Trasplante combinado hígado-riñón en la fundación valle del Lili, Cali, Colombia - Experiencia de un centro / The experience of the Fundacion Valle Del Lili in Cali, Colombia with Combined Liver and Kidney Transplantation

Introducción: el trasplante combinado de hígado y riñón (CLK) ha mostrado ser una buena alternativa para pacientes con diagnóstico concomitante de enfermedad renal crónica (ERC) y enfermedad hepática terminal. Algunos estudios han mostrado además un beneficio inmunológico del trasplante combinado, con disminución de la tasa de rechazo del injerto renal. Objetivo: describir las indicaciones y los resultados clínicos en receptores de trasplante CLK en un hospital de alta complejidad. Materiales y métodos: se seleccionaron los pacientes con trasplante CLK del registro institucional de trasplante (TRENAL) entre 2000 y 2011. Se describieron las características demográficas y clínicas y se estimó la sobrevida de los pacientes y de los injertos con el método Kaplan Meier. Resultados: en un período de 11 años, se realizaron 16 trasplantes CLK. Esto corresponde al 1.51% de los trasplantes de riñón y al 3.48% de los trasplantes de hígado hechos en la institución durante el mismo periodo de tiempo. La mayoría de los receptores fueron de sexo masculino (10/16). La mediana de la edad fue 56.5 años. La mediana del MELD fue de 17 (RIQ: 12.5-20.5, Rango 8-24). El diagnóstico hepático más frecuente fue cirrosis por NASH (4/16). Todos los pacientes tenían diagnóstico de ERC, en 4 casos secundaria a diabetes mellitus. Las indicaciones más comunes del trasplante fueron ascitis de difícil manejo, encefalopatía recurrente y desnutrición. El tiempo promedio de isquemia en frío del hígado fue de 7,3 horas, y del riñón 9,6 horas. La sobrevida de los pacientes y de los injertos hepático y renal fue de 87,5% al año y 67,3% a los 5 años. Cuatro pacientes murieron, 2 casos como consecuencia de sepsis y otros 2 por malignidad. Conclusión: el trasplante CLK en la Fundación Valle del Lili tiene resultados clínicos satisfactorios y comparables a los reportados en otros centros.

Introduction: Combined liver and kidney transplantation (CLK) has been shown to be a good alternative for patients with concomitant diagnosis of chronic kidney disease (CKD) and end-stage liver disease. Some studies have also shown immunological benefits from combined transplantation with decreased rates of kidney graft rejection. Objective: The objective of this study was to describe the indications and clinical outcomes of CLK transplant recipients in a highly complex hospital. Materials and Methods: CLK transplant patients were selected from the institutional transplant registry (Trenal) from 2000 to 2011. Demographic and clinical characteristics were described and survival of patients and grafts were estimated with the Kaplan-Meier method. Results: Over a period of 11 years, 16 CLK transplants were performed. This was 1.51% of kidney transplants and 3.48% of liver transplants done in the institution during this period. Most recipients were male (10/16). The median age was 56.5 years. The median MELD was 17 (IQR: 12.5 to 20.5, range: 8 to 24). The most frequent diagnosis was liver cirrhosis due to NASH (4/16). All patients had been diagnosed with CKD: four cases were secondary to diabetes mellitus. The most common indications for transplants were difficult to manage ascites, recurrent encephalopathy and malnutrition. The average liver cold ischemia time was 7.3 hours, and the average kidney cold ischemia time 9.6 hours. The five-year liver graft survival rate was 87.5%, and the five-year kidney graft survival rate was 67.3%. Four patients died: two as the result of sepsis and two as the result of malignancy. Conclusion: CLK transplantation results at the Fundación Valle del Lili have been satisfactory and comparable to those reported by other transplant centers.

Evaluation of diuretic activity of the constituents of Clematis montevidensis Spreng. (Ranunculaceae) in rats.

The effects of Clematis montevidensis Spreng. (Ranunculaceae) on urinary excretion of water, sodium and potassium were investigated in rats loaded with isotonic saline solution. The data reported in the present work indicate that the infusions of the root and aerial part of Clematis montevidensis showed a moderate diuretic activity. This effect could be due, at least in part, to the presence of oleanolic acid isolated from this plant.

