Endoscopic placement of enteral feeding tubes.

The techniques for placement of feeding tubes using fiberscopes are described and an evaluation of the results obtained in the last 12 months is made. The techniques are discussed and compared with other methods of enteral feeding known at present. It is concluded that placement of feeding tubes by endoscopy can be achieved easily, that it is possible to choose the site of enteric liberation of nutrients under conditions which previously represented contraindications, and that this procedure is free of complications even during long periods of time.

Hipertension arterial pulmonar como causa del deterioro hemodinamico en pacientes con sepsis por Gram-negativos: (presentacion de un caso). / Pulmonary arterial hypertension as a cause of hemodynamic abnormalities in patients with Gram-negative sepsis: report of a case

Se presenta el caso de una paciente con sepsis por Gram negativos que, durante su evolucion, curso con la aparicion subita de hipertension arterial pulmonar. Este evento correlaciono con la progresion rapida de la fase hiperdinamica a la de hipodinamia caracteristicas de la sepsis. Esta situacion se revirtio con el empleo de vasodilatadores. En este caso nitroprusiato sodio, exclusivamente. Se informan los cambios observados en los diversos parametros hemodinamicos medido, se analizan las hipotesis convencionalmente invocadas tendientes a explicar la progresion de fase A a fase B en la sepsis y se revisan los criterios tradicionales de manejo en los enfermos en estas condiciones. Se propone la hipertension arterial pulmonar como un mecanismo mas a ser considerado como causa del deterioro hemodinamico agudo durante la evolucion del choque endotoxico sugiriendo ademas que, estos casos, son tributarios de tratamiento con vasodilatadores solos o, en asociacion, con inotropicos

Lactose enemas plus placebo tablets vs. neomycin tablets plus starch enemas in acute portal systemic encephalopathy. A double-blind randomized controlled study.

A randomized, double-blind comparison of lactose enemas plus placebo tablets vs. starch enemas plus neomycin tablets was performed on 18 patients with acute portal systemic encephalopathy. Ten patients received starch enemas (10%; 1000 ml t.i.d.) plus neomycin tablets and 8 patients received lactose enemas (20%; 1000 ml t.i.d.) plus placebo tablets. A significant mental state improvement was demonstrated in the group of patients treated with starch enemas-neomycin tablets (p less than 0.05) and in the group of patients treated with lactose enemas-placebo tablets (p less than 0.025). Both treatments significantly improved the frequency of asterixis, ammonia blood levels, and electroencephalograms. In addition, patients treated with lactose enemas showed significant improvement in number-connection test times (p less than 0.02), and their stools showed a more acid pH (p less than 0.05). No side effects were evident with either treatment. Lactose enemas are a safe and effective treatment for acute portal systemic encephalopathy.

Dantroleno sodico en el tetanos. Informe de un caso. / Sodium dantrolene for tetanus. Report of a case

Se informa un caso de tetanos generalizado grave, tratado con dantroleno. Inicialmente el enfermo se manejo en la forma convencional con diazepan y cloropromazina, presentando depresion en el estado de conciencia y de la funcion respiratoria. El uso del dantroleno (100 mg/dia), produjo una excelente respuesta miorrelajante, con minima depresion respiratoria. Se corroboro la accion terapeutica al reaparecer el cuadro espastico 12 horas despues de suspender el dantroleno, y desaparecer al reiniciarlo

[Treatment of hepatorenal syndrome with dopamine and bromocriptine]. / Tratamiento del síndrome hepatorrenal con dopamina y bromocriptina.

Two cirrhotic patients with hepatorenal syndrome were treated with Dopamine hydrochloride and Bromocriptine, a Dopamine agonist. Dopamine hydrochloride was given at a dosis of 0.30 to 0.90 mg/min. and Bromocriptine 15 mg/day. Although a transient raise of urinary output was observed in one patient, both patients died six to ten days later with an urinary output of less than 100 ml/day. Dopamine and Bromocriptine combined are of poor therapeutic value in hepatorenal syndrome.

[Minimal protein and calories parenteral route requirements in order to have a positive nitrogen balance in patients with acute diseases]. / Requerimientos mínimos de calorías y proteínas por vía parenteral para lograr balance positivo de nitrógeno en el paciente grave.

A study was conducted on a group of 30 patients with mormal nutritional conditions who required parenteral alimentation. Three groups were selected at random. They received glucose as a calorie source and nitrogen from amino acids derived from hidrolizate of natural protein. Group I received 40 Kcal/kg/day and 250 mg of nitrogen/day. Group II 30 Kcal/kg/day and 175 mg nitrogen/kg/24 hours. And group III received 20 Kcal/kg/day and 100 mg of nitrogen/kg/24 hours. The first two groups had a positive nitrogen balance and the third group had negative balance. The positive nitrogen balance of group I, was only 670 mg better than the obtained for group II. Group I received 4 gr more of nitrogen than group II. This study show that the scheme of calories and nitrogen administered to the group II was the best for the maintenance of the nutritional conditions in the patients studied.

[Generalized peritonitis. Morbidity and mortality with respect to the development of oncotic pressure in the early postoperative period]. / Peritonitis generalizada. Morbilidad y mortalidad con respecto al desarrollo de la presion oncotica en el postoperatorio temprano.

A group of forty patients with generalized peritonitis was studied comparing their clinical evolution and mortality with the plasma coloidosmotic pressure values (COP). Twentynine patients survived without complications (Group I) this patients had the higher mean COP values, 17.56 mm Hg at the beggining and 19.06 mm Hg at the end of the study. Three patients showed complications directly related with peritonitis but finally survived (Group II). Their mean COP values were 16.08 mm Hg at the beggining and 13.44 mm Hg at the end. Eight patients died (Group III) lower mean COP values were obtained in this group; 13.5 at the begging and 11.94 at the end. Despite the same kind of medical and surgical treatment, response was very different in each group. Lower values of COP were found as clinical avolution worsened. A very low inicial value or failure to raise it despite the treatment may be considered as a bad prognosis sing.

[Measurement of colloidosmostic pressure]. / Medición de la presión coloidosmótica (PCO).

In the patient in a critical state there are numerous conditions which alter the COP (Coloidosmotic pressure), which is important for the exchange of liquids at the capillary level of the entire organism. As a consequence for these changes, problems occur with the accumulation of water in the intersticia and a malfunction of organs. A device to measure the COP in a reliable, rapid, and economical form is described. Its simple operation is of great use in the intensive care units for the rapid diagnosis and adequate management of the alterations in the water balance of the critical patient.