24h after T3 (T4). RESULTS: In PEG group occurred Na retention after 4h, causing alkalemia, sustained for 24h with HCO3 retention. In ISS group occurred isotonic water retention and hyperchloremic acidosis after 4h, which was partially compensated in 24h. GS group showed metabolic acidosis after 4h, compensated in 24h. In SPS group occurred hypernatremic dehydration, metabolic acidosis in 4h, and hypokalemia, hypocalcemia, hypomagnesemia, and metabolic alkalosis with partially compensated dehydration in 24h. CONCLUSIONS: All solutions used in this study caused minor alterations on water, electrolyte or acid-base balances. The most intense ones were caused by hypertonic sodium phosphate solution (SPS) and isotonic saline solution (ISS) and the least by polyethyleneglycol electrolyte solution (PEG) and glycerin solution 12 percent (GS).

OBJETIVO: Estudar os efeitos no equilíbrio hídrico, eletrolítico e ácido-base, do enema anterógrado com diferentes soluções em coelhos através de apendicostomia. MÉTODOS: 40 coelhos Nova Zelândia, machos, submetidos a apendicostomia, distribuídos em quatro grupos segundo a solução de enema: grupo PEG (n = 10) solução de polietilenoglicol com eletrólitos; grupo SF (n = 10) solução fisiológica; grupo SG (n = 10) solução glicerinada; grupo FS (n = 10) solução de fosfato de sódio. Realizou-se pesagem, gasometria arterial, série vermelha, creatinina e ionograma, em quatro tempos: TI (pré-operatório); T2 (6o PO antes do enema); T3 (4h após enema); T4 (24h após T3). RESULTADOS: No PEG ocorreu retenção de Na em 4h, com alcalemia por retenção de HCO3, mantida por 24h. No SF ocorreu retenção hídrica isotônica e acidose hiperclorêmica em 4h, resolvidos parcialmente com 24h. No SG ocorreu acidose metabólica hiperclorêmica em 4h, compensada com 24h. No FS ocorreu desidratação hipenatrêmica, acidose metabólica com ânion gap elevado em 4h, hipopotassemia, hipocalcemia, hipomagnesemia e alcalose metabólica com recuperação parcial da desidratação em 24h. CONCLUSÕES: Todas as soluções empregadas neste estudo causam alterações de pouca intensidade no equilíbrio hídrico, eletrolítico ou ácido-base. As mais intensas foram causadas pela solução de fosfato de sódio e solução fisiológica, e as menos intensas pela solução de polietilenoglicol com eletrólitos e solução glicerinada.

Efeitos da solução salina hipertônica a 7,5 por cento em glicose a 5 por cento nas concentrações séricas de sódio, cloreto e potássio de eqüinos com hipovolemia induzida / Effects of 7,5 percent hypertonic saline in 5 percent glucose on serum levels of sodium, chloride and potassium in induced hypovolemic horses

Estudaram-se os efeitos de soluções salinas isotônica e hipertônica em eqüinos hipovolêmicos sobre as concentrações séricas de sódio, cloreto e potássio e freqüências cardíaca (FC) e respiratória (FR). Quinze eqüinos machos com peso entre 390 e 475kg e idades entre quatro e 18 anos foram submetidos à retirada de sangue correspondente a 2 por cento do peso corporal e distribuídos em três grupos de igual número: o grupo GSH recebeu solução hipertônica de NaCl a 7,5 por cento em glicose a 5 por cento; o GSI, solução isotônica de NaCl a 0,9 por cento; e o GC não foi tratado. Os eletrólitos séricos foram avaliados antes (T0), após a retirada de sangue (T1) e após a infusão das soluções, entre 20 e 30 minutos (T2), entre 60 e 70 minutos (T3) e entre 120 e 130 minutos (T4). Após T0, houve elevação da FC e da FR, e as concentrações séricas de Na, Cl, K permaneceram inalteradas. Após a infusão, houve melhora das variáveis clínicas em GSI e GSH, em relação ao GC. Quanto a T3 e T4, os valores de Na em T2 do GSH foram maiores, e os de Cl e de K não se alteraram. As soluções hipertônica e isotônica são seguras na correção da hipovolemia induzida e não produzem alteração eletrolítica significativa.

