Calidad de vida en demencia Alzheimer: un nuevo desafío / Quality of life in Alzheimer's dementia: a new challenge

Resumen El progresivo envejecimiento de la población mundial se encuentra directamente asociado al aumento de las patologías neurodegenerativas. Dentro de estas, la Enfermedad de Alzheimer es el tipo de demencia de mayor prevalencia a nivel mundial y se asocia a un mayor deterioro de la calidad de vida, no solo en los pacientes, sino que también en sus cuidadores y entorno familiar. Frente a este escenario, durante los últimos años ha adquirido especial importancia el evaluar la calidad de vida en pacientes con demencia Alzheimer, siendo un aspecto de creciente interés en el ámbito clínico y de la salud pública al ser considerado como un indicador en la medición de la efectividad de los distintos tipos de intervenciones, farmacológicas y no farmacológicas, sobre la enfermedad y su evolución. El conocer el concepto calidad de vida por parte de los equipos de salud y la evaluación clínica de esta en pacientes con demencia Alzheimer se ha vuelto un pilar fundamental tanto en el manejo, como en el uso de la información para la toma de decisiones en relación a políticas públicas relacionadas a pacientes con demencia. En este trabajo se abordará la temática desde tres ámbitos, la importancia de la enfermedad de Alzheimer, la calidad de vida a lo largo de los años, y como ésta puede ser utilizada en el manejo de patologías neurodegenerativas como la demencia.

The progressive aging of the world population is directly associated with the increase in neurodegenerative pathologies. Among these, Alzheimer's disease is the most prevalent type of dementia worldwide which is associated with a greater deterioration in the quality of life, not only in patients but also in their caregivers and family environment. In this context, during the last years has become important to evaluate the quality of life in patients with Alzheimer's dementia to be an area of growing interest in clinical and public health because it is considered as an indicator in effectiveness measurement of the different types of interventions, pharmacological and non-pharmacological, on the disease and its evolution. Heath teams know the concept of quality of life and its clinical evaluation in patients with Alzheimer's dementia and it has become fundamental support for both management and the use of information for decision-making in the field of public policies related to patients with dementia. In this viewpoint the theme will be addressed from three areas, the importance of Alzheimer's disease, quality of life throughout history, and how it can be used in the management of neurodegenerative diseases such as dementia.

Factores asociados a respuesta favorable de tratamiento corticoidal en pacientes con polirradiculoneuropatía desmielinizante inflamatoria crónica / Variables associated with a good response to steroids in chronic inflammatory demyelinating polyradiculoneuropathy

Background: The treatment of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is based on corticosteroids, immunoglobulin and plasmapheresis. In our Health System, corticosteroids are commonly used as first line therapy for economic reasons and accessibility. However, the factors associated with a good response are not well known. Aim: To assess the association of demographic, clinical and laboratory variables with a favorable response to corticosteroid therapy in patients with CIDP. Material and Methods: Observational, descriptive, longitudinal and retrospective study of 33 patients with a diagnosis of typical, definitive or probable CIDP, treated with corticosteroids for at least six months. Results: Twenty-three patients had a good clinical response to corticosteroid treatment and 10 were non-responders. The variables significantly associated with a good response to steroids were a disease lasting less than 1 year prior to the start of treatment, the absence of axonal damage in electromyography a relapsing-recurrent course and a favorable response within two months of treatment. Conclusions: Most of these patients with CIDP had good response to corticosteroid therapy.

[Variables associated with a good response to steroids in chronic inflammatory demyelinating polyradiculoneuropathy]. / Factores asociados a respuesta favorable de tratamiento corticoidal en pacientes con polirradiculoneuropatía desmielinizante inflamatoria crónica.

