Early suppression of peripheral mononuclear blood cells in sepsis in response to stimulation with cytomegalovirus, OKT3, and pokeweed mitogen.

Critically ill patients are at risk for sepsis, and immunosuppressive mechanisms may prevail. Whether functional tests are helpful to detect immune alterations is largely unknown. Therefore, we tested the hypotheses that reactivity of peripheral blood mononuclear cells (PBMCs) to secrete interferon-γ (IFNγ) following stimulation in vitro is decreased in patients with early sepsis compared with postoperative patients. IFNγ secretion [enzyme-linked immunospot (ELISpot)] in response to stimulation with cytomegalovirus (CMV), pokeweed mitogen (PWM), muromonab-anti-CD3 (OKT3), and human leukocyte antigen (HLA)-DRA-mRNA expression and serum cytokine concentrations were repeatedly [days 1, 3, 5, and 7 after intensive care unit (ICU) admission] determined in patients with sepsis (n = 7) and patients undergoing major abdominal surgery (radical prostatectomy, cystectomy, n = 10). In a second cohort, HLA-DRA expression was assessed in 80 patients with sepsis, 30 postoperative patients, and 44 healthy volunteers (German clinical trials database no. 00007694). In patients with sepsis, IFNγ secretion (ELISpot) was decreased compared with controls after stimulation with CMV (P = 0.01), OKT3 (P = 0.02), and PWM (P = 0.02 on day 5), whereas unstimulated IFNγ secretion did not differ. HLA-DRA expression was also significantly decreased in patients with sepsis at all time points (P = 0.004) compared with postoperative surgical patients, a finding confirmed in the larger cohort. Reactivity of PBMCs to stimulation with CMV, PWM, and OKT3 as well as HLA-DRA expression was already decreased upon ICU admission in patients with sepsis when compared with postoperative controls, suggesting early depression of acquired immunity. ELISpot assays may help to clinically characterize the time course of immunocompetence in patients with sepsis.NEW & NOTEWORTHY We observed suppression of reactivity to stimulation with cytomegalovirus, muromonab-anti-CD3, and pokeweed mitogen in mononuclear blood cells of patients with early sepsis when compared with postoperative controls. Thus, there is early depression of acquired immunity in sepsis. Enzyme-linked immunospot assays may help to characterize immunocompetence in patients with sepsis.

Transport of hydrogen isotopes through interlayer spacing in van der Waals crystals.

Atoms start behaving as waves rather than classical particles if confined in spaces commensurate with their de Broglie wavelength. At room temperature this length is only about one ångström even for the lightest atom, hydrogen. This restricts quantum-confinement phenomena for atomic species to the realm of very low temperatures1-5. Here, we show that van der Waals gaps between atomic planes of layered crystals provide ångström-size channels that make quantum confinement of protons apparent even at room temperature. Our transport measurements show that thermal protons experience a notably higher barrier than deuterons when entering van der Waals gaps in hexagonal boron nitride and molybdenum disulfide. This is attributed to the difference in the de Broglie wavelengths of the isotopes. Once inside the crystals, transport of both isotopes can be described by classical diffusion, albeit with unexpectedly fast rates comparable to that of protons in water. The demonstrated ångström-size channels can be exploited for further studies of atomistic quantum confinement and, if the technology can be scaled up, for sieving hydrogen isotopes.

Capture of heavy hydrogen isotopes in a metal-organic framework with active Cu(I) sites.

The production of pure deuterium and the removal of tritium from nuclear waste are the key challenges in separation of light isotopes. Presently, the technological methods are extremely energy- and cost-intensive. Here we report the capture of heavy hydrogen isotopes from hydrogen gas by selective adsorption at Cu(I) sites in a metal-organic framework. At the strongly binding Cu(I) sites (32 kJ mol-1) nuclear quantum effects result in higher adsorption enthalpies of heavier isotopes. The capture mechanism takes place most efficiently at temperatures above 80 K, when an isotope exchange allows the preferential adsorption of heavy isotopologues from the gas phase. Large difference in adsorption enthalpy of 2.5 kJ mol-1 between D2 and H2 results in D2-over-H2 selectivity of 11 at 100 K, to the best of our knowledge the largest value known to date. Combination of thermal desorption spectroscopy, Raman measurements, inelastic neutron scattering and first principles calculations for H2/D2 mixtures allows the prediction of selectivities for tritium-containing isotopologues.

