Perfil lipídico en mujeres embarazadas sanas de tres regiones de Chile / Lipid profile in healthy pregnant women in three regions of Chile

Antecedentes: Los lípidos plasmáticos maternos durante el embarazo pueden influir en el crecimiento fetal, particularmente en pacientes con diabetes gestacional; estos lípidos cambian su concentración plasmática materna a lo largo de la gestación. Objetivo: Calcular tablas y curvas de lípidos normales según edad gestacional en una población de embarazadas chilenas. Método: Se midió el colesterol total (CT), colesterol LDL (LDL-C) triglicéridos (TG), Colesterol-HDL (HDL-C), y ácidos grasos no esterificados (NEFA), en 94 embarazadas sanas y jóvenes (<33 años, edad media de 27,6 +/- 6,2 años), con peso pregestacional normal (Índice de Masa Corporal entre 20 y 24,9 Kg/m2 y medio de 23,3 +/- 2,0 Kg/m2). Las pacientes provenían de: Hospital Parroquial de San Bernardo, Santiago (n=55), Hospital de Talca (n=2); Hospital del Profesor, Santiago (n=18); Hospital Regional de Concepción (n=9) y Hospital Clínico de la Pontificia Universidad Católica de Chile (n=10). Resultados: Calculamos, para cada uno de los cuatro lípidos, las curvas de percentil 50, percentil 90 y percentil 10, en mg/dL y mmol/l. Los NEFA solo fueron expresados en mmol/l. Incluimos las funciones matemáticas de las curvas de regresión polinomial de los cuatro lípidos con el fin que sean fácilmente reproducibles en otros tamaños. Conclusiones: Calculamos las tablas y curvas de lípidos maternos normales a lo largo del embarazo, que sean aplicables a la población de embarazadas chilenas.

Background: In normal human pregnancy, maternal lipids can modify the rate of fetal growth, particularly in pregnancies with Gestational Diabetes Mellitus (GDM). These lipids change continuously their serum concentration in the mother along the pregnancy. Aim: To calculate tables and curves of normal serum lipids, according to gestational age, in healthy Chilean pregnant women. Methods: We measured total cholesterol (CT), LDL-cholesterol (LDL-C), triglycerides (TG), HDL-Cholesterol (HDL-C), and Non-Esterified Fatty Acids (NEFA) in 94 young and healthy pregnant women (< 33 years, mean age 27.6 +/- 6.2 years), with normal pregestational Body Mass Index (BMI, 20.0-24.9 Kg/m2 , mean value= 23.3 +/- 2.0 Kg/m2). The women of the study were patients of 5 hospitals: Hospital Parroquial de San Bernardo, Santiago (n=55), Hospital de Talca (n=2); Hospital del Profesor, Santiago (n=18); Hospital Regional de Concepción (n=9) and Hospital Clínico de la Pontificia Universidad Católica de Chile (n=10). Results: For each one of the lipids, we calculated curves of 50th, 90th and 10th percentiles, both in mg/dL and mmol/L (the NEFA were expressed only in mmol/L). The mathematical functions of the curves of polynomial regression of all lipids were included in the manuscript, in order to facilitate their reproduction. Conclusions: We calculated tables and curves of normal maternal serum lipids in relation to gestational, in order to make these available for use in the care of Chilean pregnant women.

Experimental study comparing meshes made of polypropylene, polypropylene + polyglactin and polypropylene + titanium: inflammatory cytokines, histological changes and morphometric analysis of collagen.

PURPOSE: Incisional hernia occurs in approximately 11% of all laparotomies. Changes in collagen have been closely implicated in its pathogenesis. The high recurrence rate (45-54%) after primary suture has stimulated the development of meshes. Currently, meshes are the biomaterials implant group most used in medicine. This study aims to compare the serum and tissue inflammatory responses and collagen deposition caused by meshes made of polypropylene, polypropylene + polyglactin and polypropylene + titanium. METHODS: Thirty Wistar rats were divided into three groups. In group I, a high-density polypropylene mesh was positioned on the abdominal wall. In groups II and III, low-density meshes were used in associations with polyglactin and titanium, respectively. Immediately before the operation and on the first, third and fortieth postoperative days, pro-inflammatory cytokines were assayed. On the 40th postoperative day, the region of the inserted prosthesis was biopsied. The tissue inflammatory reaction was evaluated using a scale for objective scoring. For collagen, picrosirius was used with data reading using the Image Tool computer software. RESULTS: Cytokines: there were no statistically significant differences between the groups. HISTOLOGY: on the 40th postoperative day in group I, there were fewer inflammatory tissue response and greater collagen deposition (P < 0.01). In group II, there were greater inflammatory tissue response and less collagen deposition (P < 0.01). Group III presented intermediate values between groups I and II. CONCLUSIONS: There were no significant differences in cytokine levels between the groups in the present study. In the animals with the polypropylene + polyglactin mesh implant there was the most intense inflammatory process with lower tissue maturation and collagen deposition on the 40th postoperative day. The polypropylene mesh presented a less severe late inflammatory process, with greater tissue maturation and collagen deposition. The polypropylene + titanium mesh presented intermediate values between the others.

