Isolation, characterization, and experimental infection of Streptococcus gallolyticus subspecies pasteurianus from commercial turkeys with acute septicemia: a pilot study.

Streptococcus gallolyticus (SG) is a Gram-positive cocci found as commensal gut flora in animals and humans. SG has emerged as a cause of disease in young poults between 1 and 3 wk of age. SG is associated with septicemia resulting in acute mortality with no premonitory signs in turkeys. Three SG isolates were obtained from clinical field cases of acute septicemia of commercial turkeys and used in three independent experiments. In Experiment 1, embryos were inoculated 25 d of embryogenesis with varying concentrations of SG1, SG2, or SG3. In Experiment 2, day of hatch, poults were inoculated with varying concentrations using different routes of administration of SG1, SG2, or SG3. In Experiment 3, day of hatch, poults were inoculated with only isolate SG1 using different paths. Poults were randomly selected for necropsy on d 8 and d 15 and sampled to collect spleen, heart, and liver for SG on d 21, the remaining poults were necropsied and cultured. Samples were plated on Columbia nalidixic acid and colistin agar (CNA) (40°C, 18-24 h). Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) confirmed suspect colonies. Data were analyzed using the chi-square test of independence, testing all possible combinations to determine significance (P < 0.05). Weight data were subjected to ANOVA using JMP with significance (P < 0.05). No differences were found in BW or BWG on d 0, 8, 15, or 22. Splenomegaly, focal heart necrosis, and pericarditis were observed in all groups in experiments 1 through 3. In Experiment 3, only airsacculitis was observed in a negative control in separate isolation (P > 0.05). On d 21 of Experiment 3, increased (P < 0.05) recovery of SG from spleens were observed in co-housed negative controls, as well as poults challenged by oral gavage (P > 0.05 for d 7 and d 14). These results confirm numerous previous studies indicating that SG subsp. pasteurianus is a primary infectious microorganism that causes septicemia in young poults.

Correction to: A decade of progress in critical care echocardiography: a narrative review.

The original version of this article unfortunately contained a mistake.

A decade of progress in critical care echocardiography: a narrative review.

INTRODUCTION: This narrative review focusing on critical care echocardiography (CCE) has been written by a group of experts in the field, with the aim of outlining the state of the art in CCE in the 10 years after its official recognition and definition. RESULTS: In the last 10 years, CCE has become an essential branch of critical care ultrasonography and has gained general acceptance. Its use, both as a diagnostic tool and for hemodynamic monitoring, has increased markedly, influencing contemporary cardiorespiratory management. Recent studies suggest that the use of CCE may have a positive impact on outcomes. CCE may be used in critically ill patients in many different clinical situations, both in their early evaluation of in the emergency department and during intensive care unit (ICU) admission and stay. CCE has also proven its utility in perioperative settings, as well as in the management of mechanical circulatory support. CCE may be performed with very simple diagnostic objectives. This application, referred to as basic CCE, does not require a high level of training. Advanced CCE, on the other hand, uses ultrasonography for full evaluation of cardiac function and hemodynamics, and requires extensive training, with formal certification now available. Indeed, recent years have seen the creation of worldwide certification in advanced CCE. While transthoracic CCE remains the most commonly used method, the transesophageal route has gained importance, particularly for intubated and ventilated patients. CONCLUSION: CCE is now widely accepted by the critical care community as a valuable tool in the ICU and emergency department, and in perioperative settings.

The effect of enhanced carotenoid content of transgenic maize grain on fungal colonization and mycotoxin content.

