Renal paratransplant hernia: an unusual complication of renal transplantation?

Renal paratransplant hernia constitutes an unusual variant of internal hernia caused by entrapment of bowel through a defect in the peritoneum covering the transplanted kidney. Only three cases have been previously reported. We present three new cases of renal paratransplant hernia. Abdominal pain and vomiting were the main symptoms. Clinical diagnosis of bowel obstruction and paratransplant hernia was reached using abdominal CT scan. All patients underwent an emergency surgical procedure, and one patient needed resection of necrotic bowel. The three patients survived owing to early surgical intervention, and they were discharged asymptomatic. Paratransplant hernia represented 1.1% of our series of transplant patients. Early diagnosis and surgical treatment are esential in transplant patients with bowel obstruction to avoid high morbidity and mortality rates.

Estudio prospectivo de la frecuencia de infección nosocomial y factores de riesgo en un servicio de cirugía general / Prospective study of the frequency of nosocomial infection and its risk factors in a general surgery department

Objetivo. Cuantificar la frecuencia de infección nosocomial (IN) en un servicio de cirugía general e identificar los factores de riesgo asociados. Pacientes y método. Se realizó un estudio prospectivo, longitudinal, descriptivo y analítico, entre enero de 1995 y diciembre de 1998, de una cohorte de 2.794 pacientes que fueron intervenidos quirúrgicamente, con una estancia postoperatoria superior a las 48 h. Resultados. La IN más frecuente fue la infección quirúrgica (IQ), con una tasa de incidencia acumulada (IA) global del 7,7 por ciento, oscilando entre el 3,4 por ciento para la cirugía limpia y el 23,7 por ciento para la cirugía sucia. Le siguen, en orden de frecuencia, la infección del tracto urinario (ITU) y la bacteriemia (B), con el 1,5 por ciento, y la neumonía nosocomial (NN) con el 0,5 por ciento. Una puntuación de la American Society of Anesthesiology (ASA) superior a 2 multiplica por 1,76 el riesgo de IQ, por 2,13 el riesgo de ITU, por 5,93 el riesgo de NN y por 4,72 el riesgo de B. La probabilidad de detectar una IQ según la estancia posquirúrgica oscila entre el 0,4 en los pacientes con una estancia de 3-4 días hasta el 0,93 en los pacientes con una estancia de 10-12 días. Conclusiones. La IN más frecuente fue la IQ. Una puntuación ASA superior a 2, la estancia prequirúrgica, el número de días con sonda urinaria, con catéter venoso central, con ventilación mecánica, así como el mejor uso de profilaxis antibiótica son factores que influyeron en la frecuencia de infección nosocomial. La frecuencia de IN ha disminuido a lo largo de los años del estudio; sin embargo, el acortamiento de la estancia posquirúrgica enmascara el verdadero valor de este descenso (AU)

Nosocomial infection and related risk factors in a general surgery service: a prospective study.

OBJECTIVES: The aim of this study was to quantify the frequency of nosocomial infection in the general surgery service of a tertiary-care hospital and to identify associated risk factors. METHODS: A prospective, longitudinal, descriptive and analytical study was made from January 1995 to December 1998 of a clinical cohort of 2794 patients who underwent a surgical procedure with a post-surgery stay of more than 48 h. The criteria for infection were those defined by the Center for Disease Control and Prevention (CDC) of the USA. RESULTS: The most frequent nosocomial infection was surgical infection (SI), with a global cumulative incidence (CI) of 7.7%, ranging from 3.4% for clean surgery to 23.7% for dirty surgery. The next most frequent were urinary tract infection (UTI) and bacteremia (1.5%) and nosocomial pneumonia (NP) (0.5%). The global CI of SI decreased from 11.7% in 1995 to 4% in 1998. An ASA classification higher than 2 multiplied the risk of SI by 1.76; with respect to UTI multiplied the risk by 2.13; the risk of NP by 5.93 and multiplied the risk of B by 4.72. CONCLUSIONS: The most frequent nosocomial infection was surgical infection. An ASA higher than 2, the stay prior to surgery; the number of days with a urinary catheter, with a central venous catheter and with mechanical ventilation; as well as the improvement in the use of antimicrobial prophylaxis, were all factors that influenced the frequency of nosocomial infection.

[Correlation between pressure phenomena and transport of solids in the human left colon]. / Correlación entre fenómenos presivos y transporte de sólidos en el colon izquierdo humano.

The aim of this study was to correlate the pressure phenomena with the transport capacity of the left human colon. Studies were performed in 6 volunteers with a terminal left colostomy for low rectal neoplasia. Our method is original and it is based in the introduction into the colonic lumen of a 2 cm diameter litle deformable solid ballon (Sham-fecaloma) with 3 perfused catheters in the vicinity. This ballon is connected by a semirigid probe with a displacement measurer. Our results show that there are a two kinds of segmental motor phenomena: those which provoke a solid displacement (Displacement Motor Phenomenon-DMP) and those which do not (Non Displacement Motor Phenomenon-NDMP). Both are a pressure increase but the DMP show a pressure gradient in the aboral direction (P = 0.003) and the NDMP in the oral direction (P = 0.003). The DMP provoke a quickly solid output but with a short (X = 4.2 cm). In this way, we can say that segmental contractions are propulsive if in the biohydraulic system there is a pressure gradient in the distal (aboral) direction. If these gradients are not established or they are in oral direction there is no progression neither backward movements. During the periods without pressure activity also there is a slow displacement in the aboral direction (35%). These movements without pressure phenomena may be explained by the tonic contractions (stretching and shortening) not detectable by the conventional manometric systems.