Actualización en anemia y terapia transfusional / Anemia and transfusion therapy: an update

La anemia representa una de las patologías más prevalentes en la población general y constituye una entidad extremadamente frecuente en pacientes médicos y quirúrgicos de todas las especialidades. Una correcta valoración de su impacto y de las posibilidades terapéuticas resulta crucial. La transfusión de sangre alogénica representa una medida eficaz en el manejo de la anemia, pero no está exenta de importantes complicaciones. Es responsabilidad del clínico conocer y sopesar todas las alternativas disponibles para el manejo global de la anemia. Transfusiones sanguíneas, agentes estimuladores de la eritropoyesis, ferroterapia (oral y endovenosa) y otras alternativas terapéuticas han de ser empleadas de forma racional y ajustándonos a la evidencia clínica disponible hasta la fecha. El presente artículo de revisión resume algunas características epidemiológicas de la anemia, su valoración clínica y las principales alternativas terapéuticas a la luz de los conocimientos actuales, con especial énfasis en el paciente crítico (AU)

Anemia is one of the most prevalent diseases in the general population and is a very frequently found condition in medical and surgical patients in all medical specialties. A good evaluation of its clinical impact and its therapeutic possibilities is essential. Allogenic blood transfusion is a useful procedure in anemia management, although it has important adverse effects. It is the responsibility of the clinician to know and to take into account all the available alternatives for the treatment of anemia. Blood transfusions, erythropoiesis-stimulating agents, iron therapy (oral and endovenous) and other therapeutic alternatives must be rationally used, in accordance with the currently available clinical evidence. This review article summarizes some epidemiological characteristics of anemia, its clinical evaluation and the main therapeutic possibilities based on the present knowledge, placing special emphasis on the critically ill patient (AU)

[Anemia and transfusion therapy: an update]. / Actualización en anemia y terapia transfusional.

Anemia is one of the most prevalent diseases in the general population and is a very frequently found condition in medical and surgical patients in all medical specialties. A good evaluation of its clinical impact and its therapeutic possibilities is essential. Allogenic blood transfusion is a useful procedure in anemia management, although it has important adverse effects. It is the responsibility of the clinician to know and to take into account all the available alternatives for the treatment of anemia. Blood transfusions, erythropoiesis-stimulating agents, iron therapy (oral and endovenous) and other therapeutic alternatives must be rationally used, in accordance with the currently available clinical evidence. This review article summarizes some epidemiological characteristics of anemia, its clinical evaluation and the main therapeutic possibilities based on the present knowledge, placing special emphasis on the critically ill patient.

[Results of cephalic pancreaticoduodenectomy in patients with chronic pancreatitis]. / Resultados de la duodenopancreatectomía cefálica en los pacientes con pancreatitis crónica.

OBJECTIVE: To analyse the results obtained after cephalic pancreatoduodenectomy in patients with severe chronic pancreatitis. DESIGN: Retrospective study of indications and results of the intervention.Patients. The inclusion criteria were severe anatomic alteration of the head of the pancreas associated with refractory pain. Pancreatoduodenectomy was performed in 19 patients. RESULTS: Four patients had postoperative morbidity, and the mean hospital stay was 15 days. One patient died in the postoperative period. The pain evolution after surgery was: total control in 72% and satisfactory control in the remaining patients. During follow-up, de novo diabetes was detected in two patients, difficulty in maintaining weight in one patient, and de novo steatorrhea in four patients. CONCLUSIONS: Cephalic pancreatoduodenectomy is a good therapeutic alternative for the treatment of patients with chronic pancreatitis, refractory pain, and severe involvement of the pancreas head. Pain control is excellent and sequelae, such as diabetes or steatorrhea, are easily amenable to medical treatment.

Resultados de la duodenopancreatectomía cefálica en los pacientes con pancreatitis crónica / Results of cephalic pancreatoduodenectomy in patients with chronic pancreatitis