BACKGROUND: The treatment of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is based on corticosteroids, immunoglobulin and plasmapheresis. In our Health System, corticosteroids are commonly used as first line therapy for economic reasons and accessibility. However, the factors associated with a good response are not well known. AIM: To assess the association of demographic, clinical and laboratory variables with a favorable response to corticosteroid therapy in patients with CIDP. MATERIAL AND METHODS: Observational, descriptive, longitudinal and retrospective study of 33 patients with a diagnosis of typical, definitive or probable CIDP, treated with corticosteroids for at least six months. RESULTS: Twenty-three patients had a good clinical response to corticosteroid treatment and 10 were non-responders. The variables significantly associated with a good response to steroids were a disease lasting less than 1 year prior to the start of treatment, the absence of axonal damage in electromyography a relapsing-recurrent course and a favorable response within two months of treatment. CONCLUSIONS: Most of these patients with CIDP had good response to corticosteroid therapy.

[Results of extended transsternal thymectomy for Myasthenia gravis. Experience with 58 patients]. / Miastenia gravis: resultados inmediatos y alejados de la timectomía transesternal extendida.

BACKGROUND: Thymectomy improves clinical outcomes and decreases the need for medical treatment in patients with myasthenia gravis (MG). AIM: To describe the immediate and long-term results of extended transsternal thymectomy (ETT) in patients with MG. MATERIAL AND METHODS: A review of databases, surgical protocols, clinical records and interviews of patients subjected to extended transsternal thymectomy for MG between 1990 and 2016. Perioperative clinical characteristics, anticholinesterase treatment, immediate and remote surgical results were analyzed and patients were followed from one to 10years. RESULTS: We studied 58 patients aged 35 ± 14years (72%) women. In the preoperative period, according to Osserman classification, nine patients (15,5%) were in grade I, eight (13,8%) in grade IIA 8 and 40 (69%) in grade IIB. The pathological study of the surgical piece showed thymic hyperplasia in 39 cases (67,2%). Four patients had postoperative complications but none died. In the Follow-up at 1, 3, 5, 8 and 10years the Masaoka palliation rate was 71.7, 77.5, 67.7, 70.0 and 70,6% respectively. The figures for remission rate were 13.0, 15.0,19.4, 35.0 and 35,3% respectively. The figures for Zielinski positive results were 79.6, 87.5, 87.1, 90.0 and 82,4% respectively. The DeFilippi score improved by 80.4, 87.5, 87.1, 90.0 and 82.4% respectively. The Myasthenia Gravis Foundation of America Post-Intervention State improved by 67.4, 77.5, 77.5, 75.0 and 70,6% respectively. Mean Myasthenia Gravis Activities of daily living (MGADL) and Myasthenia Gravis Quality of life scale 15 (MGQOL 15) were 1.65 and 6.31 respectively. CONCLUSIONS: In selected patients with MG, extended transsternal thymectomy in MG has good immediate and long-term results.

Miastenia gravis: resultados inmediatos y alejados de la timectomía transesternal extendida / Results of extended transsternal thymectomy for Myasthenia gravis: experience with 58 patients

Background: Thymectomy improves clinical outcomes and decreases the need for medical treatment in patients with myasthenia gravis (MG). Aim: To describe the immediate and long-term results of extended transsternal thymectomy (ETT) in patients with MG. Material and Methods: A review of databases, surgical protocols, clinical records and interviews of patients subjected to extended transsternal thymectomy for MG between 1990 and 2016. Perioperative clinical characteristics, anticholinesterase treatment, immediate and remote surgical results were analyzed and patients were followed from one to 10years. Results: We studied 58 patients aged 35 ± 14years (72%) women. In the preoperative period, according to Osserman classification, nine patients (15,5%) were in grade I, eight (13,8%) in grade IIA 8 and 40 (69%) in grade IIB. The pathological study of the surgical piece showed thymic hyperplasia in 39 cases (67,2%). Four patients had postoperative complications but none died. In the Follow-up at 1, 3, 5, 8 and 10years the Masaoka palliation rate was 71.7, 77.5, 67.7, 70.0 and 70,6% respectively. The figures for remission rate were 13.0, 15.0,19.4, 35.0 and 35,3% respectively. The figures for Zielinski positive results were 79.6, 87.5, 87.1, 90.0 and 82,4% respectively. The DeFilippi score improved by 80.4, 87.5, 87.1, 90.0 and 82.4% respectively. The Myasthenia Gravis Foundation of America Post-Intervention State improved by 67.4, 77.5, 77.5, 75.0 and 70,6% respectively. Mean Myasthenia Gravis Activities of daily living (MGADL) and Myasthenia Gravis Quality of life scale 15 (MGQOL 15) were 1.65 and 6.31 respectively. Conclusions: In selected patients with MG, extended transsternal thymectomy in MG has good immediate and long-term results.

