Hernioplastía ambulatoria en paciente de la tercera edad: seguimiento a largo plazo / Ambulatory hernioplasty in the elderly

Introducción: La seguridad de la hernioplasta ambulatoria en adultos es un procedimiento bien establecido. El objetvo de este estudio es mostrarla factbilidad de la Hernioplasta de la pared abdominal y de la región inguino-femoral en forma ambulatoria bajo anestesia local en pacientes de latercera edad y evaluar la tasa de recidiva a mediano y largo plazo.Pacientes y Método: Presentamos nuestra experiencia sobre 547 Pacientes a quienes se le realizó Hernioplasta de la Pared Abdominal y Región Inguino-femoralen una Unidad Independiente de Cirugía Ambulatoria del Insttuto Guatemalteco de Seguridad Social (IGSS), localizada en el Centro de AtenciónMédica Integral para Pensionados (CAMIP), que atende pacientes jubilados de la tercera edad y de los benefciarios del programa de jubilación.Todos los pacientes fueron atendidos de manera ambulatoria y operados con anestesia local durante el período de mayo de 1994 a Julio del 2002. Latécnica quirúrgica dependió del diagnóstco pre-operatorio y en ningún paciente se utlizó malla. Se hizo seguimiento a inmediato y mediano plazo enlas clínicas de los cirujanos y posteriormente se hace seguimiento a 11 años a través de contacto telefónico.Resultados: La tasa de complicaciones fue del 4.3%, siendo el hematoma de la pared abdominal la principal causa. Nuestra tasa de recidiva a cortoplazo fue de 2.93 % (16/547) y 5.55% (13/234) a largo plazo.Conclusiones: La Hernioplasta ambulatoria de la pared abdominal y de la región inguinal bajo anestesia local en pacientes de la tercera edad es unprocedimiento seguro y puede ser reproducible con mínima morbilidad y nula mortalidad.

Background: Safety of ambulatory hernioplasty in adults is a well-established procedure. The aim of this study was to show the feasibility of ambulatoryabdominal wall and inguino-femoral region hernioplasty, under local anesthesia in elderly patents, and assess medium and long term recurrences.Patents and Methods: A total of 547 senior patents from May 1994 to July 2002 underwent ambulatory hernioplasty of the abdominal wall and inguino-femoralregion at the Center for Integral Health Care for Pensioners (CAMIP). All ambulatory surgeries were performed under local anesthesia withan open surgical technique. Mesh was not used in any patent. Immediate, medium-term and long term follow-up was performed to assess long-termrecurrence rate 11 years afer the procedure.Results: Complicaton rate was 4.3%, abdominal wall hematoma was the leading cause of morbidity. Short term recurrence rate was 2.93% (16/547)and long term 5.55% (13/234).Conclusions: Ambulatory hernia repair of abdominal wall and groin region under local anesthesia of senior patents is a safe procedure.

Rhodotorula mucilaginosa catheter-related fungaemia in a patient with multiple myeloma.

To date, there have been several case reports of Rhodotorula infection in haematological patients, but none affecting patients with multiple myeloma (MM). We describe a 54-year-old man with MM receiving prophylaxis with fluconazole who was using a subclavian Port-A-Cath and presented two episodes of fungaemia caused by Rhodotorula mucilaginosa. The first episode was resolved with oral itraconazole and neutropenia recovery. During the second episode, caspofungin was administered without success; however, liposomal amphotericin B and catheter withdrawal resolved the fungaemia. As far as we know, this is the first case reported of R. mucilaginosa fungaemia in a patient with MM.

beta-Carboline alkaloids in Peganum harmala and inhibition of human monoamine oxidase (MAO).

Peganum harmala L. is a multipurpose medicinal plant increasingly used for psychoactive recreational purposes (Ayahuasca analog). Harmaline, harmine, harmalol, harmol and tetrahydroharmine were identified and quantified as the main beta-carboline alkaloids in P. harmala extracts. Seeds and roots contained the highest levels of alkaloids with low levels in stems and leaves, and absence in flowers. Harmine and harmaline accumulated in dry seeds at 4.3% and 5.6% (w/w), respectively, harmalol at 0.6%, and tetrahydroharmine at 0.1% (w/w). Roots contained harmine and harmol with 2.0% and 1.4% (w/w), respectively. Seed extracts were potent reversible and competitive inhibitors of human monoamine oxidase (MAO-A) with an IC(50) of 27 microg/l whereas root extracts strongly inhibited MAO-A with an IC(50) of 159 microg/l. In contrast, they were poor inhibitors of MAO-B. Inhibition of MAO-A by seed extracts was quantitatively attributed to harmaline and harmine whereas inhibition by root extracts came from harmine with no additional interferences. Stems and leaves extracts were poor inhibitors of MAO. The potent inhibition of MAO-A by seed and root extracts of P. harmala containing beta-carbolines should contribute to the psychopharmacological and toxicological effects of this plant and could be the basis for its purported antidepressant actions.