Objetivo. Análisis de los resultados obtenidos tras la realización de una duodenopancreatectomía cefálica en pacientes con pancreatitis crónica grave. Diseño. Estudio retrospectivo de las indicaciones y resultados de la intervención. Pacientes. Los criterios de inclusión fueron la alteración anatómica grave de la cabeza pancreática asociada a dolor intratable. Se efectuó duodenopancreatectomía en 19 pacientes. Resultados. Cuatro pacientes presentaron morbilidad postoperatoria, siendo la estancia postoperatoria media de 15 días. Un paciente falleció en el postoperatorio. La evolución del dolor tras la intervención fue: de control total en el 72 por ciento y satisfactorio en el resto. Durante el seguimiento se detectó diabetes de novo en 2 pacientes, dificultad para mantener el peso en un caso y esteatorrea de novo en 4. Conclusiones. La duodenopancreatectomía cefálica es una buena alternativa terapéutica para el tratamiento de los pacientes con pancreatitis crónica, dolor intratable y afectación grave de la cabeza pancreática. El control del dolor es excelente y las secuelas como la diabetes o la esteatorrea son fácilmente controlables con tratamiento médico. (AU)

Mortalidad en el trasplante hepático: causas y período de máxima incidencia / Mortality in liver transplantation. Causes and period of maximum incidence

Objetivos. Describir y cuantificar las causas de muerte de nuestros pacientes e identificar su incidencia en los diversos períodos postrasplante. Pacientes y métodos. Durante el período de estudio, se realizaron 441 trasplantes hepáticos en 381 pacientes. Definimos como causa predisponente de fallecimiento aquella que pone al paciente en situación de riesgo de muerte, y causa inmediata la que precipita el fallecimiento. Definimos 3 períodos: mortalidad postoperatoria, temprana y tardía. Resultados. La mortalidad fue de 112 pacientes (29 por ciento). Los pacientes que fallecieron en período de mortalidad postoperatoria, temprana y tardía fueron 32 (30 por ciento), 13 (12 por ciento) y 65 (58 por ciento), respectivamente. Los tumores de novo (15 por ciento) y la recidiva viral (14 por ciento) fueron las causas predisponentes globales más frecuentes. Las infecciones (24 por ciento) y las complicaciones médicas (12 por ciento) fueron las causas inmediatas principales. En el período postoperatorio y temprano las causas más frecuentes fueron las complicaciones médicas y el rechazo ductopénico (4 por ciento), respectivamente; en cambio, en el período de mortalidad tardía lo fueron los tumores de novo (13 por ciento) y la recurrencia de hepatopatía por virus de la hepatitis C (13 por ciento). Conclusiones. La diferenciación entre causa predisponente e inmediata define con precisión la frecuencia de cada una de ellas. Los tumores de novo y la recurrencia de hepatopatía por virus de la hepatitis C son las causas más frecuentes de muerte global y tardía (AU)

A randomized trial on the effect of isotonic amino acid infusion on postoperative complications and short life plasma protein concentrations.

In a randomized clinical study 30 patients with high risk surgical procedures were distributed to receive either standard fluid-therapy (n = 14) or an isotonic amino acid solution (n = 16) during five days. The patients were evaluated pre- and postoperatively using: anthropometric parameters: body weight, biceps and triceps skinfold thickness, and mid arm circumference; biochemical parameters: albumin, prealbumin, transferrin, retinol-binding protein, total iron-binding capacity, and cholesterol; and delayed cutaneous hypersensitivity. Clinical outcome and complications were also recorded. Positive ketonuria was obtained soon in the treatment group after 24 h. Mean daily nitrogen balance was better in the protein sparing group (-3.8 g vs -9.3 g) p less than 0.02. No differences were observed between both groups in the postoperative plasma protein levels. There were no significant differences in delayed cutaneous reactivity nor anthropometric parameters between both groups; and mortality and morbidity were similar. The present study lends little support for substituting the routine D5W and saline postoperative fluid regime. No clinical advantage of amino acids over standard fluids could be appreciated indicating that the much less expensive conventional solutions should not be replaced by amino acids, at least in routine postoperative cases.

Does peripheral hypocaloric parenteral nutrition benefit the postoperative patient? Results of a multicentric randomized trial.

To study the potential benefits of hypocaloric peripheral parenteral nutrition (HPPN) in medium to high risk surgical patients we compared this regimen with standard fluid therapy during the postoperative period. Seventy patients were randomised to receive HPPN, consisting of 1 g of amino acids and 2 g of polyols (sorbitol and xylitol) per Kg per day (n = 41), or 1500 ml of 5% glucose and 1500 ml of saline (n = 29). There were no differences in length of hospital stay, postoperative complications or weight loss between the two groups. Concentrations of short and long half-life plasma proteins were similar in both groups. Nitrogen balance was negative and the nitrogen retention was low (60%) in the HPPN group. We conclude that there are no discernible clinical advantages in giving HPPN postoperatively to patients undergoing medium or major severity elective surgery.