Ni on the CeO2(110) and (100) surfaces: adsorption vs. substitution effects on the electronic and geometric structures and oxygen vacancies.

We report density functional theory (DFT) calculations of the interactions of both Ni adsorbate and substitutional dopant with the ceria (110) and (100) surfaces to explain the origin of the activity of Ni/ceria catalysts. Our results indicate that the Ni adatom on the (110) surface prefers to adsorb on a two-fold bridge site over a hollow site up to 0.25 ML coverage, and the most stable position of a Ni adsorbate on the (100) surface was found to be the bridge site where the Ni atom is coordinated to two surface O atoms. The Ni(+) oxidation state for the Ni adatom on the (110) surface was found to be more favorable than the Ni(2+) state on the two-fold bridge site while on the (100) surface, a Ni adatom prefers its Ni(2+) oxidation state over the Ni(+) oxidation state. With increasing coverage, the binding energy of a Ni adatom on the (110) surface was found to decrease from -0.45 eV at 0.083 ML coverage to -0.32 eV at 0.25 ML coverage. Oxidation of the Ni adatom to Ni(+) reduces one Ce(4+) ion on the ceria surface to Ce(3+) which preferred to be located next to the Ni(+) ion in the nearest neighbor location. The Ce(3+) ions on the (100) surface also prefer to stay in the vicinity of the adsorbed Ni atom, while they prefer to be located away from the Ni adatom on the (111) surface. No reduction of Ce(4+) ions was observed upon substitution of Ce atoms by Ni atoms. Two Ni substituents preferred to be distributed on adjacent metal ion sites on the (110) surface. Ni adsorbate and substituent on the (110) surface were both found to induce significant structural distortions. In comparison to the pure ceria (110) and (100) surfaces, we show that a Ni adsorbate increases the energy required to create an oxygen vacancy while a Ni dopant reduces it. While multiple dopants on the (110) surface do reduce the vacancy formation energy, the degree of reduction is smaller compared to a single dopant indicating the presence of an optimum level of doping to obtain enhanced catalytic activity.

Controlling embedment and surface chemistry of nanoclusters in metal-organic frameworks.

A combined theoretical and experimental approach demonstrates that nanocluster embedment into the pores of metal-organic frameworks (MOF) may be influenced by the chemical functionalisation of the MOF. Furthermore, this results in the surface functionalisation of the embedded nanoclusters, highlighting the potential of MOF scaffolds for the design and synthesis of novel functional materials.

Stacking dependence of carrier transport properties in multilayered black phosphorous.

We present the effect of different stacking orders on carrier transport properties of multi-layer black phosphorous. We consider three different stacking orders AAA, ABA and ACA, with increasing number of layers (from 2 to 6 layers). We employ a hierarchical approach in density functional theory (DFT), with structural simulations performed with generalized gradient approximation (GGA) and the bandstructure, carrier effective masses and optical properties evaluated with the meta-generalized gradient approximation (MGGA). The carrier transmission in the various black phosphorous sheets was carried out with the non-equilibrium green's function (NEGF) approach. The results show that ACA stacking has the highest electron and hole transmission probabilities. The results show tunability for a wide range of band-gaps, carrier effective masses and transmission with a great promise for lattice engineering (stacking order and layers) in black phosphorous.

The minimally invasive MitraClip™ procedure for mitral regurgitation under general anaesthesia: immediate effects on the pulmonary circulation and right ventricular function.