Pruebas diagnósticas en miastenia gravis. Conformación de un estándar diagnóstico mediante un método de consenso / Diagnostic test in myasthenia gravis. Creation of a standard for diagnosis using a method of consensus

Introducción. En la actualidad la mejor prueba para el diagnóstico de miastenia gravis (MG) es la electromiografía de fibra única (EFU). Debido al coste de la prueba, pocos hospitales en el mundo la pueden tener para uso rutinario para confirmar el diagnóstico de MG. Objetivo. Identificar un estándar de oro aceptable para hospitales que no cuenten de manera habitual con EFU mediante la utilización de una metodología de consenso realizado en tres etapas. Sujetos y métodos. Las dos primeras etapas del estudio se realizaron mediante encuestas prolectivas y la tercera etapa mediante una metodología Delfos. En la primera etapa se aplicó un instrumento a 55 neurólogos generales donde se preguntaba cuál era la mejor combinación de pruebas y la mejor prueba aislada con las que habitualmente realizaban el diagnóstico de MG. En la segunda etapa se aplicó un segundo instrumento de recolección a 15 expertos de unidad motora (EUM), quienes analizaron cuatro situaciones clínicas frecuentes en la práctica (cuadro clínico clásico de MG generalizada, paciente con cuadro de miastenia ocular, cuadro de MG generalizada de mediana probabilidad y cuadro clínico de baja probabilidad), identificando la mejor prueba aislada y el mejor conjunto de pruebas para el diagnóstico de miastenia gravis con y sin el uso de EFU. Finalmente, se crearon cuatro flujogramas de las cuatro situaciones clínicas analizadas que fueron consensuados mediante una metodología Delfos con ocho neurólogos EUM. Resultados. Hemos identificado un estándar de oro aceptable para hospitales que no cuenten de manera general con EFU mediante una metodología de consenso. También hemos consensuado cuatro flujogramas diagnósticos de las situaciones clínicas más frecuentes a las que nos enfrentamos en la práctica clínica habitual. Conclusión. Hemos encontrado una serie de resultados con una utilidad importante para el diagnóstico de MG aplicables a médicos generales, médicos internistas y neurólogos que no cuenten con todas las pruebas disponibles para el diagnóstico de esta enfermedad (AU)

Regional and temporal progression of reactive astrocytosis in the brain of the myelin mutant taiep rat.

Reactive astrocytosis in taiep rats was shown by glial fibrillary acidic protein (GFAP) immunoreactivity measured by means of enzyme-linked immunosorbent assay and indirect immunofluorescence. Increased GFAP immunoreactivity was first observed in the brainstem of 15-day-old taiep rats and was widespread throughout all brain regions at 6 months of age. Characteristically, astrocytes were hypertrophic and displayed strong GFAP fluorescence. The pattern of these reactive cells may correlate with the process of dysmyelination in the taiep rat.

[Diagnostic tests in myasthenia gravis. Creation of a standard for diagnosis using a method of consensus]. / Pruebas diagnósticas en miastenia gravis. Conformación de un estándar diagnóstico mediante un método de consenso.

INTRODUCTION: Nowadays the best test for the diagnosis of myasthenia gravis (MG) is the single fiber electromyography (SFEMG). Due to the cost of the test it has not become routine in most part of the hospitals to confirm the diagnosis of MG. OBJECTIVE: To identify an acceptable gold standard for hospitals which do not have access to SFEMG, but have access to some other classical test through the use of a consensus methodology. SUBJECTS AND METHODS: The study was realized in three stages. The first two stages were done through a prolective survey and the third stage through a Delfos methodology. During the first stage 59 general neurologist were interviewed, applying an instrument in which they were asked which were the best test and the best group of tests to diagnose MG without using the SFEMG. During a second stage, a second collection instrument was applied to 15 experts in motoneuron diseases to identify the best isolated test and the best test scheme with and without using the SFEMG in four frequent clinical situations in clinical practice (typical clinical case of generalized MG, patient with ocular myasthenia, patient with generalized MG of medium and low probability). Finally four flowcharts were created of the four analyzed clinical situations and were approved through a Delfos methodology with 8 neurologist motoneuron disease. RESULTS: We identified an acceptable gold standard for hospitals which do not have access to SFEMG through the use of a consensus methodology. We have also completed four diagnostic flowcharts about the most frequent clinical situations that we have faced in the ordinary practice. CONCLUSIONS: We have found a series of important results for the diagnosis of MG available to general physicians, internists and neurologist that do not have all the test for the diagnosis of MG.