Evaluation of sequential perfusion with Euro-Collins and Belzer solutions for pancreas preservation in rats.

OBJECTIVE: To investigate the effect of Euro-Collins and Belzer solutions in a sequential preservation of the pancreas. METHODS: Forty-five Wistar-EPM rats were divided into four groups, according to the solution used during preservation: (1) saline solution (SF): animals perfused and preserved with saline solution; (2) Euro-Collins group (C): animals perfused and preserved with Euro-Collins solution; (3) Belzer group (B): animals perfused and preserved with Belzer solution; (4) Euro-Collins/Belzer group (CB): animals perfused with equal parts of Euro-Collins and Belzer solutions sequentially and preserved with Belzer solution. After perfusion, the animals underwent pancreas resection and preservation with the respective substance at 4 degrees C. Amylase was measured in the preservation solution after 12, 24, 36, or 48 hours. Finally, the pancreas was analyzed histologically, and a statistical analysis was performed. RESULTS: Groups SF and C showed the highest amylase levels in the preservation solution during all periods. The levels were higher than in groups C and CB (P = .05). Amylase levels were similar in groups B and CB to 24 hours (P = .05). Histological analysis was significant for analysis of pancreas islet cells and edema. Groups B and CB were histologically similar (P = .001) and different from groups SF and C. CONCLUSION: Sequential perfusion using Euro-Collins and Belzer solutions was effective for pancreas preservation in rats up to 24 hours.

[Study of preoperative risk factors for bacteriobilia in patients with acute calculosis cholecystitis]. / Estudos dos fatores de risco pré-operatórios para bacteriobilia em doentes portadores de colecistite aguda calculosa.

OBJECTIVE: to determine an association between the preoperative clinical status and the result of bile and gallbladder wall cultures. MATERIAL AND METHODS: 28 variables regarding history, physical examination and labatorial assessment in 38 patients with acute calculosis cholecystitis submitted to urgency surgery were prospectively studied during a 19-month period, between November 1995 and May 1997. Cultures for aerobic and anaerobic agents from both the gallbladder wall and the bile were performed, in three different culture media (BACTEC 9240, BHI and HEMOBAC). RESULTS: bacteria were isolated in at least one culture medium, in 68.2% of the patients. At univariate analysis, five preoperative factors were identified as predictors of bactibilia: over 55 years of age, a greater than 0.4 degrees C difference in the axillary-rectal temperature, a greater than 12.000 cels/m3 blood leukocyte count, a greater than 75% neutrophil percentage and a greater than 4% rod neutrophil percentage. Owing to the small sample size, statistical significance of the series could not be noted by logistic regression, although a trend to preoperative determination could be observed in 98% of the subjects with positive culture, by means of the model based on age and percentage of rod neutrophil. By analyzing predictive factors jointly, it was noted that patients with more than one predictive factor have a significantly greater possibility to yielding positive culture when compared to those with up to one predictive factor for bactibilia. CONCLUSIONS: We concluded that, in patients with acute calculosis cholecystitis, bactibilia may be predicted yet at the preoperative period, by using simple and easily obtained data.

Estudos dos fatores de risco pré-operatórios para bacteriobilia em doentes portadores de colecistite aguda calculosa / Study of preoperative risk factors for bactibilia in patients with calculosis acute cholecystitis

OBJETIVO: Determinar uma associaçäo entre o quadro clínico pré-operatório e os resultados das culturas de bile e da parece vesicular. CASUISTICA E METODOS: Foram estudadas 28 variáveis considerando-se história clínica, exame físico e investigaçäo laboratorial em 38 doentes portadores de colecistite aguda calculosa, submetidos à cirurgia de urgência. Este estudo prospectivo foi realizado em 19 meses, entre novembro de 1995 a maio de 1997. Foram realizadas culturas para agentes anaeróbios e aeróbios, em três diferentes meios de cultura (BACTEC 9240, BHI e HEMOBAC). RESULTADOS: Foram isoladas bactérias em pelo menos um meio de cultura em 68,2 por cento dos doentes. Pela anßlise univariada, foram identificadas cinco variáveis pré-operatórias como preditivas de bacteriobilia: idade acima de 55 anos, temperatura diferencial axilo-retal maior do que 0,4 C, leucocitose acima de 12000 cels/mmÝ, neutrofilia acima de 75 por cento e neutrófilos bastonetes acima de 4 por cento. Devido ao pequeno tamanho da amostra, näo pôde ser observada significância estatística por regressäo logística, embora pudesse ser observada em 98 por cento uma tendência para determinaçäo pré-operatória dos indivíduos com cultura positiva por meio do modelo baseado na idade e porcentagem de neutrófilos bastonetes. Pela análise em conjunto dos fatores preditivos, pôde-se observar que doentes com mais de um fator preditivo têm uma possibilidade significantemente maior para cultura positiva, quando comparado com aqueles com fator preditivo de bacteriobilia. CONCLUSAO: Conclui-se, portanto, que pela utilizaçäo de dados facilmente disponíveis em doentes com colecistite aguda calculosa, a bacteriobilia pode ser previsível no pré-operatório,