A relatively new minimally invasive cardiological procedure, called the MitraClip(™), does not require sternotomy and may have a number of advantages compared with open mitral valve surgery, but its acute impact on the pulmonary circulation and right ventricular function during general anaesthesia is unclear. We prospectively assessed the effects of the MitraClip procedure in 81 patients with or without pulmonary hypertension (defined as mean pulmonary artery pressure > 25 mmHg), who were anaesthetised using fentanyl (5 µg.kg(-1)), etomidate (0.2-0.3 mg.kg(-1)), rocuronium (0.5-0.6 mg.kg(-1)) and isoflurane. Placement of the MitraClip led to a 60% increase in mean (SD) right ventricular stroke work index (from 512 (321) to 820 (470) mmHg.ml.m(-2), p < 0.0001), while mean (SD) pulmonary vascular resistance index decreased by 24% (522 (330) to 399 (244) dyn.s.cm(-5), p < 0.0001), and mean (SD) pulmonary artery pressure decreased by 10% (30 (8) to 27 (8) mmHg, p < 0.0001). Patients with pulmonary hypertension experienced a similar decrease in mean pulmonary artery pressure compared with those without, and they also had a slight reduction in mean (SD) pulmonary artery occlusion pressure (22 (6) down to 20 (6) mmHg, p = 0.044). We conclude that successful MitraClip treatment for mitral regurgitation acutely improves right ventricular performance by reducing right ventricular afterload, regardless of whether patients have pre-operative pulmonary hypertension.

Myocardial protection by remote ischaemic pre-conditioning is abolished in sulphonylurea-treated diabetics undergoing coronary revascularisation.

BACKGROUND: Remote ischaemic pre-conditioning attenuates myocardial injury. Because sulphonylurea drugs interfere with ischaemic and anaesthetic pre-conditioning, we assessed whether remote ischaemic pre-conditioning effects are altered in sulphonylurea-treated diabetics. METHODS: Using the database of our ongoing randomised, placebo-controlled study (ClinicalTrials.gov NCT01406678), we assessed the troponin I concentration area under curve (measurements: baseline, 1, 6, 12, 24, 48, and 72 h post-operatively) in sulphonylurea-treated diabetics (n = 27) and non-diabetics (n = 230) without and with remote ischaemic pre-conditioning (three 5-min periods of left upper arm ischaemia with 5-min reperfusion each) during isoflurane anaesthesia before two- to three-vessel coronary artery surgery. RESULTS: Remote ischaemic pre-conditioning in non-diabetic patients evoked a 41% decrease in the troponin I concentration area under curve (514 ng/ml × 72 h ± 600 vs. 302 ± 190, P = 0.001) but no change (404 ng/ml × 72 h ± 224 vs. 471 ± 383, P = 0.62) in sulphonylurea-treated diabetics. There was no significant correlation between the troponin I concentration area under curve and arterial glucose concentrations, and the latter was not an independent confounder. CONCLUSION: Cardioprotection by remote ischaemic pre-conditioning during isoflurane anaesthesia is abolished in sulphonylurea-treated diabetics.

Cross-sectional assessment of neuromuscular function using mechanography in women and men aged 20-85 years.

OBJECTIVES: The aim of this cross-sectional study was to examine the influence of age and sex on neuromuscular function of the lower limbs using mechanography. 704 adults aged 20-85 years from Germany participated in this study. METHODS: Ground reaction force and power were assessed with countermovement jumps and the chair rising test on a ground reactions force plate. RESULTS: While ground reaction force per unit body mass declined by about 20% from the third to the ninth decade, the decline of power per unit body mass was much greater, varying between 40-50%. Men and women are affected equally by the decline. Age and sex explained the variability of the power parameters to a much greater extent (R(2)=0.54 to R(2)=0.70) than the force parameters (R(2)=0.18 to R(2)=0.36). CONCLUSIONS: Our reference values can help to identify those who might be affected by the development of sarcopenia. Preventive exercise programs should focus on preserving muscle power in addition to the training of muscle force.

Resultados a corto y largo plazo con la técnica de Karydakis para la enfermedad pilonidal sacrocoxígea / Short-and long-term results with Karydaki’s technique for sacrococcygeal pilonidal disease

Introduction: Sacrococcygeal pilonidal cyst or sinus is a common condition in young people. There is still discussion about which of the many existing techniques is best suited to resolve this condition. Objective: To analyze the short-and long-term use of Karydaki's technique in our Hospital. Material and Methods: We analyzed prospective protocols from patients with pilonidal cyst with Karydaki's technique from June 2005 to August 2010. Clinical and telephonic follow-up was done to all patients and a satisfaction survey done to a random sample of the series. Results: We analyzed 62 patients with mean age of 24.5 years (15-45), being 33 men (53 percent). Cysts were previously relapsed in 20.9 percent of cases. The average hospital stay was 2.5 days (1-3). Early complications occurred in 14.3 percent of patients being the most common seroma in 8 percent and dehiscence in 6.4 percent. At a mean follow up of 38 months (12-62), relapse occurred in two patients (3.2 percent), one at 6 months and the other at 3 years, being resolved one by a new Karydaki's technique and the other with marsupialization. Among the group surveyed for satisfaction, 75 percent found the technique satisfactory or very satisfactory in terms of aesthetics and 95 percent would recommend this technique. Conclusions: Karydaki's operation achieves with a simple and aesthetic technic a low recurrence and morbidity and a complete recovery after 15 days in most patients.

