Renal replacement therapy prior to liver transplant and inpatient mortality in patients without advanced kidney disease: A nationwide study.

Background and Aim: The utility of renal replacement therapy (RRT) before liver transplant (LT) in patients without end-stage renal disease (ESRD) or advanced chronic kidney disease (CKD-IV/V) is debatable and lacks data support. We aimed to evaluate the impact of RRT on patients undergoing LT. Methods: We used the National Readmission Database (2016-2019) to identify all index hospitalizations undergoing RRT before LT (cases). A matched comparison cohort of similar hospitalizations without RRT before LT was identified (controls) after 1:1 propensity score matching for age, gender, and available comorbidities. Results: We matched 364 cases (RRT before LT) to 364 controls (LT without prior RRT). There was no statistical difference in all-cause inpatient mortality (4.9% vs 3.6% P = 0.4). A significantly greater proportion of cases were associated with ICU admission (40.7% vs 17.0%, P < 0.001) and RRT requirement post LT (100% vs 17%, P < 0.001). There was no difference in 30- (hazard ratio [HR] 1.1, 0.4-2.6), 60- (HR 0.9, 0.4-1.8), or 90-day (HR 0.8, 0.4-1.6) inpatient mortality between the groups. Also, 180-day survival estimates were comparable (P = 0.5). The results were similar in patients with no chronic kidney disease (CKD) and CKD-III. Conclusion: RRT prior to LT, in patients without advanced CKD or ESRD, was associated with greater instances of ICU stay and need for future RRT. Also, 30-, 60-, and 90-day inpatient mortality rates were similar, and 180-day survival estimates were comparable.

Management of Decompensated Cirrhosis and Associated Syndromes.

Patients with cirrhosis account for 3% of intensive care unit admissions with hospital mortality exceeding 50%; however, improvements in survival among patients with acutely decompensated cirrhosis and organ failure have been described when treated in specialized liver transplant centers. Acute-on-chronic liver failure is a distinct clinical syndrome characterized by decompensated cirrhosis associated with one or more organ failures resulting in a significantly higher short-term mortality. In this review, we will discuss the management of common life-threatening complications in the patient with cirrhosis that require intensive care management including neurologic, cardiovascular, gastrointestinal, pulmonary, and renal complications.

Outcomes among inpatients with cirrhosis and Clostridioides difficile infection in the modern era: results from an analysis of the National Inpatient Sample.

BACKGROUND: Patients with cirrhosis are at increased risk of Clostridioides difficile infection (CDI). We analyzed outcomes and healthcare utilization in hospitalized cirrhotic patients with CDI. METHODS: The Nationwide Inpatient Sample from 2016-2017 identified 8245 hospitalized patients with a concurrent diagnosis of cirrhosis and CDI. Our primary outcome was in-hospital all-cause mortality. Secondary outcomes were length of stay (LOS), hospitalization charges and costs, shock, sepsis, acute kidney injury (AKI), intensive care unit (ICU) admission, and home discharge. RESULTS: There was no significant difference in all-cause in-hospital mortality between patients with cirrhosis compared to patients without cirrhosis (adjusted odds ratio [aOR] 1.31, 95% confidence interval [CI] 0.89-1.93; P=0.16). Patients with cirrhosis had a slightly but statistically significantly longer mean LOS (+0.57 days, P=0.001). The adjusted difference in mean hospitalization charges was greater in patients with cirrhosis ($+4094, 95%CI $1080-7108; P=0.008), as was the mean hospitalization cost ($+1349, 95%CI $600-2098; P<0.001). There was no difference in the likelihood of sepsis, ICU admission, or home discharge between the groups. Patients with cirrhosis were significantly less likely to develop AKI (aOR 0.82, 95%CI 0.72-0.93; P=0.003). CONCLUSIONS: Mortality outcomes associated with CDI have improved over time. Patients with cirrhosis continue to exhibit greater LOS and hospital costs.

