Tratamiento del absceso hepatico. Experiencia en el hospital nacional de itaugua / Treatment of hepatic abscess. The experience at the national hospital of itaugua

Introducción: La introducción de los antibióticos y el desarrollo de técnicas radiológicas (ecografía y TC) que han mejorado la eficacia diagnóstica y posibilitado el drenaje percutáneo de los abscesos. Se realiza un estudio de los aspectos clínicos, terapéuticos y evolutivos. Las técnicas percutáneas, la aspiración y el catéter drenaje han relegado a un segundo plano al drenaje quirúrgico como principal forma de tratamiento. OBJECTIVO: conocer en profundidad la situación actual de este proceso patológico, estudiando los diferentes aspectos clínicos, terapéuticos y evolutivos en el Hospital Nacional de Itaugua en 3 años. MÉTODOS: Estudio descriptivo – retrospectivo, basado en la revisión de historias clínicas de pacientes con diagnóstico de AH entre Enero 2011 a junio 2014. Resultados: De 58 historias clínicas revisadas. La edad media fue entre los 41-50 años (43,1%), y 55% fueron varones. El diagnóstico principalmente fue ecográfico (97,8%), absceso único (73%), ubicado en lóbulo derecho (77%). Treinta y nueve pacientes (67,2%) fueron operados, diesinueve pacientes (32,7%) recibieron drenaje percutáneo. CONCLUSIÓN: El absceso hepatico es una patología aguda, de mediana edad, frecuente en el sexo masculino, el tratamiento actual es el drenaje percutaneo.

Introduction: The introduction of antibiotics and the development of imaging techniques (ultrasound and CT) have improved the diagnostic efficacy and facilitated percutaneous drainage of abscesses. A study of clinical, therapeutic and evolutionary aspects is performed. Percutaneous techniques, aspiration and drainage catheter been relegated to the background surgical drainage as the main form of treatment. OBJECTIVE: To learn more about the current status of this disease process, studying the different clinical, therapeutic and evolutionary aspects in the National Hospital of Itaugua in three years. METHODS: Descriptive - retrospective, based on review of medical records of patients diagnosed with AH between January 2011 to June 2014. RESULTS: Of 58 clinical histories. The average age was between 41-50 years (43.1%), and 55% were male. The diagnosis was mainly ultrasound (97.8%), single (73%) abscess located in the right lobe (77%) .. Thirty-nine patients (67.2%) underwent surgery, diesinueve patients (32.7%) received percutaneous drainage. CONCLUSION: The liver abscess is an acute disease of middle age, frequent in males, the current treatment is percutaneous drainage.

Renal function improvement after conversion to proliferation signal inhibitors during long-term follow-up in heart transplant recipients.

INTRODUCTION: The use of proliferation signal inhibitors (PSIs) for calcineurin-inhibitor (CNI) minimization or conversion protocols has been promoted for heart transplantation (HT) in the contexts of renal insufficiency, cardiac allograft vasculopathy (CAV), or malignancy. We evaluated our experience with conversion of patients from a CNI-based to a PSI-based immunosuppressive regimen. We focused on improvement in renal function. METHODS: This prospective follow-up included 96 HT patients converted to a PSI-based regimen from 2001 to 2010. We evaluated changes in creatinine clearance (CrCl) prior to at 1 year and at the end of follow-up after conversion. RESULTS: Ninety-six patients including 86% men showed a mean age of 62 ± 8 years. They were converted to a PSI-based regimen at 6.3 ± 4 years post-HT due to the following causes: CNI toxicity (45%), CAV (16%), cancer (16%), CNI toxicity + CAV (17%), or CNI toxicity + cancer (6%). CNI withdrawal was achieved in 77 cases (80%) and minimization in 19 (20%). Everolimus was used in 54 (56%) and sirolimus in 42 (44%) cases. Median follow-up time was 3.8 years. PSI discontinuation due to side effects was common (38%). There were 43 deaths mainly due to cancer and CAV. CrCl improved albeit not significantly in the withdrawal group from a median of 51 mL/min preconversion to 59 mL/min at the last follow-up (P = .12). In the minimization group, median CrCl worsened from a median of 61 mL/min preconversion to 51 mL/min at the last follow-up (P = .001). In the 58 cases (61%) of CNI nephrotoxicity, median CrCl improved from a median of 41 mL/min preconversion to 49 mL/min at the last follow-up (P = .04). CONCLUSION: Despite high rates of discontinuation of PSIs during long-term follow-up, the conversion regimen seemed to be useful to diminish CNI-related renal insufficiency especially with CNI withdrawal.