The pathophysiological impact of intra-abdominal hypertension in pigs.

BACKGROUND: Intra-abdominal hypertension and abdominal compartment syndrome are common with clinically significant consequences. We investigated the pathophysiological effects of raised IAP as part of a more extensive exploratory animal study. The study design included both pneumoperitoneum and mechanical intestinal obstruction models. METHODS: Forty-nine female swine were divided into six groups: a control group (Cr; n = 5), three pneumoperitoneum groups with IAPs of 20mmHg (Pn20; n = 10), 30mmHg (Pn30; n = 10), 40mmHg (Pn40; n = 10), and two mechanical intestinal occlusion groups with IAPs of 20mmHg (MIO20; n = 9) and 30mmHg (MIO30; n = 5). RESULTS: There were significant changes (p<0.05) noted in all organ systems, most notably systolic blood pressure (SBP) (p<0.001), cardiac index (CI) (p = 0.003), stroke volume index (SVI) (p<0.001), mean pulmonary airway pressure (MPP) (p<0.001), compliance (p<0.001), pO2 (p = 0.003), bicarbonate (p = 0.041), hemoglobin (p = 0.012), lipase (p = 0.041), total bilirubin (p = 0.041), gastric pH (p<0.001), calculated glomerular filtration rate (GFR) (p<0.001), and urine output (p<0.001). SVV increased progressively as the IAP increased with no obvious changes in intravascular volume status. There were no significant differences between the models regarding their impact on cardiovascular, respiratory, renal and gastrointestinal systems. However, significant differences were noted between the two models at 30mmHg, with MIO30 showing worse metabolic and hematological parameters, and Pn30 and Pn40 showing a more rapid rise in creatinine. CONCLUSIONS: This study identified and quantified the impact of intra-abdominal hypertension at different pressures on several organ systems and highlighted the significance of even short-lived elevations. Two models of intra-abdominal pressure were used, with a mechanical obstruction model showing more rapid changes in metabolic and haematological changes. These may represent different underlying cellular and vascular pathophysiological processes, but this remains unclear.

Influence of Coach’s Anger on Team’s Performance in Basketball / Influencia de la ira del entrenador en el rendimiento del equipo en baloncesto

Coaches exert a significant influence on team enviroment as well as on the collective performance in team sports. Based on these premises, this study aims to analyze the effects of the coaches’ anger on the basketball teams’ performance in youth players. The study sample was composed by 24 basketball matches of the semifinals and finals of the Spanish Championship of Autonomous Teams for Under-16 (U16) and under-14 (U14) male and female players during the years 2019 and 2020. Every game was video observed using an ad hoc observational instrument. A total of n=544 anger events from the coaches of all 32 teams were analysed. The results showed a higher frequency of anger in the U14 category, in female players, in teams that were losing and when the result was close. Most anger actions seem to have a negative or neutral effect on team’s performance. It is particularly negative when it is focused on the referee, who is the main cause and object of the anger. When coaches showed low intensity anger, they obtained slight improvements. The results suggest that coaches need to manage and control their emotions according to the game context.(AU)

Development and assessment of an ex-vivo bench model aimed at laparoscopic ureteric reconstructive techniques.

INTRODUCTION/BACKGROUND: Reconstructive and ablative urologic techniques require special technical mastery, especially the intracorporeal suturing. OBJECTIVE: To report the subjective evaluation of a versatile ex-vivo model aimed to practice laparoscopic ureteric reconstructive techniques (LURT) on box-trainer. STUDY DESIGN: The model is a continuous portion of porcine urinary bladder ("dilated pelvis"), the vesico-ureteral joint ("stenosis") and healthy ureter. All 127 participants (n = 119 urologists and n = 8 paediatric surgeons) performed on the model laparoscopic Anderson-Hynes dismembered pyeloplasty, and then, in the animal model, different LURT procedures (ureteroneocystostomy, ureteric reimplantation and/or dismembered pyeloplasty). The model was subjectively evaluated (face and content validity), through a 12 items questionnaire, based on a Likert scale (1-5 points) and a global question (1-10 points). RESULTS: The total mean rating for 11/12 items was very high (>4points). Only one was rated under 3 points. The overall total mean rating from 1 to 10 points was very high (9.19 ± 0.82 points). In 10/12 items, expert's feedback (content validity) prevailed over non-experts (face validity). DISCUSSION/CONCLUSION: The model was highly accepted for the practice of LURT techniques. Additionally, it is cost-effective, easy to assemble, ethically considerate, and realistic.