Carta al editor: Manual de práctica clínica basado en la evidencia: preparación del paciente para el acto quirúrgico y traslado al quirófano / Letter to the Editor: Evidence based clinical practice manual: Patient preparation for surgery and transfer to the operating room

Letter to the Editor

[Emergency oral contraception policy: the Peruvian experience]. / Política de anticoncepción oral de emergencia: la experiencia peruana.

Emergency oral contraception is part of the sexual and reproductive rights of women. In 2001, this health policy was incorporated into the Rules of the National Family Planning Program of the Ministry of Health, primarily to prevent unwanted pregnancy and its serious consequences, induced abortion and the high associated maternal mortality rate, which are major public health problems. Scientific research has confirmed that the main mechanism of action of levonorgestrel, component of emergency oral contraception (EOC) is to inhibit or delay ovulation, preventing fertilization of the egg; additionally, it increases the thickening of the cervical mucus, making the sperm migration more difficult. No study has found endometrial abnormalities that may interfere with the implantation of the fertilized egg or embryo development of an implanted egg. However, despite the support of medical science and legal backing, the EOC is available only to users with economic resources, but its use has not been fully implemented in public sector services, due to obstacles created by groups opposed to contraception under claim of an alleged abortive effect that has already been ruled out scientifically. This article describes the administrative experience and legal confrontations between groups of power that prevent the proper implementation of an emergency contraception policy in Peru.

Política de anticoncepción oral de emergencia: la experiencia peruana / Emergency oral contraception policy: the peruvian experience

La anticoncepción oral de emergencia es parte del derecho sexual y reproductivo de la mujer. En el año 2001, esta política de salud fue incorporada en las Normas del Programa Nacional de Planificación Familiar del Ministerio de Salud, principalmente para prevenir el embarazo no deseado y sus graves consecuencias, el aborto inducido y la alta tasa de mortalidad materna que conlleva, los cuales constituyen importantes problemas de salud pública. La investigación científica ha confirmado que el principal mecanismo de acción del levonorgestrel, componente de la anticoncepción oral de emergencia (AOE), es inhibir o postergar la ovulación, evitando la fecundación del óvulo; adicionalmente incrementa el espesamiento del moco cervical que dificulta la migración espermática. Ningún estudio ha encontrado alteraciones endometriales que puedan interferir con la anidación del óvulo fecundado ni del desarrollo embrionario de un óvulo implantado. No obstante del soporte de la ciencia médica y del aval legal recibido, la AOE está disponible solo para usuarias con recursos económicos, pero su uso no se ha implementado plenamente en los servicios del sector público, debido a obstáculos generados por grupos opositores a la anticoncepción, aferrándose a un supuesto efecto abortivo que ha sido descartado científicamente. El presente artículo describe la experiencia administrativa y los enfrentamientos legales entre los grupos de poder que impiden la adecuada implementación de una política de anticoncepción oral de emergencia en el Perú.

Emergency oral contraception is part of the sexual and reproductive rights of women. In 2001, this health policy was incorporated into the Rules of the National Family Planning Program of the Ministry of Health, primarily to prevent unwanted pregnancy and its serious consequences, induced abortion and the high associated maternal mortality rate, which are major public health problems. Scientific research has confirmed that the main mechanism of action of levonorgestrel, component of emergency oral contraception (EOC) is to inhibit or delay ovulation, preventing fertilization of the egg; additionally, it increases the thickening of the cervical mucus, making the sperm migration more difficult. No study has found endometrial abnormalities that may interfere with the implantation of the fertilized egg or embryo development of an implanted egg. However, despite the support of medical science and legal backing, the EOC is available only to users with economic resources, but its use has not been fully implemented in public sector services, due to obstacles created by groups opposed to contraception under claim of an alleged abortive effect that has already been ruled out scientifically. This article describes the administrative experience and legal confrontations between groups of power that prevent the proper implementation of an emergency contraception policy in Peru.

[Innovation in research]. / Innovación en la investigación.

We briefly revise the economic resources that the State allocated between the years 2000 and 2005, and their relationship with the production of research projects. In face of the few fiscal resources, innovations are proposed to the traditional research model, sustained in producing new products. Assuming it is possible to perform innovations in the process of producing a service or a product, which implies modifying the regional and national policies, driving the model proposed by P. Drucker of producing innovations with technology with T in capital letters, would on turn generate patents and social and economic profitability.