Introducción: El quiste o seno pilonidal sacrocoxígeo es una patología frecuente en gente joven. Aún hay discusión sobre cual de las múltiples técnicas existentes es la más adecuada para resolver esta patología. Objetivo: Analizar los resultados a corto y largo plazo con la utilización de la técnica de Karydakis en nuestro medio. Material y Método: Se analizan los protocolos prospectivos de pacientes intervenidos por quiste pilonidal con la técnica de Karydakis desde junio de 2005 hasta agosto de 2010. Se realizó seguimiento clínico y telefónico de los pacientes y una encuesta de satisfacción a una muestra aleatoria de la serie. Resultados: Se analizan 62 pacientes con promedio de edad de 24,5 años (15-45), siendo de ellos 33 hombres (53 por ciento). En un 20,9 por ciento de los casos eran quistes recidivados. La hospitalización promedio fue de 2,5 días (1-3). Un 14,3 por ciento presentó complicaciones precoces siendo las más frecuentes el seroma (8 por ciento) y dehiscencia de sutura (6,4 por ciento). El seguimiento promedio fue de 38 meses (i: 12-62). Dos pacientes tuvieron recidivas (3,2 por ciento), a los 6 meses y a los 3 años, resolviéndose una con nueva técnica de Karydakis y la otra con marsupialización. Del grupo encuestado, el 75 por ciento consideró que la técnica fue satisfactoria o muy satisfactoria (estética) y el 95 por ciento de los pacientes la recomendaría. Conclusiones: La operación de Karydakis logra con una técnica simple y estética una baja recidiva y morbilidad y una recuperación definitiva a los 15 días en la mayoría de los pacientes.

Protection by remote ischemic preconditioning during coronary artery bypass graft surgery with isoflurane but not propofol - a clinical trial.

BACKGROUND: Remote ischemic preconditioning (RIPC) of the myocardium by limb ischemia/reperfusion may mitigate cardiac damage, but its interaction with the anesthetic regimen is unknown. We tested whether RIPC is associated with differential effects depending on background anesthesia. Specifically, we hypothesized that RIPC during isoflurane anesthesia attenuates myocardial injury in patients undergoing coronary artery bypass graft (CABG) surgery, and that effects may be different during propofol anesthesia. METHODS: In a randomized, single-blinded, placebo-controlled prospective study, serum troponin I concentration (cTnI) (baseline, and 1, 6, 12, 24, 48, and 72 h postoperatively) were measured during isoflurane/sufentanil or propofol/sufentanil anesthesia with or without RIPC (three 5-min periods of intermittent left upper arm ischemia with 5 min reperfusion each) in non-diabetic patients (n = 72) with three-vessel coronary artery disease (ClinicalTrials.gov NCT01406678). RESULTS: RIPC during isoflurane anesthesia (n = 20) decreased the area under the cTnI time curve (cTnI AUC) (-50%, 190 ± 105 ng/ml × 72 h vs. 383 ± 262 ng/ml × 72 h, P = 0.004), and the peak (7.3 ± 3.6 ng/ml vs. 11.8 ± 5.5, P = 0.004) and serial (P < 0.041) postoperative cTnI when compared to isoflurane alone (n = 19). In contrast, RIPC during propofol anesthesia (n = 14) did not alter the cTnI AUC [263 ± 157 ng/ml × 72 h vs. 372 ± 376 ng/ml × 72 h (n = 19), P = 0.318] or peak postoperative cTnI (10.1 ± 4.5 ng/ml vs. 12 ± 8.2, P = 0.444). None of the patients experienced harm or side effects from the intermittent left arm ischemia. CONCLUSION: Thus, RIPC during isoflurane but not during propofol anesthesia decreased myocardial damage in patients undergoing CABG surgery. Accordingly, effects of RIPC evoked by upper limb ischemia/reperfusion depend on background anesthesia, with combined RIPC/isoflurane exerting greater beneficial effects under conditions studied.