Intracisternal BioGlue injection in the fetal lamb: a novel model for creation of obstructive congenital hydrocephalus without additional chemically induced neuroinflammation.

OBJECTIVE: The authors hypothesized that new agents such as BioGlue would be as efficacious as kaolin in the induction of hydrocephalus in fetal sheep. METHODS: This study was performed in 34 fetal lambs randomly divided into 2 studies. In the first study, fetuses received kaolin, BioGlue (2.0 mL), or Onyx injected into the cisterna magna, or no injection (control group) between E85 and E90. In the second study, fetuses received 2.0-mL or 2.5-mL injections of BioGlue into the cisterna magna between E85 and E90. Fetuses were monitored using ultrasound to assess lateral ventricle size and progression of hydrocephalus. The fetuses were delivered (E120-E125) and euthanized for histological analysis. Selected brain sections were stained for ionized calcium binding adaptor 1 (Iba1) and glial fibrillary acidic protein (GFAP) to assess the presence and activation of microglia and astroglia, respectively. Statistical comparisons were performed with Student's t-test for 2 determinations and ANOVA 1-way and 2-way repeated measures for multiple determinations. RESULTS: At 30 days after injection, the lateral ventricles were larger in all 3 groups that had undergone injection than in controls (mean diameter in controls 3.76 ± 0.05 mm, n = 5). However, dilatation was greater in the fetuses injected with 2 mL of BioGlue (11.34 ± 4.76 mm, n = 11) than in those injected with kaolin (6.4 ± 0.98 mm, n = 7) or Onyx (5.7 ± 0.31 mm, n = 6) (ANOVA, *p ≤ 0.0001). Fetuses injected with 2.0 mL or 2.5 mL of BioGlue showed the same ventricle dilatation but it appeared earlier (at 10 days postinjection) in those injected with 2.5 mL. The critical threshold of ventricle dilatation was 0.1 for all the groups, and only the BioGlue 2.0 mL and BioGlue 2.5 mL groups exceeded this critical value (at 30 days and 18 days after injection, respectively) (ANOVA, *p ≤ 0.0001). Moderate to severe hydrocephalus with corpus callosum disruption was observed in all experimental groups. All experimental groups showed ventriculomegaly with significant microgliosis and astrogliosis in the subventricular zone around the lateral ventricles. Only kaolin resulted in significant microgliosis in the fourth ventricle area (ANOVA, *p ≤ 0.005). CONCLUSIONS: The results of these studies demonstrate that BioGlue is more effective than Onyx or kaolin for inducing hydrocephalus in the fetal lamb and results in a volume-related response by obstructive space-occupancy without local neuroinflammatory reaction. This novel use of BioGlue generates a model with potential for new insights into hydrocephalus pathology and the development of therapeutics in obstructive hydrocephalus. In addition, this model allows for the study of acute and chronic obstructive hydrocephalus by using different BioGlue volumes for intracisternal injection.

Intestinal histopathological changes in a porcine model of pneumoperitoneum-induced intra-abdominal hypertension.