Novel strategies that address vitamin A deficiency have been developed, such as high-carotenoid maize, a biofortified transgenic maize line rich in carotenoids generated by genetic transformation. The South African white maize inbred (M37W), which is devoid of carotenoids, was engineered to accumulate high levels of ß-carotene (provitamin A), lutein, and zeaxanthin. Maize seeds contaminated with fumonisins and other mycotoxins pose a serious threat to both humans and livestock. During three consecutive harvests, the fungal incidence and the fumonisin and aflatoxin content of maize seeds grown in an experimental field in Catalonia (Northeastern Spain) were evaluated. Fungal infection was similar in high-carotenoid maize and its isogenic line, with Fusarium verticillioides being the most prevalent fungus in all the harvests. Neither Aspergillus spp. nor aflatoxin contamination was found. Fumonisin levels were lower in high carotenoid than in its isogenic line, but this reduction was statistically significant in only 2 of the 3 years of study. Our results suggest that high carotenoid content reduces fumonisin levels in maize grains.

Técnica Semidirecta para Disfunciones en FRS de C3 / Semidirect techniques for FRS dysfunctions of C3

Algunas de las recomendaciones basadas en la evidencia científica disponible establecen que, aunque se han hecho muchos estudios sobre la eficacia de la manipulación, existen escasas descripciones sobre la manipulación cervical para disfunción en FRS, y sus consideraciones clínicas de aplicación. El objetivo de nuestro estudio es aportar las generalidades básicas para la adecuada aplicación de este procedimiento terapéutico (AU)

Some of the recommendations based on the available scientific evidence establish that although there are many trials about the effectiveness of manipulation, there are few descriptions about cervical manipulation for dysfunctions in FRS, and their clinical considerations of being applied. The objective of our trial is to provide the basic generalities for the appropriate application of this therapeutic procedure (AU)

Homocistinuria; curso clínico y tratamiento dietético; a propósito de dos casos / Clinical management of homocystinuria; case report and review of the literature

La homocistinuria es un error congénito del metabolismo de la metionina que conduce al acúmulo de metionina y de su principal metabolito, homocisteína, en plasma, orina y tejidos. El acúmulo de homocisteína posee toxicidad sobre los sistemas óseo (osteoporosis), ocular (luxación del cristalino), nervioso (convulsiones, alteraciones psiquiátricas) y vascular (accidentes cerebrovasculares, enfermedad cardiovascular). Presentamos 2 casos de homocistinuria en 2 pacientes hermanos y, a continuación, revisamos las estrategias terapéuticas disponibles (AU)

Homocystinuria is a congenital disorder of methyonine metabolism that leads to increased plasmatic, urinary and tissue deposits of methyonine and its main metabolite: homocysteine. Homocysteine deposits are toxic for the skeletal system (osteoporosis), the eyes (lens dislocation), central nervous system (seizures, psychiatric disorders) and also induce vascular damage (stroke and other cardiovascular events). This article reports two patients with homocystinuria in two siblings, followed by a concise review on the therapeutic strategies available for this disorder (AU)

Nutritional intervention in oncohematological patient.

BACKGROUND: Oncohematological diseases such as lymphoma or leukaemia affect an increasing number of newly diagnosed patients in Spain and other countries. Both disease and treatment may have a negatively impact in the nutritional status of the patient. Malnutrition is not uncommon among oncohematological patients. This situation can compromised the course of the disease, the clinical response of the treatment and the patient's quality of life. METHOD: The implementation of a multidisciplinary approach and a systematic and protocolled nutritional assessment would be useful when dealing with haematological malignancies. RESULTS: We present a proposal of protocol for nutritional intervention in oncohematological patients. This proposal is been developed from the analysis of the published literature as well as clinical practice of a multi-disciplinary team specialized in the management of patients with haematological malignancies.

Recent advances in perioperative anesthetic management update on the role of vasopressin and its effects on outcomes.

