Long-Term Outcomes of Intestinal and Multivisceral Transplantation at a Single Center in Argentina.

BACKGROUND: Intestinal failure (IF) patients received parenteral nutrition (PN) as the only available therapy until intestinal transplantation (ITx) evolved as an accepted treatment. The aim of this article is to report the long-term outcomes of a series of ITx performed in pediatric and adult patients at a single center 9 years after its creation. PATIENTS AND METHODS: This is a retrospective analysis of the ITx performed between May 2006 and January 2015. Diagnoses, pre-ITx mean time on PN, indications for ITx, time on the waiting list for types of ITx, mean total ischemia time, and warm ischemia time, time until PN discontinuation, incidence of acute and chronic rejection, and 5-year actuarial patient survival are reported. RESULTS: A total of 42 patients received ITx; 80% had short gut syndrome (SG); the mean time on PN was 1620 days. The main indication for ITx was lack of central venous access followed by intestinal failure-associated liver disease (IFALD) and catheter-related infectious complications. The mean time on the waiting list was 188 days (standard deviation, ±183 days). ITx were performed in 26 children and 14 adults. In all, 32 procedures were isolated ITx (IITX); 10 were multiorgan Tx (MOT; 3 combined, 7 multivisceral Tx (MVTx), 1 modified MVTx and 2 with kidney); 2 (4.7 %) were retransplantations: 1 IITx, 1 MVTx, and 5 including the right colon. Thirteen patients (31%) received abdominal rectus fascia. All procedures were performed by the same surgical team. Total ischemia time was 7:53 ± 2:04 hours, and warm ischemia time was 40.2 ± 10.5 minutes. The mean length of implanted intestine was 325 ± 63 cm. Bishop-Koop ileostomy was performed in 67% of cases. In all, 16 of 42 Tx required early reoperations. The overall mean follow-up time was 41 ± 35.6 months. The mean time to PN discontinuation after Tx was 68 days (P = .001). The total number of acute cellular rejection (ACR) episodes until the last follow-up was 83; the total number of grafts lost due to ACR was 4; and the total graft lost due to chronic rejection was 3. At the time of writing, the overall 5-year patient survival is 55% (65% for IITx vs 22% for MOT; P = .0001); 60% for pediatric recipients vs 47% for adults (P = NS); 64% when the indication for ITx was SG vs 25% for non-SG (P = .002). CONCLUSIONS: At this center, candidates with SG, in the absence of IFALD requiring IITx, showed the best long-term outcomes, independent of recipient age. A multidisciplinary approach is mandatory for the care of intestinal failure patients, to sustain a rehabilitation and transplantation program over time.

Cáncer pulmonar: prevención y pesquisa precoz / Lung cancer: screening and prevention

El cáncer pulmonar es el más mortal de todos los cánceres. Debido a que la gran mayoría de los cánceres pulmonares son causados por el hábito de fumar, su erradicación es la mejor estrategia de prevención primaria. El diagnóstico del cáncer pulmonar en etapas tempranas mejora significativamente su pronóstico, por lo que ésta es la mejor estrategia de prevención secundaria. Recientemente se ha reportado que un programa de pesquisa de cáncer pulmonar con escáner de tórax (TAC) reduce la mortalidad por cáncer. El objetivo de esta revisión es, en primer lugar, apelar a la evidencia en cuanto al rendimiento de los programas de pesquisa de cáncer pulmonar en poblaciones de alto riesgo, y en segundo lugar, analizar las distintas estrategias que tiene un médico cuando se enfrenta a un paciente a quien se le ha encontrado incidentalmente un nódulo pulmonar.

Lung cancer is a deadly disease. Since this cancer is closely related to tobacco smoke, the best way to avoid this disease is smoking prevention. Unfortunately smoking is a worldwide epidemic and in Chile its prevalence is not decreasing. The second best strategy is an early detection. For the first time there is a report showing that screening with the use of low dose CT reduces mortality from lung cancer. The prognosis is much better in early stages. The purpose of this publication is to review the evidence about screening of lung cancer, and to analyze the different strategies to deal, in the general practice, with a finding of a lung nodule.

Caracterización clínica de adultos menores y mayores de 50 años hospitalizados por influenza A H1N1 2009 en un centro hospitalario privado en Santiago, Chile / Clinical features of adults younger and older than 50 years hospitalized with influenza A H1N1 2009 in a private hospital in Santiago, Chile

Introduction: The new pandemic influenza A H1N1 2009 virus has shown a different clinical behavior in different age groups. Objective: To describe the clinical features of adult patients hospitalized with influenza AH1N1 2009 and compare the clinical and demographic variables among adults < 50 years and over 50 years old. Patients and Method: We included hospitalized patients between May 17 and July 17, 2009 confirmed by polymerase chain reaction (PCR) and/or rapid test for influenza A. Results: 124 patients were hospitalized with a median age of 33 years (range: 15-82 years). 36 percent had comorbidities and the main symptoms were fever, cough, myalgia and sore throat. There were 16 cases with pneumonia. From 124 patients, 77 percent were A-49 and 23 percentA-50, with comorbidity of 21 percent and 86 percent, respectively. There were no fatalities. Conclusions: Hospitalized patients had mild to moderate disease, a benign course and short hospitalization stay. There were more hospitalizations in A-49 and higher comorbidity in A-50.

