Esteatosis hepatica no alcoholica: Un enfoque sobre la relación con la obesidad y sus comorbilidades. Revisión (Parte 2) / Non-alcoholic hepatic steatosis: A review on its association with obesity and its comorbidities (Part 2)

La esteatosis hepática no alcohólica abarca un amplio espectro de alteraciones clínico-patológicas, que van desde la esteatosis simple, pasando por la esteatohepatitis hasta la posible culminación en cirrosis hepática. La prevalencia en la población obesa es del 20

Farmacologia de la Insulinorresistencia: Situacion actual y perspectivas / Insulin Resistance Pharmacology: Current Situation and Perspectives

El proposito de este trabajo es revisar las estrategias farmacologicas especificamente destinadasa disminuir la insulinoresistencia. Se plantean cuatro objetivos, siendo el primero la inhibicion de la produccion hepatica de glucosa. Aqui se incluye a la metformina, biguanida que reduce la gluconeogenesis desde lactato y aumenta la actividad de la AMPK (enzima que estimula la oxidacion de acidos grasos no esterificados y disminuye la gluconeogenesis y sintesis de colesterol), Tambien se encuentran el BAY-27-9955 y NNC-25-2504L (antagonistas del glucagon) y los inhibidores de la glucogeno fosforilasa hepatoica, glucogenosintasa-kinasa-3, piruvato-deshidrogena-kinasa, fructosa-1,6-difosfatasa y glucosa-6-fosfatasa. Los insulinosensibilizadores, segundo objetivo, incluyen a tiazolidinodionas (agonistas PPARgamma) que aumentan la exposicion de GLUT 4, lipogenesis y disminuyen la glucogenesis. y a drogas en desarrollo: nuevos agonistas PPAR, activadores RxR, agosnistas Beta3 e inhibidores de la PTB-1B. El tercer objetivo son los modificadores del metabolismo lipidico, y contiene a los inhibidores de la 11Beta-HSD1. Los activadores del receptor insulinico, dependientes e independientes de insulina, constituyen el cuarto objetivo. La importancia del desarrollo de nuevos farmacos radica en que el control de la insulinorresistencia retrasaria la aparicion de diabetes 2 e implicaria un menor riesgo cardiovascular

Farmacologia de la Insulinorresistencia: Situacion actual y perspectivas / Insulin Resistance Pharmacology: Current Situation and Perspectives

El proposito de este trabajo es revisar las estrategias farmacologicas especificamente destinadasa disminuir la insulinoresistencia. Se plantean cuatro objetivos, siendo el primero la inhibicion de la produccion hepatica de glucosa. Aqui se incluye a la metformina, biguanida que reduce la gluconeogenesis desde lactato y aumenta la actividad de la AMPK (enzima que estimula la oxidacion de acidos grasos no esterificados y disminuye la gluconeogenesis y sintesis de colesterol), Tambien se encuentran el BAY-27-9955 y NNC-25-2504L (antagonistas del glucagon) y los inhibidores de la glucogeno fosforilasa hepatoica, glucogenosintasa-kinasa-3, piruvato-deshidrogena-kinasa, fructosa-1,6-difosfatasa y glucosa-6-fosfatasa. Los insulinosensibilizadores, segundo objetivo, incluyen a tiazolidinodionas (agonistas PPARgamma) que aumentan la exposicion de GLUT 4, lipogenesis y disminuyen la glucogenesis. y a drogas en desarrollo: nuevos agonistas PPAR, activadores RxR, agosnistas Beta3 e inhibidores de la PTB-1B. El tercer objetivo son los modificadores del metabolismo lipidico, y contiene a los inhibidores de la 11Beta-HSD1. Los activadores del receptor insulinico, dependientes e independientes de insulina, constituyen el cuarto objetivo. La importancia del desarrollo de nuevos farmacos radica en que el control de la insulinorresistencia retrasaria la aparicion de diabetes 2 e implicaria un menor riesgo cardiovascular(AU)

Effect of highly active antiretroviral therapy on cytomegalovirus antigenaemia in AIDS patients.

To assess the effect of highly active antiretroviral therapy (HAART) on cytomegalovirus (CMV) antigenaemia in AIDS patients, 70 patients with CD4+ cell counts < or = 50/mm3 and positive anti-(CMV) immunoglobulin G (IgG) were tested at 15-30 day intervals for CMV antigenaemia. We selected those patients who had been followed up for more than 3 months. Three patient profiles were defined: A, followed up before the introduction of HAART; B, followed up before and after the use of HAART; and C, followed up after the use of HAART. Thirty-nine patients were included, 12 in group A, 17 in group B, and 10 in group C. Group A patients presented a lower median CD4+ cell count compared with groups B and C patients (9, 122 and 127 cells/mm3, respectively), with the increase in the last 2 groups being related to the use of HAART (P<0.001). A lower proportion of positive antigenaemia was observed in group B after the introduction of HAART compared with the time before HAART (P=0.02). HAART caused an immunological improvement and was found to be associated with negativity of CMV antigenaemia.

