Study of the relationship between regional cerebral saturation and pCO2 changes during mechanical ventilation to evaluate modifications in cerebral perfusion in a newborn piglet model.

Near-infrared spectroscopy (NIRS) could be a useful continuous, non-invasive technique for monitoring the effect of partial pressure of carbon dioxide (PaCO2) fluctuations in the cerebral circulation during ventilation. The aim of this study was to examine the efficacy of NIRS to detect acute changes in cerebral blood flow following PaCO2 fluctuations after confirming the autoregulation physiology in piglets. Fourteen piglets (<72 h of life) were studied. Mean arterial blood pressure, oxygen saturation, pH, glycemia, hemoglobin, electrolytes, and temperature were monitored. Eight animals were used to evaluate brain autoregulation, assessing superior cava vein Doppler as a proxy of cerebral blood flow changing mean arterial blood pressure. Another 6 animals were used to assess hypercapnia generated by decreasing ventilatory settings and complementary CO2 through the ventilator circuit and hypocapnia due to increasing ventilatory settings. Cerebral blood flow was determined by jugular vein blood flow by Doppler and continuously monitored with NIRS. A decrease in PaCO2 was observed after hyperventilation (47.6±2.4 to 29.0±4.9 mmHg). An increase in PaCO2 was observed after hypoventilation (48.5±5.5 to 90.4±25.1 mmHg). A decrease in cerebral blood flow after hyperventilation (21.8±10.4 to 15.1±11.0 mL/min) and an increase after hypoventilation (23.4±8.4 to 38.3±10.5 mL/min) were detected by Doppler ultrasound. A significant correlation was found between cerebral oxygenation and Doppler-derived parameters of blood flow and PaCO2. Although cerebral NIRS monitoring is mainly used to detect changes in regional brain oxygenation, modifications in cerebral blood flow following experimental PaCO2 changes were detected in newborn piglets when no other important variables were modified.

Study of the relationship between regional cerebral saturation and pCO2 changes during mechanical ventilation to evaluate modifications in cerebral perfusion in a newborn piglet model

Near-infrared spectroscopy (NIRS) could be a useful continuous, non-invasive technique for monitoring the effect of partial pressure of carbon dioxide (PaCO2) fluctuations in the cerebral circulation during ventilation. The aim of this study was to examine the efficacy of NIRS to detect acute changes in cerebral blood flow following PaCO2 fluctuations after confirming the autoregulation physiology in piglets. Fourteen piglets (<72 h of life) were studied. Mean arterial blood pressure, oxygen saturation, pH, glycemia, hemoglobin, electrolytes, and temperature were monitored. Eight animals were used to evaluate brain autoregulation, assessing superior cava vein Doppler as a proxy of cerebral blood flow changing mean arterial blood pressure. Another 6 animals were used to assess hypercapnia generated by decreasing ventilatory settings and complementary CO2 through the ventilator circuit and hypocapnia due to increasing ventilatory settings. Cerebral blood flow was determined by jugular vein blood flow by Doppler and continuously monitored with NIRS. A decrease in PaCO2 was observed after hyperventilation (47.6±2.4 to 29.0±4.9 mmHg). An increase in PaCO2 was observed after hypoventilation (48.5±5.5 to 90.4±25.1 mmHg). A decrease in cerebral blood flow after hyperventilation (21.8±10.4 to 15.1±11.0 mL/min) and an increase after hypoventilation (23.4±8.4 to 38.3±10.5 mL/min) were detected by Doppler ultrasound. A significant correlation was found between cerebral oxygenation and Doppler-derived parameters of blood flow and PaCO2. Although cerebral NIRS monitoring is mainly used to detect changes in regional brain oxygenation, modifications in cerebral blood flow following experimental PaCO2 changes were detected in newborn piglets when no other important variables were modified.

Refuerzo de Anastomosis esofagogástrica con Tachosil por vía toracoscópica / Thoracoscopic esophagogastric anastomoses covered with Tachosil

El abordaje mínimamente invasivo en el tratamiento de la patología oncológica esofagogástrica aporta grandes ventajas respecto al dolor postoperatorio y las complicaciones pulmonares fundamentalmente derivadas del abordaje clásico por toracotomía. La realización de la anastomosis digestiva intratorácica por vía toracoscópica es todavía un reto técnico y grave problema postoperatorio de difícil manejo. Aportamos la descripción de un caso realizado por nuestro equipo en el que la anastomosis se reforzó con una placa de Tachosil(R), una material hemostático con probada eficacia en la disminución de tasas de fístula postoperatoria en anastomosis digestivas

