RESUMO
Antecedentes: los programas fast-track en cirugía hepática muestran ventajas con respecto al manejo perioperatorio tradicional al favorecer principalmente una disminución de la estancia hospitalaria y, por ende, de los costos hospitalarios. Material y métodos: en un estudio observacional y descriptivo se analizan resecciones hepáticas abiertas dentro de un programa de recuperación rápida, haciendo especial hincapié en la adherencia a este, la recuperación total de los enfermos, la morbilidad y la estancia hospitalaria. Resultados: se realizaron 32 hepatectomías en 30 pacientes, 27 de los cuales fueron oncológicos. La adherencia al programa utilizado fue del 78,1% y la recuperación total al momento del alta del 75%. La morbilidad fue del 12,5% y las complicaciones fueron de baja complejidad, aunque 2 pacientes necesitaron reingresar. La estancia hospitalaria tuvo una media de 3,4 días y, sumando los reingresos, de 3,6 días. Conclusión: la aplicación de un ERP en cirugía hepática no solo es factible sino trae aparejada como principal beneficio una disminución en la estancia hospitalaria y, por ende, de los costos. Pero no estamos convencidos de que un ERP mejore la morbilidad de los pacientes.
Background: Background: Fast-track programs in liver surgery offer advantages over traditional perioperative management, particularly in terms of reducing length of hospital stay and hospital costs. Material and methods: We conducted an observational and descriptive analysis of patients undergoing open liver resections as part of an enhanced recovery program. Adherence to the program, full recovery of the patients, complications and length of hospital stay were assessed. Results: A total of 32 liver resections were performed in 30 patients, 27 with cancer. The adherence to the program was 78.1% and full recovery on discharge was 75%. The incidence of complications was 12.5%; most of them were not severe but two patients required rehospitalization. Mean length of hospital stay was 3.4 days and 3.6 days when readmissions were considered. Conclusion: The implementation of an ERP after liver resections is feasible and offers advantages in terms of reducing length of hospital stay and hospital costs. We do not think that ERP improves morbidity in these patients.
RESUMO
Saccharomyces cerevisiae uses glucose preferentially to any other carbon source and this preferential use is ensured by control mechanisms triggered by glucose. The consensus is that inactivation of sugar transporters other than glucose transporters is one of these mechanisms. This inactivation is called catabolite inactivation because of its apparent analogy with the catabolite inactivation of gluconeogenic enzymes. Recently, doubt has been cast on the role of the inactivation of the sugar transporters in controlling the use of glucose because this inactivation neither is specifically triggered by glucose nor specifically affects non-glucose sugar transporters. Based on the fact that this inactivation has been almost exclusively investigated using nitrogen-starved cells, it has been proposed that it might be due to the stimulation of the protein turnover that follows nitrogen starvation. The results obtained in this work support this possibility since they show that the presence of a nitrogen source in the medium strongly inhibited the inactivation. It is concluded that, in growing yeast cells, the contribution of the inactivation by glucose of the non-glucose sugar transporters to the preferential use of glucose is much lower than generally believed.