Innovación en la investigación / Innovation in research

Se revisa brevemente los recursos económicos que el Estado entre los años 2000 a 2005, y su relación con la producción de trabajos de investigación. Frente a los escasos recursos fiscales se propone innovaciones en el modelo tradicional de investigación sostenido en producir nuevos productos. Asumiendo que es posible realizar innovaciones en el proceso de producción de un servicio o de un producto, lo cual implica modificar las políticas regionales y nacionales impulsando el modelo planteado por P. Drucker de producir innovaciones con tecnología T mayúscula, lo cual generaría patentes y rentabilidad económica y social.

We briefly revise the economic resources that the State allocated between the years 2000 and 2005, and their relationship with the production of research projects. In face of the few fiscal resources, innovations are proposed to the traditional research model, sustained in producing new products. Assuming it is possible to perform innovations in the process of producing a service or a product, which implies modifying the regional and national policies, driving the model proposed by P. Drucker of producing innovations with technology with T in capital letters, would on turn generate patents and social and economic profitability.

La metoclopramida no disminuye la incidencia de náusea y vómito postoperatorios cuando se asocia a dexametasona en pacientes ambulatorios llevados a procedimientos otorrinolaringológicos / Metoclopramide do not reduce the incide of postoperative nausea and vomiting, associated to dexamethasone in ambulatory patients undergoing ambulatory ear, nose and thorat surgery

Objetivo: evaluar el efecto profiláctico antiemético de la combinación dexametasona – metoclopramida en pacientes llevados a procedimientos otorrinolaringológicos. Materiales y Métodos: En este estudio doble ciego y placebo controlado, 208 pacientes ambulatorios anestesiados con una técnica anestésica convencional, fueron aleatorizados para recibir dexametasona 8 mg durante la inducción anestésica y metoclopramida, 10 mg al final de la cirugía (Grupo A), dexametasona, 8 mg durante la inducción anestésica y placebo al final de la cirugía (Grupo B), placebo durante la inducción anestésica y metoclopramida, 10 mg al final de la cirugía (Grupo C) o placebo durante la inducción anestésica y al final de la cirugía (Grupo D). La ausencia de vómito y de náusea moderada y no solicitud de administración de medicación antiemética de rescate, se consideraron componentes de la respuesta completa al tratamiento antiemético. Resultados: Durante el período pre-alta del hospital, el número de pacientes que experimentaron respuesta completa al tratamiento profiláctico fue significativamente mayor en los grupos B (90.4%) y A (86.5%) al compararlos con los grupos D (55.8%) y C (75%). A las 24 horas, la proporción de pacientes con una respuesta completa fue significativamente mayor en el grupo A (96.2%) en comparación con los grupo C (67.3%) y D (78.8%) y de igual forma en el grupo B (88%) en comparación con el grupo C (67.3%). Conclusiones: La combinación de dexametasona con metoclopramida no es significativamente más efectiva que la administración de dexametasona sola en la profilaxis de náusea y vómito postoperatorios.

Objective: The aim of this study was to evaluate the prophylactic antiemetic effects of the combination dexamethasone – metoclopramide in patients undergoing ear-nose-throat procedures. Materials and methods: In this placebo-controlled, double-blind study, 208 outpatients under standardized anesthetic were randomized to receive dexamethasone 8 mg before anesthesia induction and metoclopramide, 10 mg at the end of surgery (Group A), dexamethasone 8 mg before anesthesia induction and placebo at the end of surgery (Group B), placebo before anesthesia induction and metoclopramide, 10 mg at the end of surgery (Group C) or placebo before anesthesia induction and at the end of surgery (Group D). Complete response to prophylactic antiemetic medication was defined as no vomiting no sustained moderate nausea and no requesting of antiemetic drug. Results: During predischarge period, the number of patients with complete response to prophylactic antiemetic medication was significantly higher in groups B (90.4%) and A (86.5%) in comparison with groups D (55.8%) and C (75%). At the 24 h follow-up evaluation, complete response was higher in group A (96.2%) in comparison with groups C (67.3%) and D (78.8%). Conclusions: combination dexamethasone-metoclopramide is not more effective than administration of dexamethasone alone in the posoperative profylaxis of nausea and vomiting.