BACKGROUND: Low splanchnic perfusion is an immediate effect of pneumoperitoneum-induced intra-abdominal hypertension (IAH). Anatomical structure results in the intestinal mucosa being the area most sensitive to hypoperfusion. The relationship between intestinal injury and clinical parameters of tissue perfusion [abdominal perfusion pressure (APP), gastric intramucosal pH (pHi) and lactic acid (Lc)] has not been previously studied. This study aimed to monitorize intestinal pathogenesis through sequential ileal biopsies and to measure APP, pHi, and Lc levels at different pneumoperitoneum-induced intra-abdominal pressures (20, 30, and 40 mmHg) to evaluate the potential relationships between them. MATERIALS AND METHODS: Fifty pigs were divided into four groups; a control group (C) and three experimental groups with different pneumoperitoneum-induced levels [20 mmHg (G20), 30 mmHg (G30), and 40 mmHg (G40)], that were maintained for 3 and 5 h. APP, pHi, and Lc were measured and ileal biopsies taken laparoscopically every 30 min. The mucosal damage was graded using the standardized Park's Score and animals were classified as injured (I+) or uninjured (I-). RESULTS: Different histopathological lesions were observed in groups G20, G30, and G40 but no damage observed in group C. A 33.3% of animals in G20 and G30 were I+ after 3 h, while 93.3% were injured in G40. After 5 h, histopathological lesions were no longer seen in some animals in G20 and only 10% were I+. Conversely, in G30 I+ pigs increased to 80% while those in G40 remained at 93.3% I+. The I+ animals had significantly lower APP and pHi than those I-. Lc was the clinical parameter that showed the earliest differences, with significantly higher figures in I+ animals. CONCLUSIONS: The evolution of intestinal injuries from pneumoperitoneum-induced IAH depends on the degree of IAP. These damages may be associated with decreases in APP and pHi, and increases in Lc.

Evaluación de competencias en Urología. Esscolap® basic, como aproximación a la mejora de las capacidades de los urólogos / Evaluation of competencies in urology. Esscolap® basic, as aproximation to urologists skills improvement

Introducción: La Urología necesita de modelos de evaluación de capacidades, a pesar de que existe una variada oferta de herramientas que no están integradas en los programas de formación. Contexto: No existe un criterio universal para medir el nivel de competencia. Los programas de formación deben proporcionar conocimientos y destrezas, y deben considerar las habilidades cognitivas, la formación basada sobre simulación y modelo animal. La validez es un concepto complejo que hace referencia a la capacidad del instrumento de evaluación, por lo que es necesario establecer varios tipos de validación para asegurar la capacidad de un método, reforzarse con distintos test de fiabilidad y cálculo de consistencia interna entre evaluadores. Objetivo: A partir de un dossier estructurado de competencias quirúrgicas, clasificadas por grupos, se planteó el sistema ESSCOLAP® Basic con 5 ejercicios sobre simulador, para la evaluación de las competencias básicas en Laparoscopia. Una vez validado, en el CCMIJU, se planteó ampliar el alcance e implementación del mismo en otras localizaciones. Resultados: Nuestro sistema no ha demostrado aún su validez en el ámbito clínico real, porque no presenta una validez predictiva con datos clínicos de resultados en salud. Existe, además, un cierto rango de subjetividad, por lo que se requiere establecer criterios claros y definidos para cualquier situación. El número de evaluadores y de los ejercicios a evaluar, va a influir en los test de fiabilidad que miden el grado de acuerdo entre evaluadores, de modo que sólo obteniendo un elevado número de casos evaluados, podremos acercarnos a una mayor fiabilidad de nuestro sistema. Por último, asumimos que la incorporación de este tipo de herramientas implica un coste añadido a cargo de las instituciones públicas y privadas responsables, que sólo se considerará rentable cuando se demuestre su trazabilidad real y positiva en resultados sanitarios. Conclusiones: ESSCOLAP® Basic, con capacidad de implementación rápida y sencilla, ha sido validado y contrastado para la evaluación de las habilidades técnicas básicas en laparoscopia (AU)