The vasoconstrictive and antidiuretic physiologic properties of vasopressin (antidiuretic hormone) have long been known. Until recently however, vasopressin was mostly used for diabetes insipidus and noctournal enuresis. This review summarizes the growing body of evidence regarding the perioperative use of vasopressin and its analogues in the management of certain forms of cardiovascular collapse. Physiologically, vasopressin is involved in regulating osmotic, volemic, and cardiovascular homeostasis. It acts via several specific vasopressin receptors that are variably distributed in the heart, kidneys and vasculature etc. Under normal conditions, its antidiuretic effect predominates and vasopressin only induces vasoconstriction at high concentrations. Regarding catecholamine-resistant vasodilatory shock, current evidence suggests that with adequate volume resuscitation, exogenous vasopressin in low "physiologic" doses (0.01-0.04 units/min) safely supports mean arterial pressure without adversely affecting myocardial function and splanchnic circulation. One possible explanation is that metabolic acidosis impairs the function of alpha-adrenergic (but not vasopressin) receptors, thus diminishing the response to catecholamines. Although there is yet no clear cut mortality benefit, vasopressin is now recommended as a second-line agent in septic shock for its catecholamine-sparing effect and as an alternative to epinephrine in cardiopulmonary resuscitation. It has also demonstrated efficacy in ameliorating vasoplegia after cardiopulmonary bypass as well as perioperative hypotension in patients on renin-angiotensin system antagionists preoperatively. In summary, accumulating clinical experience and formal studies indicate that vasopressin has a role in restoring vascular tone in refractory vasodilatory shock states with minimal adverse effects provided that euvolemia is assured.

Intervención nutricional en el paciente oncohematológico / Nutritional intervention in oncohematological patient

Objetivos: Las enfermedades oncohematológicas como el Linfoma o la Leucemia afectan a un número importante y creciente de personas en España. Tanto la enfermedad como las distintas modalidades de tratamiento que puede llegar a precisar el paciente a lo largo del curso de la misma impactan negativamente en el estado nutricional del paciente, no siendo infrecuente el desarrollo de desnutrición, situación que compromete la evolución, la respuesta al tratamiento y la calidad de vida del paciente. Método: La implementación de una estrategia multidisciplinar, sistematizada y protocolizada de valoración nutricional puede resultar de utilidad a la hora de abordar a los pacientes con enfermedades oncohematológicas. Resultados: Se presenta una propuesta de protocolo de evaluación y soporte nutricional en el paciente oncohematológico elaborada a partir del análisis de la literatura publicada al respecto, así como de la práctica clínica habitual de un equipo sanitario multidisciplinar especialmente implicado en el manejo de los pacientes con enfermedades oncohematológicas (AU)

Background: Oncohematological diseases such as lymphoma or leukaemia affect an increasing number of newly diagnosed patients in Spain and other countries. Both disease and treatment may have a negatively impact in the nutritional status of the patient. Malnutrition is not uncommon among oncohematological patients. This situation can compromised the course of the disease, the clinical response of the treatment and the patient's quality of life. Method: The implementation of a multidisciplinary approach and a systematic and protocolled nutritional assessment would be useful when dealing with haematological malignancies. Results: We present a proposal of protocol for nutritional intervention in oncohematological patients. This proposal is been developed from the analysis of the published literature as well as clinical practice of a multi-disciplinary team specialized in the management of patients with haematological malignancies (AU)

[Clinical management of homocystinuria: case report and review of the literature]. / Homocistinuria; curso clínico y tratamiento dietético: a propósito de dos casos.

Homocystinuria is a congenital disorder of methyonine metabolism that leads to increased plasmatic, urinary and tissue deposits of methyonine and its main metabolite: homocysteine. Homocysteine deposits are toxic for the skeletal system (osteoporosis), the eyes (lens dislocation), central nervous system (seizures, psychiatric disorders) and also induce vascular damage (stroke and other cardiovascular events). This article reports two patients with homocystinuria in two siblings, followed by a concise review on the therapeutic strategies available for this disorder.