Comparison of spinal anesthesia with combined sciatic-femoral nerve block for outpatient knee arthroscopy.

STUDY OBJECTIVE: To compare spinal anesthesia and combined sciatic-femoral nerve block for outpatient knee arthroscopy. DESIGN: Prospective, randomized, controlled study. SETTING: Postoperative recovery area at a university-affiliated medical center. PATIENTS: 50 ASA physical status I and II adult outpatients undergoing arthroscopic knee surgery. INTERVENTIONS: Study subjects were equally divided (n = 25 each) into spinal and sciatic-femoral groups. Spinal group patients received spinal anesthesia with 7.5 mg of 0.5% hyperbaric bupivacaine. Sciatic-femoral group patients received combined sciatic-femoral nerve blocks using a mixture of 20 mL of lidocaine 2% plus 20 mL of bupivacaine 0.5%. MEASUREMENTS: Times including that from arrival in the operating room to readiness for surgery, duration of surgery, recovery time, and patient satisfaction were recorded. Analgesia and occurrence of adverse events also were recorded. MAIN RESULTS: No significant differences between the two groups were found for any of the study measurements of recovery. After discharge, postoperative pain differed significantly between groups only at 6 hours (P < 0.002). Patient satisfaction was high with both techniques. CONCLUSIONS: Combined sciatic-femoral nerve block for outpatient arthroscopic knee surgery offers satisfactory anesthesia, with a clinical profile similar to that of low-dose spinal anesthesia. Sciatic-femoral nerve blocks are associated with significantly lower pain scores during the first 6 postoperative hours.

Eliminación sostenida de los desórdenes por deficiencia de yodo en Perú. 25 años de experiencia / Sustained elimination of iodine deficiency disorders in Perú. 25 years experience

Introducción: la prevalencia de bocio y cretinismo endémicos en sierra y selva ha sido reconocida a través de la historia del Perú, dado que la deficiencia natural de yodo es permanente, sin embargo recibió poca atención. Nuevas investigaciones a partir de los 60s demostraron la persistencia severa de la deficiencia y, principalmente, que la deficiencia de yodo es causa de daño cerebral, dando como resultado la creación de un programa para control de los desordénes por deficiencia de Iodo (DDI) en 1983. El programa se implementó de manera efectiva en 1986.Material y método: el plan de acción estratégico incluyó protección inmediata de la población en riesgo alto con aceite yodado e incremento progresivo en producción, calidad y consumo de sal yodada, al mismo tiempo que se desarrolló una red de trabajo nacional bien entrenada y motivada, con el apoyo de un intenso programa de comunicación, abogacía y mercadeo social, y un sistemático monitoreo del yodo en la sal y en la población. Resultados: desde 1995 la demanda poblacional de sal yodada está ampliamente cubierta y más de 90 por ciento de hogares consumen sal adecuadamente yodada desde 1998. Se ha normalizado la nutrición de yodo en la población, la media del yodo urinario, principal indicador, se ha mantenido sobre 100 μg/l desde 1995. La disminución significativa en prevalencia de bocio fue observada a seis años de iniciado el programa. Entre los factores para el éxito alcanzado destacan el sistema demonitoreo y vigilancia, el programa educativo promocional, el soporte permanente del MINSA y el apoyo de la industria salinera. Conclusiones: el Perú ha logrado la eliminación sostenida de DDI previniendo el daño cerebral en 600 mil recién nacidos cada año. El programa es reconocido como uno de los más exitosos a nivel mundial.

