Laparoscopic Liver Resection: A South American Experience with 2887 Cases.

BACKGROUND: Laparoscopic liver resections (LLR) have been increasingly performed in recent years. Most of the available evidence, however, comes from specialized centers in Asia, Europe and USA. Data from South America are limited and based on single-center experiences. To date, no multicenter studies evaluated the results of LLR in South America. The aim of this study was to evaluate the experience and results with LLR in South American centers. METHODS: From February to November 2019, a survey about LLR was conducted in 61 hepatobiliary centers in South America, composed by 20 questions concerning demographic characteristics, surgical data, and perioperative results. RESULTS: Fifty-one (83.6%) centers from seven different countries answered the survey. A total of 2887 LLR were performed, as follows: Argentina (928), Brazil (1326), Chile (322), Colombia (210), Paraguay (9), Peru (75), and Uruguay (8). The first program began in 1997; however, the majority (60.7%) started after 2010. The percentage of LLR over open resections was 28.4% (4.4-84%). Of the total, 76.5% were minor hepatectomies and 23.5% major, including 266 right hepatectomies and 343 left hepatectomies. The conversion rate was 9.7%, overall morbidity 13%, and mortality 0.7%. CONCLUSIONS: This is the largest study assessing the dissemination and results of LLR in South America. It showed an increasing number of centers performing LLR with the promising perioperative results, aligned with other worldwide excellence centers.

Indicación de estimulación cerebral profunda en casos complejos de enfermedad de Parkinson. Experiencia en el Hospital Clínico Universidad de Chile / Indication of deep brain stimulation in complex cases of Parkinson's disease. Experience at the Hospital Clínico Universidad de Chile

Introduction: Deep brain stimulation (DBS) is a standard surgical procedure for the treatment of advanced Parkinson Disease (PD) with motor complications that cannot be adequately managed by medical treatment. Currently available literature can guide physicians on basic aspects of patients' selection and indications for DBS. However, there is a range of real-world clinical settings where the indications of DBS for Parkinson disease are debatable. Objective: to present the experience on PD patients with complex clinical manifestations treated with DBS in our hospital. Method: Report of four PD cases treated with DBS. Case 1: 63-year old woman with advanced PD and severe motor complications; Case 2: 60-year old man with 5 years of disease duration and mild motor complications; Case 3: 67-year old man with severe ventriculomegaly that may have precluded direct electrode passage to the surgical target; Case 4: 67- year-old woman with putative severe axial disability. Results: After one year of follow-up, all patients showed improvement on motor symptoms as well as quality of life. Discussion: We provide a brief rationale for the patient selection in each case to support the decision-making in the management of PD patients with complex clinical cases. (AU)

Normal values of 3 methods to determine patellar height in children from 6 to 12 years. / Valores normales de 3 métodos para determinar rótula alta en niños de 6 a 12 años.

The aim of the study was to compare three methods for high-score measurement in children, Caton-Deschamps, Blackburne-Peel and Koshino-Sugimoto, to determine the normal value of each method in a group of normal children. MATERIALS AND METHODS: A cross-sectional study on knee x-rays of normal children. Three orthopaedic surgeons measured the Caton-Deschamps, Blackburne-Peel and Koshino-Sugimoto indices. Concordance was assessed using the intraclass correlation coefficient. For interobserver variability, the measurements of each observer for each index were compared and for intraobserver variability, the coefficient between the 2 measurements was calculated by the same observer at 2 different times. RESULTS: 140 knee X-rays divided into 4 age groups were obtained. For the Blackburne-Peel index, an average median of the 3 observers was obtained of 1.07 and with P5-P95 (0.76-1.60). For the Caton-Deschamps index, an average median of the three observers of 1.22 was obtained and with P5-P95 (0.91-1.70). For the Koshino-Sugimoto index, we obtained an average median of the 3 observers of 1.16 and with P5-P95 (0.99-1.36). DISCUSSION: This study shows that the Koshino-Sugimoto index had the highest reliability, reproducibility and similarity in the population studied, both intra-observer and inter-observer. The other methods evaluated also had variability indices to be taken into account, but were inferior to the Koshino-Sugimoto index.

[Intravenous thrombolysis for ischemic stroke: Experience in 54 patients]. / Trombolisis intravenosa en accidente cerebro vascular isquémico agudo en un hospital público de Chile: Análisis prospectivo de 54 casos.

BACKGROUND: Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) reduces disability in patients with ischemic stroke. However, its implementation in Chilean public general hospitals has been slow and faces some difficulties. AIM: To analyze the results of an intravenous thrombolysis protocol implementation in a public general hospital. MATERIAL AND METHODS: During a lapse of 28 months a standardized protocol for intravenous thrombolysis implemented in the emergency room of a public hospital, was prospectively evaluated. Fifty four patients with ischemic stroke were treated and assessed three months later as outpatients. RESULTS: At three months of follow-up, 66.4% of patients subjected to thrombolysis had a favorable evolution, defined as having 0 to 1 points in the modified Rankin scale. Intracerebral hemorrhage rate was 11.1%, including 5.5% of symptomatic intracerebral hemorrhage. Four percent of patients had systemic bleeding complications after thrombolysis. The mortality rate was 14.8%. CONCLUSIONS: The success rates, mortality, and complications rate were comparable to the results obtained in international studies, despite of the absence of a stroke unit to manage stroke and its complications.