Influence of quantum effects on the physisorption of molecular hydrogen in model carbon foams.

The physisorption of molecular hydrogen in model carbon foams has been investigated from 50 K to room temperature. The study is carried out within the framework of the density functional theory for quantum liquids at finite temperatures. Calculations are performed in the grand canonical ensemble, i.e., the adsorbed fluid is assumed to be in equilibrium with an external gas of hydrogen molecules with concentrations ranging from 8×10(-4) kg m(-3) to n=71 kg m(-3). It is shown that, while strong zero-point energy effects are present even at room temperature, the adsorption isotherms exhibit only a weak dependence on the explicit incorporation of the bosonic exchange symmetry of hydrogen molecules. The increase of the average particle density prevents the deviations from the Maxwell-Boltzmann statistics to become noticeable if the system is cooled down. The volumetric storage capacity of these materials at low temperatures is about one half of the U. S. Department of Energy goal, while the gravimetric capacity is still far from the standards required by mobile applications. The relation between the microscopic structure of the hydrogen fluid and the calculated adsorption properties is also addressed.

Cirugía laparoscópica colorrectal en Chile / Laparoscopic colorectal surgery in Chile

The development of laparoscopic colorectal surgery began 20 years ago; however it took several years before gaining its acceptance by the international surgical community. The first report in Chile was published in 1995. However, were necessary many years, until the middle of this decade, to know the first prospective series experiences. Out of these reports, no reliable data exist regarding the development of laparoscopic colorectal surgery in Chile, related to the number of centers performing laparoscopic colorectal surgery or the number of procedures performed. For record these data, a standardized questionnaire was send to colorectal chairmans of all hospitals that had reported to be developing laparoscopic colorectal surgery in our country. Ten of 15 hospitals responded to the survey. Most of the procedures performed were hemicolectomies, principally for cancer and diverticular disease. The average conversion rate was 7 percent and hospital stay was 5 days. Morbidity and mortality rates were 12 percent and 0.4 percent respectively. In the last year was seen an increase in the number of laparoscopic procedures in relation to the previous period. In conclusion, laparoscopic colorectal surgery is a recent technique in Chile, which is being implemented progressively, with good overall results.

El desarrollo de la cirugía laparoscópica colorrectal (CLCR) se inició en la década de los 90, sin embargo, pasaron varios años antes de lograr su aceptación por la comunidad quirúrgica internacional. En Chile, los primeros relatos en congresos datan del año 1995 y las primeras experiencias de series prospectivas fueron publicadas 10 años más tarde. Fuera de estos reportes, no existe información fidedigna en relación al desarrollo de la cirugía laparoscópica colorrectal en Chile, relacionados con el número de centros que la realizan, la formación actual de los cirujanos colorrectales en esta técnica ni en cuanto al número de procedimientos realizados. Para conocer estos datos se envió una encuesta estandarizada a los jefes de equipo de los centros que habían comunicado estar desarrollando la CLCR en nuestro país. Diez de 15 centros respondieron la encuesta. La mayor parte de los procedimientos corresponden a hemicolectomías, siendo las principales indicaciones el cáncer y la enfermedad diverticular. La tasa de conversión promedio fue de 7 por ciento y la estadía hospitalaria de 5 días. La morbilidad y mortalidad fue de 12 por ciento y 0,4 por ciento respectivamente. En el último año se ha visto un aumento del número de procedimientos laparoscópicos en relación al período previo. En conclusión, La CLCR es una técnica de reciente incorporación en Chile, que está siendo implementada en forma progresiva, con buenos resultados globales.