Introduction: Urology needs models of competencies assessment, although there is a wide range of tools not yet integrated into the official training programs. Context: At present, there is no universal framework for measuring surgeons ́ level of competence. Urology training programs should provide and consider knowledge, pyschomotor/cognitive skills, and simulator, cadaver or animal models-based training. Validity is a complex concept that refers to the capacity of the evaluation tool, so it is necessary to demonstrate several types of validation to assure the capacity of a method, reinforced with different reliability tests and calculation of internal consistency between evaluators. Objective: Based on a structured dossier of surgical skills, classified by groups, the ESSCOLAP® Basic system was proposed with 5 simulator tasks to evaluate basic laparoscopic skills. Once validated in the JUMISC (Spain), the tool was proposed to extend its scope and implementation in other locations. Results: Our system has not yet demonstrated a full validity in the real clinical setting because a predictive validity needs to be demonstrated on the basis of clinical data. It also suffers from a certain range of subjectivity, thus implying clear and defined criteria for any situation. Factors like the number of evaluators and tasks to assess will influence the reliability tests that measure the degree of agreement between evaluators, so that a higher number of evaluated cases would imply a greater reliability of our system. Finally, we assume that the incorporation of this type of tools implies an added cost, charged to the public and private responsible institutions, which will only be considered cost-effective when it is demonstrated its real and positive traceability in health outcomes. Conclusions: ESSCOLAP® Basic, of quick and simple implementation capacity, has been validated and calibrated for the evaluation of basic technical skills in laparoscopy (AU)

[Evaluation of competencies in urology. Esscolap® basic, as aproximation to urologists skills improvement.] / Evaluación de competencias en Urología. Esscolap® basic, como aproximación a la mejora de las capacidades de los urólogos.

Urology needs models of competencies assessment, although there is a wide range of tools not yet integrated into the official training programs. CONTEXT: At present, there is no universal framework for measuring surgeons' level of competence. Urology training programs should provide and consider knowledge, pyschomotor/cognitive skills, and simulator, cadaver or animal models-based training. Validity is a complex concept that refers to the capacity of the evaluation tool, so it is necessary to demonstrate several types of validation to assure the capacity of a method, reinforced with different reliability tests and calculation of internal consistency between evaluators. OBJECTIVE: Based on a structured dossier of surgical skills, classified by groups, the ESSCOLAP® Basic system was proposed with 5 simulator tasks to evaluate basic laparoscopic skills. Once validated in the JUMISC (Spain), the tool was proposed to extend its scope and implementation in other locations. RESULTS: Our system has not yet demonstrated a full validity in the real clinical setting because a predictive validity needs to be demonstrated on the basis of clinical data. It also suffers from a certain range of subjectivity, thus implying clear and defined criteria for any situation. Factors like the number of evaluators and tasks to assess will influence the reliability tests that measure the degree of agreement between evaluators, so that a higher number of evaluated cases would imply a greater reliability of our system. Finally, we assume that the incorporation of this type of tools implies an added cost, charged to the public and private responsible institutions, which will only be considered cost-effective when it is demonstrated its real and positive traceability in health outcomes. CONCLUSIONS: ESSCOLAP® Basic, of quick and simple implementation capacity, has been validated and calibrated for the evaluation of basic technical skills in laparoscopy.

Time-course evaluation of intestinal structural disorders in a porcine model of intra-abdominal hypertension by mechanical intestinal obstruction.

