Serum levels of the apoptosis-associated molecules, tumor necrosis factor-alpha/tumor necrosis factor type-I receptor and Fas/FasL, in sepsis.

STUDY OBJECTIVE: s: Numerous reports suggest that apoptosis may play an important role in the sepsis syndrome. The objective of the present study was to examine the levels of molecules associated with apoptosis belonging to the tumor necrosis factor (TNF)-alpha/TNF type-I receptor (TNFRI) and Fas ligand (FasL)/Fas receptor (Fas) pathways in patients with sepsis. PATIENTS AND METHODS: Twenty-two patients with sepsis (14 patients with severe sepsis and 8 patients with sepsis), and 6 healthy volunteers were evaluated. Sequential analysis of the serum levels of TNF-alpha, TNFRI, FasL, and Fas were performed in these patients using enzyme-linked immunosorbent assays. RESULTS: Detectable levels of TNF-alpha were found in only 8 of 14 patients with severe sepsis. Patients with severe sepsis and sepsis had similarly increased levels of FasL, compared with healthy individuals (p < 0.05). Higher levels of TNFRI and Fas were found in patients with severe sepsis than in patients with sepsis and healthy volunteers (p < 0.001 and p < 0.01, respectively). Fas levels were also higher in patients who died than in those who survived (p < 0.01). A direct relationship was found between serum levels of TNFRI and Fas, and multiorgan dysfunction (sequential organ failure assessment score) [p < 0.0001]. CONCLUSIONS: These results suggest that the TNF-alpha/TNFRI and FasL/Fas systems may be involved in the pathogenesis of sepsis. Serum levels of the death-receptors, TNFRI and Fas, could serve as potential markers of the severity of human sepsis.

Patologia medica del embarazo en un departamento de Medicina Interna / Medical pathology of pregnancy in departament of Internal Medicine

La patologia medica del embarazo represento el 0,9% de las pacientes ingresadas en un lapso de 2 anos (1990-1992). Las patologias mas frecuentes fueron : asma bronquial, infecciones y transtornos psiquiatricos. La terminacion del parto fue por via vaginal en la mayoria de los casos. El peso promedio de los recien nacidos fue superior a 2.500 g y la puntuacion en la escala de Apgar en el 84,6% fue igual o superior a 6. Hubo 2 muertes maternas (6,5%)

Soporte nutricional por microyeyunostomía en embarazo de 19 semanas llevado a término: primer caso en Venezuela / Nutritional support for microjejunostomy in a pregnancy of 19 weeks terminated: first case in Venezuela

Se describe un caso de esófago gastritis cáustica y estenosis pilórica, consecuente a un intento de suicidio en paciente de 26 años y embarazo de 19 semanas. Se trató con nutrición parenteral y enteral, vía microyeyunostomía y cirugía abdominal logrando la viabilidad fetal y restablecimiento de la salud materna