Introduction: Endemic goiter and cretinism in both highlands and Amazon jungle regions have been recognized in Peruvian history, because of the permanent natural iodine deficiency in these areas, and both conditions received little attention. New research studies initiated in the 60s proved the persistence of severe iodine deficiency, and also that this deficiency is a cause of preventable brain damage, so a program for controlling iodine deficiency disorders was created in 1983, and it was fully implemented in 1986. Material and method: The strategic action plan of the program included immediate protection of the population at high risk with the use of iodized oil and a progressive increase in production, quality and consumption of iodized salt. At the same time a well-trained and motivated national network was developed, with the support of an intensive communication program, advocacy and social marketing, and with systematic monitoring of the iodine contents in salt and iodine levels in the population. Results: Since 1995, the demand of iodized salt is well covered, and adequately iodized salt is consumed by more than 90 per cent of households since 1998. Currently, iodine nutritional levels are normal, and the median urinary iodine value, the best indicator of iodine levels, has stayed above 100 ìg/L since 1995. A significant decrease in the prevalence of goiter was already observed six years after the program started. Factors for this Program success include monitoring and surveillance systems, as well as effective communication and support from the Ministry of Health and the salt industry. Conclusions: Perú has succeeded in the sustained elimination of iodine deficiency disorders, preventing brain damage in six hundred thousand newborns each year. The control program has been recognized as one of the most successful of its kind all over the world.

Comparación de anestesia espinal versus bloqueo nervioso ciático-femoral en pacientes ambulatorios sometidos a cirugía artroscópica de rodilla / Comparison of spinal anesthesia versus nervous sciatic - femoral blockade in ambulatory patients submitted to surgery artroscópica of knee

Se ha sugerido que la anestesia regional posee efectos benéficos en cirugía ambulatoria resultando en mejor analgesia, superior satisfacción del paciente y disminución de la utilización de recursos. El objetivo del presente estudio fue comparar dos técnicas anestésicas regionales en relación con la preparación para cirugía y la recuperación de los pacientes, en una población ambulatoria estandarizada. Métodos: Se estudiaron 50 pacientes adultos, ASA I-II, sometidos a cirugía artroscópica de rodilla. Los sujetos se dividieron aleatoriamente en grupo espinal (n = 25) y grupo ciático-femoral (n=25). Pacientes del grupo espinal recibieron anestesia subaracnoidea con 7.5 mg de bupivacaina hiperbárica. Pacientes del grupo ciáticofemoral recibieron bloqueo nervioso ciático-femoral utilizando una mezcla de 20 mL de lidocaina al 2 por cien más 20 mL de bupivacaina al 0.5 por cien. Se registraron los tiempos desde el ingreso a salas de cirugía hasta el comienzo de la misma, duración del procedimiento quirúrgico, tiempos de recuperación, satisfacción del paciente, calidad de la analgesia y ocurrencia de efectos adversos. Resultados: No se encontraron diferencias significativas en las medidas de recuperación entre los dos grupos. Luego de la salida del hospital el dolor difirió significativamente a las 6 horas post-operatorias (P = 0.002). La satisfacción fue alta con ambas técnicas. Conclusiones: En pacientes sometidos ambulatoriamente a cirugía artroscópica de rodilla la utilización de bloqueo nervioso ciático-femoral ofrece anestesia satisfactoria con un perfil clínico similar al obtenido con anestesia espinal a bajas dosis. Sin embargo, el bloqueo ciático-femoral se asocia significativamente con menos dolor durante las primeras 6 horas post-operatorias.

Variación y distribución genética de los SNP's 19, 43 y 63 del gen de susceptibilidad de diabetes tipo 2 Calpaina 10 (Capn10) en la población peruana / Variation and genetic distribution of SNP's 19, 43 y 63 of the susceptibility gene calpain 10 (Capn10) for the type 2 diabetes in the peruvian population