La malnutrición como causa y consecuencia de distorsiones sensoriales / Malnutrition as cause and consequence of sensory distorsions

La malnutrición es una enfermedad provocada por un exceso o defecto en el consumo o aprovechamiento de los nutrientes. Habitualmente, se utiliza este término para referirse a la desnutrición, es decir, a un trastorno derivado del déficit de algún macro y/o micronutrientes. Las alteraciones quimiosensoriales pueden reducir de forma importante la alimentación en el individuo, por lo que es importante verificar que el aporte de nutrientes y, de forma concreta, de algunos micronutrientes, sea suficiente, ya que alguno de ellos, como el zinc, desempeñan un papel primordial en las alteraciones del gusto y del olfato. Además, el paciente malnutrido o con una alimentación que excluya gran número de alimentos, tiene mayor riesgo de presentar déficits de dichos micronutrientes. Diversas enfermedades, tanto agudas como crónicas, se asocian a alteraciones de la percepción sensorial, y pueden llegar a afectar a más del 50% de las personas mayores de 65 años. Los efectos provocados por los fármacos y algunos tratamientos como la quimioterapia y la radioterapia, juegan también un papel muy importante en la distorsión sensorial y en la incidencia de malnutrición (AU)

Malnutrition is a pathological condition caused by an excess or deficiency in the consumption or the use of the nutrients. Usually this term refers to a lack of adequate nourishment, a disorder resulting from a deficiency of some macro and/or micronutrients. Chemo-sensory alterations can significantly reduce food choice and intake, so it is very important to verify that the supply of nutrients and specifically of some micronutrients are sufficient. Some of them, such as «zinc», play a very important role in alterations in the sense of taste and smell. In addition malnutrition patients or a poorly-balanced diet or faulty utilization of foods have increased the risk of deficiencies in these micronutrients. Several types of diseases, both acute and chronic ones, are associated with sensory perception and can affect more than 50% of people over 65 years old. The effects caused by drugs and some treatments such as chemotherapy and radiation therapy play an important role in sensory distortion and the incidence of malnutrition (AU)

[Spanish version of the CAM-ICU (Confusion Assessment Method for the Intensive Care Unit). Pilot study of validation]. / Versión en español del método para la evaluación de la confusión en cuidados intensivos, estudio piloto de validación.

OBJECTIVE: To validate the Spanish version of the CAM-ICU. DESIGN: Validation study. The inter-rater reliability and validity were evaluated using a blind comparison with the DSM-IVTR criteria (reference standard) in a group of patients hospitalized in an Intensive Care Unit (ICU). SETTING: Medical-surgical ICU. PATIENTS: 129 adults with RASS >-4 score, within the 24-48 h of ICU admission. Independent application of the CAM-ICU by two intensive care specialists and evaluation by a psychiatrist using the DSM-IVTR criteria for delirium. RESULTS: Prevalence of delirium in the sample was 26.4%, this being and 48.3% in the 29 patients who received mechanical ventilation. Inter-rater reliability in the whole sample according to the Kappa index was 0.792 (95% CI 0.662-0.922, p<0.001) and in those who received mechanical ventilation was 0.726 (95% CI 0.487-0.965, p<0.001). The sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV), positive likelihood ratio (+LR), and negative likelihood ratio (-LR) were 79.4% (95% CI 63.2-89.7%); 97.9% (95% CI 92.6-99.4%); 93.1% (95% CI 78.0-98.1%); 93.0% (95% CI 86.3-96.6%); 37.72 (95% CI 9.47-150.20) and 0.21(95% CI 0.11-0.41), respectively, in the whole sample. In mechanically-ventilated patients, sensitivity, specificity, PPV, NPV, +LR and -LR were 92.9% (95% CI 68.5-98.7%); 86.7% (95% CI 62.1-96.3%); 86.7% (95% CI 62.1-96.3%); 92.9% (95% CI 68.5-98.7%); 6.96(95% CI 1.90-25.51) and 0.08 (95% CI 0.01-0.55), respectively. CONCLUSION: The Spanish version of the CAM-ICU is reliable. Its sensitivity, specificity and predictive values should be considered good.

