[Knowing an infrequent complication of endoscopic retrograde cholangiopancreatography]. / Conociendo una complicación poco frecuente de la colangiopancreatografía retrógrada endoscópica.

OBJECTIVE: Describe the clinical and tomographic characteristics in relation to the extra peritoneal distribution of collections and air in patients with periampullary perforation after performing endoscopic retrograde cholangiopancreatography (ERCP) with or without sphincterotomy. MATERIALS AND METHODS: Observational, descriptive study in patients with periampullary perforation after ERCP with or without sphincterotomy, treated in the Pancreas Surgery Service at Edgardo Rebagliati Martins Hospital, Lima, Peru between January 2013 and January 2015. RESULTS: Ten patients with periampullary perforation after ERCP were included. 40% were male. The mean age was 47.2 years. 100% showed abdominal pain, fever 70%, 60% had jaundice, oral intolerance and vomiting. In 100% of cases the description of the procedure was for choledocolithiasis. Difficult cannulation is described in 80% of cases. Air or fluid was found in 90% in the right anterior pararenal space and the right perirenal, and the place where air or liquid is distributed less frequently was right extraperitoneal pelvis with 20%, in no caserevealed air in the mediastinum. CONCLUSIONS: The finding of a liquid collection and / or air in the retroperitoneal space right after ERCP without further involvement of the pancreatic gland should make us think of periampullary perforation, especially if you are in the right anterior pararenal space and perirenal space. This entity we call bilioretroperitoneo.

Conociendo una complicación poco frecuente de la colangiopancreatografía retrógrada endoscópica / Knowing an infrequent complication of endoscopic retrograde cholangiopancreatography

Objetivo: Describir las características clínicas y tomográficas en relación a la distribución extra peritoneal de colecciones y aire seguida de perforación periampular luego de la realización de colangiopancreatografía retrograda endoscópica (CPRE) con o sin esfinterotomía. Materiales y métodos: Estudio observacional, descriptivo y transversal, en pacientes con perforación periampular, después de CPRE con o sin enfinterotomía, tratados en el Servicio de Cirugía de Páncreas del Hospital Edgardo Rebagliati Martins, Lima, Perú, entre enero del 2013 y enero del 2015. Resultados: Se incluyeron 10 pacientes con perforación periampular, después CPRE. El 40% fue de sexo masculino. La edad media fue de 47,2 años. El 100% presento dolor abdominal, el 70% fiebre, el 60% presentó ictericia, intolerancia oral y vómitos. En el 100% de los casos la indicación del procedimiento fue por litiasis coledociana. Se describe canulación difícil en el 80% de los casos. Se encontró aire o líquido en el 90% en los espacios pararrenal anterior derecho y el perirrenal derecho, y el lugar en donde se distribuyó el aire o liquido con menor frecuencia fue la pelvis extra peritoneal derecha con el 20%, en ningún caso se evidenció aire en el mediastino. Conclusiones: El hallazgo de una colección líquida y/o aire en el espacio retroperitoneal derecho, después de CPRE, sin mayor afección de la glándula pancreática, debe hacernos pensar en perforación periampular, sobre todo si se encuentra en el espacio pararrenal anterior derecho y el espacio perirrenal derecho. A esta entidad nosotros la hemos denominado bilioretroperitoneo.

Objective: Describe the clinical and tomographic characteristics in relation to the extra peritoneal distribution of collections and air in patients with periampullary perforation after performing endoscopic retrograde cholangiopancreatography (ERCP) with or without sphincterotomy. Materials and methods: Observational, descriptive study in patients with periampullary perforation after ERCP with or without sphincterotomy, treated in the Pancreas Surgery Service at Edgardo Rebagliati Martins Hospital, Lima, Peru between January 2013 and January 2015. Results: Ten patients with periampullary perforation after ERCP were included. 40% were male. The mean age was 47.2 years. 100% showed abdominal pain, fever 70%, 60% had jaundice, oral intolerance and vomiting. In 100% of cases the description of the procedure was for choledocolithiasis. Difficult cannulation is described in 80% of cases. Air or fluid was found in 90% in the right anterior pararenal space and the right perirenal, and the place where air or liquid is distributed less frequently was right extraperitoneal pelvis with 20%, in no case revealed air in the mediastinum. Conclusions: The finding of a liquid collection and / or air in the retroperitoneal space right after ERCP without further involvement of the pancreatic gland should make us think of periampullary perforation, especially if you are in the right anterior pararenal space and perirenal space. This entity we call bilioretroperitoneo.