La diabetes tipo 2 es una enfermedad compleja que tiene un componente genético. Calpaina 10 (CAPN10) es un gen de susceptibilidad para este gen y está localizado en 2q37.3. Pacientes de algunas poblaciones de origen amerindio presentan las frecuencias alélicas de los SNP19, 43 y 63 del gen CAPN10, que sugiere una relación causal entre este gen y la biabetes tipo 2. El origen filogenético común, nos permite suponer que CAPN10 también sería un gen de susceptibilidad en la población peruana nativa y mestiza, lo cual nos motivó a investigar esta relación en nuestra población. Se obtuvieron resultados de la frecuencia alélica de los SNP19, 43 y 63 de CAPN10 en 129 controles normales de Lima, la mayoría de origen mestizo. Además de la prueba del equilibrio de Hardy-Weinberg (H-W) para determinar si la población tiene una distribución genéticamente homogénea en dichos marcadores. Se puede concluir que la prueba de H-W sugiere fuertemente que nuestra población control es adecuada para un estudio de asociación y desequilibrio de ligamiento en pruebas caso-control. Esto a su vez es la base para futuros estudios de asociación y desequilibrio de ligamiento, postulando a CAPN10 como gen de susceptibilidad de diabetes tipo 2 en la población peruana.

Type 2 diabetes is a complex genetic disorder, where the gene calpain 10 (CAPN10) located in 2q37.3, plays an important role. Allele frequencies of SNP19, 43 and 63 are present in affected Amerindian populations and might suggest a possible relationship between CAPN10 and type 2 diabetes. The fact that Amerindian populations has a common phyllogenetic origin was our main motivation for studying this possible relation, because it would suggest' that CAPN10 is a susceptibility gene for native and admixed Peruvian populations. Allelic frequencies of SNP19, 43 and 63 of calpain 10 was obtained of 129 normal controls from Lima, most of them admixed population. Hardy-Weinberg test (H-W) was used in order to determine if the population had a genetically homogenous distribution for the employed molecular markers. It can be concluded that the H-W test strongly suggests that the control population is adequate for an association and linkage disequilibrium in case-control studies. Furthermore, this would mean be thstart of future association and linkage disequilibrium studies where CAPN10 would be considered as a susceptibility gene for type 2 diabetes in Peruvian population.

Determinación de la frecuencia alélica del SNP 19 del gen Calpaína 10 (CAP10) y factores de riesgo de diabetes 2 en población peruana / Determination of SNP allele frequency of Calpain 19 of the gene 10 (CAP10) and risk factors for type 2 diabetes in Peruvian population

La diabetes tipo 2 es una enfermedad compleja que tiene un componente genético. Se ha comprobado que calpaína 10 (CAPN10) localizado en 2q37.3, constituye un gen de susceptibilidad para esta enfermedad. La asociación alélica y haplotípica con diabetes, observada en poblaciones amerindias (México-americana, pima, surui y maya), y algunas europeas (finlandesas y alemanas), confirmarían estos resultados. El origen ancestral amerindio nos hace suponer que CAPN10 constituiría un gen de susceptibilidad en población peruana nativa y mestiza. Para utilizar los alelos del CAPN10 como factores de riesgo genético necesitamos establecer la frecuencia en la población normal. En el presente trabajo se observa la frecuencia de los alelos SNP19 en 116 controles normales de Lima, mayormente de origen mestizo. La frecuencia alélica analizada es similar a la descrita en las poblaciones mexico-americanas.

Type 2 diabetes is a complex disorder where genetic factors play an important role. Several studies suggest that some genetic variants of calpain 10 (CAPN10) increase susceptibility to type 2 diabetes. Some allelic and haplotype combinations are associated with increased risk in Amerindian populations (Mexican American, Pima and Surui) and Finnish and German groups. The ancestral Amerindian origin suggests that CAPN10 is a susceptibility gene in native and admixed Peruvian populations. To use CAPN10 alleles as genetic risk factors, we need to establish their baseline frequencies in normal populations. Allele frequencies of SNP19 in 116 individuals of Lima (admixed population) are similar to those reported for Mexican American groups.

[Renal trauma in childhood. Second-level hospital experience]. / Trauma renal en la edad pediátrica. Experiencia de un hospital de segundo nivel.