Versión en español del método para la evaluación de la confusión en cuidados intensivos, estudio piloto de validación / Spanish version of the method for evaluation of confusion in intensive cares, pilot study of validation

Objetivo: Validar la versión en español del CAM-ICU (confusion assessment method for the intensive care unit «método para la evaluación de la confusión en cuidados intensivos»). Diseño: Estudio de validación. Se valoran la concordancia interevaluador y la validez mediante comparación ciega con los criterios del Manual Diagnóstico y Estadístico de los Trastornos Mentales, cuarta edición, texto revisado (DSM-IV TR) (estándar de referencia) en un grupo de pacientes ingresados en una unidad de cuidados intensivos (UCI). Ámbito: UCI médico-quirúrgica. Pacientes: Ciento veintinueve adultos con puntuación >-4 en la Richmond Agitation Sedation Scale y entre las 24-48h de admisión en la UCI. Se tuvo en cuenta la aplicación independiente del CAM-ICU por 2 intensivistas y la valoración por psiquiatría con el uso de los criterios del DSM-IV TR para delírium. Resultados: La prevalencia de delírium en la muestra fue del 26,4% y fue del 48,3% en los 29 pacientes que recibieron ventilación mecánica. La concordancia interevaluador en toda la muestra, según el índice κ fue de 0,792 (intervalo de confianza [IC] del 95%: 0,662-0,922; p<0,001) y en los pacientes con ventilación mecánica fue de 0,726 (IC del 95%: 0,487-0,965; p<0,001). La sensibilidad fue del 79,4% (IC del 95%: 63,2-89,7%); la especificidad, del 97,9% (IC del 95% 92,6-99,4%); el valor predictivo positivo (VP+), del 93,1% (IC del 95%: 78,0-98,1%); el valor predictivo negativo (VP-), del 93,0% (IC del 95%: 86,3-96,6%); el cociente de probabilidades positivo (CP+), de 37,72 (IC del 95%: 9,47-150,20), y el cociente de probabilidades negativo (CP-), de 0,21(IC del 95%: 0,11-0,41) en toda la muestra. En los pacientes con ventilación mecánica, la sensibilidad fue del 92,9% (IC del 95%: 68,5-98,7%); la especificidad, del 86,7% (IC del 95%: 62,1-96,3%); el VP+, del 86,7% (IC del 95%: 62,1-96,3%); el VP-, del 92,9% (IC del 95%: 68,5-98,7%); el CP+, de 6,96 (IC del 95%: 1,90-25,51), y el CP-, de 0,08 (IC del 95%: 0,01-0,55). Conclusión: El CAM-ICU en español es reproducible. Su sensibilidad y especificidad así como sus valores predictivos son buenos (AU)

Objective: To validate the Spanish version of the CAM-ICU. Design: Validation study. The inter-rater reliability and validity were evaluated using a blind comparison with the DSM-IVTR criteria (reference standard) in a group of patients hospitalized in an Intensive Care Unit (ICU). Setting Medical-surgical ICU. Patients 129 adults with RASS >-4 score, within the 24-48h of ICU admission. Independent application of the CAM-ICU by two intensive care specialists and evaluation by a psychiatrist using the DSM-IVTR criteria for delirium. Results: Prevalence of delirium in the sample was 26.4%, this being and 48.3% in the 29 patients who received mechanical ventilation. Inter-rater reliability in the whole sample according to the Kappa index was 0.792 (95% CI 0.662-0.922, p<0.001) and in those who received mechanical ventilation was 0.726 (95% CI 0.487-0.965, p<0.001). The sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV), positive likelihood ratio (+LR), and negative likelihood ratio (-LR) were 79.4% (95% CI 63.2-89.7%); 97.9% (95% CI 92.6-99.4%); 93.1% (95% CI 78.0-98.1%); 93.0% (95% CI 86.3-96.6%); 37.72 (95% CI 9.47-150.20) and 0.21(95% CI 0.11-0.41), respectively, in the whole sample. In mechanically-ventilated patients, sensitivity, specificity, PPV, NPV, +LR and -LR were 92.9% (95% CI 68.5-98.7%); 86.7% (95% CI 62.1-96.3%); 86.7% (95% CI 62.1-96.3%); 92.9% (95% CI 68.5-98.7%); 6.96(95% CI 1.90-25.51) and 0.08 (95% CI 0.01-0.55), respectively. Conclusion: The Spanish version of the CAM-ICU is reliable. Its sensitivity, specificity and predictive values should be considered good (AU)