The minimally invasive boarding in the treatment of oesophagus and gastric cancer contributes big advantages with regard to the postoperatory pain and the pulmonary complications fundamentally derived from the classic boarding for thoracotomy approach The accomplishment of the intrathoracic thoracoscopic digestive anastomoses is still a technical challenge and serious problem with difficult managing and control. We contribute the description of a case performed by our team in which the anastomoses reinforced with Tachosil's plate materially hemostatic with proven efficiency in the decrease of rates of postoperatory digestive leak

Mejora de la calidad de vida y pérdida de peso en pacientes obesos sometidos a gastrectomía tubular, un procedimiento seguro en cirugía bariátrica / Improvement of th quality of life and loss of weight in obese patients with sleeve gastrectomy, a safe procedure in bariatric surgery

Introducción: En relación con el Porcentaje de Exceso de Peso Perdido, la gastrectomía tubular ha demostrado ser superior a la banda gástrica ajustable, obteniendo resultados similares al bypass en el primer año. La evaluación de la calidad de vida se realiza mediante diferentes escalas, entre ellas el sistema BAROS. Evaluamos la satisfacción de los 100 primeros pacientes intervenidos en nuestro hospital con esta técnica. Material y Métodos: Se indicó la gastrectomía tubular siguiendo nuestro protocolo de tratamiento. Se realiza según técnica habitual con cinco puertos. La recogida de datos se ha basado en la revisión sistemática de las historias clínicas. La evaluación de la calidad de la cirugía se analiza con escala BAROS. El análisis de la pérdida ponderal se realiza utilizando el porcentaje de exceso de peso perdido (%EPP)[(peso inicial-peso actual/peso inicial-peso ideal)x100]. Resultados: El IMC medio de los pacientes intervenidos fue 43 kg/m2 con una desviación típica de 4,8 y mínimo y máximo de 32 kg/m2 y 63 kg/m2 respectivamente. En las revisiones posteriores, el porcentaje del exceso de peso perdido (%EPP) era del 37% a los 6 meses, con una desviación típica de 17 y una p50 del 54% y a los 18 meses en el 63% con una desviación típica de 19 y una p50 del 64%. El cuestionario BAROS fue aplicado al 98% de los pacientes de la muestra inicial. Encontramos que el 21% de los pacientes estudiados presentaron una puntuación excelente, el 43% muy buena, el 21% buena, el 10% regular

Introduction: In relation with excess weight loss, sleeve gastrectomy there has demonstrated being superior to the adjustable gastric band obtaining results similar to bypass in the first year. The evaluation of the quality of life is realized by means of different scales, including BAROS scale. We evaluate the satisfaction of the first 100 patient operated in our hospital. Methods: Sleeve gastrectomy was indicated following our protocol of treatment. It was performed under the usual surgical technique with five ports. The withdrawal of information has been based on the systematic review of clinical reports. Evaluation of quality of life was analyzed by BAROS scale. Analysis of weight loss was realized using the percentage of excess weight loss (%EWL) Results: The average BMI was 43kg/m2 with standard deviation of 4.8 and minimum and maximum of 32kg/m2 and 63 kg/m2 respectively. In posterior reviews, %EWL was 37% on 6 moths, with standard deviation of 17 and p50 54% and on 18 months in 63% with standard deviation of 19 and p50 64%. The BAROS scale was applied to 98% of the patients. 21% of studied patients presented an excellent, 43% very good, 21% good and 10% regulate

The treatment of tetanus neonatorum

1. There is still a high incidence of tetanus neonatorum. An average admission of 40 cases a year was noted from 1960-1963 in the Southern Islands Hospital2. Mortality rate used to be very high in this hospital. Prior to 1960, it was almost 100. From 1960-1962 mortality rate decreased to 70-753. The rationale of treatment is discussed with emphasis on the necessity of a direct I.V. route for tetanus antitoxin4. Forty-nine cases of tetanus neonatorum admitted in the Southern Islands Hospital from January 1963 to December 1963 were included in the study5. A survival rate of about 69.4 was noted in the study6. Higher mortality rate was noted on those with ages 5 days and below and those where treatment has been delayed over 12 hours from onset7. Cases given insufficient tetanus antitoxin may survive but with longer duration than those who received sufficient antitoxin8. Tetanus antitoxin serum of 40,000 - 80,000 units, with 40,000 - 60,000 given by direct I.V. and the rest by I.M. are sufficient for most of the severe and moderate severe cases, preferably given early at the onset of symptoms to prevent fixation of lethal amounts of toxins in the central nervous system. (Summary and Conclusions)

Thyroxine treatment and the recovery of pyramidal cells of the cerebral cortex from changes induced by juvenile-onset hypothyroidism.