The effect of isotonic and hypertonic solutions on serum levels of sodium, chloride and potassium and cardiac (CR) and respiratory rates (RR) of hypovolemic horses were studied. Fifteen horses weighting from 390 to 475kg, aging from four to 18-years-old were submitted to bleeding of 2 percent of body weight and divided in three groups: 7.5 percent NaCl hypertonic saline in 5 percent glucose (GSH), 0.9 percent NaCl isotonic saline and control group (GC). Serum electrolytes were evaluated before (T0) and after bleeding (T1) and after the administration of the solutions between 20 and 30 minutes (T2), 60 and 70 minutes (T3) and 120 and 130 minutes (T4). After T0, CR and RR increased while serum sodium, chloride, potassium were not affected. After the treatment, the clinical variables improved in GSI and GSH as compared to GC. The Na levels increased in GSH at T2 being higher than T3 and T4 while chloride and potassium concentrations did not change. The hypertonic and isotonic solutions safely corrected the hypovolemia of the horses, without altering significantly the electrolyte balance.

Parâmetros fisiológicos do desempenho de cavalos de alta performance hidratados voluntariamente com água ou solução isotônica contendo carboidrato / Physiological parameters of high performance horses watered spontaneously with regular (ordinary) water or isotonic solution containing carbohydrate

Durante 8 semanas, no verão, 4 cavalos de alta performance treinados para enduro, realizaram exercício de resistência recebendo 2 tipos diferentes de hidratação, água ou solução isotônica contendo carboidrato, com o objetivo de comparar seus parâmetros fisiológicos. Somente as variáveis Tr, Fc, Fr, peso e proteína total, consumo, glicose, os eletrólitos K, Ca e a enzima muscular CK apresentaram efeito de distância. Dos demais parâmetros avaliados não foram identificados os efeitos de tratamento e de interação da distância com o tratamento estudado (P>0,05), concluindo assim que a solução isotônica contendo carboidrato não teve influencia na performance dos animais, quando comparada com a água.

During eight weeks, in summer, four endurance trained high performance horses were worked in resistence exercise, recieving two different types of hydratatio, water or an isotonic solution containing carbohydrates, with the objective to compare their performance physiological parameters. Only the RT (rectal temperature), HR (heart rate), RR (respiratory rate), weight, total protein, glucose, the electrolytes K, Ca and the muscular enzyme CK presented distance effect. The others parameters evaluated, there weren’t any identified effects of treatment and of the interaction between distance and treatments, with a significancy level of 5%, and it was concluded that the isotonic solution containing carbohydrate didn’t have any significant influence on the animal’s performance when compared to water.

Can fluid preloading attenuate spinal induced hypotension in the elderly?

Physiologic is aimost associated with progressive loss of reserve in organ function. The objective of this study was to evaluate fluid preloading either by colloid, crystalloid or both on the incidence and frequency of spinal anesthesia induced hypotension in elderly patient. 60 patients scheduled for lower limb orthopedic surgery under spinal anaesthesia were randomly allocated to receive preload with either 6% hydroxyethyl starch 500 ml [Colloid group], 1000 ml lactated Ringer's [Crystalloid group], 500 mI lactated Ringer's plus 250 ml 6% hydroxyethylstarch [Combined group] or received no prehydration [No preload group]. ABP decreased significantly in the four groups after induction of spinal anaesthesia and it was significantly higher in the colloid goup than the other groups. The mean of ephedrine and incidence of hypotension was significantly lower in colloid group 3 of 15 [20%], compared with crystalloid 9 of 15 [60%], combined group 7 of 15 [46%] and no preload group 11 of 15 [73%]. intravascular administration in the four groups resulted in significant increase of CVP then decrease after spinal block. The use of colloid as a pre-emptive infusion is demonstrably effective to attenuate spinal anaesthesia induced hypotension in elderly patient as compared with crystalloid or no fluid preload. However, the incidence of hypotension was only reduced but not completely eliminated

Effect of an isotonic rehydration sports drink and exercise on urolithiasis in rats

The objective of the present study was to evaluate the role of physical exercise as well as the influence of hydration with an isotonic sports drink on renal function in male Wistar rats. Four groups were studied over a period of 42 days: 1) control (N = 9); 2) physical exercise (Exe, N = 7); 3) isotonic drink (Drink, N = 8); 4) physical exercise + isotonic drink (Exe + Drink, N = 8). Physical exercise consisted of running on a motor-driven treadmill for 1 h/day, at 20 m/min, 5 days a week. The isotonic sports drink was a commercial solution used by athletes for rehydration after physical activity, 2 ml administered by gavage twice a day. Urine cultures were performed in all animals. Twenty-four-hour urine samples were collected in metabolic cages at the beginning and at the end of the protocol period. Urinary and plasma parameters (sodium, potassium, urea, creatinine, calcium) did not differ among groups. However, an amorphous material was observed in the bladders of animals in the Exe + Drink and Drink groups. Characterization of the material by Western blot revealed the presence of Tamm-Horsfall protein and angiotensin converting enzyme. Physical exercise and the isotonic drink did not change the plasma or urinary parameters measured. However, the isotonic drink induced the formation of intravesical matrix, suggesting a potential lithogenic risk.