Cicatrización: procesos de reparación tisular. Aproximaciones terapéuticas / Woun healing: process of tissue repair therapeutic approaches

Introducción: el proceso de cicatrización es una secuencia de eventos quedepende de la dinámica celular del tejido celular lesionado y circundante. Estas células permiten la liberación de factores de crecimiento y citocinas para llevar a cabo la reparación en tres fases: aguda o inflamatoria, proliferación celular y remodelación tisular. Métodos: se buscaron artículos en las principales bases de datos científicas como PubMed del NCBI, Science Direct, HINARI y JSTOR.Resultados: los estudios relacionados en la presente revisión, intentan mejorary optimizar el fenómeno de la cicatrización en adultos, con el fin de acelerar el tiempo de reparación y evitar la aparición de procesos infecciosos secundarios, al restaurar el transcurso normal en la reparación de heridas crónicas.Conclusiones: es evidente que los extractos crudos procedentes de hojas,cáscaras, flores y corteza de raíz, tienen potencial para acelerar los eventosde la cicatrización. Sin embargo, se desconocen en la mayoría de los casos los metabolitos activos y sus mecanismos de acción sobre las células y los factores de crecimiento que intervienen en el proceso, por lo que se requerirán más estudios para profundizar en este aspecto.

Staining of wool using the reaction products of ABTS oxidation by laccase: synergetic effects of ultrasound and cyclic voltammetry.

The effects of ultrasound on 2,2'-Azinobis(3-ethylbenzothiazoline-6-sulfonate) enzymatic oxidation by laccase (Trametes villosa) has been studied by means of cyclic voltammetry. The reaction was allowed to proceed in the presence of a piece of wool and the coloration depth of the wool fabric was measured by means of K/S. It was observed that cyclic voltammetry is influenced the dyeing process and higher K/S values were obtained when the cyclic voltammetry was combined with the ultrasonic irradiation. Moreover, the K/S value is the sum of the values obtained when the wool staining is done in just the presence of cyclic voltammetry or in just the presence of ultrasound. The results obtained on the indigo carmine decolourization gives information on the importance of controlling the amount of ABTS(+) formed during the ultrasonication process.

Combined ultrasound-laccase assisted bleaching of cotton.

This study evaluates the potential of using ultrasound to enhance the bleaching efficiency of laccase enzyme on cotton fabrics. Ultrasound of low intensity (7W) and relatively short reaction time (30 min) seems to act in a synergistic way with the enzyme in the oxidation/removal of the natural colouring matter of cotton. The increased bleaching effect could be attributed to improved diffusion of the enzyme from the liquid phase to the fibres surface and throughout the textile structure. On the other hand inactivation of the laccase occurred increasing the intensity of the ultrasound. However, at the ultrasound power applied in the bleaching experiments the loss of enzyme activity was not significant enough to justify the use stabilizer such as polyvinyl alcohol. Furthermore, the polyvinyl alcohol appears to be a substrate for the laccase.

Stability and decolourization ability of Trametes villosa laccase in liquid ultrasonic fields.

We report in this study that the sonication of laccase from Trametes villosa and bovine serum albumin promotes the formation of protein aggregates with high molecular weight. The formation of aggregates leads to the deactivation of the enzyme, fact that was confirmed by the analysis of the enzyme stability (half-life time) upon ultrasound treatment. This inactivation was mainly caused by the radicals formed by the cavitation phenomenon. It was verified that the addition of polyvinyl alcohol to laccase had a protecting effect against enzyme inactivation. The performance of laccase in the decolourization of indigo carmine was studied. It was observed that the best results were attained when the dye solution was treated with ultrasound and enzyme stabilized with polyvinyl alcohol, where more than 65% of decolourization was achieved. This value is remarkably higher than that attained for the enzyme alone, which was only able to decolourize 20% of the dye solution within 1h of treatment. These results have important implications for the exploitation of sonication in textile industry, where the pollution caused by the release of dyes into effluents is one of the major concerns.

Total enteral nutrition as prophylactic therapy for pancreatic necrosis infection in severe acute pancreatitis.

OBJECTIVE: To evaluate the capacity of enteral nutrition, in comparison with the total parenteral nutrition (TPN) plus antibiotic therapy, for avoiding pancreatic necrosis infection in the severe acute pancreatitis. METHODS: In the period between October 1998 and September 2003, 87 patients met the inclusion criteria and took part in this research. Within the first week from their admission, 43 patients received TPN and 44 patients received total enteral nutrition (TEN). An adequate prophylactic antibiotic therapy was used in both groups. The severity of the manifestations was similar for both groups having a tomographic 'severity index' of 8 and an entry C-reactive protein of 208 and 203 mg/l, respectively. RESULTS: The group that received TPN suffered an organ failure in 79% of the cases, while the percentage showed by the group that received TEN was 31%; 88 and 25% of the patients in each group requiring a surgical intervention, respectively (p < 0.001). There was decreased presence of pancreatic necrosis infection in the group of patients that was supplied with TEN (20%) than in the group receiving TPN, where it reached 74% (p < 0.001). The death rate was significantly higher among the patients who received TPN, (35%), while for the patients who received TEN it was only 5% (p < 0.001). CONCLUSION: TEN could be used as a prophylactic therapy for infected pancreatic necrosis since it significantly diminished the necrosis infection as well as the mortality.