Long-term outcome following pneumatic dilatation as initial therapy for idiopathic achalasia: an 18-year single-centre experience.

BACKGROUND: Relapse after treatment for idiopathic achalasia is common and long-term outcome data are limited. AIM: To determine the cumulative relapse rate and long-term outcome after pneumatic dilatation (PD) for achalasia in a tertiary referral centre. METHODS: A retrospective study of 301 patients with achalasia treated with PD as first-line therapy. Short-term outcome was measured at 12 months. Long-term outcome was assessed in those who were in remission at 12 months by cumulative relapse rate and cross-sectional analysis of long-term remission rate regardless of any interval therapy, using a validated achalasia-specific questionnaire. RESULTS: Eighty-two percent of patients were in remission 12 months following initial PD. Relapse rates thereafter were 18% by 2 years; 41% by 5 years and 60% by 10 years. Whilst 43% patients underwent additional treatments [PD (29%), myotomy (11%) or botulinum toxin (3%)] beyond 12 months, 32% of those who had not received interval therapy had relapsed at cross-sectional analysis. After a mean follow-up of 9.3 years, regardless of nature, timing or frequency of any interval therapy, 71% (79/111) patients were in remission. The perforation rate from PD was 2%. Chest pain had a poor predictive value (24%) for perforation. CONCLUSIONS: Long-term relapse is common following pneumatic dilatation. While on-demand pneumatic dilatation for relapse yields a good response, one-third of relapsers neither seek medical attention nor receive interval therapy. Close follow-up with timely repeat dilatation is necessary for a good long-term outcome. Given the poor predictive value of chest pain for perforation, routine gastrografin swallow is recommended postdilatation.

Modulation of esophageal afferent pathways by 5-HT3 receptor inhibition.

BACKGROUND: The study aims were to investigate whether neural pathways involving 5-HT3 receptors mediate: (i) distension-induced upper esophageal sphincter (UES) relaxation reflex, (ii) esophageal sensitivity to acid and electrical stimuli, and (iii) viserosomatic sensitization following acid exposure. METHODS: In Study I, in a double-blind crossover trial (n = 9) esophageal sensory and pain thresholds to electrical stimulation were measured in the esophagus, midsternum, and the foot, before subjects were randomized to receive either Ondansetron (8 mg i.v.) or NaCl (0.9% w/v). HCl (0.15 mol L(-1)) was then infused into distal esophagus and electrical thresholds were reassessed. Following electrical sensory threshold testing, subjects received a second esophageal infusion of HCl to evaluate esophageal sensitivity to acid. In Study II (N = 10), frequencies of distension-induced UES relaxation responses were scored before and after treatment with Ondansetron and NaCl in a double-blind crossover trial. KEY RESULTS: In Study I, ondansetron had no effect on esophageal sensitivity to HCl or acid-induced sensitization. However, blockade of 5-HT3 receptors did reduce midsternum somatic pain thresholds. Sixty minutes after esophageal acid exposure, pain thresholds were significantly lower in the ondansetron arm (mean Δ-1.36 ± 0.4 mA) when compared with NaCl (mean Δ-0.14 ± 0.58 mA) (P < 0.05). In Study II, 5-HT3 receptor blockade had no significant effect on UES relaxation reflex. CONCLUSIONS & INFERENCES: This study does not support the hypothesis that in health, 5-HT3 receptors play a significant role in esophago-UES distention-induced relaxation reflex and esophageal sensitivity to acid or electrical stimulation. It does provide new evidence for involvement of 5-HT3 receptors in viscerosomatic sensitization.