Trombolisis intravenosa en accidente cerebro vascular isquémico agudo en un hospital público de Chile: análisis prospectivo de 54 casos / Intravenous thrombolysis for ischemic stroke: experience in 54 patients

Background: Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) reduces disability in patients with ischemic stroke. However, its implementation in Chilean public general hospitals has been slow and faces some difficulties. Aim: To analyze the results of an intravenous thrombolysis protocol implementation in a public general hospital. Material and Methods: During a lapse of 28 months a standardized protocol for intravenous thrombolysis implemented in the emergency room of a public hospital, was prospectively evaluated. Fifty four patients with ischemic stroke were treated and assessed three months later as outpatients. Results: At three months of follow-up, 66.4% of patients subjected to thrombolysis had a favorable evolution, defined as having 0 to 1 points in the modified Rankin scale. Intracerebral hemorrhage rate was 11.1%, including 5.5% of symptomatic intracerebral hemorrhage. Four percent of patients had systemic bleeding complications after thrombolysis. The mortality rate was 14.8%. Conclusions: The success rates, mortality, and complications rate were comparable to the results obtained in international studies, despite of the absence of a stroke unit to manage stroke and its complications.

Síndrome miasteniforme de Lambert-Eaton idiopático: Report of one case / Idiopathic Lambert-Eaton myasthenic syndrome

Lambert-Eaton myasthenic syndrome (LEMS) is an autoinmune idiopathic or paraneoplastic syndrome producing antibodies agaisnt presynaptic voltage calcium channels. The clinical features of patients with LEMS are muscle weakness and autonomic dysfunction. We report a 40 years old man with a four years history of proximal weakness, absent tendon reflexes and dry mouth. The diagnosis was confirmed by characteristic electromyographic findings, showing a low-amplitude muscle response that increased dramatically after activation. Circulating antibodies to voltage-gated calcium channel were present. The search for malignant tumors was negative. The patient was treated with prednisone and azathioprine and after four months, he was able to walk and signs of autonomic dysfunction started to subside.

Estados de hipercoagulabilidad heredados y trombosis venosa cerebral: experiencia en 3 casos / Cerebral venous thrombosis in hereditary hypercoagulability: report of three cases

Hereditary hypercoagulability has been identified as risk factor in approximately 30 percent of cerebral venous thrombosis cases. We report three females with this association. A 38 years old female with a history of deep venous thrombosis of the lower limb, presented with headache, vomiting and a generalized seizure. Magnetic resonance angiography showed a partial thrombosis of the left lateral and superior longitudinal venous sinuses. Coagulation study showed a resistance to activated C protein and factor V Leyden. A 42 years old woman with a history of deep venous thrombosis, presented a right hemiplegia during a hospitalization. Magnetic resonance showed a left lateral hemorrhagic infarction. Magnetic resonance angiography showed an absence of signal in three venous sinuses. Coagulation study showed a protein C deficiency. A 17 years old woman presented a right hemiparesis in the sixth day of puerperium. CAT scan showed a left frontoparietal subcortical venous infarction. Coagulation study showed an antithrombin III deficiency

Postoperative liver function after elective right hepatectomy in elderly patients.

BACKGROUND: Because the influence of age on the risk of liver resection is controversial, the outcome of major liver resection in patients older than 65 years was evaluated. METHODS: Between 1990 and 1997, 24 patients aged 65 years or more underwent elective right hepatectomy (segments V-VIII) for a malignant liver tumour arising in a normal liver. They were evaluated retrospectively in terms of operative deaths, morbidity and postoperative liver function, and compared with 22 patients aged 40 years or less who had undergone a similar resection during the same interval. RESULTS: Elective right hepatectomy in patients aged 65 years or more resulted in a similar number of deaths (one versus none) and a similar severe complication rate (12 versus 5 per cent) to that observed in patients aged 40 years or less. Evaluation of liver function on days 2, 5 and 8 after operation, in patients aged 65 years or more and 40 years or less, showed that mean prothrombin time was 52 versus 56 per cent, 58 versus 62 per cent and 76 versus 72 per cent respectively (P not significant) and that the mean total serum bilirubin level was 35 versus 38 micromol/l, 32 versus 36 micromol/l and 25 versus 28 micromol/l (P not significant). Postoperative levels of aminotransferases, gamma-glutamyl transpeptidase and alkaline phosphatase were similar in the two groups. Mean(s.d.) duration of hospital stay was 15(7) days in patients aged 65 years or more and 13(4) days in the younger patients. CONCLUSION: Postoperative liver function after elective right hepatectomy in selected patients older than 65 years was similar to that in younger patients.

Amino acid determination in some edible Mexican insects.

