Protein S-100B as biochemical marker of brain ischemic damage after treatment of carotid stenosis.

BACKGROUND: S-100 protein is a family of low molecular weight proteins found in vertebrates characterized by two calcium binding sites of the helix-loop-helix ("EF-hand type") conformation. There are at least 21 different types of S-100 proteins. The name is derived from the fact that the protein is 100% soluble in ammonium sulfate at neutral pH. Protein S-100B was investigated as a marker of brain ischemic damage after treatment of carotid stenoses. METHODS: Between December 1, 2009 and December 1, 2010, S-100B protein was monitored in 76 patients after carotid artery stenting (CAS) and in 24 patients after carotid endarterectomy (CEA). In each patient, multiple samples were taken: before the procedure (basal sample), immediately after CAS or CEA, 60 minutes after CAS or CEA, and daily during the hospital stay. Evaluation of S-100B was carried out by blind assessment. Patients underwent pre- and postoperative diffusion-weighted magnetic resonance imaging or computed tomographic scan. RESULTS: An S-100B coefficient of variation higher than the established cut-off was detected in 16 patients: three affected by postoperative stroke, two patients with minor stroke, and one patient with fatal stroke; 12 patients presented with uneventful neurological outcome and positive brain imaging; and there was one false positive case. No false negative cases occurred. The postoperative protein S-100B level lowered to basal level in 15 patients: within 24 hours in the 12 patients with the uneventful outcome (and positive brain imaging) and in the false positive case; and after 120 and 144 hours, respectively, in the two patients with minor stroke. In the patient with fatal stroke, protein S-100B never returned to the preoperative level. CONCLUSIONS: In patients with an increased S-100B coefficient of variation, the diffusion-weighted magnetic resonance imaging was positive for ischemic brain lesions, except for one patient who was reported as a false positive case. The postoperative S-100B protein level decreased within 24 hours in the uneventful neurological cases and in the false positive case, whereas long-lasting postoperative increased values of the S-100B protein were observed in patients with poor neurological outcomes.

Cierre total vs cierre parcial de la herida abdominal en apendicitis gangrenosas y perforadas / Complete vs partial closure of the abdominal wound in gangrenous and/or perforated appendicitis

Se presentan los resultados de un análisis comparativo de 55 pacientes en dos grupos tratados por apendicitis ganfrenosa y/o perforada durante los años de 1.979,80 y 81, en el Hospital General de San Félix del IVSS. De 24 apendicectomizados usando un Mc. Burney y cerrando todos los planos de la pared abdominal, 16 (67%) desarrollaron abcesos de pared, y en los 10 casos en que se drenó la cavidad abdominal, no se evitó la formación de abceso, aún extrayendo el dren por otra herida. De los 31 pacientes en quienes se usó una incisión transversa y se dejó la piel y el subcutáneo abiertos, 2 (6%) hicieron abceso. Se recomienda el uso de la incisión transversal para la apendicectomía y en casos de apendicitis gangrenosa y/o perforada, dejar abiertos los planos superficiales de la herida para evitar la formación de abceso en la pared