UNLABELLED: The leading cause of death in children is accidents. Severe craniocerebral trauma and injuries to the heart or major vessels are mainly responsible for immediate death. This phenomenon is also reflected in the increasing number of pediatric admissions for renal trauma. MATERIAL AND METHODS: From 1990 to 2000, the charts of 132 patients with renal injuries secondary to blunt and penetrating trauma in childhood are reviewed. RESULTS: A total of 88 were male patients and 126 sustained blunt trauma (motor accidents, falls, etc.). Gross and microscopic hematuria were the most important finding at the time of presentation, and correlated with severe renal injury, and both were present in 122 cases. Intravenous pyelography and CT scan were the most useful diagnosis tools. Only 27 patients were managed operatively, the majority because of associated intra-abdominal injury. CONCLUSIONS: Intravenous pyelography remains the most cost-effective means of investigating renal injuries in a second-level hospital. Renal contusion and most laceration should be managed conservatively. Only few a renal transactions should be managed operatively.

Trauma renal en la edad pediátrica. Experiencia de un hospital de segundo nivel / Renal trauma in childhood. Second-level hospital experience

The leading cause of death in children is accidents. Severe craniocerebral trauma and injuries to the heart or major vessels are mainly responsible for immediate death. This phenomenon is also reflected in the increasing number of pediatric admissions for renal trauma. MATERIAL AND METHODS: From 1990 to 2000, the charts of 132 patients with renal injuries secondary to blunt and penetrating trauma in childhood are reviewed. RESULTS: A total of 88 were male patients and 126 sustained blunt trauma (motor accidents, falls, etc.). Gross and microscopic hematuria were the most important finding at the time of presentation, and correlated with severe renal injury, and both were present in 122 cases. Intravenous pyelography and CT scan were the most useful diagnosis tools. Only 27 patients were managed operatively, the majority because of associated intra-abdominal injury. CONCLUSIONS: Intravenous pyelography remains the most cost-effective means of investigating renal injuries in a second-level hospital. Renal contusion and most laceration should be managed conservatively. Only few a renal transactions should be managed operatively.

Evaluación a mediano plazo de pacientes con enfermedades de Graves tratados con Yodo Radioactivo (I131) / Evaluation to medium term of patients with diseases of serious agreements with radioactive iodine (I131)

El presente estudio evalúa la evolución temprana del tratamiento del hipertiroidismo por Enfermedad de Graves con yodo radioactivo (I131)), en un grupo de 180 pacientes del Servicio de Endocrinología del Hospital Nacional Cayetano Heredia y de un centro asistencial privado, tratados entre 1991 a 1997 con el mismo protocolo. De (metimazol). Hubo 58 pacientes (32 por ciento) con exoftalmos leve, 24 de los cuales habían recibido prednisona desde antes del tratamiento con yodo radioactivo. La dosis de yodo radioactivo osciló entre 80-100 uCi por gramo de tejido tiroideo y la gran mayoría recibió una sola dosis. El 89 por ciento de mujeres y la edad promedio 37.6 años. El control de pacientes hasta 21 meses mostró que la concurrencia fue alta en los primeros tres y satisfactoria hasta un año, pero luego se observó una ausencia progresiva, siendo mayor dentro del sector público. La evolución post-tratamiento se caracterizó por la concurrencia temprana de hipotiroidismo, 24 por ciento en los tres primeros meses, seguida de un incremento más lento hasta 40 por ciento a los 21 meses, no se ha descartado la posibilidad de hipotiroidismo transitorio en parte de estos pacientes. Al mismo tiempo se aprecia que el hipertiroidismo desaparece rápidamente en los primeros tres meses en alrededor de 50 por ciento de los pacientes, persistiendo sólo un 5 por ciento a los 21 meses. No se observó relación entre la evolución clínica y la dosis de yodo radioactivo por gramo de tejido tiroideo. El estudio muestra, además, que el pre-tratamiento con antitiroideos resulta beneficioso, en cuanto favorece la recuperación del estado eutiroideo y disminuye el riesgo de hipertiroidismo. En esta serie no se aprecia exacerbación del exoftalmos, sino más bien disminución del mismo, indistintamente del tratamiento no con prednisona; el beneficio preventivo de la corticoterapia sobre otras manifestaciones de la oftalmopatía no fue evaluado.