Manejo anestésico del transplante intestinal: Reporte de un caso / Anesthetic management for bowel transplantation. Case report

Antecedentes: El Síndrome de Intestino Corto (SIC) se caracteriza por diarrea, pérdida de peso y desnutrición en pacientes que sufren de algún trastorno en la motilidad o absorción intestinal o en aquellos que por diversas causas se les ha resecado más del 50 por ciento de la longitud intestinal total y que requieren de apoyo nutricio parenteral más allá de 3 meses. Hasta 1997 se habían reportado 273 casos de trasplante intestinal en el mundo, el presente reporte está relacionado con el segundo en nuestro país y el primero realizado de donador vivo relacionado. Caso clínico: Paciente masculino de 21 años de edad con SIC secundario a lesión por proyectil de arma de fuego que condicionó resección intestinal, con una longitud residual total de 10cm de intestino delgado y 55cm de colon. Se inició la preparación para trasplante intestinal con injerto de su hermana con quien compartía 3 antígenos HLA y grupo sanguíneo. Se monitorizó al paciente en forma invasiva y no invasiva. La anestesia se administró con Citrato de Fentanyl e Isoflurano en 02 al 100 por ciento. Se tomaron registros de ph, electrolitos, pruebas de coagulación, hemoglobina, hematocrito y plaquetas durante un tiempo quirúrgico y anestésico de 19 y 20 horas respectivamente. Se manejo la terapia inmunosupresora desde el período pre, trans y postanestésico. La ecolución postoperatoria inicial fue satisfactoria hasta el séptimo día en que presentó datos de lesión pulmonar aguda y muerte. Conclusión: Aunque el programa de trasplante intestinal está iniciando, ofrece una alternativa de manejo para pacientes con síndrome de intestino corto.

Mycoplasma penetrans bacteremia and primary antiphospholipid syndrome.

Mycoplasma penetrans, a rare bacterium so far only found in HIV-infected persons, was isolated in the blood and throat of a non-HIV-infected patient with primary antiphospholipid syndrome (whose etiology and pathogenesis are unknown).

Thyroid hormones and cytogenetic outcomes in backpack sprayers using ethylenebis(dithiocarbamate) (EBDC) fungicides in Mexico.

Ethylenebis(dithiocarbamate) (EBDC) fungicides are used heavily in the United States. EBDCs (e.g., mancozeb, maneb) are metabolized to ethylene thiourea (ETU). The EPA classifies ETU as a carcinogen, based on thyroid and other cancers in rodents, and has restricted the use of EBDCs, while requiring workers to use protective equipment. There are no data on the potential carcinogenicity of EBDCs in humans, and there is only one study on human genotoxicity. ETU is known to cause decreases of thyroxine (T4) and increases in thyroid-stimulating hormone (TSH) in rodents. We have studied cytogenetic outcomes and serum thyroid hormone levels among 49 heavily exposed workers without protective equipment spraying EBDC on tomatoes in Mexico. We also studied 14 lightly exposed landowners and 31 nonexposed controls. Urinary ETU was used to compare exposure between groups. We found an increase in TSH (p = 0.05) among applicators compared to controls, but no decrease in thyroid hormone (T4). We found increases in sister chromatid exchange (p = 0.03) and in chromosome translocations (chromosome aberrations that persist through cell division) for applicators compared to controls (p = 0.05). However, the subset of reciprocal translocations showed a lesser increase (p = 0.24). Our data suggest that EBDCs affect the thyroid gland and the lymphocyte genome among heavily exposed workers. However, our data are limited to subclinical outcomes, are of borderline statistical significance, and should be interpreted with caution.

Detection of Mycoplasma hominis and Ureaplasma urealyticum in women sexually active or not.

Genital mycoplasmas play an important role in genitourinary tract disease. The purpose of this study was to isolate M. hominis and U. urealyticum from vaginal and throat swabs and urine from women sexually active or not. Samples were taken from women with (cases) or without (controls) genitourinary tract disease and were dipped inoculated into 1 ml of E broth with arginine or urea and ten-fold dilutions were done. Samples were incubated at 37 degrees C until phenol red indicator changed to color purple. Identification of species was done by polymerase chain reaction technique. M. hominis was identified with oligonucleotides that correspond to the nucleotide sequence of 16S rRNA gene and U. urealyticum was identified with oligonucleotides that correspond to the nucleotide sequence of the urease gene (Blanchard et al.). There was no statistical difference (X2 P > .05) between isolation percentages from vaginal swabs, while there was statistical difference between urine samples. These mycoplasmas were isolated in higher percentages from pubertal girls and were recovered until the fifth ten-fold dilution both from vaginal swabs and urine. For throat swabs they were only recovered from sexually active women.