BACKGROUND: A mechanical intestinal obstruction (MIO) can generate intraabdominal hypertension (IAH) that is life threatening. The intestines are very sensitive to IAH since the low splanchnic perfusion causes intestinal hypoxia, local acidosis and bacterial translocations. This may lead to acute intestinal distress syndrome (AIDS). The identification of intestinal injuries during IAH and its correlation with clinical parameters as the abdominal perfusion pressure (APP), the gastric intramucosal pH (pHi) and lactic acid (Lc) are still unknown. This study aimed to evaluate the sequence of intestinal histopathological findings in an MIO model and to analyze potential relationships with parameters currently used in clinical practice (APP, pHi and Lc). MATERIAL AND METHODS: Twenty pigs were divided into three groups: a control group (n = 5) and two experimental groups with 20 mmHg (G1, n = 10) and 30 mmHg (G2, n = 5) of IAH by MIO. The pressures were maintained for 3 hours, except in 5 animals in G1 where it was maintained for 5 hours. The APP, pHi and LA were recorded and biopsies of the terminal ileum were taken every 30 minutes in all groups. The intestinal damage was graded according to the Park Score. RESULTS: Intestinal injuries were found in 42.9% of pigs in the experimental groups. The lesions were independent of the level and duration of IAH. Although APP and pHi were slightly lower in injured animals (I +) of G1 and G2, there were no significant differences among those uninjured (I-). Lc was significantly increased in all I+ pigs from the onset of IAH. CONCLUSION: The IAH by MIO causes intestinal lesions from the first 30 minutes with concurrent decreases in APP and pHi and increases in Lc. Lc could be the best clinical parameter related to intestinal damages with a clear difference between I + and I- animals.

Intervertebral disc degeneration: an experimental and numerical study using a rabbit model.

Animal models have been extensively used for the study of degenerative diseases and evaluation of new therapies to stop or even reverse the disease progression. The aim of this study is to reproduce lumbar intervertebral disc degeneration in a rabbit model by performing a percutaneous annular puncture at L4L5 level. The effect of this damage on the spine behaviour was analysed combining three different techniques: imaging processing, mechanical testing and computational modelling. Twenty New Zealand white rabbits were divided into control and experimental groups and followed up during 6 months. Intervertebral disc height, as well as nucleus area and signal intensity, decreased with degeneration while storage and loss moduli increased. Both changes may be related to the loss of water and tissue fibrosis. Similar but slighter changes were reported for adjacent discs. A finite element model was built based on MRI and mechanical testing findings to add new biomechanical information that cannot be obtained experimentally. Four stages were computationally simulated representing the different experimental phases. The numerical simulations showed that compressive stresses in the damaged and adjacent discs were modified with the progression of degeneration. Although extrapolation to humans should be carefully made, the use of numerical animal models combined with an experimental one could give a new insight of the overall mechanical behaviour of the spine.

Mechanical Intestinal Obstruction in a Porcine Model: Effects of Intra-Abdominal Hypertension. A Preliminary Study.

INTRODUCTION: Mechanical intestinal obstruction is a disorder associated with intra-abdominal hypertension and abdominal compartment syndrome. As the large intestine intraluminal and intra-abdominal pressures are increased, so the patient's risk for intestinal ischaemia. Previous studies have focused on hypoperfusion and bacterial translocation without considering the concomitant effect of intra-abdominal hypertension. The objective of this study was to design and evaluate a mechanical intestinal obstruction model in pigs similar to the human pathophysiology. MATERIALS AND METHODS: Fifteen pigs were divided into three groups: a control group (n = 5) and two groups of 5 pigs with intra-abdominal hypertension induced by mechanical intestinal obstruction. The intra-abdominal pressures of 20 mmHg were maintained for 2 and 5 hours respectively. Hemodynamic, respiratory and gastric intramucosal pH values, as well as blood tests were recorded every 30 min. RESULTS: Significant differences between the control and mechanical intestinal obstruction groups were noted. The mean arterial pressure, cardiac index, dynamic pulmonary compliance and abdominal perfusion pressure decreased. The systemic vascular resistance index, central venous pressure, pulse pressure variation, airway resistance and lactate increased within 2 hours from starting intra-abdominal hypertension (p<0.05). In addition, we observed increased values for the peak and plateau airway pressures, and low values of gastric intramucosal pH in the mechanical intestinal obstruction groups that were significant after 3 hours. CONCLUSION: The mechanical intestinal obstruction model appears to adequately simulate the pathophysiology of intestinal obstruction that occurs in humans. Monitoring abdominal perfusion pressure, dynamic pulmonary compliance, gastric intramucosal pH and lactate values may provide insight in predicting the effects on endorgan function in patients with mechanical intestinal obstruction.