Lithium effect on testicular tissue and spermatozoa of viscacha (Lagostomus maximus maximus). A comparative study with rats.

We investigated the effect of lithium chloride administration (Sigma): 1 mmol/kg b.w. i.p./day for 35 days on the testes and sperm of viscacha (Lagostomus maximus maximus), a nocturnal rodent found only in the pampas of Argentina. The histological study showed that hypospermatogenesis and the sperm number per mL decreased markedly in comparison with the controls (treatment group: 315 x 10(6) +/- 77 x 10(6); control group: 693 x 10(6) +/- 39 x 10(6), Means +/- SEM, Student's t-test: p < 0.05). The sperm motility and viability were also affected. Under the same treatment, the testicular tissue and the sperm of rats were not damaged. Moreover, lithium induced these changes when the plasm levels were within the therapeutic range in humans. Our results provide evidence for the claim that viscacha testes and sperm react very sensitively to low doses of lithium, whereas these concentrations do not produce damage in rats.

The influence of the variable sample volume and constant added standard on the determination of copper, nickel and chromium by atomic absorption spectrometry.

Bader indicated as the most convenient approaches for the determination of an element by atomic absorption spectrometry the (1) continuous variation of standard at constant total volume, and (2) continuous variation of the unknown analyte at constant total volume. Considering the relevance of the ease of atomization, Bader's statement were put to the test in the determination of copper, nickel, and chromiun in nodular iron by use of analysis of variance (ANOVA). The results presented here lead to the conclusion that Bader's modes (1) and (2) are not equivalent for all cases.

Distribution of lithium in different CNS areas and other tissues of adult male and female vizcacha (Lagostomus maximus maximus).

In a previous study (1) we demonstrated that lithium administration (1.0 mmol/kg b.wt., per day for 4 weeks) in intact vizcacha (Lagostomus maximus maximus) leads to significant histological alterations in the kidneys, ovarie and testicles, while these three tissues were not damaged in rats. Male vizcachas died within 4 days when administered LiCl 3 mmol/kg b.wt., while females were not affected. The lithium renal clearance presented no changes in either males or females. The 1.0 mmol/kg b.wt. dose was used in the experiments (2). In this study we examined the distribution of lithium in various tissues of male and female vizcacha (Lagostomus maximus maximus) administered LiCl by injection (1 mmol/kg b.wt.) for one day (Group I) and thirty days (Group II). Blood sample was obtained after 24 hours (Group I) and 30 days (Group II). The tissues investigated were: pituitary, hypothalamus, cerebral cortex, cerebellum, corpus callous, small and large intestine, kidney and suprarenal. The concentration of lithium in tissues and serum was determined by atomic absortion spectrometry (3,4). In Group I a significant lithium concentration increment (mumol/g of tissue) was observed in all the tissues of male vizcachas as compared to female vizcacha. A similar distribution was obtained in animals treated for 30 days. In the pituitary, however this difference between males and females was not significant. The male lithium serum levels were significantly higher than those of female animals. In conclusion, we suggest that the particular structure of the cell membrane (e.g., number and characteristic of sodium channels) of each tissue and/or the intracellular mechanisms of transport, elimination and metabolism might explain the unequal lithium distribution and the difference recovery from the damage produced. The results suggest that the vizcacha could be a useful model for the study of lithium toxicity.

[Biochemical-histological study of the effects of lithium on various organs of vizcacha (Lagostomus maximus maximus)]. / Estudio bioquímico-histológico de los efectos de litio en algunos órganos de vizcacha (Lagostomus maximus maximus).

