Calidad de vida en pacientes portadores de cardiopatías congénitas / Quality of life in patients with congenital heart disease

Antecedentes: La corrección de las Cardiopatías Congénitas (CC) tiene como fin mejorar la calidad de vida de los pacientes portadores de ellas, pero no existen en nuestro medio estudios sobre ésta, ni su comparación con niños sanos. Objetivos: Estudiarla calidad de vida de los CC, objetivando tres áreas, en tres grupos de pacientes de complejidad diferente, y compararlos con un grupo sano. Método: Se escogieron 4 grupos de niños del área sur oriente de Santiago; 3 grupos de CC: comunicación interventricular (CIV), Tetralogía de Fallot(T4F), Ventrículo único (VU), y un grupo de niños sanos (S). Se sometieron a encuesta de calidad de vida ellos y sus padres, se evaluaron tres áreas especificas; actividad escolar, actividades cotidianas (actividad física y generales) y vida familiar. Se objetivó capacidad física con Test de Esfuerzo (TE), con protocolo de Bruce modificado, en todos. El análisis estadístico incluyó análisis de varianza y chi cuadrado. Resultados: Se seleccionaron 65 niños, 12 con CIV, 18 con T4F, 15 con VU,y 20 sanos. Treinta y cuatro de ellos son hombres (52 por ciento). En escolaridad no existen diferencias significativas en edad/curso, promedio de notas (5.7), repetición (24.8 por ciento), en percepción de notas y rendimiento escolar los pacientes con VU tanto ellos como sus padres perciben peor rendimiento que sus pares. Con relación a actividades físicas generales el TE reveló concordancia con percepción cualitativa y diferencias de rendimientos de acuerdo a la gravedad de la patología, estadísticamente significativa sólo VU en esfuerzos mayores (S: 11:75min CIV: 12:2min, T4F:10min y VU: 7:3min). Con relación a actividades cotidianas, no perciben limitación de la vida diaria en forma significativa, excepto en algunas actividades, los pacientes con VU. Los padres de niños con CC tienen percepción de mayor limitación. Con relación a la vida familiar no hay diferencias significativas entre los 4 grupos...

Background: Surgical correction of congenital heart diseases (CHD) intends to improve quality of life (QL) in affected patients. In Chile this aspect has not been objectively evaluated, especially through comparison with normal children. Aim: to compare the quality of life in three groups of CHD patients with that of normal controls. Three aspects of QL were evaluated. Methods: three groups of patients with CHD (Ventricular septal defect, Tetralogy of Fallot, Single Ventricle) were compared to a group of healthy children from the south east area of Santiago. A standard QL questionnaire was used to evaluate school performance, physical and general daily activities and family life . A treadmill test with a modified Bruce protocol was used to evaluate physical capacity Results: There were 12 patients in the VSD, 12 in the Fallot, 15 in the Single Ventricle and 20 in the normal groups. 52 percent were males. Age at each school level, school performance (grades and failure rates) were similar across groups except for a lower performance in patients with Single Ventricle. Physical capacity (duration of stress test) was lower in patients with Single Ventricle (7.3 min average) compared to normal (11.75min), VSD (12.2min) and Tetralogy of Fallot (10.0 min). The results of these test correlated with subjective performance of physical capacity. Similarly patients with Single Ventricle perceived a greater limitation for daily activities (60 percent) compared to VSD (100 percent), Fallot's (89 percent) and healthy controls (89 percent). In general, parents of CHD patients perceived a greater limitation compared to their children. Family life was not different among groups. Conclusions: The perception of QL in these patients with corrected CHD did not differ compared to healthy controls. Objective evaluation showed a lower physical capacity in patients with a more severe type of CHD.

