Uso preoperatorio de fármacos hemostáticos para disminuir la transfusión de hemocomponentes en histerectomía total abdominal / Preoperative use of hemostatic drugs to reduce hemocomponent transfusion in total abdominal hysterectomy

Resumen: Introducción: en la actualidad se usan fármacos para disminuir el sangrado transoperatorio, la transfusión de hemoderivados como el ácido tranexámico que es un antifibrinolítico análogo de la lisina y desmopresina que actúa incrementando de forma autóloga el factor VIII y el factor de Von Willebrand (FVW) en individuos sanos. Objetivo: demostrar la eficacia del uso y seguridad del ácido tranexámico vs desmopresina para disminuir la transfusión de hemocomponentes en pacientes sometidos a histerectomía total abdominal electiva. Material y métodos: se estudiaron 72 pacientes, los cuales se dividieron en dos grupos (36 pacientes cada uno) asignados al azar para recibir ácido tranexámico 10 mg/kg de peso o desmopresina 0.3 mg/kg de peso, ambos por vía intravenosa 20 minutos previo al evento quirúrgico. Resultados: en comparación del ácido tranexámico contra desmopresina para la disminución del sangrado transoperatorio, 100% de las pacientes a las que se les administró el ácido tranexámico no requirieron transfusión de hemoderivados y presentado el 100% de efectividad siendo estadísticamente significativos con un valor de p < 0.05. Conclusiones: la administración de ácido tranexámico resultó más eficaz para disminuir la administración de hemoderivados en pacientes sometidos a histerectomía total abdominal electiva. Además, no se presentaron efectos adversos graves durante su administración.

Abstract: Introduction: drugs are currently used to reduce intraoperative bleeding, transfusion of blood products such as tranexamic acid, which is an antifibinolytic lysine analogue, and desmopressin, which acts by autologously increasing factor VIII and VWF in healthy individuals. Objective: demonstrate the efficacy of the use and safety of tranexamic acid vs desmopressin to reduce the transfusion of blood components in patients undergoing elective total abdominal hysterectomy. Material and methods: 72 patients were studied, divided into two groups (36 patients each one) randomly assigned to receive tranexamic acid 10 mg/kg weight or desmopressin 0.3 mg/kg weight, both intravenously 20 minutes prior to the surgical event. Results: the comparison of tranexamic acid against desmopressin for the reduction of intraoperative bleeding, 100% of the patients who were administered tranexamic acid did not require transfusion of blood products and presented 100% effectiveness, being statistically significant with a value of p < 0.05. Conclusions: the administration of tranexamic acid was more effective in reducing the administration of blood products in patients undergoing elective total abdominal hysterectomy.

Hyaluronic Acid Reduces Fibrosis in a Rabbit Model of Urethral Anastomosis.

INTRODUCTION: Urethral stricture caused by fibrosis is a common medical condition, but top-line therapy for this pathology has a high recurrence rate. This study aimed to determine the efficacy of hyaluronic acid (HA) treatment in preventing the development of fibrosis in a rabbit model of urethral anastomosis. MATERIALS AND METHODS: This experimental study involved 20 rabbits. HA (0.5 mL, 25 µg/mL) was applied in the experimental group (n = 10) during an experimental urethral anastomosis, and sterile saline (0.9%) solution was applied in the control group (n = 10). Animals underwent reoperation 12 weeks later for urethral resection. Fibrosis, inflammation, and urethral diameter were measured by two blinded pathologists at the site of the anastomosis. RESULTS: The amount of inflammatory infiltrate was similar in both groups. The thicknesses of the collagen fiber band were 275.9 ± 62.3 and 373.4 ± 44.3 µm in the study and control groups (p = 0.001), respectively, and the urethral lumen diameters at the anastomosis site at follow-up were 2575 ± 167 and 2382 ± 214 µm, respectively (p = 0.04). CONCLUSION: HA treatment reduced fibrosis at the anastomosis site during this experiment; we suggest further research to corroborate its efficacy in the treatment of urethral stricture.

Sex-dependent mechanisms involved in renal tolerance to ischemia-reperfusion: Role of inflammation and histone H3 citrullination.