Expresion de la proteína P504S en las células prostáticas en la circulación sanguínea (CPCS) en pacientes con cáncer prostático y el efecto de la supresión adrogénica: estudio inmunocitoquímico / Circulating prostate cells(CPCS)in patient with prostate cancer express P504S and androgen blockage effect: an immunocytochemical based study

Determinar la presencia de CPCS en pacientes con cáncer prostático, la expresión de p504 S yel efecto de la supresión androgénica. Pacientes, materiales y método: en muestras de sangre venosa de 92 pacientes portadores de cáncer a la prostáta se separaron las células mononucleares por centrifugación diferencial. Las cpcs fueron identificadas utilizando anticuerpos monoclonales contra APE y P504S. Muestras de sangre de 10 mujeres fueron usadas como controles. Resultados: En ninguna de las muestras utilizadas como control y en el 68 por ciento de los hombres estudiados se detectaron CPCS. Todas las células detectadas fueron positivas para la expresión de P504S. Los pacientes con supresión androgénica, DES o después de una orquidectomía, tuvieron un nivel de P504S promedio menor que aquellos sin terapia sistémica p menor que 0,03. Conclusiones: la detección de CPCS P504S positivas en biopsias de prostáta es utilizada para el diagnóstico de cáncer, las celulas benignas no expresan este antígeno. Este estudio pionero demuestra que la expresión de P504S en CPCS es menor eb hombres con tratamiento hormonal sistémico.

Objective To determine the effect of androgen blockage on the expression of P504S en circulating prostate cells (CPCs) in men with prostate cancer. Patients, material and method: mononuclear cells were separated from venous blood using differential centrifugation and identification fied using monoclonal antibodies against PSA and P504S. 10 women were used as controls and 92 men with prostate cancer formesd the study group. Results: 64,8 percent of men were positive for CPCs, all the CPCs detected expressed the antigen P504S. No controls were positive. Conclusions. The detection of P504S postive cells in prostate biopsies is used to determine whether they are malignant or not, benign cells P504S negative. This is pioner study to show that CPCs are P504S positive, with the implication that they are malignant cells.

Pancolonic spatiotemporal mapping reveals regional deficiencies in, and disorganization of colonic propagating pressure waves in severe constipation.

BACKGROUND: The morphology, motor responses and spatiotemporal organization among colonic propagating sequences (PS) have never been defined throughout the entire colon of patients with slow transit constipation (STC). Utilizing the technique of spatiotemporal mapping, we aimed to demonstrate 'manometric signatures' that may serve as biomarkers of the disorder. METHODS: In 14 female patients with scintigraphically confirmed STC, and eight healthy female controls, a silicone catheter with 16 recording sites spanning the colon at 7.5 cm intervals was positioned colonoscopically with the tip clipped to the cecum. Intraluminal pressures were recorded for 24 h. KEY RESULTS: Pan-colonic, 24 h, spatiotemporal mapping identified for the first time in STC patients: a marked paucity of propagating pressure waves in the midcolon (P = 0.01), as a consequence of a significant (P < 0.0001) decrease in extent of propagation of PS originating in the proximal colon; an increase in frequency of retrograde PS in the proximal colon; a significant reduction in the spatiotemporal organization among PS (P < 0.001); absence of the normal nocturnal suppression of PS. CONCLUSIONS & INFERENCES: Pancolonic, 24 h, spatiotemporal pressure mapping readily identifies characteristic disorganization among consecutive PS, regions of diminished activity and absent or deficient fundamental motor patterns and responses to physiological stimuli. These features are all likely to be important in the pathophysiology of slow transit constipation.

