[Effectiveness of tranexamic acid in routine performance of total knee replacement surgery]. / Efectividad de ácido tranexámico en prótesis total de rodilla en la práctica clínica habitual.

OBJECTIVES: To evaluate the effectiveness of treatment with tranexamic acid, compared to absence of antifibrinolytic treatment, in reducing transfusion rates and the number of units of packed red blood cells required in patients undergoing total knee replacement surgery. MATERIAL AND METHODS: We reviewed the medical records of all patients who underwent total knee replacement surgery in a general hospital in 2006. Information was recorded on treatment with tranexamic acid, use of other antifibrinolytic drugs, hemoglobin and hematocrit levels before surgery and 3 days after surgery, patients requiring transfusions, units of packed red blood cells administered, and whether or not drains were clamped within 4 hours. Complications attributable to tranexamic acid (thromboembolic or systemic complications) and preoperative treatment with erythropoietin were also recorded. RESULTS: Data for 166 patients were analyzed. Of these, 120 (72.3%) received tranexamic acid, 15 (9%) received epsilon-aminocaproic acid, and 31 (18.7%) received no antifibrinolytic treatment. Transfusions were given to 17 patients, of whom 6 (5.0%) had received tranexamic acid, 2 (133%) had received epsilon-aminocaproic acid, and 9 (29.0%) had received no antifibrinolytic treatment. The mean numbers of packed red blood cell units transfused in each group were as follows: 0.075 in the tranexamic acid group, 0.200 in the epsilon-aminocaproic acid group, and 0.645 in the group with no antifibrinolytic treatment (P < .001). The mean decrease in hemoglobin levels 5 days after surgery was 3.04 g/dL in the tranexamic acid group, 3.55 g/dL in the epsilon-aminocaproic acid group and 3.76 g/dL in the group with no antifibrinolytic treatment (P < .001). CONCLUSIONS: Tranexamic acid is effective in reducing the percentage of patients requiring transfusions and in the number of units of packed red blood cells required in total knee replacement surgery. No complications attributable to this treatment were found.

Efectividad de ácido tranexámico en prótesis total de rodilla en la práctica clínica habitual / Effectiveness of tranexamic acid in routine performance of total knee replacement surgery

OBJETIVOS: Evaluar la efectividad en la práctica clínica habitual del tratamiento con ácido tranexámico (TRAN) versus no antifibrinolíticos (NA) en la disminución de la tasa de transfusiones y unidades de concentradosde hematíes (CH) requeridas en pacientes intervenidosde prótesis total de rodilla (PTR).MATERIAL Y MÉTODO: Se revisaron las historias clínicas de todos los pacientes intervenidos de PTR primaria en un hospital general durante el año 2006. Se registró: tratamiento con TRAN, utilización de otros antifibrinolíticos(AF), hemoglobina (Hb) y hematocrito (Hto) preoperatorios y al 3er día postoperatorio (p.o.), pacientestrasfundidos, unidades de CH administradas, y si se realizóo no el clampaje de los drenajes durante las primeras 4 horas del p.o. También se registraron las complicacionesrelacionables con TRAN (tromboembólicas y/o sistémicas) y tratamiento preoperatorio con eritropoyetina (rhEPO).RESULTADOS: Se analizaron los datos de 166 pacientes. De éstos, 120 (72,3%) recibieron TRAN, 15 (9%) recibieron ácido épsilon-aminocaproico (EACA), y 31 (18,7%) no recibieron AF (NA). En total se transfundieron17 (10,2%) pacientes, de los cuales 6 en TRAN (5,0%), 2 en EACA (13,3%), y 9 en NA (29,0%) (p<0,001). La media de CH transfundidas en cada grupofue de 0,075 en TRAN, 0,200 en EACA, y 0,645 en NA (p<0,001). El descenso medio de la Hb al quinto día p.o.fue de 3,04 g/dl en TRAN, 3,55 en EACA, y 3,76 en NA (p=0,016).CONCLUSIONES: El TRAN es efectivo en la reducción del porcentaje de pacientes transfundidos y de CH administradosen PTR. No se encontró ninguna complicación relacionada con este tratamiento (AU)

OBJETIVOS: To evaluate the effectiveness of treatmentwith tranexamic acid, compared to absence of antifibrinolytic treatment, in reducing transfusion ratesand the number of units of packed red blood cells required in patients undergoing total knee replacement surgery.MATERIAL AND METHODS: We reviewed the medical records of all patients who underwent total knee replacement surgery in a general hospital in 2006.Information was recorded on treatment with tranexamic acid, use of other antifibrinolytic drugs, hemoglobin andhematocrit levels before surgery and 3 days after surgery, patients requiring transfusions, units of packedred blood cells administered, and whether or not drains were clamped within 4 hours. Complicationsattributable to tranexamic acid (thromboembolic or systemic complications) and preoperative treatment with erythropoietin were also recorded.RESULTS: Data for 166 patients were analyzed. Ofthese, 120 (72.3%) received tranexamic acid, 15 (9%)received å-aminocaproic acid, and 31 (18.7%) received no antifibrinolytic treatment. Transfusions were given to17 patients, of whom 6 (5.0%) had received tranexamic acid, 2 (13.3%) had received å-aminocaproic acid, and 9(29.0%) had received no antifibrinolytic treatment. The mean numbers of packed red blood cell units transfusedin each group were as follows: 0.075 in the tranexamic acid group, 0.200 in the å-aminocaproic acid group, and0.645 in the group with no antifibrinolytic treatment (P<.001). The mean decrease in hemoglobin levels 5 days after surgery was 3.04 g/dL in the tranexamic acid group, 3.55 g/dL in the å-aminocaproic acid group and 3.76 g/dLin the group with no antifibrinolytic treatment (P<.001).CONCLUSIONS: Tranexamic acid is effective in reducing the percentage of patients requiring transfusions and inthe number of units of packed red blood cells required in total knee replacement surgery. No complications attributable to this treatment were found (AU)

[Pancreatobiliary maljunction. Not only an Eastern disease]. / Unión biliopancreática anómala. Una enfermedad no exclusiva de pacientes orientales.