Ischemia-reperfusion (I/R) injury, an inevitable result of kidney transplantation, triggers early inflammatory events that affect graft viability. Evidence from human transplantation and preclinical models of I/R suggests that a female hormonal environment positively influences the ability to recover from ischemic injury. However, the mechanisms behind these effects remain mostly unexplored. Here, we studied the influence of sex on pro-inflammatory mediators involved in the pathophysiology of acute I/R injury in male, female, and female ovariectomized (OVX) Wistar rats that underwent unilateral renal ischemia for 45 min, followed by 24 h of reperfusion. We found improved renal function, reduced cytokine expression, and decreased infiltration of myeloperoxidase-positive cells in females after I/R, when compared to their male and female OVX counterparts. Remarkably, citrullination of histone H3 was exacerbated in serum and renal tubules of females after I/R. In contrast, we observed lower levels of citrullinated histone H3 in male and female OVX rats in response to I/R, mostly in neutrophil extracellular traps. Our results demonstrate that female sex promotes renal I/R tolerance by attenuating pro-inflammatory mediators involved in I/R-induced damage.

Malignant primary tumor in left atrium with mitral valve invasion, pulmonary veins and cerebral metastasis. A case report.

INTRODUCTION: The incidence of cardiac primary tumors is estimated to be 0.0017-0.28%, of which 25% are malignant, occupying mainly right cavities. CLINICAL CASE: Patient who present with neurological symptoms due to brain metastasis of primary cardiac tumor in the left atrium, infiltrating the mitral valve and pulmonary veins. Tumor resection was performed with mitral valve replacement and atrial re-modeling with the use of the left appendage. CONCLUSIONS: Imaging techniques are fundamental for the diagnosis of this pathology, since the majority of cardiac tumors are asymptomatic until late stages.

INTRODUCCIÓN: La incidencia de tumores primarios cardiacos se calcula en 0.0017 a 0.28%, de los cuales el 25% es maligno y ocupa principalmente cavidades derechas. CASO CLÍNICO: Paciente que inicia con síntomas neurológicos por metástasis cerebrales de tumor primario cardiaco en cavidades izquierdas, que infiltra válvula mitral y venas pulmonares. Se realiza resección tumoral con reemplazo valvular mitral y remodelamiento auricular con uso de orejuela izquierda. CONCLUSIONES: Las técnicas de imagen son fundamentales para el diagnóstico de esta afección, ya que la mayor parte de los tumores cardiacos se muestra asintomática hasta etapas tardías.

Bone chondrosarcomas: clinical features and surgical outcomes in five years / Condrosarcomas óseos: características clínicas y resultados quirúrgicos en cinco años

Background: Biological and clinical behavior of chondrosarcoma, and its prognosis, are broadly related to histological grade, location and treatment. Surgery plays the most important role in local control and preservation of the limb. Given its low incidence, there are few cancer surgical centers in our country that report their experience concerning the treatment of this pathology. Objective: To describe the management, clinical features, and outcomes of surgical treatment in patients diagnosed with bone chondrosarcoma. Methods: Descriptive study which included 25 patients diagnosed with bone chondrosarcoma who received surgical treatment. We assessed their clinical features, localization, stage, treatment and surgical outcomes. Results: Mean age was 43.4 ± 14.7 years and the most frequently affected site was the pelvis (44%). The most frequently performed surgery was wide resection and immediate reconstruction with implants in 10 patients (40%). Local recurrence was observed in six patients (24%). During follow up, two patients died from metastatic disease (8%). Conclusions: Due to the characteristics of chondrosarcoma, the treatment is multidisciplinary. Local surgery plays the most important role in control, limb preservation and function.