Comparación a 5 años de dos técnicas de cirugía bariátrica en pacientes con obesidad mórbida seguidos en consulta enfermera / Five-year comparison of two techniques of baritatric surgery in patients with morbid obesity followed up in a nurse consultation

Objetivo: Comparar la evolución de la pérdida ponderal y las complicaciones en los pacientes sometidos a dos técnicas de cirugía bariátrica (GVA: gastroplastia vertical anillada y BP: by pass gástrico tipo Capella) realizadas en el Hospital La Paz durante los años 2000 y 2001. Material y métodos: Se intervinieron 51 pacientes (27 GVA y 24 BP), de los que 44 (22 GVA y 22 BP) completaron 1 año de seguimiento, 43 (22 GVA y 21 BP) 2 años y 28 (10 GVA y 18 BP) 5 años. Los parámetros analizados a los 6, 12, 18, 24 meses y 5 años fueron IMC (índice de masa corporal), IE (índice de eficacia), % PP (porcentaje de peso perdido), % EPP (porcentaje de exceso de peso perdido), intolerancias alimentarias, complicaciones digestivas, complicaciones quirúrgicas, actividad física y modificación de hábitos alimentarios. Resultados: Con ambas técnicas se observa una importante reducción de peso a los 6 meses (% EPP: 45,8% con GVA y 53,4% con BP). A partir de los 12 meses la pérdida de peso era significativamente superior con BP (% EPP a 2 años: 59,5% con GVA y 83% con BP). Sin embargo, a los 5 años se detecta una recuperación ponderal en ambas técnicas. A los 12 meses los pacientes del grupo GVA toleraban peor la carne y a los 18 meses los del grupo de BP toleraban peor el arroz. No se encontraron diferencias significativas en otros parámetros. Conclusión: Los resultados a largo plazo son mejores con la técnica BP que con la GVA. Hay una reducción de la eficacia a los 5 años que podría estar relacionada con la modificación de hábitos alimentarios y con el abandono del refuerzo en consulta enfermera (AU)

Aims: To compare the evolution of weight loss and complications in the patients subjected to two techniques of bariatric surgery (RVG: ring vertical gastroplasty and BP: gastric by pass type Capella) carried out in HospitalLa Paz during the years 2000 and 2001. Material and methods: 51 patients (27 RVG and 24 BP) were operated, and 44 (22 RVG and 22 BP) completed the follow-up at 1 year, 43 (22 RVG and 21 BP) at 2 years, and 28 (10 RVG and 18 BP) at 5 years. The parameters analyzed at 6, 12, 18, 24 months and 5 years were BMI (body mass index), EI (effectiveness index), % LW (percentage of lost weight), % LEW (percentage of lost excess of weight), alimentary intolerances, digestive complications, surgical complications, physical activity and modification of alimentary habits. Results: An important reduction of weight was observed at 6 months with both techniques (% LEW: 45.8% with RVG and 53.4% with BP). After 12 months the loss of weight was significantly higher with BP (% LEW at 2 years: 59.5% with RVG and 83% with BP). However, at 5 years a weight recovery was detected in both groups of patients. At 12 months the patients subjected to RVG tolerated worse the meat and at 18 months the group of BP tolerated worse the rice. There were not significant differences in other parameters. Conclusion: The long term results are better with BP than with RVG. There is a reduction of effectiveness at 5 years that could be related with the modification of alimentary habits and with giving up attendance to the nurse consultation (AU)

Tratamiento dietético de la ascitis quilosa postquirúrgica: caso clínico y revisión de la literatura / Postsurgical chylousascites: Case report and literature review

