A phase II, single-center, double-blind, randomized placebo-controlled trial to explore the efficacy and safety of intravenous melatonin in surgical patients with severe sepsis admitted to the intensive care unit.

To determine whether IV melatonin therapy improves redox status and inflammatory responses in surgical patients with severe sepsis, a unicenter, phase II double-blind, randomized, placebo-controlled trial was carried out. The study included patients with severe sepsis marked by infectious systemic inflammatory response syndrome (SIRS), associated with organ dysfunction, hypoperfusion or hypotension requiring surgical intervention. IV melatonin at a daily dose of 60 mg, which was dissolved in 500 ml of 5% dextrose serum, was continuously administered to the patients for over 30 min starting on the day of the diagnoses during a 5-day period. A total of 14 patients received a placebo treatment and 15 melatonin doses. Redox status decreased in melatonin-treated patients during the 5 days of treatment as compared to the placebo-treated patients. Procalcitonin performed better in the melatonin group, whose neutrophil to lymphocyte ratio was also significantly reduced, resulting in an improved evolution of the disease. Moreover, hospital stays decreased by 19.60% from 26.64 days for the placebo group to 21.42 days for the melatonin group. The placebo group recorded five mortalities, as compared to three for the melatonin group. IV melatonin administration improved the course of the disease in surgical patients with severe sepsis, with no side effects. Additional studies with higher doses of melatonin and a long duration of therapy need to be carried out to assess its clinical use.

Leiomioma de esófago tratamiento por abordaje mínimamente invasivo (laparoscopia-toracoscopia) / Oesophageal leiomyoma using minimally invasive treatment (laparoscopy-thoracoscopy)

No disponible

Indicaciones infrecuentes de trasplante: síndrome de Budd-Chiari y enfermedad poliquística del hígado / No disponible

No disponible

[Traumatic diaphragmatic rupture]. / Rotura traumática del diafragma.

Traumatic diaphragmatic rupture is an infrequent lesion that can result from penetrating or blunt trauma to the abdomen or chest. Early diagnosis continues to be a challenge and this type of injury is associated with high morbidity and mortality. Preoperative diagnosis is difficult and a high level of suspicion, careful scrutiny of the chest x-ray, and early surgical treatment are required for successful management. We present a case of rupture of the left hemidiaphragm that was diagnosed and treated successfully within the first few hours. We also review the literature on controversial issues in the diagnosis and treatment of this injury.

Positron-emission tomography with fluorine-18-fluoro-2-deoxy-D-glucose for gallbladder cancer diagnosis.

BACKGROUND: Recent advances in hepatobiliary surgery have underscored the need for presurgical diagnosis of gallbladder cancer. Frequently, clinical presentation, biochemical analysis, and structural ultrasound or computed axial tomography images do not enable definitive differentiation of cholecystitis or cholethiasis from gallbladder cancer. The aim of this study was to evaluate the role of fludeoxy glucose-positron-emission tomography (FDG-PET) in establishing the benign or malignant nature of gallbladder lesions. METHODS: A case series of 16 patients with clinical symptoms suggestive of biliary colic or chronic cholecystitis and with inconclusive ultrasound and/or computed axial tomography findings for presence of gallbladder cancer were studied by FDG-PET. RESULTS: FDG-PET showed a sensitivity of 0.80, a specificity of 0.82, and positive and negative predictive values of 0.67 and 0.90, respectively. There was 1 false- negative result in 1 patient with mucinous adenocarcinoma and 2 false-positive results in 1 patient with tuberculoid granulomatous reaction and 1 patient with polypoid lesion with adenomyomatosis. CONCLUSIONS: FDG-PET may be of utility to establish the diagnosis of gallbladder cancer in patients with nonspecific clinical and imaging findings.

Effect of pretreatment with interleukin-1 beta on inflammatory infiltrates and tissue damage after experimental endotoxic challenge.

OBJECTIVE: To evaluate the effect of treatment with murine recombinant interleukin-1 beta on inflammatory infiltrate and tissue damage after experimental endotoxic challenge. DESIGN: Randomized, controlled study. SETTING: Experimental Unit, Virgen de las Nieves University Hospital. SUBJECTS: Seventy-two female CBA/H mice, 20-21 g, supplied by the animal center of the Experimental Unit. INTERVENTION: The mice were randomized into three groups of 24. Group 1 (sham) received two intraperitoneal doses of 0.1 mL of phosphate-buffered saline; group 2 (lipopolysaccharide) was injected with 125 mg/kg lipopolysaccharide (Escherichia coli, intraperitoneally) 24 hrs after 0.1 mL of phosphate-buffered saline; group 3 was pretreated with 80 ng of recombinant interleukin-1 beta per mouse (intraperitoneally) 24 hrs before the endotoxic challenge. MEASUREMENTS AND MAIN RESULTS: At 1, 2, 4, and 24 hrs after the endotoxic challenge, we studied inflammatory infiltrate and tissue damage in lung, liver, and intestine by determining myeloperoxidase and malondialdehyde tissue concentrations. When we compared the pretreated group with the lipopolysaccharide group, myeloperoxidase concentrations decreased significantly in lung (p <.001) and liver (p <.001) at all study times, and in intestine (p <.001) at 2, 4, and 24 hrs; malondialdehyde concentrations significantly decreased in lung at 1 (p <.05), 2 (p <.01), and 24 (p <.001) hrs, in liver at 2 (p <.001), 4 (p <.01), and 24 (p <.001) hrs, and in intestine at 1 (p <.001), 2, 4 (p <.05), and 24 (p <.001) hrs. CONCLUSION: Pretreatment with recombinant interleukin-1 beta significantly reduces inflammatory infiltrate and tissue damage in mouse lung, liver, and intestine after an experimental endotoxic challenge.