Introducción: La conducta biológica de los condrosarcomas, así como su comportamiento clínico y pronóstico están ampliamente relacionados con el grado histológico, la localización y el tratamiento. La cirugía juega el papel más importante en el control local y la preservación de las extremidades. Debido a su baja incidencia, en nuestro país existen pocos centros que informen acerca de su experiencia en el tratamiento de esta patología. Objetivo: Describir el manejo y los resultados del tratamiento quirúrgico de pacientes con diagnóstico de condrosarcoma óseo. Métodos: Estudio descriptivo en el que se incluyeron 25 pacientes con diagnóstico de condrosarcoma óseo que recibieron tratamiento quirúrgico. Se estudiaron variables sociodemográficas, así como localización, grado histológico, estadio clínico, cirugía realizada, complicaciones y mortalidad. Resultados: La edad media de los pacientes fue de 43.4 ± 14.7 años y el sitio anatómico más frecuentemente afectado fue la pelvis (44%). La resección amplia y la reconstrucción inmediata con prótesis se realizó en 10 pacientes (40%). Seis pacientes (24%) se registraron con recurrencia local y se presentaron dos muertes (8%). Conclusiones: Debido a las características del condrosarcoma, el tratamiento es multidisciplinario. La cirugía juega el papel más importante en el control local, la preservación de la extremidad y su función.

Anti-Inflammatory Effect of Atorvastatin on the Kidney Graft of Living Donor Transplants.

BACKGROUND Recent studies have demonstrated that statins have anti-inflammatory and immunomodulatory properties, which could be considered beneficial in kidney transplantations. This study assesses the anti-inflammatory effect of atorvastatin on the kidney grafts of living donor transplants. MATERIAL AND METHODS In a randomized clinical trial, kidney donors were divided into 2 groups. The study group constituted 24 donors who received 40 mg atorvastatin, and 24 donors who received a placebo control, 4 weeks prior to transplantation. Serum C-reactive protein (CRP) levels were measured before and after atorvastatin administration. CRP and renal function of kidney recipients were measured at baseline and 1, 6, and 24 hours after transplantation. RESULTS After 4 weeks of treatment, the CRP level was 5.62±3.82 mg/dL in the control group and 3.27±0.62 mg/dL in the study group (P=0.007). Upon reperfusion, CRP levels in recipients at 1 hour were, 5.8±3.9 and 3.8±1.0 mg/dL, respectively (P=0.04). Twenty-four hours after the kidney transplantations, serum creatinine levels were 2.5±1.5 mg/dL in the study group and 3.7±2.4 mg/dL in the control group (P=0.04). CONCLUSIONS Our study suggests that the use of atorvastatin prior to allograft procurement of kidney transplant, reduces the acute kidney inflammatory burden profile, and promotes an improved kidney function recovery following transplantation.

[Findings of thyroid nodules in autopsies in Western Mexico]. / Hallazgo de nódulos tiroideos en autopsias en el occidente de México.

BACKGROUND: International literature reports a prevalence of 50% of thyroid nodules detected during autopsies of subjects without known thyroid disease. Currently there are no studies of this type in Mexico. The aim was to identify the prevalence of thyroid nodules in autopsied bodies without known thyroid pathology. METHODS: A series of cases of 300 cadavers without known thyroid pathology, from which we obtained their thyroid glands. It was analyzed the presence of thyroid nodules as well as their macroscopic and microscopic characteristics. RESULTS: 300 autopsies were included. 123 cadavers (41%) presented thyroid nodules; 69 were men (56%) and 54, women (44%). The mean age was 37 ± 14 years. A total of 149 nodules were found, out of which 94 were solid nodules (63%), and 55 were cystic (37%). Histopathological diagnosis of malignancy was found in 12 of the analyzed thyroid glands (4%). CONCLUSIONS: There was a greater prevalence of thyroid nodules in men and in subjects whose age at the time of dying was 45 years or less, unlike what is found in the international literature. We consider necessary to create screening programs for early diagnosis of thyroid nodules.