Trasplante hepático en pacientes con trombosis portal: manejo intraoperatorio y resultados / Hepàtico transplant in patients with thrombosis vestibule: intraoperating handling and results

Antedecentes: La trombosis de la vena porta (TVP) es una complicación del paciente cirrótico que previamente era considerada una contraindicación para el trasplante hepático. Objetivos: Describir los resultados y evolución alejada de una serie consecutiva de trasplantes hepáticos realizados en pacientes portadores de TVP y analizarlos comparativamente con pacientes trasplantados sin TVP. Lugar de aplicación: Programa de trasplante hepático de una hospital público. Diseño: Retrospectivo, longitudinal, descriptivo. Material y Método: Entre julio de 1995 y junio del 2006, se realizaron 26 trasplantes hepáticos en pacientes con TVP (8,7%). Se analizaron factores de riesgo para TVP, variables del trasplante y del postrasplante. Se realizó un análisis comparativo con 273 pacientes trasplantados sin TVP. Resultados: 53,8% varones, edad 40,7 años. La TVP fue un hallazgo intraoperatorio en el 65%. Etiologías: cirrosis postnecróticas 73%, hepatopatías colestáticas 23% y fibrosis hepática congénita 4%. El 61,5% Child-Pugh C. Se realizó trombectomia en 21 pacientes con TVP Grados I, II y IV e injerto mesentérico portal extra-anatómico en 5 pacientes con TVP Grado III. La morbilidad fue del 57,7% la recurrencia de la TVP de 7,7% y la mortalidad durante la internación 26,9%. El trasplante en TVP presentó un incremento en el requerimiento de hemoderivados y en el índice de reoperaciones. La supervivencia al año fue 59,6% 75,2% para el Grado I y 44,8% para el Grado 2, 3 y 4. Conclusiones: La TVP no es contraindicación para el trasplante, su variedad más frecuente es el grado 1 y la técnica más empleada es trombectomía. El trasplante en pacientes con TVP demostró mayor requerimiento de hemoderivados, incidencia de complicaciones y de retrombosis portal y se asoció a una menor supervivencia en TVP grados 2, 3 y 4.

Liver transplantation in adult patients with portal vein thrombosis: risk factors, management and outcome.

BACKGROUND: Portal vein thrombosis (PVT) is a well recognized complication of patients with end-stage cirrhosis and its incidence ranges from 2 to 26%. The aim of this study was to analyze the results and long-term follow-up of a consecutive series of liver transplants performed in patients with PVT and compare them with patients transplanted without PVT. PATIENTS AND METHODS: Between July 1995 and June 2006, 26 liver transplants were performed in patients with PVT (8.7%). Risk factors and variables associated with the transplant and the post-transplant period were analyzed. A comparative analysis with 273 patients transplanted without PVT was performed. RESULTS: The patients comprised 53.8% males, average age 40, 7 years. PVT was detected during surgery in 65%. Indications for transplantation were: post-necrotic cirrhosis 73%, cholestatic liver diseases 23%, and congenital liver fibrosis 4%. Child-Pugh C: 61.5%. Techniques were trombectomy in 21 patients with PVT grades I, II, IV, and extra-anatomical mesenteric graft in 5 with grade III. Morbidity was 57.7%, recurrence of PVT was 7.7%, and in-hospital mortality was 26.9%. Greater operative time, transfusion requirements, and re-operations were found in PVT patients. One-year survival was 59.6%: 75.2% for grade 1 and 44.8% for grades 2, 3, and 4. DISCUSSION: The study demonstrated a PVT prevalence of 8.7%, a higher incidence of partial thrombosis (grade 1), and successful management of PVT grade 4 with thrombectomy. Liver transplant in PVT patients was associated with an increased operative time, transfusion requirements, re-interventions, and lower survival rate according to PVT extension.

Evaluation of PNEC values: extrapolation from Microtox, algae, daphnid, and fish data to HC5.

In order to evaluate the risk to the environment from long term exposure of any discharged substance, toxicity thresholds are estimated, and particularly the Predicted No Effect Concentration (PNEC). This concentration can be estimated by the classic assessment factor approach or by statistical methods. These are more scientifically sound but they require several (at least 5-6) chronic ecotoxicity data, implying greater cost and time. New extrapolation methods derived from the statistical concept but requiring less data have been studied. Results show that methods based on chronic data are more reliable than methods based on acute data but the improvement is quite small. Considering the costs of chronic tests compared to acute tests, approaches based on acute data are an attractive alternative. A simple regression on the mean of the acute data gives the best results.

Augmentation of indices of oxidative damage in life-long melatonin-deficient rats.