Introducción: El nuevo virus influenza AH1N1 2009 ha mostrado un comportamiento clínico diferente en distintos grupos etáreos. Objetivo: Describir las características clínicas de los pacientes adultos hospitalizados con influenza A H1N1 2009 y comparar las variables clínicas y demográficas entre menores y mayores de 50 años. Pacientes y Método: Se incluyeron los pacientes hospitalizados entre el 17 de mayo y 17 de julio del 2009 confirmados por reacción de polimerasa en cadena (RPC) y/o pruebas rápidas para influenza A. Resultados: Se hospitalizaron 124 pacientes con una mediana de edad de 33 años (rango: 15-82 años). Un 36 por ciento presentó co-morbilidad y los síntomas principales fueron: fiebre, tos, mialgias y odinofagia. Hubo 16 casos con neumonía. Del total, 77 por ciento fueron < 50 y 23 por ciento ≥ 50 años. Tenían co-morbilidades 21 por ciento en el grupo < 50 versus 86 por ciento en ≥ 50 años. No hubo casos fatales. Conclusiones: Los pacientes presentaron una enfermedad leve a moderada, de curso benigno y corta hospitalización. Hubo más hospitalizados en < 50 y mayor co-morbilidad en ≥ 50 años.

Factores de riesgo de enfermedades crónicas no transmisibles en funcionarios de una empresa de servicios financieros de la Región Metropolitana / Risk factors for non communicable chronic diseases among workers of a financial company

Background: The epidemic of cardiovascular diseases in Chile, requires the development of strategies in health promotion and prevention. Aim: To assess the prevalence of risk factors for chronic non communicable diseases among workers of a financial company in Metropolitan Santiago. Material and Methods: Assessment of 2,225 workers (1,383 males with a median age of 49 years and 842 females with a median age of 43 years). All answered an enquiry about education, medical history, smoking habits and physical activity. Body mass index and blood pressure were measured and a blood sample was obtained to measure blood glucose and lipid levels. Logistic repression models were used to determine the main risk factors for hypertension, diabetes, obesity, hypercholesterolemia and hyperuricemia. Results: Sixteen percent of studied subjects were obese, 49% had overweight, 57% had hypercholesterolemia, 28% had high blood pressure, 4% were diabetic, 4% had hyperuricemia, 45% smoked and 83% were sedentary. Each worker had a mean of 2.4±1.1 risk factors. This figure was significantly higher among men, obese subjects, those older than 40 years and those with a lower educational level. Conclusions: There is an important disease burden among the studied subjects, specially among obese and older individuals. Healthy lifestyles should be promoted in this population.

Mal agudo de montaña a 3.500 y 4.250 m: un estudio de la incidencia y severidad de la sintomatología / Acute mountain sickness at 3.500 and 4.250 m: a study of symptom incidence an severity

Background: Acute Mountain Sickness (AMS) refers to signs and symptoms associated with hypobaric hypoxia. Its reported incidence is highly variable. Aim: To determine the incidence of AMS symptoms and severity at 3,500 and 4,250 m above sea level. Subjects and methods : A population of 362 soldiers without former exposure to altitude was studied. AMS symptoms, were assessed by an extensively used standard questionnaire (Lake Louise), applied 36-72 hours after exposure to high altitude. Results : A group of 200 recruits ascended to Putre (3,500 m) and a second group (162) ascended to Alto Pacollo (4,250 m). The incidence of AMS was 28 percent and 60 percent respectively (p<0.05). Headaches and sleeping difficulties were the most frequent symptoms at both altitudes. Furthermore, severe digestive problems and dizziness were described in a high proportion of individuals at both 3,500 and 4,250 m. Conclusions: The prevalence of AMS in this study is similar to that reported elsewhere at equivalent altitudes

Experiencia clínica y seguimiento microbiológico de pacientes con cólera ingresados al Hospital Clínico de la Universidad de Chile / Clinical evaluation and microbiological follow up of colera patients hospitalized at Hospital Clínico de la Universidad de Chile

El propósito de esta comunicación es mostrar los aspectos más relevantes de la epidemiología, cuadro clínico y el estudio microbiológico de seguimiento realizado a cuatro pacientes con cólera ingresados al Hospital Clínico de la Universidad de Chile. Todos refirieron haber consumido verduras crudas 18 a 48 h antes del inicio de la enfermedad. Presentaron diarrea blanco grisácea, deshidratación, hipotensión y tendencia al shock. El primer dia eliminaron deposiciones y vómitos entre 3.680 y 10.400 ml y se les administraron soluciones orales y parenterales que fluctuaron entre 4.900 y 15.150 ml. Entre los exámenes destacaron coprocultivos positivos para V. cholerae, leucocitosis entre 14.500 y 30.000 además pH y gases que demostraron acidosis metabólica moderada a severa. Se trataron con tetraciclina salvo un paciente que además recibió previamente ciprofloxacino ev evolucionando todos en buenas condiciones. Entre 45 a 60 dias después de alta hospitalaria se realizaron coprocultivos con tórula rectal y de las deposiciones, siendo todos negativos para V. chollerae

Criterios de ingreso y egreso de una unidad de pacientes críticos / Admission and discharge criteria at an intensive care unit

Admission and discharge criteria for patients in an intensive care unt are controversial, especially in view of the fact that some patients derive no benefit from intensive care therapy while depriving others from a potential benefit. The general characteristics of patients in need of intensive care are discussed. Irreversibility of the underlyng condition, the quality of "terminal patient" and other factors that may contraindicate admission to an intensive care unit are analyzed. Discharge criteria for patients not expected to derive further benefit from a prolonged stay in unit are outlined