Espresión de enzima metalproteinasa de matriz 2 (MPM-2) en células prostáticas en circulación sanguínea (CPCS) en pacientes con cáncer prostático: estudio utilizando inmunocitoquímica / Expression of matrix metalproteinasa enzyme 2 (MPM-2) in prostate cells in blood circulation (CPCS) in men with prostate cancer: an immunocytochemistry study

La metaloproteinasa de matriz-2 (MPM-2) es una gelatinasa implicada en el proceso de metástasis. Las células que expresan MPM-2pueden cruzar la matriz extracelular y diseminarse a los tejidos distantes. Presentamos un estudio de la detección de células prostáticas en la circulación sanguínea y la expresión de MPM-2 en varones con cáncer prostático antes y después de una prostatectomía radical. Método y pacientes: Estudio prospectivo, multicéntrico, de pacientes atendidos en el Hospital de Carabineros de Chile, INRAD y el Instituto de Bío-Oncología, entre los años 2006 y 2008. Después de un consentimiento informado por escrito, 4 ml de sangre venosa fueron obtenidos. Las células mononucleares fueron aisladas por centrifugación diferencial y la CPCs detectadas con anti-PSA e identificadas mediante inmunocitoquímica con un sistema basado en fosfatasa alcalina con neofuscina como cromógeno. Las muestras positivas tuvieron un segundo proceso con anti-MPM-2, un sistema de detección basado en peroxidasa y Vector VIP como cromogen. Detalles de la etapa, la edad y nivel de APE sérico fueron registrados. Resultados: 105 pacientes participaron, 30 pretratamiento y 75 postratamiento, con una edad promedio de 71,3 +/- 8,4 años. Existió una asociación entre la frecuencia de detección de CPCs, la etapa clínica y el índice de Gleason. Todas las CPCs expresaron MPM-2. Conclusiones: Los resultados confirman que la expresión de MPM-2 tiene un papel importante en la 1a y 2a diseminación de células cancerosas y no hay una asociación de los otros factores pronóstico. La presencia de las CPCs no implica la presencia de micrometástasis ni su origen de diseminación en el 2o caso de CPCs, pero implica un riesgo más elevado de la enfermedad micrometastásica. Su detección podría ser útil durante el seguimiento para la detección precoz de estos pacientes.

Objective: Matrix metalloproteinase-2 is a gelatinase implicated in the metastatic process. Cells expressing MMP-2 can cross the extracellular matrix and disseminate to other tissues. We present a study of MMP-2 express of circulating prostate cells in men with prostate cancer. Methods and Patients: A prospective, multicenter study of men with prostate cancer attending the Hospital de Carabineros de Chile, INRAD and the Instituto de BioOncología between 2006 and 2008. After written informed consent a 4 ml blood sample was taken, mononuclear cells were obtained using differential centrifugation and CPCs identified using immunocytochemistry. Positive samples with PSA staining cells underwent a second process with anti-MPM-2. Age, clinical stage, serum PSA were noted for each patient. Results: 105 patients entered the study, 30 pre-treatment and 75 post treatment, with an average age of 71.3 +/- 8.4 years. There was an association with CPC detection frequency with clinical stage and Gleason score. All CPCs expressed MMP-2. Conclusions: The results indicate that MMP-2 expression is important in the dissemination of primary and secondary prostate cancer cells, that there is no association between prognostic factors and MMP-2 expression in CPCs. The presence of CPCs does not imply the presence of micrometastasis nor origin of dissemination in the case of 2nd CPCs but the presence implies a higher risk of micrometastasis. The detection of these cells could be a useful tool in the follow up of patients with prostate cancer.

Intraluminal impedance detects failure of pharyngeal bolus clearance during swallowing: a validation study in adults with dysphagia.