In contrast to the permanent alterations resulting from neonatal hypothyroidism, the effects of juvenile-onset hypothyroidism on the number and distribution of spines along the apical shaft of pyramidal neurons of the visual cortex appeared to be potentially reversible with adequate thyroxine (T4) therapy (Ruiz-Marcos et al., 1980, Brain Res. 185:91-102 and 1982, Brain Res. 239:559-574). Treatment with 0.20 or 1.50 micrograms T4/100 g body weight per day had, however, only partially reversed the changes induced by juvenile-onset hypothyroidism. We here study whether or not a higher dose of T4 would totally reverse these effects. A group of rats were thyroid-ectomized at 40 days of age, and injected once daily with placebo or T4 (1.75 micrograms/100 g BW per day) from 70 to 90 days of age, a group on 1.50 micrograms being included to compare with previous results. Spine number and distribution were measured, as well as the concentrations of T4 and triiodothyronine (T3) in plasma, liver and brain. The activities of two hepatic enzymes were measured as thyroid hormone-sensitive biological end points. The 1.75-micrograms dose restored spine number to 88% of normal values and was markedly more effective than the 1.50-micrograms dose, which increased it to 68%. The degree of restoration appeared related to the concentration of T3. It is concluded that the changes caused by juvenile-onset hypothyroidism in the number and distribution of dendritic spines along the apical shafts of pyramidal neurons are reversible, although complete restoration might require a higher dose of T4, a continuous mode of administration, or longer period of treatment.

Rapid effects of adult-onset hypothyroidism on dendritic spines of pyramidal cells of the rat cerebral cortex.

We have previously shown (Ruiz-Marcos et al. 1980, 1982) that thyroidectomy (T) performed in rats at 40 days of age, well past the neonatal period of development, results by 80-90 days of age in a decrease of the number of spines along the shaft of pyramidal neurons with the cell body in layer V in the visual area of the cerebral cortex. We have here studied how soon after the operation an effect on spine number and distribution may be observed. We have found that the response of these neurons to T is very rapid: a decrease in the number of spines/shaft between T and age-paired controls (C) rats is statistically significant by the earliest period of observation, namely 5 days after T. These results may be related to those of Dembri et al. (1983) showing that T performed in adult rats decreases the activity of Type I RNA polymerase by 5 days after the operation. It is possible that T impairs the synthesis of some compound(s) necessary for the formation and maintenance of spines. The present results suggest that spine number is not a fixed structure of the apical shaft once brain development is over, but is in a state of continuous formation and degradation. We have further observed that the effect of T performed at 40 days of age is more pronounced in the distal part of the shaft than on the rest, a result similar to that found after neonatal T (Ruiz-Marcos et al. 1982). However, contrary to findings after early hypothyroidism, T at 40 days of age does not distort the distribution of spines along the shaft.

LDH isoenzyme patterns in tumors, polyps, and uninvolved mucosa of human cancerous colon.

By using a method of electrophoresis separation, the authors determined the relative values of each one of the lactic dehydrogenase (LDH) isoenzymes in the normal colonic mucosa. In adenocarcinomas, there is a significant rise in the percent of LDH-5. A similar disturbance has been demonstrated in 14 polyps, which confirms the known precancerous condition of these lesions. In the uninvolved mucosa surrounding neoplasm, the authors found that the increase in the relative proportion of "type M" isoenzymes, starting at 2 cm from the edge of the tumor, progressively disappears as the sample are taken farther away from the neoplasm. The authors conclude that these LDH isoenzyme pattern shifts in a normal mucosa could be an early sign of malignancy before the morphologic changes and could also be of great interest in the prediction of cancer relapse in the suture line after surgery.

LDH isoenzyme patterns in human gastric mucosa with precancerous changes.

By using an original method of electrophoresis separation, the normal relative values of each one of the LDH isoenzymes in the gastric body and antral mucosa were determined. It has been shown in gastric tumors that there is a significance rise in the relative values of "type M" isoenzymes (iso-LDH-4-5). With intestinal metaplasia as well as gastritis, a significant elevation of the relative value of iso-LDH-5 has been demonstrated in the antral mucosa. In 6 benign gastric polyps we found a similar disturbance. This would confirm the known precancerous condition of these lesions. In the normal mucosa of subtotal gastrectomy specimens, 19 patients with antral cancer had 2 types of LDH isoenzyme patterns: one normal and the other with an increase in the relative proportion of "type M" isoenzymes. These LDH isoenzyme pattern shifts in the gastric mucosa could be an early sign of malignancy prior to the morphologic changes.

Interposition left gastric-caval shunt using internal jugular vein autograft in the treatment of portal hypertension.

The selective left gastric-caval shunt is, in theory, one of the better procedures in the surgical treatment of portal hypertension. We have performed a modification of the previously described technique utilizing an internal jugular vein autograft in 4 patients who had had more than one major haemorrhage from oesophageal varices 3-12 months before operation. There were no post-operative deaths. All 4 patients are still alive 3 months to 4 years after shunting, with no episodes of bleeding. On radiological and endoscopic follow-up, the oesophagogastric varices were noted to be markedly smaller in size than before shunting.