The amino acid contents of edible insects from different provinces of Mexico and reference proteins were analysed by reversed-phase high-performance liquid chromatography and ion exchange chromatography. The insect amino acid contents were higher than the adult requirements indicated by the WHO/FAO pattern.

[The seroprevalence of antibodies against the hepatitis C virus in blood donors at the Hospital Central Militar]. / Seroprevalencia de anticuerpos contra el virus de la hepatitis C en donadores de sangre del Hospital Central Militar.

The main transmission mechanism for hepatitis C virus is through blood products. In order to know seroprevalence of antibodies in military personnel, 2,564 samples at the Central Military Hospital with a second generation Enzymatic Immunoassay (EIA-2) were studied. All participants were males; the mean age was 25 years (range 17-47). Positive results were found in 19 potential donors (0.74%); similar seroprevalences have been reported by others. Patient selection helps to improve the safety of transfusions.

Uso práctico de los índices de trauma / Trauma indexes: a practical use

Presentamos una propuesta para la aplicación práctica de metodos de cuantificacion del trauma, en el Hospital San Juan de Dios de Santa Fe de Bogota. Al ingreso del paciente al servicio de Urgencias se calcula un indice fisiologico, el Revised Trauma Score (RTS). En el postoperatorio se realiza el Injury Severity Score (ISS), con base en el Abbreviated Injury Scale (AIS), que indica la severidad anatómica de la lesion. Con los anteriores datos y la edad, se calcula el Trauma Score-Injury Severity Score (TRISS), con lo que se obtiene la Probabilidad de supervivencia (Ps). Para el paciente con trauma abdominal, se calcula el Abdominal Trauma Index (ATI), como indice pronostico de complicaciones , utilizando el Organ Injury Scaling (OIS). Al paciente con trauma torácico se le cuantifica el Penetrating Thoracic Trauma Index (PTTI), con el cual se obtiene como resultado, al sumarlo con el ATI, el Penetrating Trauma Index (PTI). Con estos indices se pretende cuantificar la severidad del trauma y lograr una buena prediccion de los resultados, lo que permite evaluar la calidad de la atencion, comparar grupos e inclusive guiar politicas administrativas.

Analgesia interpleural con bupivacaina en pacientes post-toracotomía / Interpleural analgesia with bupivacaine in post thoracotomy patients

Se plantea el uso de la técnica de analgesia interpleural por catéter con la administración de bupivacaína al 0.5 por ciento con adrenalina para el control del dolor postoperatorio en pacientes sometidos a cirugía de tórax unilateral (toracotomía). Se estudiaron 20 pacientes a los cuales al término de la cirugía se les colocó un catéter interpleural a nivel del segundo espacio intercostal ipsilateral por el cual se administró 100 mg de bupivacaína al 0.5 por ciento con adrenalina cada vez que el paciente presentó dolor y éste fue mayor de 5 en la escala visual análoga. El control del dolor se realizó por 72 horas a cada paciente. La analgesia fue adecuada en 18 (n=20) pacientes (p<0.005) sin encontrar alteraciones en la frecuencia cardiaca-respiratoria ni en la tensión arterial. Se considera que éste es un método útil, y seguro.

Further physicochemical characterization of the monocyte locomotion inhibition factor (MLIF) produced by Entamoeba histolytica.

Ultrafiltration, gel-sieve chromatography and HPLC were used to purify MLIF. This material was HCl-hydrolyzed and the amino acids analyzed by HPLC-ortho-ophthaldialdehyde. Two hydrophobic non-polar (ile,leu), two uncharged polar (thr,tyr) and two positively charged (basic) (his, arg) amino acids were found in clear excess to their concentration in AMC and thus may intervene in the composition of MLIF.

Rapid determination of beta-aminoisobutyric acid by reversed-phase high-performance liquid chromatography.

For the determination of beta-aminoisobutyric acid (BAIBA) in urine samples in which the beta-alanine concentrations are higher than those of BAIBA, the resolution between these two amino acids, separated by reversed-phase liquid chromatography on an octadecylsilane column, was optimized. The chromatographic analysis included precolumn derivatization of amino acids with o-phthalaldehyde, followed by a 15-min isocratic elution and detection at 340 nm. Because of its simplicity, this method should be useful for monitoring urinary excretion of BAIBA.

Identification and isolation of human insulin A and B chains by high-performance liquid chromatography.

A method for the isolation, identification and quantification of human insulin A and B chains by high-performance liquid chromatography (HPLC) is described. These chains were isolated from a peptide mixture produced by E. coli with modified genes obtained by genetic engineering. The method is based on the use of hydrophilic reagents, forming ion pairs in a reversed-phase column. Because some undesirable effects resulting from the use of phosphoric acid were observed, especially with the B chain, a new HPLC method was developed for each of the two human insulin chains. The use of trifluoroacetic acid as a counter ion for the A chain and of formic acid for the B chain led to the rapid isolation and purification of each chain by HPLC. The advantage of this method is that it provides a highly pure product, which was identified by polyacrylamide gel electrophoresis and amino acid analysis.