Multichannel intraluminal impedance (MII) detects bolus flow through a healthy pharynx. The aim of this study was to determine whether the technique detects bolus flow and retention in patients with pharyngeal dysphagia; develop appropriate impedance-based criteria for assessing patients and to provide some preliminary insights into the clinical utility of the technique. Pharyngo-oesophageal pressure and impedance were recorded simultaneously with videofluoroscopy (VF) during swallows in six patients with dysphagia. Agreement, as to the presence or absence of bolus material, between the VF and MII was expressed using the Cohen's Kappa statistic. To test whether the impedance criteria for the detection of bolus passage in dysphagia could be improved, a Kappa statistic was calculated in an iterative process for a range of impedance values (100%-0%) defining bolus head entry and bolus tail clearance from the pharynx. Bolus presence according to the MII criteria previously derived by us in healthy controls demonstrated a modest correlation with VF when applied to this dysphagia population [0.37, 0.5 and 0.58 in the hypopharynx, upper oesophageal sphincter (UOS) and proximal oesophagus respectively]. In the patient population, the optimal impedance criteria were 50% for bolus head entry and 20% for bolus tail clearance. Adopting these criteria demonstrated enhanced agreement between VF and impedance; yielding Kappa coefficients of 0.42 in the hypopharynx, 0.54 in the UOS and 0.62 in the proximal oesophagus. With the adoption of appropriate criteria, pharyngeal impedance measurement can accurately detect bolus passage and failed or impaired clearance during swallowing in patients with dysphagia.

Optimal criteria for detecting bolus passage across the pharyngo-oesophageal segment during the normal swallow using intraluminal impedance recording.

The impedance criteria for the detection of the arrival of bolus head and clearance of bolus tail in the pharynx have not been defined, and may differ from accepted criteria used in the oesophagus. Our aim was to define the optimal impedance criteria that most accurately defined passage of the swallowed bolus moving through the pharyngo-oesophageal segment. In eight healthy volunteers, an assembly incorporating seven impedance-measuring segments was positioned across the pharyngo-oesophageal segment, and subjects swallowed liquid and semisolid radio-opaque boluses (2-20 mL) while impedance was simultaneously recorded with videofluoroscopic images. To derive the optimal criteria, in an iterative process we correlated impedance defined bolus presence with fluoroscopy (Cohen's Kappa) for a range of impedance cut-off values from 100% to 0% for both the initial fall, and recovery of impedance. Bolus presence in the pharynx, as determined by the 'standard' criteria (50% drop and recovery to 50% of baseline), correlated very modestly with videofluoroscopy (kappa approximately 0.35). The criteria that most accurately defined bolus passage varied between pharyngeal regions. Threshold (% of baseline) for bolus head entry into the region ranged from 71% to 80%. Threshold for bolus tail clearance varied from nadir to 19%. Correlation of impedance with videofluoroscopy improved to kappa approximately 0.6 with the above criteria. The impedance criteria defining bolus presence across the pharyngo-oesophageal segment differ from those adopted in the oesophagus. Pharyngeal impedance provides an accurate, non-radiological indicator of bolus transit through the pharynx.

Sacral nerve stimulation induces pan-colonic propagating pressure waves and increases defecation frequency in patients with slow-transit constipation.

OBJECTIVE: Colonic propagating sequences are important for normal colonic transit and defecation. The frequency of these motor patterns is reduced in slow-transit constipation. Sacral nerve stimulation (SNS) is a useful treatment for fecal and urinary incontinence. A high proportion of these patients have also reported altered bowel function. The effects of SNS on colonic propagating sequences in constipation are unknown. Our aims were to evaluate the effect of SNS on colonic pressure patterns and evaluate its therapeutic potential in severe constipation. METHOD: In eight patients with scintigraphically confirmed slow-transit constipation, a manometry catheter (16 recording sites at 7.5 cm intervals) was positioned colonoscopically and the tip fixed in the caecum. Temporary electrodes (Medtronic) were implanted in the S2 and S3 sacral nerve foramina under general anaesthesia. In the fasted state, 14 Hz stimulation was administered and four sets of parameters (pulse width 300 or 400 micros; S2 and S3) were tested in four 2-h epochs, in random order, over 2 days. Patients were then discharged home with the sacral wires in situ and a 3-week trial stimulation commenced during which patients completed a daily stool diary. RESULTS: When compared with basal activity, electrical stimulation to S3 significantly increased pan-colonic antegrade propagating sequence (PS) frequency (5.4 +/- 4.2 vs 11.3 +/- 6.6 PS/h; P=0.01). Stimulation at S2 significantly increased retrograde PSs (basal 2.6 +/- 1.8 vs SNS 5.6 +/- 4.8 PS/h; P=0.03). During the subsequent three-week trial (continuous stimulation), six of eight reported increased bowel frequency with a reduction in laxative usage. CONCLUSION: These data demonstrate that SNS induces pan-colonic propagating pressure waves and therefore shows promise as a potential therapy for severe refractory constipation.

