ABSTRACT
Low diameter porto-systemic shunts for the treatment of portal hypertension bleeding have emerged as a consequence of the technical development of vascular grafts (PTFE) that allow the use of a narrow lumen. The experience with this kind of operation at the Instituto Nacional de la Nutrición Salvador Zubirán, Mexico City during a 6-year period is reported. There were twenty-seven patients with good liver function (Child-Pugh A-B) were operated or electively, average Age 47.5 years (range 17-71), twenty three patients with liver cirrhosis, one with portal fibrosis and three with idiopathic portal hypertension. Operative mortality: 4%. Rebleeding: 14%. Postoperative encephalopathy was observed in 14 of 27, three of them being grade III-IV (11%). In the remaining 11 cases, it was mild and easily controlled. Postoperative angiography showed shunt patency in 81% of the cases; in 33% of the cases, portal vein diameter reduction was shown, as well as two cases with portal vein thrombosis. In 77% of the cases, adequate postoperative quality of life was observed. Survival (Kaplan-Meier): 86% at 12 months and 56% at 60 months. These kinds of shunts are a good alternate choice for patients considered for surgery, in which other portal blood flow preserving procedures (selective shunts, devascularization with transection) are not feasible.
Subject(s)
Hypertension, Portal/surgery , Portasystemic Shunt, Surgical , Adolescent , Adult , Aged , Evaluation Studies as Topic , Female , Follow-Up Studies , Humans , Hypertension, Portal/mortality , Liver Circulation , Male , Middle Aged , Patient Selection , Polytetrafluoroethylene , Portasystemic Shunt, Surgical/mortality , Survival Rate , Time FactorsABSTRACT
Specialization courses in the medical area purport the preparation of specialists in various branches of medicine, orienting the students in their search for useful knowledge to resolve daily problems in the specialties and forming them for daily practice. These courses take place in different hospitals of the Health Sector within Mexico. Agreements with the National University (UNAM) have been reached with this purpose. Formation and training activities of specialties is a function of the Health Institutions in accord with existent resources and needs. The UNAM forms the specialists in the field where they will be later required. The physicians who are submitted to this training are prepared to practice clinical, institutional, medicine, as well as to teach and do research. The following four elements of the process are emphasized: the students, the teachers, the characteristics of the seat hospitals and the curricula. The programs lead the teaching activities with a tendency to form the expected resources with an establishment of the students and teacher's roles, as well as the teaching methology to be used. The success of these programs is limited because the particular conditions and organization of the hospitals, the characteristics of the teachers and the background of the students.
Subject(s)
Education, Medical, Graduate , Education, Medical , Specialization , Curriculum , Education, Medical, Graduate/organization & administration , Education, Medical, Graduate/standards , Inservice Training , Mexico , Schools, Medical , UniversitiesABSTRACT
In a controlled double blind study the therapeutic efficacy and tolerability of equimolar doses of [1-(p-chlorobenzoyl)-5-methoxy-2-methylindol-3-acetoxy] acetic acid (acemetacin, TV 1322, Rantudil) and indometacin (acemetacin: 180 mg/day, indometacin: 150 mg/day) were studied in 40 patients suffering from rheumatoid arthritis. The period of treatment lasted 42 days. With the exception of the parameter "state of the joint" a statistically confirmed improvement was detectable in the acemetacin group. The parameter "pain" was significantly improved after acemetacin as well after indometacin. With regard to the test criteria "functional disturbances" and "inflammation" only acemetacin was able to achieve a significant improvement. Neither of the antirheumatic agents had a significantly positive influence on the "state of the joint". The therapeutic effect on the course of the disease was better in the group treated with acemetacin than in the group treated with indometacin. However, the difference was not statistically significant. The number of undesired effects which occurred in the acemetacin group was smaller and less pronounced than in the indometacin group. In one instance, the therapy in the acemetacin group was discontinued because of a glossitis and stomatitis. one patient in the control group was excluded from the study owing to heamatemesis.