INTRODUCCIÓN: la literatura internacional reporta una prevalencia de nódulos tiroideos de 50% en autopsias de personas sin enfermedad tiroidea conocida. Hasta el momento no existen estudios de este tipo en México. El objetivo de este trabajo fue identificar la prevalencia de nódulos tiroideos en cadáveres humanos sin patología tiroidea conocida. MÉTODOS: serie de casos de 300 cadáveres sin patología tiroidea conocida, de los cuales se obtuvieron las glándulas tiroideas. Se analizó la presencia de nódulos tiroideos, así como sus características macroscópicas y microscópicas. RESULTADOS: se incluyeron 300 necropsias y se encontró una prevalencia de nódulos tiroideos en 123 de los cadáveres (41%), de los cuales 69 fueron hombres (56%) y 54 mujeres (44%). La edad promedio fue de 37 ± 14 años. Se encontraron 149 nódulos en total, de los cuales 94 fueron sólidos y 55 quísticos (37%); obtuvimos un diagnóstico histopatológico de malignidad en 12 de las glándulas analizadas (4%). CONCLUSIONES: se encontró una mayor prevalencia de nódulos tiroideos en cadáveres del sexo masculino y cuya edad al momento de morir fue de 45 años o menos, contrario a lo descrito en la literatura internacional. Consideramos necesaria la creación de programas de escrutinio para el diagnóstico oportuno de nódulos tiroideos.

Biomechanics of the Median Nerve During Stretching as Assessed by Ultrasonography.

The objective of this observational cross-sectional study was to investigate the normal motion of the median nerve when stretched during a neurodynamic exercise. In recent years, ultrasonography has been increasingly accepted as an imaging technique for examining peripheral nerves in vivo, offering a reliable and noninvasive method for a precise evaluation of nerve movement. Transverse motion of the median nerve in the arm during a neurodynamic test was measured. A volunteer sample of 22 healthy subjects (11 women) participated in the study. Nerve displacement and deformation were assessed by dynamic ultrasonography. Excellent interobserver agreement was obtained, with kappa coefficient of .7-.8. Ultrasonography showed no lateral motion during wrist extension in 68% of nerves, while 73% moved dorsally, with statistically significant differences between sexes (ORlat = 6.3; 95% CI = 1.4-27.7 and ORdor = 8.3; 95% CI = 1.6-44.6). The cross-sectional area was significantly greater in men (3.6 mm2). Quantitative analysis revealed no other statistically significant differences. Our results provide evidence of substantial individual differences in median nerve transverse displacement in response to a neurodynamic exercise.

Pig heart preservation with antegrade intracellular crystalloid versus antegrade/retrograde miniplegia.

Both histidine-tryptophan-ketoglutarate (HTK) solution and Braile miniplegia are commercially available and used with high success. The objective of this work was to compare the effects of both strategies in an animal model. Twelve pigs were divided into control, HTK, or Braile groups using a model of controlled global cardiac ischemia/reperfusion under cardiopulmonary bypass with 1 hour heart ischemia followed by 2 hour reperfusion. No significant differences were found over time or between groups for heart rate, arrhythmia, number of defibrillations required, blood gases, myocardial lactate production, myocardial oxygen consumption, nor coronary flow index. The Braile strategy was associated with a lower 120 minute postreperfusion coronary vascular resistance with higher water content, leukocyte infiltration, and oxidative damage compared with controls. Drainage of HTK solution to the venous return was followed by higher potassium and lower sodium blood concentrations. One-hour heart preservation with HTK or Braile systems followed by 2 hour reperfusion both allow for acceptable preservation of the healthy pig myocardium. Maneuvers such as leukocyte filtration or hemofiltration may further improve these conditions.

[Larrea tridentata. Effect on a non-metabolic model of urolithiasis in rats]. / Larrea tridentata en urofitiasls. Efecto en un modelo no metabólico en ratas.

OBJECTIVE: To evaluate the effect of L. tridentata infusion on the development of urinary calculi in a non-metabolic model. METHODS: Male Wistar rats were divided into two groups (n = 10 each). The experimental group received 1 mL of oral L. tridentata infusion three times daily for 95 days. Control group received 1 mL tap water. Five days after initiating treatment, urolithiasis was induced inserting a series of 15 knots of 5-0 chromic catgut into the urinary bladder. Measurements included body weight and water intake, complete blood counts, glucose, BUN, creatinine, bacterial culture, and weight of urinary stones and sands. RESULTS: No statistically significant differences were found between groups for any variable. CONCLUSIONS: An infusion of L. tridentata was not effective in the prevention of urolith formation in the suture-induced rat model. It produced no alterations in body weight gain, blood counts, or water intake. Future work is needed to completely rule out any effect of the plant on urolith formation.