Pancreatobiliary maljunction, an extramural junction of the pancreatic and biliary ducts in the duodenum, apparently beyond the scope of intramural sphincter function, is thought to be a preferential disease of Eastern people. However, this diagnosis is increasingly being made in other populations. We present a 41-year-old woman who presented with intermittent epigastric pain and mild raise in amylase levels. MRCP did not offer a definitive diagnosis, perhaps because of lack of experience in this disease. Finally, ERCP showed a pancreatobiliary maljunction, type acute angle, but with a complex connection between the choledocus and the pancreatic duct. Fusiform dilation of the common bile duct and of the left main hepatic duct were also present. The patient was referred for extrahepatic biliary resection and a diversion procedure. But also because of lack of experience in this disease, a wait-and-see approach was undertaken. In conclusion, pancreatobiliary maljunction will be increasingly diagnosed in western communities and more diagnostic and therapeutic experience will be needed.

Coledococele de pequeño tamaño como causa de dolor epigástrico crónico: diagnóstico y tratamiento mediante CPRE / Small size choledochocele as a cause of chronic epigastric pain: diagnosis and treatment by means of ERCP

El coledococele pertenece al tipo III de los quistes biliares según la clasificación de Alonso-Lej, y son considerados los quistes menos frecuentes entre ellos. La definición habitual del coledococele es la de una dilatación quística de la porción distal intramural del colédoco que protruye en la luz duodenal. La CPRE es una de las pruebas de elección tanto para su diagnóstico como para su tratamiento, especialmente cuando son pequeños y la cavidad quística está habitualmente colapsada. La distensión de la papila (“ballooning”) durante la inyección de contraste en la CPRE se considera un signo diagnóstico. Presentamos un paciente con dolor epigástrico crónico a causa de un pequeño coledococele. La Colangiografía por Resonancia Magnética no fue diagnóstica. La CPRE proporcionó el diagnóstico y el tratamiento mediante una esfinterotomía biliar

Choledochocele belongs to type III Alonso-Lej’s classification of biliary cysts and they are considered the less frequent of such cysts. The definition most often given of choledochocele is a cystic dilation of the distal intramural portion of the bile duct, protruding into the duodenal lumen. ERCP is one of the diagnostic and therapeutic procedures of choice, specially when they are small and the cystic cavity is usually collapsed. The ballooning of the papilla during contrast injection in ERCP is thought to be a diagnostic sign. We present a patient suffering from chronic epigastric pain due to a small choledochocele. Magnetic Resonance Cholangiopancreatography failed to diagnose it. ERCP offered both diagnosis and treatment by means of biliary sphincterotomy

Development of a citrus genome-wide EST collection and cDNA microarray as resources for genomic studies.

A functional genomics project has been initiated to approach the molecular characterization of the main biological and agronomical traits of citrus. As a key part of this project, a citrus EST collection has been generated from 25 cDNA libraries covering different tissues, developmental stages and stress conditions. The collection includes a total of 22,635 high-quality ESTs, grouped in 11,836 putative unigenes, which represent at least one third of the estimated number of genes in the citrus genome. Functional annotation of unigenes which have Arabidopsis orthologues (68% of all unigenes) revealed gene representation in every major functional category, suggesting that a genome-wide EST collection was obtained. A Citrus clementina Hort. ex Tan. cv. Clemenules genomic library, that will contribute to further characterization of relevant genes, has also been constructed. To initiate the analysis of citrus transcriptome, we have developed a cDNA microarray containing 12,672 probes corresponding to 6875 putative unigenes of the collection. Technical characterization of the microarray showed high intra- and inter-array reproducibility, as well as a good range of sensitivity. We have also validated gene expression data achieved with this microarray through an independent technique such as RNA gel blot analysis.

[Small size choledochocele as a cause of chronic epigastric pain: diagnosis and treatment by means of ERCP]. / Coledococele de pequeño tamaño como causa de dolor epigástrico crónico: diagnóstico y tratamiento mediante CPRE.

Choledochocele belongs to type III Alonso-Lej's classification of biliary cysts and they are considered the less frequent of such cysts. The definition most often given of choledochocele is a cystic dilation of the distal intramural portion of the bile duct, protruding into the duodenal lumen. ERCP is one of the diagnostic and therapeutic procedures of choice, specially when they are small and the cystic cavity is usually collapsed. The ballooning of the papilla during contrast injection in ERCP is thought to be a diagnostic sign. We present a patient suffering from chronic epigastric pain due to a small choledochocele. Magnetic Resonance Cholangiopancreatography failed to diagnose it. ERCP offered both diagnosis and treatment by means of biliary sphincterotomy.

Isoprinosine en la hepatitis viral aguda tipo A. Comunicacion preliminar. / Isoprinosine in acute viral hepatitis type A.Preliminary report

Ante el aumento progresivo de la hepatitis viral aguda Tipo A y la necesidad de aminorar la magnitud del impacto medico social, economico, laboral, de ausentismo escolar y factores epidemiologicos de esta enfermedad.Se estudio el efecto del isoprinosine sobre la evolucion clinica, histologica y de laboratorio en 13 ninos sin demostrar ventajas con respecto al uso de placebo