Laparoscopic cholecystectomy in a patient with a duplicated cystic duct.

Cystic duct duplication with a single gallbladder is one of the most uncommon abnormalities of the biliary tract, with fewer than 15 instances published. The authors describe a 49-year-old patient undergoing a laparoscopic cholecystectomy in whom a second cystic duct was found, initially misdiagnosed as the biliary tract. The cholecystectomy was performed successfully with the aid of intraoperative cholangiography. It is the first time a duplicated cystic duct has been treated successfully using a laparoscopic approach.

Video-endoscopic dissection of multiple pedicled arterial grafts for use in minimally invasive coronary artery bypass surgery.

BACKGROUND: We evaluated the possibility of video-endoscopic dissection of both internal thoracic arteries (rTAs) through the left thoracic approach and right gastroepiploic artery (GEA) via a small laparoscopic access, for use in minimally invasive coronary artery bypass surgery. METHODS: The procedure was performed on twenty-two mongrel dogs. Three 10 mm ports were inserted in the left hemithorax to enable the introduction of a rigid 0-degree videoscope and forceps which allowed access to the left and right ITAs. For dissection of the GEA, one 10 mm and two 5 mm ports were inserted in the para-umbilical region. RESULTS: The left and right ITAs and the GEA were easily visualized and dissection and complete mobilization was achieved without injury, which was checked by the presence of good blood flow. The ITAs and GEA were divided distally, exteriorized through a small left anterior thoracotomy and the length of these three grafts were able to reach all of the left coronary artery branches. CONCLUSIONS: We have demonstrated, in dogs, the feasibility of video-assisted dissection of both the left and right ITAs through the left thoracic approach, without sternotomy, avoiding the risks of sternal complications and expanding its use for all patients. Furthermore, a third arterial conduit (the RGA) can be used without requiring laparotomy.

Bronconeumonía por adenovirus, complicada con derrame pleural / Bronchopneumonia by adenovirus complicated with pleural effusion

Se relata la historia clínica de un lactante de 8 meses que presentó una Bronconeumonia con derrame, aislándose en el líquido pleural un Adenovirus. La titulación serológica fue positiva para este virus. Los cultivos para bacterias fueron negativos tanto en sangre como en el líquido pleural. Se revisa la literatura sobre el tema

Associacao entre molestia de Crohn e adenocarcinoma no ileo terminal. Apresentacao de um caso e revisao da literatura / Association of Crohn disease and adenocarcinoma in the terminal ileum. Presentation of a case and review of the literature

Os autores descrevem um caso de molestia de Crohn e adenocarcinoma localizados no ileo terminal. O diagnostico de molestia de Crohn foi baseado em dados clinicos e radiologicos 12 anos antes da comprovacao da co-existencia daquelas duas molestias. A indicacao cirurgica foi realizada quando surgiu o quadro de obstrucao intestinal. Ressaltam a dificuldade de se estabelecer o diagnostico da associacao das duas doencas no pre-operatorio. O diagnostico so pode ser feito baseado nos dados anatomo-patologicos da peca operatoria com o exame minucioso de multiplos cortes histologicos. A revisao da literatuta permitiu verificar que existem apenas 39 casos descritos, em que as duas doencas estavam associadas no ileo terminal. As publicacoes a esse respeito foram feitas somente em tres paises: Estados Unidos, Inglaterra e Canada. O presente caso constitui o primeiro descrito na literatura brasileira

Estudo experimental do comprometimento pulmonar apos a injecao de suco gastrico com e sem cimetidine. / Experimental study of the pulmonary lesion after gastric juice injections with and without cimetidine

Os autores realizaram estudo experimental em caes, comparando o comprometimento pulmonar apos injecoes endotraqueais de suco gastrico colhido por sonda nasogastrica, com e sem administracao previa de cimetidine e injecoes de soro fisiologico. Comprovaram alteracoes pulmonares bem mais evidentes e intensidade maior de inflamacao, nos animais em que se injetou suco gastrico sem cimetidine. Concluiram que a cimetidine possui acao protetora contra o dano pulmonar que se estabelece na pneumonia aspirativa