ABSTRACT
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Subject(s)
Humans , Male , Female , Trigeminal Neuralgia/drug therapy , Trigeminal Neuralgia/radiotherapy , Trigeminal Ganglion , Trigeminal Ganglion , Trigeminal Neuralgia/complications , Trigeminal Neuralgia/physiopathology , Trigeminal Neuralgia , Trigeminal Ganglion/metabolism , Trigeminal Ganglion/radiation effectsABSTRACT
El trasplante hepático ortotópico (THO) es el tratamiento de elección y en muchos casos definitivo de la patología hepática terminal. Desde la introducción de la técnica en España, en 1984, hasta la actualidad la supervivencia en el primer año posterior al THO ha aumentado aproximadamente un 10 %, situándose en el 85,9 % (1). Dicho aumento de la supervivencia se asocia a mejoras en la técnica quirúrgica, en el tratamiento inmunosupresor y en los cuidados perioperatorios. Es por tanto crucial, para asegurar la supervivencia y la calidad de vida de los pacientes sometidos a THO el conocimiento de todos los factores que pueden interferir en la evolución del injerto. Entre ellos se encuentran la indicación del THO, el estado basal de los pacientes antes del THO, la técnica quirúrgica y las distintas fases del THO, el tratamiento inmunosupresor y las probables complicaciones posoperatorias tanto precoces como tardías (AU)
Orthotopic liver transplantation (OLT) is the treatment of choice and in most cases the definitive treatment in end-stage liver disease. Since the introduction of the technique in Spain, in 1984, to the present day survival in the first year after OLT has increased approximately 10 %, reaching 85.9 % (1). This increase in survival is associated with improvements in the surgical technique, immunosuppressive therapy and perioperative care. In order to ensure the survival and quality of life of patients undergoing OLT it is crucial to know all factors that may interfere with the graft outcome. These include indication for OLT, preoperative state of patients, surgical technique and phases of OLT, immunosuppressive therapy and postoperative complications (AU)
Subject(s)
Humans , Male , Female , Transplantation/instrumentation , Liver Transplantation/instrumentation , Liver Transplantation/methods , Immunosuppressive Agents/therapeutic use , Quality of Life , Liver Diseases/drug therapy , Liver Diseases/surgery , Postoperative Complications/drug therapyABSTRACT
INTRODUCTION: The interindividual variability in cardiorespiratory function during liver transplantation (OLT) has been attributed to various factors, including polymorphisms in immunity genes known to affect the circulation levels of cytokines. AIM: To evaluate polymorphisms of genes encoding for interleukin-6 (IL6) and tumor necrosis factor (TNF) in association with cardiorespiratory function in OLT. DESIGN: Prospective observational study. PATIENTS AND METHODS: We studied 62 consecutive patients who had OLT performed in our hospital between 2004 and 2005. Polymorphisms at positions -308 and -409 of TNF gene, as well as those at -174 and -574 of IL6 gene were determined in all patients by means of PCR-RFLPs. Associations were carried out using chi-square tests and analysis of variance. A bilateral P < .05 was accepted as significant. RESULTS: No statistically significant associations were observed. CONCLUSIONS: A relationship between the polymorphisms studied and respiratory function in OLT was lacking. These results must be interpreted with caution due to the limited sample size.
Subject(s)
Heart Function Tests , Interleukin-6/genetics , Liver Transplantation/physiology , Polymorphism, Genetic , Promoter Regions, Genetic , Respiratory Function Tests , Tumor Necrosis Factor-alpha/genetics , Analysis of Variance , Chi-Square Distribution , Humans , Length of Stay , Polymerase Chain Reaction , Polymorphism, Restriction Fragment Length , Retrospective Studies , Treatment OutcomeABSTRACT
AIMS: The aim of the study was to assess the effectiveness of laparoscopic colorectal surgery in patients at high preoperative anesthetic risk because of associated pathologies. MATERIALS AND METHODS: From January 2003 until January 2005, 116 patients were systematically assigned at a ratio of 1:1 to one of two groups: laparoscopy surgery (n=59, of which 31 were American Society of Anesthesiologists score [ASA] I-II [L1] and 28 ASA III-IV [L2]) or open surgery (n=57, of which 30 were ASA I-II [O1] and 27 ASA III-IV [O2]). Data on patient demographics and clinical and anesthetic variables were collected prospectively. Informed consent was obtained from the patients, and approval was obtained from the designated review board of the institution involved. RESULTS: The number of minor anesthetic complications during surgery was higher in L2 patients. No differences were observed in blood gas parameters studied during surgery (pCO(2), pH, and pO(2)/FiO(2)). Transfusion rates in the laparoscopy group at greater anesthetic risk (L2) were lower than those of the high-risk conventional surgery group (O2; 21.4 vs 63%, P<0.02). Duration of stay in the surgical recovery room and the inpatient ward were also shorter in the L2 group than in the O2 group (8.7+/-4.5 vs 12.2+/-6 days, P=0.02). There was no difference in perioperative clinical variables between laparoscopy groups (L1, L2). CONCLUSION: Postoperative recovery of ASA III-IV patients is better after laparoscopic surgery for colorectal cancer, at the expense of a higher rate of minor anesthetic occurrences during surgery.
