ABSTRACT
Hypopituitarism after moderate or severe traumatic brain injury (TBI) is usually underdiagnosed and therefore undertreated. Its course can be divided in an acute phase during the first 14 days after TBI with 50 to 80% risk of hypopituitarism, and a chronic phase, beginning three months after the event, with a prevalence of hypopituitarism that ranges from 2 to 70%. Its pathophysiology has been addressed in several studies, suggesting that a vascular injury to the pituitary tissue is the most important mechanism during the acute phase, and an autoimmune one during chronic stages. In the acute phase, there are difficulties to correctly interpret pituitary axes. Hence, we propose a simple and cost-effective algorithm to detect and treat a potential hypothalamic-pituitary-adrenal axis impairment and alterations of sodium homeostasis, both of which can be life-threatening. In the chronic phase, post-concussion syndrome is the most important differential diagnosis. Given the high prevalence of hypopituitarism, we suggest that all pituitary axes should be assessed in all patients with moderate to severe TBI, between 3 to 6 months after the event, and then repeated at 12 months after trauma by a specialized team in pituitary disease.
Subject(s)
Humans , Pituitary Diseases , Brain Injuries, Traumatic , Hypopituitarism , Pituitary-Adrenal System , Brain Injuries, Traumatic/complications , Hypopituitarism/diagnosis , Hypopituitarism/etiology , Hypothalamo-Hypophyseal SystemABSTRACT
Hypopituitarism after moderate or severe traumatic brain injury (TBI) is usually underdiagnosed and therefore undertreated. Its course can be divided in an acute phase during the first 14 days after TBI with 50 to 80% risk of hypopituitarism, and a chronic phase, beginning three months after the event, with a prevalence of hypopituitarism that ranges from 2 to 70%. Its pathophysiology has been addressed in several studies, suggesting that a vascular injury to the pituitary tissue is the most important mechanism during the acute phase, and an autoimmune one during chronic stages. In the acute phase, there are difficulties to correctly interpret pituitary axes. Hence, we propose a simple and cost-effective algorithm to detect and treat a potential hypothalamic-pituitary-adrenal axis impairment and alterations of sodium homeostasis, both of which can be life-threatening. In the chronic phase, post-concussion syndrome is the most important differential diagnosis. Given the high prevalence of hypopituitarism, we suggest that all pituitary axes should be assessed in all patients with moderate to severe TBI, between 3 to 6 months after the event, and then repeated at 12 months after trauma by a specialized team in pituitary disease.
Subject(s)
Brain Injuries, Traumatic , Hypopituitarism , Pituitary Diseases , Brain Injuries, Traumatic/complications , Humans , Hypopituitarism/diagnosis , Hypopituitarism/etiology , Hypothalamo-Hypophyseal System , Pituitary-Adrenal SystemABSTRACT
BACKGROUND: There is a gap between the number of patients requiring a renal allograft and the number of potential deceased donors (DD). One alternative is using allografts from non-related living donors (NRLD). AIM: To compare survival and complications of renal allograft recipients from DD, related living donors (RLD) and NRLD. MATERIAL AND METHODS: Observational study of a cohort of renal allograft recipients. Of 253 transplants performed in a Chilean region between 1981 and 2003, 20 patients received and allograft from a NRLD. Graft and patient survival of these patients were compared with those of 93 patients receiving an allograft from a related living donor and 140 receiving it from a DD. Patients were followed for 10 years or until death or dialysis requirement. RESULTS: No significant differences between groups in graft and patient survival, deaths with a functioning graft or return to dialysis were observed. Receptors of DD had more hospital admissions during the first years after receiving the graft, usually due to infections. Also a delayed graft function was more common among them. Glomerular filtration rate ten years after the graft was similar among the three groups. CONCLUSIONS: No differences in graft or patient survival was observed between patients receiving a renal allograft from NRLD, RLD or DD.
Subject(s)
Allografts/statistics & numerical data , Graft Survival/physiology , Kidney Transplantation/mortality , Living Donors , Unrelated Donors/statistics & numerical data , Adult , Cause of Death , Chile/epidemiology , Female , Follow-Up Studies , Glomerular Filtration Rate/physiology , Hospitalization/statistics & numerical data , Humans , Immunosuppression Therapy/statistics & numerical data , Infections/complications , Kidney Transplantation/adverse effects , Male , Middle Aged , Retrospective Studies , Survival Rate , Time Factors , Young AdultABSTRACT
Background: There is a gap between the number of patients requiring a renal allograft and the number of potential deceased donors (DD). One alternative is using allografts from non-related living donors (NRLD). Aim: To compare survival and complications of renal allograft recipients from DD, related living donors (RLD) and NRLD. Material and Methods: Observational study of a cohort of renal allograft recipients. Of 253 transplants performed in a Chilean region between 1981 and 2003, 20 patients received and allograft from a NRLD. Graft and patient survival of these patients were compared with those of 93 patients receiving an allograft from a related living donor and 140 receiving it from a DD. Patients were followed for 10 years or until death or dialysis requirement. Results: No significant differences between groups in graft and patient survival, deaths with a functioning graft or return to dialysis were observed. Receptors of DD had more hospital admissions during the first years after receiving the graft, usually due to infections. Also a delayed graft function was more common among them. Glomerular filtration rate ten years after the graft was similar among the three groups. Conclusions: No differences in graft or patient survival was observed between patients receiving a renal allograft from NRLD, RLD or DD.
Subject(s)
Animals , Female , Mice , Rats , Analgesics , Anti-Inflammatory Agents, Non-Steroidal , Niacinamide/analogs & derivatives , Niacinamide/pharmacology , Amides/pharmacology , Carrageenan , Dipyrone/pharmacology , Edema/chemically induced , Edema/drug therapy , Formaldehyde , Hot Temperature , Isomerism , Motor Activity/drug effects , Pain Measurement/drug effects , Picolinic Acids/pharmacology , Poly(ADP-ribose) Polymerases/antagonists & inhibitors , Postural Balance/drug effects , Rats, WistarABSTRACT
La cirugía del cáncer gástrico es un procedimiento complejo que no está libre de complicaciones graves y letales. El objetivo del presente estudio es describir la morbimortalidad asociada a gastrectomía por cáncer en los últimos años. Se revisan las historias de los pacientes operados de gastrectomía en un período de 5 años. Se encuentran 107 casos, de los cuales, se realiza cirugía con intención curativa en 90 (84,1 por ciento). La cifra global de morbilidad es 25,2 por ciento y la mortalidad 7,5 por ciento. La principal complicación post operatoria es la fístula esófago-yeyunal post gastrectomía total, con una incidencia de 17,6 por ciento y una letalidad de 44 por ciento. Otras complicaciones incluyen la peritonitis post operatoria, absceso intraabdominal, infección de herida operatoria y retardo del vaciamiento gástrico, entre otros. Destaca una baja incidencia de neumonía. Se encontró una tendencia favorable en gastrectomías con intención curativa vs. paliativa y en el uso de suturas mecánicas vs. manuales. La morbimortalidad se compara favorablemente a lo encontrado en la literatura y se mantiene una tendencia a la reducción al compararla con la experiencia ya publicada por el mismo grupo quirúrgico.