La ascitis quilosa es la acumulación de quilo en la cavidad peritoneal debido a la ruptura u obstrucción de los conductos linfáticos abdominales. Clínicamente se manifiesta por distensión abdominal. El criterio diagnóstico más útil es el aumento de los triglicéridos en el líquido ascítico. Las neoplasias son la causa más frecuente, aunque también deben considerarse etiologías menos comunes como la cirugía abdominal. El tratamiento consiste en dieta hiperproteica con restricción de la grasa y suplementos de triglicéridos de cadena media. En caso de no respuesta o contraindicación de la vía oral- enteral se opta por nutrición parenteral reservándose la cirugía para las situaciones refractarias al tratamiento conservador. Presentamos un caso de ascitis quilosa secundaria a linfadenectomía retroperitoneal (AU)

Chylous ascites derives from chyle leakage into the peritoneal cavity, either due to rupture or obstruction of abdominal lymphatic vessels. The main clinical sign is abdominal distention, while diagnosis requires the presence of triglycerides in ascitic fluid. Neoplasms are the most common cause of chylous ascites, although less common causes, such as abdominal surgery, should also be considered. The mainstay of therapy is hyperproteic diet with fat restriction and middle-chain triglycerides. Parenteral nutrition is reserved for cases in which dietary treatment fails to restore an optimal nutritional status or is contraindicated, whereas surgery is considered for patients that are deemed refractory to conservative therapy. We present a case of chylous ascites secondary to retroperitoneal lymphadenectomy (AU)

Seudoaneurisma de la arteria vertebral / Vertebral artery pseudoaneurysm

No disponible

No disponible

[Five-year comparison of two techniques of bariatric surgery in patients with morbid obesity followed up in a nurse consultation]. / Comparación a 5 años de dos técnicas de cirugía bariátrica en pacientes con obesidad mórbida seguidos en consulta enfermera.

AIMS: To compare the evolution of weight loss and complications in the patients subjected to two techniques of bariatric surgery (RVG: ring vertical gastroplasty and BP: gastric by pass type Capella) carried out in HospitalLa Paz during the years 2000 and 2001. MATERIAL AND METHODS: 51 patients (27 RVG and 24 BP) were operated, and 44 (22 RVG and 22 BP) completed the follow-up at 1 year, 43 (22 RVG and 21 BP) at 2 years, and 28 (10 RVG and 18 BP) at 5 years. The parameters analyzed at 6, 12, 18, 24 months and 5 years were BMI (body mass index), EI (effectiveness index), % LW (percentage of lost weight), % LEW (percentage of lost excess of weight), alimentary intolerances, digestive complications, surgical complications, physical activity and modification of alimentary habits. RESULTS: An important reduction of weight was observed at 6 months with both techniques (% LEW: 45.8% with RVG and 53.4% with BP). After 12 months the loss of weight was significantly higher with BP (% LEW at 2 years: 59.5% with RVG and 83% with BP). However, at 5 years a weight recovery was detected in both groups of patients. At 12 months the patients subjected to RVG tolerated worse the meat and at 18 months the group of BP tolerated worse the rice. There were not significant differences in other parameters. CONCLUSION: The long term results are better with BP than with RVG. There is a reduction of effectiveness at 5 years that could be related with the modification of alimentary habits and with giving up attendance to the nurse consultation.

[Postsurgical chylous ascites: case report and literature review]. / Tratamiento dietético de la ascitis quilosa postquirúrgica: caso clínico y revisión de la literatura.

Chylous ascites derives from chyle leakage into the peritoneal cavity, either due to rupture or obstruction of abdominal lymphatic vessels. The main clinical sign is abdominal distention, while diagnosis requires the presence of triglycerides in ascitic fluid. Neoplasms are the most common cause of chylous ascites, although less common causes, such as abdominal surgery, should also be considered. The mainstay of therapy is hyperproteic diet with fat restriction and middle-chain triglycerides. Parenteral nutrition is reserved for cases in which dietary treatment fails to restore an optimal nutritional status or is contraindicated, whereas surgery is considered for patients that are deemed refractory to conservative therapy. We present a case of chylous ascites secondary to retroperitoneal lymphadenectomy.