Subject(s)
Anesthesia, General/adverse effects , Colorectal Neoplasms/surgery , Digestive System Surgical Procedures , Laparoscopy , Aged , Aged, 80 and over , Digestive System Surgical Procedures/adverse effects , Female , Humans , Laparoscopy/adverse effects , Male , Middle Aged , Patient Selection , Prospective Studies , Risk Assessment , Treatment OutcomeSubject(s)
Intraoperative Complications/diagnosis , Sternum/abnormalities , Tachycardia, Supraventricular/diagnosis , Thoracoplasty , Adolescent , Cardiac Complexes, Premature/drug therapy , Cardiac Complexes, Premature/etiology , Catheterization , Congenital Abnormalities/surgery , Humans , Intraoperative Complications/drug therapy , Intraoperative Complications/etiology , Lidocaine/therapeutic use , Male , Postoperative Complications/drug therapy , Postoperative Complications/etiology , Stress, Mechanical , Tachycardia, Supraventricular/drug therapy , Tachycardia, Supraventricular/etiologyABSTRACT
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Subject(s)
Male , Adolescent , Humans , Musculoskeletal Abnormalities/surgery , Tachycardia, Supraventricular/etiology , Thoracoplasty/adverse effects , Funnel Chest/surgery , Thoracic Surgical Procedures/adverse effectsABSTRACT
Una paciente de 63 años presentó un cuadro de isquemia aguda bilateral de miembros inferiores. Tras la embolectomía se practicó una ecocardiografía transtorácica donde se apreció una tumoración en la aurícula izquierda. El cuadro clínico se complicó por la instauración de un síndrome compartimental de extremidades inferiores, que requirió la realización de una fasciotomía descompresiva. Finalmente la tumoración auricular fue extirpada resultando ser un mixoma cardíaco. El mixoma auricular es el tumor cardíaco benigno más frecuente y que puede ocasionar clínica sistémica, cardíaca y embólica. Entre las técnicas diagnósticas utilizadas, la ecocardiografía transtorácica es la más importante, pudiéndose usar para los tumores más pequeños la ecocardiografía transesofágica. Estas técnicas también pueden emplearse durante la intervención quirúrgica, sobre todo en los casos en los que la evaluación preoperatoria ha dejado dudas en lo referente a la localización del tumor. Defendemos también el empleo temprano, ante un embolismo arterial periférico, de la ecocardiografía transtorácica para localizar un foco cardíaco como origen del cuadro clínico (AU)
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Subject(s)
Aged , Female , Humans , Neoplastic Cells, Circulating , Aorta, Thoracic , Iliac Artery , Embolectomy , Echocardiography, Transesophageal , Myxoma , Nerve Compression Syndromes , Ischemia , Leg , Embolism , Heart Atria , Heart NeoplasmsABSTRACT
A 73-year-old woman presented a clinical picture of bilateral acute ischemia of the lower limbs. After embolectomy, transthoracic echocardiography revealed left atrial tumor. The picture was complicated by the onset of compartment syndrome in the lower extremities requiring decompressive fasciotomy. The excised atrial tumor proved to be a cardiac myxoma. Atrial myxoma, the most common benign cardiac tumor, leads to systemic, cardiac and embolic sequelae. Transthoracic echocardiography is the main diagnostic technique available, proving more useful than transesophageal echocardiography for small tumors. Such techniques can also be used during surgery, particularly in cases where preoperative assessment has left doubts about tumor location. We also argue in favor of early use of transesophageal echocardiography when peripheral arterial embolism is the diagnosis, in order to locate a cardiac focus as the cause of the clinical picture.