Critical ischemia time in a model of spinal cord section. A study performed on dogs.

Vascular changes after acute spinal cord trauma are important factors that predispose quadriplegia, in most cases irreversible. Repair of the spinal blood flow helps the spinal cord recovery. The average time to arrive and perform surgery is 3 h in most cases. It is important to determine the critical ischemia time in order to offer better functional prognosis. A spinal cord section and vascular clamping of the spinal anterior artery at C5-C6 model was used to determine critical ischemia time. The objective was to establish a critical ischemia time in a model of acute spinal cord section. Four groups of dogs were used, anterior approach and vascular clamp of spinal anterior artery with 1, 2, 3, and 4 h of ischemia and posterior hemisection of spinal cord at C5-C6 was performed. Clinical evaluation was made during 12 weeks and morphological evaluation at the end of this period. We obtained a maximal neurological coordination at 23 days average. Two cases showed sequels of right upper limb paresis at 1 and 3 ischemia hours. There was nerve conduction delay of 56% at 3 h of ischemia. Morphological examination showed 25% of damaged area. The VIII and IX Rexed's laminae were the most affected. The critical ischemia time was 3 h. Dogs with 4 h did not exhibit any recovery.

The immediate response to severe shock in a canine model with a combination of hypertonic-hyperoncotic solution with naloxone.

To evaluate the acute hemodynamic and acid-base balance effects of hypertonic-hyperoncotic solution (HHS) combined with naloxone in the treatment of hemorrhagic shock in 45 male splenectomized adult mongrel dogs, a severe controlled hemorrhagic shock (20 mmHg mean arterial pressure during 30 min) was established in the groups (n=6) no treatment, shed blood reinfusion, hypertonic-hyperoncotic (saline-dextran) solution alone, naloxone alone (NX), or combination. Interventions included propiopromazine-pentobarbital anesthesia and installation of Swan-Ganz, femoral arterial, and urethral catheters, and exsanguination at 20 mmHg mean arterial pressure during 30 min followed by treatment and observation for 160 min. Fifteen (33%) dogs died before completing the 30-min shock period. Another 33% from the no-treatment group died during the following 90 min. Shed blood improved the cardiac index, arterial pressure, and acid-base balance. NX restored the cardiac index to less than 60% of baseline and reduced vascular resistance. Additionally, NX produced no improvement in acidosis, with 1 dog dead at 95 min posttreatment. HHS restored the cardiac index for 45 min and increased vascular resistance and arterial pressure. Acidosis was not improved. Single-dose HHS combined with naloxone resulted in a high cardiac index, oxygen consumption, and urine output with low peripheral vascular resistance (and no acute mortality) compared with untreated or single-dose groups.

Cambios en los gases ateriales de perros de raza Beagle durante el neumoperitoneo con bióxido de carbono / Changes in arterial blood gases from Beagles during carbono dioxide pneumoperitoneum

La laparoscopia es una alternativa común en humanos para la resolución de patología quirúrgica. Su uso en medicina veterinaria tiene a aumentar: Aunque se conocen las alteraciones gasométricas en animales adultos sometidos a neumoperitoneo con CO2, se diseñó este trabajo con el fin de valorar dichas alteraciones específicamente en perros de menos de 10 kg de peso. Cuatro de estos últimos, de raza Beagle, adultos, de entre 6 y 9 kg fueron sometidos a anestesia, ventilación de presión y neumoperitoneo con CO2 a 8 mmHg de presión durante 75 min. Se observó elevación significativa (P < 0.05) de la PaCO2 desde valores normales, hasta 51.6 ñ 1.28 mmHg, con una reducción simultánea del pHa hasta 7.29 ñ 0.02 (P < 0.05). La hiperventilación durante los últimos 50 min tendió a corregir estos valores. La PaO2 se mantuvo dentro de rangos normales, y alcanzó hasta 320 ñ 57 mmHg con la hiperventilación. Las alteraciones gasométricas en perros Beagle, entre 6 y 9 kg de PC, durante neumoperitoneo con CO2 (8 mmHg), son similarea a las observadas en animales de mayor talla. Estas pueden ser controladas modificando la frecuencia ventilatoria