Considering that the vizcacha (Lagostomus maximus maximus) is a very Lithium sensitive rodent, we planned a biochemical-histological study injecting IP doses of 1 mEq/kg/day LiCl during one month to adult vizcachas, and they were divided into three lots: Lot I the optical microscopy revealed evident renal, gonadal, hyphophyseal and adrenal damages; the biochemical analysis showed that Li significantly decreased the female serum LH levels while testosterone and estradiol levels were not affected. The male Li serum values resulted to be significantly higher than those of female animals. The damage was greater in male specimens. Lott II: the tissue recovery from the damage observed in Lot I was the following: total in hyphophysis, partial in testis, the same in kidney and was enhanced in adrenal and ovary. The Li renal clearance was determined in Lot III verifying no changes in both sexs. According to our results, Li (1 mEq/kg/day during one month) produce modifications in different tissues probably the gonadal damage may be consequence of a direct Li effect and not for a hyphophysis alteration, since in male vizcacha the LH serum level was not changed. In regard to the selective effect in the suprarenal glomerulus structure, this Li effect is produced via hyphophysis. In conclusion, the selective effect of Li on adrenal and gonada organs of this rodent is a contribution in order to warm about the possible reproduction of such effects in human beings.

Estudio bioquímico-histológico de los efectos de litio en algunos organos de vizcacha (Lagostomus maximus maximus) / Biochemical-histological study of the effects of lithium in some organs of vizcacha (Lagostomus maximus maximus)

Considerando que la vizcacha (lagostomus maximus maximus) es un roedor muy sensible al Litio (Li), planificamos un estudio bioquímico-histológico inyectando cloruro de Li 1 mEq/Kg/día vía intraperitoneal durante un mes a vizcachas adultas de ambos sexos agrupadas en tres lotes. En el lote I se comprobó por técnicas de microscopía óptica un evidente dano renal, gonodal, hipofisario y adrenal; por métodos bioquímicos se comprobó que el Li disminuyó significativamente los niveles séricos de LH en hembra, el contenido de testosterona y estradiol no fue modificado. En machos el Li sérico resultó significativamente mayor (p<0.01, Prueba de t) que en hembras. El dano fue mayor en machos. en el Lote II se estudió a 30 días de la última administración el grado de recuperación tisular del dano comprobado en el Lote I. Se verificó una recuperación total en hipófisis, parcial en testículo, nula en rinón y se incrementó el dano en adrenal y ovario. Con respecto al efecto seletivo sobre la zona glomerulosa adrenal del Li sería producido via hipófisis. En conclusión el efecto selectivo de Li en adrenal y gónadas en este roedor es una contribución para alertar sobre la posible producción de estos efectos en humanos (AU)

Estudio bioquímico-histológico de los efectos de litio en algunos órganos de vizcacha (Lagostomus maximus maximus). / [Biochemical-histological study of the effects of lithium on various organs of vizcacha (Lagostomus maximus maximus)]

Considering that the vizcacha (Lagostomus maximus maximus) is a very Lithium sensitive rodent, we planned a biochemical-histological study injecting IP doses of 1 mEq/kg/day LiCl during one month to adult vizcachas, and they were divided into three lots: Lot I the optical microscopy revealed evident renal, gonadal, hyphophyseal and adrenal damages; the biochemical analysis showed that Li significantly decreased the female serum LH levels while testosterone and estradiol levels were not affected. The male Li serum values resulted to be significantly higher than those of female animals. The damage was greater in male specimens. Lott II: the tissue recovery from the damage observed in Lot I was the following: total in hyphophysis, partial in testis, the same in kidney and was enhanced in adrenal and ovary. The Li renal clearance was determined in Lot III verifying no changes in both sexs. According to our results, Li (1 mEq/kg/day during one month) produce modifications in different tissues probably the gonadal damage may be consequence of a direct Li effect and not for a hyphophysis alteration, since in male vizcacha the LH serum level was not changed. In regard to the selective effect in the suprarenal glomerulus structure, this Li effect is produced via hyphophysis. In conclusion, the selective effect of Li on adrenal and gonada organs of this rodent is a contribution in order to warm about the possible reproduction of such effects in human beings.