Manejo inicial y conceptos en trauma: vía aérea, reposición de volumen, toracotomía de urgencia / Initial approach and trauma concepts: airway, volume reposition and resuscitative thoracotomy

La atención inicial del paciente politraumatizado incluye una evaluación inicial y resucitación, una fase intermedia o de monitorización y una evaluación secundaria, diagnóstica en la que se debe realizar un examen detallado por órganos y sistemas para proceder a un tratamiento definitivo. En este artículo se tratan aquellas patologías que ponen en peligro la vida del paciente y que precisan acciones terapéuticas inmediatas, como son la obstrucción de vía aérea, el neumotórax a tensión, el taponamiento cardiaco, neumotórax simple y neumotórax abierto. El shock, definido por un grado severo de hipoperfusión tisular, necesita ser corregido mediante una infusión adecuada de volumen incluyendo factores de coagulación para evitar el círculo vicioso de la llamada “tríada letal” que corresponde a hemorragia, hipotermia y coagulopatía, que a su vez perpetúa la hemorragia. La toracotomía de reanimación tiene indicaciones precisas y sus resultados dependen de la etiología del traumatismo, siendo mejor al utilizarse en lesiones penetrantes cardiacas y con el menor tiempo en que se efectúa.

The initial care of trauma patients includes an initial assessment and resuscitation an intermediate or secondary monitoring and evaluation (diagnostic) in which to undertake a detailed examination of organs and systems to proceed to definitive treatment. This article discusses those conditions that threaten the life of the patient and require immediate therapeutic actions. These situations are airway obstruction, tension pneumothorax, cardiac tamponade and simple or open pneumothorax. The treatment of Shock, defined by a severe degree of tissue hypoperfusion, needs to be corrected by adequate volume infusion including clotting factors to prevent the vicious circle of the "lethal triad": hemorrhage, hypothermia and coagulopathy. In the case of need for a resuscitative thoracotomy, this technique has precise indications and its results depend on the etiology of the trauma and with better results if to be used in penetrating cardiac trauma and incases of rapid use after production of the damage.

[Dyspnea and chronic recurrent respiratory tract infections]. / Dyspnoe und rezidivierende Atemwegsinfekte.

A 48-year-old man presented with recurrent bronchopulmonary infections of many years' standing. The diagnosis of tracheobronchomegaly (Mounier-Kuhn syndrome) was based on CT examination and subsequent bronchoscopy. Since lung transplantation was not considered advisable, a biluminal stent was inserted to prevent bronchial collapse.

Evaluación funcional y encuesta de satisfacción de los pacientes operados de hemorroides con técnica de PPH / Satisfaction survey of patients after hemorrhoid surgery using the procedure for prolapse and hemorrhoids (PPH) technique

Background: Hemorrhoidal disease is very common and approximately 10 percent of the patients require surgery. Within the different surgical techniques, the Longo procedure or PPH (procedure for prolapse and hemorrhoids) has gained importance. Aim: To evaluate the patients' perception of PPH hemorrhoidectomy in a medium term follow-up. Material and Methods: All patients undergoing PPH hemorrhoidectomy between January 2007 and January 2009 were identified. A survey was designed to assess the presence of specific symptoms before and after surgery, and applied to all patients. Results: Fifty-seven patients completed the survey, with a follow-up ranging from 8 to 31 months. Ninety-four percent of patients referred improvement of bleeding, 85 percent of hemorrhoidal prolapse and 68 percent of soiling after the intervention. On a scale of 1 to 7, 88 percent of patients rated the procedure with a score over 5, and 87 percent would recommend the use of this technique to other patients suffering from the disease. Conclusions: Most patients favorably assess PPH hemorrhoidectomy in terms of postoperative resolution of the symptoms, functional status and overall satisfaction in a medium-term follow-up.

Introducción: La patología hemorroidal es una condición muy frecuente en la población general y aproximadamente un 10 por ciento de los afectados requerirá cirugía. Existen distintas técnicas para su abordaje, siendo la operación de Longo o PPH (procedimiento para el prolapso y las hemorroides) una alternativa que ha cobrado relevancia. Existe poca evidencia de los resultados desde el punto de vista de la satisfacción de los pacientes. El objetivo de nuestro trabajo es dar a conocer la evaluación y percepción de los pacientes operados de hemorroides con la técnica de PPH en un seguimiento a mediano plazo. Material y Métodos: Se identificaron todos los pacientes operados con la técnica de PPH entre enero de 2007 y enero de 2009. Se aplicó una encuesta diseñada para consignar la presencia de algunos síntomas antes y después de la cirugía. Resultados: 57 pacientes completaron la encuesta, con un seguimiento promedio de 17,6 meses (extremos 8-31). Un 94 por ciento de los pacientes refirió la desaparición del sangrado, el 85 por ciento del prolapso hemorroidal y un 68 por ciento del ensuciamiento (soiling) tras la intervención. En una escala de evaluación de 1 a 7, el 88 por ciento de los pacientes calificó el procedimiento con nota > 5 y el 87 por ciento recomendaría el uso de esta técnica a otros pacientes afectados por esta patología. Conclusión: El uso de la técnica de PPH es evaluada favorablemente por la mayoría de los pacientes en relación a la resolución de sus síntomas, al estado funcional y al grado de satisfacción en un seguimiento postoperatorio a mediano plazo.