Remaining small bowel length: association with catheter sepsis in patients receiving home total parenteral nutrition: evidence of bacterial translocation.

Patients with short bowel syndrome (SBS) receiving total parenteral nutrition (TPN) have a high incidence of catheter-related sepsis, one of its major complications. The aim of this study was to correlate the length of remaining small bowel (RSB) with septic episodes related to the central venous catheter in a group of patients with severe SBS with home TPN. The length of the RSB (<50 cm or > or = 50 cm) was related to the frequency of catheter sepsis, time until the first episode, and the agents responsible in eight SBS patients receiving home TPN. There were 13 episodes of catheter infection (0.88 per patient-year). The group with a shorter RSB length (five patients) presented 1.3 to 2.76 infections/year and 2 to 9 months until the first episode, compared to 0 to 0.75 infections/ year (p = 0.0357) and 11 to 65 months until the first episode (p = 0.0332) in the group with the longer RSB. In the first group, the agents isolated were Enterobacteriae (Enterobacter sp., Klebsiella sp., Pseudomonas sp., and Proteus sp.) in eight episodes and Candida sp. in one. In the latter sepsis was caused by Staphylococcus sp. in three episodes and Pseudomonas sp. in one. Therefore patients with remaining small bowel shorter than 50 cm have a higher frequency of catheter-related sepsis, particularly by enteric microorganisms. This might be an evidence of the occurrence of bacterial translocation and its role in the pathogenesis of catheter-related sepsis in patients with an extremely short RSB receiving home TPN.

[Videolaparoscopic appendectomy with linear stapler]. / Apendicectomia videolaparoscópica com auxílio de grampeador linear cortante.

It is presented the experience of 126 cases of acute appendicitis treated by a videolaparoscopic appendectomy using a 12 mm endostapler with 4 lines of staples and a linear cutting device in the middle. It has been used two trocars (5 mm) at the left side and one other (12 mm) trocar at the umbilicus. In the first cases other dispositions were used but this one seemed to be better. Through the left trocars, a dissection is promoted, isolating the appendix, its base and its mesentery, in which a small hole is made, close to the base. Through this hole, it is passed one of the sides of the 12 mm stapler. The device promotes the bilateral stapling and cuts the appendix at its base. The stapler is reloaded with vascular staples and then the mesentery is stapled and cut by the same way. It is a very fast method. Besides, the laparoscopic option gives the opportunity to equally treat appendicitis at unusual positions, to examine other pelvic organs (eventually treating diseases) and to aspirate secretions under direct view, anywhere in the cavity. The specimen is taken out of the cavity inside a plastic bag and we had no case of infection at the trocar sites. Only in 3 cases there were conversion to open surgery, due to difficult dissection and identification of structures, in all of them with very advanced disease and necrosis. It is concluded that this method is fast, safe, easy (although more expensive) and can be utilized routinely, at least in the first approach of the treatment of acute appendicitis.

[Infections of central venous catheters]. / Infecções do catéter venoso central.

The central venous catheter is considered the lifeline of patients requiring long-term parenteral nutrition, and its infectious complications accordingly represent a frequent cause for hospitalization and morbidity. Modern catheters made of Silastic increase the duration and efficiency of venous access, but their substitution is also more complex and expensive. In a small series of patients undergoing home parenteral nutrition due to short bowel syndrome, and carrying. Silastic catheters, infection of the cannula was treated by administration of systemic as well as local antimicrobial agents. The septic process was resolved without the need of removing the catheters, and with excellent tolerance to the medications. It is concluded that in-situ sterilization of long-term catheters should be attempted in selected cases.

Colecistectomia com exploraçäo radiográfica das vias biliares com incisäo mínima (minilaparotomia) / Cholecystectomy with radiographic exploration of the bile ducts with minimal incision (minilaparotomy)

Os autores apresentam sua experiência com a colecistectomia associada à exploraçäo radiográfica das vias biliares com incisäo mínima efetuada em 66 doentes, dos quais 19 (28,79%) eram portadores de colecistite aguda e 6(9,09%) de coledocolitíase. O tempo cirúrgico foi curto e a permanência hospitalar breve, recebendo os doentes alta hospitalar em 24 horas, quando näo necessitaram coledocolitotomia. A cirurgia é realizada sob visäo direta, com equipamento de baixo custo, encontrado no mercado nacional. Näo houve nenhuma complicaçäo neste grupo de 66 doentes. Concluem que a colecistectomia por incisäo mínima constitui procedimento cirúrgico de baixo custo, que permite alta hospitalar precoce, obtendo-se, também bom resultado cosmético