Sterile endophthalmitis in vitrectomised eyes due to suspected heat resistant endotoxins in the infusion fluid.

PURPOSE: To report on to the possibility of development of severe postoperative sterile endophthalmitis due to heat-resistant bacterial endotoxins in commercially available infusion fluids METHODS: A case study of 4 eyes that had previously undergone vitreoretinal surgery, which developed clinical endophthalmitis within 18 hours of surgery and two eyes that had vitreous surgery with intraocular gas and did not develop clinical endophthalmitis following intraocular surgery on three consecutive operative days RESULTS: The vitreous samples were sterile, both for bacteria and fungi. The only common supply in all cases was a new batch of Ringer's lactate infusion fluid. Though the Ringer's lactate solutions in the same batch were also sterile, the infusion fluids contained abnormally high levels of bacterial endotoxins detected by gel clot method. CONCLUSION: Commercially available infusion fluid may be sterile, yet contain endotoxins from killed bacteria. This could cause postoperative sterile endophthalmitis.

Comparison of embryonic development in cleavage stage mouse embryo biopsy between acid Tyrode's solution and laser assisted techniques.

The study was carried out to determine the effectiveness and safety of the infrared 1.48 microm laser in cleavage stage mouse embryo biopsy, compared to the conventional acid Tyrode's solution. One hundred and thirty cryopreserved cleavage stage mouse embryos were included in the study. Fifty embryos were biopsied by acid Tyrode's solution. Forty-seven embryos were biopsied by the infrared 1.48 microm laser. Thirty-three embryos were incubated without biopsy as the control group. Thirteen of 50 embryos in the acid Tyrode's group and 16 of 47 in the laser assisted group became cavitating morulae on day 4, meanwhile 23 of 33 in the control group reached this stage. The blastocyst formation of acid Tyrode's, laser assisted and control group were 94.0, 97.8 and 100.0 per cent, respectively. The hatching rate of acid Tyrode's solution, laser assisted and control group were 78.7, 84.7 and 63.6 per cent, respectively. No significant difference in blastocyst formation and hatching rate was found. The percentage of grade I blastocysts in control group (96.9%) was significantly higher than those in acid Tyrode's solution (68.0%) and the laser assisted group (76.0%). There was no significant difference in the percentage of grade 1 blastocysts between the acid Tyrode's solution and the laser assisted group. In conclusion, the infrared 1.48 microm wavelength laser may be an alternative to acid Tyrode's solution in embryo biopsy.

Síndrome subsecuente a resección transuretral de la próstata / Post-TURP syndrome

La resección transuretral de la próstata es una de las operaciones más comunes de la cirugía urológica, y hasta hoy es la única que ha establecido su eficacia a largo plazo, su morbilidad como la hemorragia y el síndrome subsecuente a resección transuretral de la próstata (post-RTUP), tal vez tiendan a desaparecer con el advenimiento de tecnologías como la electrovaporización del tejido prostático; entre tanto, sus tasas de buen éxito objetivo y subjetivo de 85 a 90 por ciento la convierten en el estándar de oro del tratamiento de la hiperplasia benigna de la próstata, por lo que es de interés revisar las actualidades en la fisiopatología, las manifestaciones clínicas y el tratamiento del síndrome post-RTUP

Alcalose metabólica no pós-operatório de cirurgia cardíaca com circulaçäo extra-corpórea: influencia do emprego de soluçäo de Ringer-lactato e do sangue citratado / Metabolic alkalosis in the postoperative period of heart surgery with extracorporeal circulation: influence of the use of Ringer's lactate solution and citrate blood

Estudaram-se 40 pacientes submetidos à cirurgia cardíaca com circulaçäo extracorpórea (CEC), para correçäo de variadas afecçöes cardíacas. Neste estudo prospectivo, procurou-se analisar a alcalose metabólica (näo respiratória), quanto à sua importância, incidência e possíveis causas. Em relaçäo à etiologia, particular ênfase foi dada ao uso de soluçäo de Ringer-lactato no perfusato da CEC e à politransfusäo com sangue citratado. O emprego da soluçäo de Ringer-lactato näo foi responsável pelo aparecimento da alcalose metabólica, evidenciando-se em 7 casos (12,5%) a provável participaçäo etiológica do citrato empregado como anticoagulante de sangue transfundido