Invaginación intestinal en adultos como manifestación de enfermedad celíaca: Caso clínico / Celiac disease presenting as an intestinal intussusception: Report of one case

Acute abdominal pain caused by perforation, intestinal lymphoma or intussusception is an uncommon manifestation in adult celiac disease. We report a 49 year-old female with history of irritable bowel syndrome and osteoporosis consulting for acute abdominal pain and severe abdominal distention. Abdominal CT scan and magnetic resonance imaging showed a jejunal intussusception and other radiological alterations that suggested the possibility of celiac disease. Serological antibodies (endomysial and transglutaminase antibodies), endoscopy and the pathological study of duodenal biopsies confirmed the diagnosis. With a gluten free diet, the patient remains asymptomatic.

[Distal intestinal obstruction syndrome: report of two cases with cystic fibrosis]. / Síndrome de obstrucción intestinal distal en pacientes adultos con fibrosis quística: Casos clínicos.

Distal Intestinal Obstruction Syndrome (DIOS) has a 16% incidence among patients with Cystic Fibrosis (CF). It is characterized by an intestinal obstruction secondary to fecal impaction in distal ileum or cecum. We report two adult patients with DIOS. A female with CF and subjected to lung transplantation at the age of 13 years old. Five years later, she consulted for an intestinal obstruction. She was treated conservatively with a good clinical evolution. She had a new episode of DIOS eight months later that was also treated conservatively. A 31 year-old mole, subjected to bilateral lung transplantation nine years before, that was admitted to the hospital for a bronchiolitis. Three days after admission he started with an intestinal obstruction that was diagnosed as a DIOS. He was managed conservatively with a good clinical response.

Recidiva en intestino delgado de tumor de GIST de bajo riesgo: caso clínico y revisión de la literatura / Recurrence of low risk small bowel GIST tumor: case report and revision of the literature

Gastrointestinal stromal tumors (GIST) are the most common mesenchymatic neoplasm in the digestive tract, representing about 1 percent of malignant gastrointestinal lesions. Seventy to eighty percent are benign according to their size and mitotic index as predictors of malignancy. However, in the presence of relapses in patients with low risk according to the current classification and in light of new adjuvant therapies (Imatinib Mesylate), have defined new parameters for estimation of malignant potential.

Los tumores del estroma gastrointestinal (GIST) son las neoplasias mesenquemáticas más comunes del tracto digestivo representando cerca del 1 por ciento de las lesiones neoplásicas gastrointestinales. El 70 por ciento-80 por ciento de ellas son benignas siendo clasificados según su tamaño e índice mitótico como predictores de malignidad. Sin embargo, ante la presencia de recidivas en pacientes con bajo riesgo según la clasificación actual y a la luz de nuevas terapias adyuvantes (Mesilato de Imatinib), se han definido nuevos parámetros para su estimación de potencial maligno.

Síndrome de obstrucción intestinal distal en pacientes adultos con fibrosis quística: Casos clínicos / Distal intestinal obstruction syndrome: Report of two cases with cystic fibrosis

Distal Intestinal Obstruction Syndrome (DIOS) has a 16 percent incidence among patients with Cystic Fibrosis (CF). It is characterized by an intestinal obstruction secondary to fecal impaction in distal ileum or cecum. We report two adult patients with DIOS. A female with CF and subjected to lung transplantation at the age of 13 years old. Five years later, she consulted for an intestinal obstruction. She was treated conservatively with a good clinical evolution. She had a new episode of DIOS eight months later that was also treated conservatively. A 31 year-old mole, subjected to bilateral lung transplantation nine years before, that was admitted to the hospital for a bronchiolitis. Three days after admission he started with an intestinal obstruction that was diagnosed as a DIOS. He was managed conservatively with a good clinical response.