Estudio bioquímico-histológico de los efectos de litio en algunos organos de vizcacha (Lagostomus maximus maximus) / Biochemical-histological study of the effects of lithium in some organs of vizcacha (Lagostomus maximus maximus)

Considerando que la vizcacha (lagostomus maximus maximus) es un roedor muy sensible al Litio (Li), planificamos un estudio bioquímico-histológico inyectando cloruro de Li 1 mEq/Kg/día vía intraperitoneal durante un mes a vizcachas adultas de ambos sexos agrupadas en tres lotes. En el lote I se comprobó por técnicas de microscopía óptica un evidente dano renal, gonodal, hipofisario y adrenal; por métodos bioquímicos se comprobó que el Li disminuyó significativamente los niveles séricos de LH en hembra, el contenido de testosterona y estradiol no fue modificado. En machos el Li sérico resultó significativamente mayor (p<0.01, Prueba de t) que en hembras. El dano fue mayor en machos. en el Lote II se estudió a 30 días de la última administración el grado de recuperación tisular del dano comprobado en el Lote I. Se verificó una recuperación total en hipófisis, parcial en testículo, nula en rinón y se incrementó el dano en adrenal y ovario. Con respecto al efecto seletivo sobre la zona glomerulosa adrenal del Li sería producido via hipófisis. En conclusión el efecto selectivo de Li en adrenal y gónadas en este roedor es una contribución para alertar sobre la posible producción de estos efectos en humanos

[Antibiotic susceptibility to microorganisms isolated in blood cultures of patients an the Ignacio Chavez National Institute of Cardiology]. / Susceptibilidad a antimicrobianos de microorganismos aislados en hemocultivos de pacientes del Instituto Nacional de Cardiología Ignacio Chávez.

A microdilution method was utilized for determining susceptibility to several antimicrobial agents in 142 bacterial blood culture isolates obtained during a one year period. Associated clinical features were also identified. Three cases of polymicrobial bacteriemia were found. Endocarditis was the most frequent source of bacteriemia (28.5%) and the viridans streptococci were the most frequently isolated microorganism (53%). Surprisingly, half of the bacteriemic episodes corresponded to a nosocomial infection most of which were due to staphylococci (25%) and Enterobacter sp (22%). Viridans streptococci group were 61.5% resistant to penicillin (MIC > 0.12 micrograms/mL). These strains also showed a 31% resistance to ceftriaxone (MIC > 8 micrograms/mL). The staphylococcal strains showed a 19% resistance to oxacillin; this resistance occurred for coagulase negative staphylococcis in 32% (6/19) and for S. aureus in 9% (2/22). All Gram-positive microorganisms were susceptible to vancomycin. The enterobacteria group were susceptible to most antimicrobial agents; nevertheless this group showed a 45% resistance to amikacin. In contrast, the non enterobacteria group were resistant to most of the antimicrobial agents tested except to imipenem, ceftazidime and ciprofloxacin. When comparing susceptibility longitudinally, no significative changes were identified, but a significant increase was found in MIC50-90 to amikacin and cephalothin when testing S. aureus, and cefoperazone in the non enterobacteria group.

Actitud de los trabajadores de la salud ante la participacion de la comunidad, Municipio de Medellin, Noviembre de 1983 / Health workers attitude towards community participation, Municipio de Medellin, November 1983

Se realizo un estudio de tipo descriptivo en el cual mediante un instrumento estructurado segun la escala Likert, se midio la actitud ante la PACO (participacion activa de la comunidad), de los trabajadores de la salud, representados en medicos, odontologos y enfermeras de los centros de salud y unidades intermedias de la secretaria de Salud Publica y bienestar social de Medellin. La actitud se considero entre otras, una caracteristica necesaria para lograr la extension de cobertura de los servicios de salud y mejorar asi las condiciones sanitarias de los diferentes grupos humanos. En este estudio la actitud se agrupo en favorable, desfavorable e intermedia, por poblacion y profesion respectivamente. El proposito del estudio fue dar a conocer a la secretaria de Salud, los resultados para que se establezcan mecanismos de accion en la implementacion de la PACO. Sus objetivos: medir la actitud de los trabajadores de la salud ante la PACO; identificar los factores determinantes de la actitud y, probar el instrumento disenado. En el analisis se obtuvo que la formacion universitaria, la experiencia en PACO y el ano de egreso, son factores determinantes de la actitud favorable ante la PACO.