The chief pineal secretory product, melatonin, is an efficient free radical scavenger and antioxidant. The current study tested whether the life-long reduction of endogenous melatonin levels due to pinealectomy would influence the accumulation of oxidatively damaged products as the animals aged. Rats were either pinealectomized or sham operated when they were 2-months-old. At 25 months of age these animals were killed along with 2-month-old controls. Aging in the pineal-intact animals was associated with increased levels of lipid peroxidation products (malondialdehyde and 4-hydroxyalkenals in the lung, kidney and skin), rises in an oxidatively damaged DNA product (8-hydroxy-deoxyguanosine in liver, kidney and pancreas), and in the levels of protein carbonyls (in the liver). Likewise, advanced age was associated with a significant decrease in membrane fluidity (increased membrane rigidity) of hepatic microsomes in pineal-intact rats. For all of these parameters and in a number of organs, pinealectomy caused further increases in the indices of oxidative damage. Consistent with previous suggestions, the implications of these findings is that aging is associated with the augmented accumulation of oxidatively damaged macromolecules and that these increases are exaggerated when a relative melatonin deficiency is induced by pinealectomy. The findings are consistent with the idea that the accelerated accumulation of oxidatively damaged products after pinealectomy was due to reduction in melatonin since it functions as a free radical scavenger and antioxidant. On the other hand, other pineal secretory products that were reduced as a consequence of pineal removal may have also been responsible for some of the observed changes.

Factors involved in the return of peristalsis in patients with achalasia of the cardia after Heller's myotomy.

OBJECTIVE: To assess the reappearance of peristalsis in a group of 45 patients with achalasia of the cardia undergoing surgery and to analyze the factors involved in this phenomenon. METHODS: According to the postoperative manometric data, the 45 patients were divided into two groups, depending on whether or not they presented a return of peristalsis. A statistical comparison of age, sex, duration of the disease, pre- and postoperative radiological diameter of the esophagus, classic or vigorous nature of the achalasia, and manometric data of the lower esophageal sphincter and esophageal body was made. RESULTS: In 46.6% of the patients, peristalsis returned to the upper esophagus, and 100% of the waves were progressive; in 24.4%, peristalsis returned to the middle third also, but only 50% of the waves were progressive; and in 8.8% (four patients), peristalic activity returned to the whole esophagus, but only 40% of the waves were progressive. The group of patients with a return of peristalsis had a shorter duration of dysphagia, less preoperative dilation of the esophagus, and a greater contractile activity of the esophageal body. CONCLUSIONS: Return of peristalsis is a frequent phenomenon after myotomy in patients with achalasia of the cardia, especially in cases of short clinical evolution, little esophageal dilation, and a conserved contractile capacity, although its accurate production mechanism is unknown.

Can pH recordings suggest defective esophageal peristalsis in patients with gastroesophageal reflux?

The data provided by 24-h pH monitoring in 40 patients with gastroesophageal reflux, divided in three groups in accordance with esophageal motor pattern, were compared. Patients with hypomotility had significantly greater reflux rates than those with normal motility or hypermotility, if we consider both total time with pH < 4 and time with pH < 4 corresponding to episodes of > 5 min duration. We conclude that when 24-h pH monitoring shows very high reflux rates, basically corresponding to episodes lasting > 5 min, we should suspect the presence of defective esophageal peristalsis, which must be confirmed with a manometric study.

Estudio de algunas correlaciones clinicas en sindrome diarreico agudo del lactante. / Study of some clinical correlations in acute diarrhoeal syndrome of the infant

Se analizan algunas correlaciones clinicas en lactantes hospitalizados por sindrome diarreico agudo con deshidratacion estudiados con metodica de balance en cama metabolica durante las primeras 24 horas de ingresados a la Unidad de Lactantes del Hosptial Roberto del Rio. Las perdidas por deposiciones no son diferentes segun estado nutricional en terminos de promedios, pero la varianza es significativamente mayor en desnutridos severos que en eutroficos. Los signos abdominales, en su intensidad mayor, significan perdidas comparables por heces. La diferencia con la ausencia del signo clinico es significativa para ruidos hidroaereos y bazuqueno. La presencia de malabsorcion de carbohidratos en primeras 24 horas, se acompana de perdidas por heces y concentracion plasmatica de sodio mas elevadas que en los pacientes sin este trastorno