ABSTRACT
OBJETIVO: se estudia la repercusión que la pauta de profilaxis tromboembólica con heparina de bajo peso molecular (HBPM) realizada únicamente durante el periodo de hospitalización, tiene sobre el sistema biológico de la hemostasia, en pacientes colecistectomizados por vía laparoscópica. DISEÑO DE TRABAJO: se ha realizado un estudio de cohortes prospectivo apareado sin grupo control ("antesdespués"). PACIENTES Y MÉTODOS: el estudio se ha realizado en 20 pacientes intervenidos de colelitiasis no complicada, mediante cirugía laparoscópica. A todos los pacientes se les administró HBPM, dos horas antes de la intervención y a las 24 horas de la primera dosis. La duración media de la operación fue de 70 minutos. A todos se les realizó neumoperitoneo a 14 mmHg y fueron intervenidos en posición de Trendelenburg invertida (30º). La movilización se realizó antes de las 24 horas, y se les dio de alta a las 48 horas de la intervención. Los parámetros de hemostasia estudiados han sido: la actividad antifactor X activado (anti-Xa) y la Antitrombina III, el Tiempo Parcial de Tromboplastina Activada (TPTA), y el Fibrinógeno. Se recogieron muestras para la valoración de estos parámetros en los siguientes momentos: 1ª) En condiciones basales el día anterior a la intervención. 2ª) Preoperatoriamente, una hora después de administrar la HBPM. 3ª) Al finalizar la intervención. 4ª) A las 24 horas de la misma, y 5ª) En el 7º día del postoperatorio. RESULTADOS: todos los parámetros de hemostasia tenían valores medios en el rango normal, en las determinaciones basales. Los valores medios de la actividad anti-Xa aumentó significativamente en las determinaciones 2ª y 3ª en relación a los valores de la 1ª y 5ª (p < 0,05). El valor medio del TPTA aumentó significativamente en la 2ª determinación para luego descender, sin embargo ninguna de las determinaciones de este parámetro difieren de los valores normales. El valor medio de la ATIII sólo desciende significativamente en la determinación 3ª en relación a la 1ª y a la 5ª. El valor medio del Fibrinógeno aumentó significativamente en las determinaciones 4ª y 51 en relación a la 2ª y 3ª. De todos los parámetros estudiados, sólo estaban fuera del rango normal los valores de la actividad anti-Xa, en las determinaciones correspondientes a la 2ª, 3ª y 4ª extracciones. CONCLUSIONES: se ha producido un aumento de la actividad plasmática anti-factor X activado, preoperatoriamente y que se mantiene hasta las 24 horas del postoperatorio, alcanzando los valores basales en la determinación efectuada al 7º día, con sólo un pequeño alargamiento del TPTA a la hora de administrar la heparina, lo que nos indicaría una buena acción antitrombótica (AU)
Subject(s)
Middle Aged , Adult , Aged , Male , Female , Humans , Cholecystectomy, Laparoscopic , Premedication , Thromboembolism , Time Factors , Cohort Studies , Postoperative Complications , Prospective Studies , Cholelithiasis , Analysis of Variance , Heparin, Low-Molecular-Weight , Fibrinolytic AgentsABSTRACT
Changes in serum gastrin levels in the late postoperative period have been studied in 24 patients with non-stenotic duodenal ulcer who underwent proximal gastric vagotomy. Twenty healthy volunteers were used as a control group. Serum gastrin levels were determined under basal conditions and after a high protein meal stimulation. Both measurements were done in the preoperative, early postoperative (12th day) and late postoperative periods (X = 5.5 yrs.). Regarding basal serum gastrin levels, the results show mean values of 46.2 pg/ml in the preoperative, 61.6 pg/ml in the early postoperative, 73.9 pg/ml in the late postoperative and 51 pg/ml in the control group. Early and late postoperative period values show statistical significant differences when compared with preoperative values (p < 0.05), but not with the control group ones. Stimulated gastrin levels show mean values of 75.7 pg/ml in the preoperative, 99.1 pg/ml in the early postoperative, 134.1 pg/ml in the late postoperative and 73.4 pg/ml in the control group. Late postoperative values show statistical significant differences when compared with preoperative and early postoperative values (p < 0.05), and also when compared with the control group (p < 0.05). Possible causes and the physiopathological effects of these variations are discussed.
Subject(s)
Gastrins/blood , Vagotomy, Proximal Gastric , Adolescent , Adult , Aged , Dietary Proteins , Duodenal Ulcer/blood , Duodenal Ulcer/surgery , Elective Surgical Procedures , Female , Humans , Male , Middle Aged , Postoperative Period , Time FactorsABSTRACT
The authors report a case of carcinoma arising in a longstanding Zenker's diverticulum, in a 66 years old man that refused surgical treatment for 25 years. Three months prior to his admission to our hospital, an exacerbation of his dysphagia, which became severe, was observed; and so was regurgitation, with passage to the airway during swallowing or when asleep. The esophagram showed the diverticulum without images suggestive of neoplasm, and with spilling of barium into the tracheobronchial tree. Esophagoscopy was refused by the patient. After surgical diverticulectomy, a thickened area in the inferior portion of the diverticular body was observed, which was histologically reported as a squamous cell carcinoma with pearl formation, involving only the diverticular wall. Complementary radiotherapy with TCT was administered over the esophagus, mediastinum and supraclavicular lymphatic areas, with a total dose of 5000 Cgy. Concomitant chemotherapy with Mitomycin and 5-Fluorouracil was administered. After a 2 year follow-up, the patient is completely asymptomatic. We discuss etiopathogenic factors, clinical manifestations, diagnostic procedures, and therapeutic possibilities.
Subject(s)
Carcinoma, Squamous Cell/etiology , Esophageal Neoplasms/etiology , Zenker Diverticulum/complications , Aged , Carcinoma, Squamous Cell/diagnosis , Esophageal Neoplasms/diagnosis , Humans , Male , Time FactorsABSTRACT
Serum gastrin levels were measured under basal conditions and after hyperproteic meal stimulation in 24 patients with non-stenotic duodenal ulcer, 78% of them were males with a mean age of 36.4 years. Results were compared with those obtained in 20 volunteers. Basal gastrin levels in patients with duodenal ulcer 46.2 +/- 17.5 pg/ml did not show any significant statistical differences when compared with those in the control group (51.01 +/- 28.1 pg/ml). After meal stimulation gastrin levels at different time intervals, were similar in patients with duodenal ulcer and in the control group. We conclude that serum gastrin does not seem to play a relevant pathogenic role in the development of duodenal ulcer; its measurement is of no value as a biological marker of duodenal ulcer disease.