Resultados de la timectomía transesternal en miastenia gravis / Results of transsternal thymectomy in myasthenia gravis

La miastenia gravis (MG) es una enfermedad autoinmune que afecta a los músculos voluntarios. Su patogenia está relacionada con el timo. Junto a los anticolinesterásicos, la timectomía es una importante herramienta en su tratamiento. Esta cirugía puede realizarse por vía transesternal, cervical o por video toracoscopia. La vía transesternal permite resecar todo el tejido tímico y grasa del mediastino anterior, visualizando adecuadamente las estructuras vasculares. Objetivo: Estudiar la morbimortalidad de la timectomía tranesternal (TTE) por MG, los cambios en la etapa clínica y necesidad de medicamentos. Método: Estudio retrospectivo de los pacientes sometidos a TTE po MG en el HCRC entre 1990 y 2002. Se estudiaron las características clínicas y resultados de la tomografía axial computada, morbimortalidad quirúrgica, resultado del estudio histológico y los cambios en la etapa clínica y necesidad de medicamentos al mes, 6 meses y 1 año. Resultados: Correspondieron a 22 pacientes, 16 eran mujeres. Edad promedio 27,6 años; 14 pacientes estaban en etapa IIB, 5 en etapa II A y 3 en etapa I. Recibían en promedio 72,1 mg de neostigmina al día. TAC informó 9 timomas y 4 hiperplasias tímicas y 7 timos normales. Todas las timectomías se realizaron por esternotomía. No hubo fallecidos. Dos pacientes presentaron timoma maligno, 18 hiperplasia tímica. Hubo una disminución significativa en las dosis de medicamentos a los 6 meses y al año. No se encontró disminución significativa de la etapa clínica. Conclusiones: La timectomía transesternal tiene una baja morbilidad operatoria. Se asocia a una disminución significativa del requerimiento de medicamentos en el postoperatorio.

Trombosis de arteria renal en recién nascidos sometidos a cateterización de la arteria umbilical / Renal artery thrombosis in newborn infants subjected to umbilical artery catheterization

Durante un año se evaluó, mediante cintigrafía renal con Tc-99m DMSA, el riego de trombosis de arteria renal en recién nacidos (RN) sometidos a cateterización de arteria umbilical. De 62 RN cateterizados, 92% fueron pretérmino y 85% presentaron síndrome de dificultad respiratoria severa que requirió ventilación mecánica. Sobrevivieron 25/62 (40,3%), a los que se efectuó cintigrafía renal con Tc-99 DMSA en una mediana de 5 días después del retiro del catéter de arteria umbilical (CAU). Se comprobó un caso cuyo cintigrama demonstró alteración vascular segmentaria de un riñon, que coincidió con hipertensión arterial reninodependiente (4%) de los pacientes estudiados). Además, se comprobó un paciente con trombosis ilíaca izquierda y dos con vasoespasmo transitorio. Fallecieron 37/62 (59/7%) pacientes, siendo 92% de ellos sometidos a necropsia, demonstrándose en tres (8,8%) trombosis en aorta y o ilíacas, sin manifestación clínica. En 12 RN fallecidos no cateterizados no se comprobó trombosis al estudio necrópsico