Mortalidad cardiovascular en trasplante renal / No disponible

Las novedades más relevantes en el área de la patología cardiovascular en trasplante renal podemos dividirlas en varios aspectos. En cuanto a la evaluación cardiovascularantes del trasplante destaca que los pacientes que tuvieron un evento cardiovascular antes del trasplante tienen más riesgo de morbimortalidad cardiovascular post-tras-plante, que el eco cardiograma puede predecir mejor la su-pervivencia del paciente trasplantado renal que la coronariografía y que el resultado de la coronariografía no es pronostica en los paciente diabéticos. Por otro lado, muchos de los estudios publicados se han centrado en estudiar la obesidad como factor de riesgo cardiovascular. Aunque hay algún resultado contradictorio, parece que la obesidad influye negativamente en la supervivencia del injerto y del paciente, sobre todo en las situaciones más extremas. También se han publicado va-rios estudios que destacan la gran prevalencia de prediabetes y de diabetes en el primer año de trasplante, con la consecuente necesidad de realizar test de sobrecarga oral de glucosa a los pacientes no diabéticos. En cuanto a los marcadores intermedios de lesión de órgano diana, recalcar la importancia progresiva de la medición del grosor íntima-media carotídeo y de las calcificaciones coronarias en el seguimiento de los pacientes trasplanta-dos renales con alto riesgo cardiovascular. Las novedades más relevantes en el área de intervenciones terapéuticas son las derivadas del efecto de los diferentes inmunosupresores sobre los factores de riesgo cardiovascular y el efecto de los hipolipemiantes (estatinas, ezetimibe, aceite de pescado) en la evolución del injerto renal y del paciente trasplantado renal (AU)

The most relevant novelties in the area of cardiovascular disease in kidney transplant can be divided into various aspects. The most noteworthy findings with regard to pretransplant cardiovascular evaluation were that patients who had a cardiovascular event before transplant are at greater risk of cardiovascular morbidity and mortality post transplant, the echocardiogram can predict kidney transplant patient survival better than coronary angiography, and the result of coronary angiography is not prognostic in diabetic patients. On the other hand, many of the published studies focused on obesity as a cardiovascular risk factor. Although some results are contradictory, it seems that obesity adversely affects graft and patient survival, especially in more extreme situations. Various studies have also been published that stress the high prevalence of prediabetes and diabetes in first year after transplant, with the consequent need to perform the oral glucose tolerance test in non diabetic patients. With regard to intermediate markers of target-organ damage, the progressive importance of measuring carotid intima-mediathickness and coronary calcifications in the follow-up of kidney transplant patients with high cardiovascular risk should be stressed. The most relevant novelties in the area of therapeutic interventions are those related to the effect of different immunesuppressants on cardiovascular risk factors and the effect of hypolidemic agents (statins, ezetimibe, fish oil) on the course of the kidney graft and kidney transplant patient (AU)

[Cardiovascular mortality in kidney transplatation]. / Mortalidad cardiovascular en trasplante renal.

The most relevant novelties in the area of cardiovascular disease in kidney transplant can be divided into various aspects. The most noteworthy findings with regard to pretransplant cardiovascular evaluation were that patients who had a cardiovascular event before transplant are at greater risk of cardiovascular morbidity and mortality posttransplant, the echocardiogram can predict kidney transplant patient survival better than coronary angiography, and the result of coronary angiography is not prognostic in diabetic patients. On the other hand, many of the published studies focused on obesity as a cardiovascular risk factor. Although some results are contradictory, it seems that obesity adversely affects graft and patient survival, especially in more extreme situations. Various studies have also been published that stress the high prevalence of prediabetes and diabetes in first year after transplant, with the consequent need to perform the oral glucose tolerance test in nondiabetic patients. With regard to intermediate markers of target-organ damage, the progressive importance of measuring carotid intima-media thickness and coronary calcifications in the follow-up of kidney transplant patients with high cardiovascular risk should be stressed. The most relevant novelties in the area of therapeutic interventions are those related to the effect of different immunosuppressants on cardiovascular risk factors and the effect of hypolidemic agents (statins, ezetimibe, fish oil) on the course of the kidney graft and kidney transplant patient.