Escitalopra y extrasistoles ventriculares / Escitalopram and ventricular extrasystoles

La toxicidad cardíaca de los inhibidores selectivos de la recaptación de serotonina como citalopram y escitalopram ha sido asociada a un alargamiento del intervalo QT en el electrocardiograma. Presentamos el caso de extrasístoles ventriculares bigeminados asociados al consumo de escitalopram. Deberíamos evitar su uso en pacientes con historia personal o familiar de muerte súbita, sexo femenino, insuficiencia cardíaca congestiva descompensada, infarto de miocardio, bradiarritmias, alteraciones iónicas, y antecedentes de intervalo QT alargado, además de monitorizar electrocardiográficamente a los pacientes mayores de 65 años (AU)

Cardiac toxicity of selective serotonin reuptake inhibitors, such as citalopram and escitalopram, has been associated with a prolonged QT interval on the electrocardiogram. We present a case of bigeminal ventricular extrasystole associated with escitalopram use, which should be avoided in patients with a personal or family history of sudden death, female patients, decompensated congestive heart failure, myocardial infarction, bradyarrhythmias, electrolyte changes, and a history of long QT interval. In patients over 65, electrocardiographic monitoring is also advisable (AU)

Hipertensión intraabdominal: consecuencias sobre la circulación esplácnica. Estudio preliminar en un modelo de ascitis / Intra-abdominal hypertension: Effects on the splanchnic circulation. Preliminary study in a model of ascites

INTRODUCCIÓN: La hipertensión intraabdominal se define como una elevación de la presión intraabdominal que da lugar a una disfunción progresiva de los órganos intraabdominales. Objetivo Estudiar las consecuencias de la hipertensión intraabdominal a nivel esplácnico en un modelo porcino determinando la medida indirecta de elección. Material y métodos Se utilizaron 10 cerdos divididos en un grupo control y en un grupo de presión de 20 mmHg con un modelo de ascitis. Se registraron las presiones intraabdominal transvesical y transperitoneal, calculándose el grado de correlación entre ambas. Se obtuvo el ácido láctico, la alanina aminotransferasa, la glucosa y el pH intramucoso gástrico. Se determinó la presión arterial media y la presión de perfusión abdominal, observando la correlación de esta con el pH intramucoso gástrico y el ácido láctico. Los parámetros se registraron durante 3 h. Resultados Hubo una alta correlación entre ambas presiones (R2 = 0,98). A 20 mmHg el ácido láctico aumentó significativamente entre grupos a los 180 min (p < 0,011). El pH intramucoso gástrico mostró diferencias significativas entre grupos desde el inicio (p = 0,004) descendiendo significativamente a partir de los 120 min. La presión arterial media y la perfusión abdominal disminuyeron progresivamente apreciándose cambios significativos más precoces en la presión de perfusión abdominal (p = 0,001) mostrando una buena correlación con los parámetros estudiados. No hubo afectación significativa de los parámetros hepáticos. Conclusiones Consideramos la presión intraabdominal transvesical como la técnica de elección, siendo la presión de perfusión abdominal un marcador sensitivo de la hipertensión intraabdominal y el pH intramucoso gástrico el parámetro más precozmente afectado

INTRODUCTION: Intra-abdominal hypertension is defined as a rise in intra-abdominal pressure leading to progressive dysfunction of the abdominal organs. OBJECTIVE: To evaluate the effects of intra-abdominal hypertension on the splanchnic circulation in a porcine animal model with a view to determining the diagnostic method of choice. MATERIAL AND METHODS: A total of 10 swine were divided into 2 groups: a control group and a group with an ascites pressure of 20 mmHg. Transvesical and transperitoneal intra-abdominal pressures were registered, and the correlation between the measurements obtained was determined. Concentrations of lactic acid, alanine aminotransferase, glucose and gastric mucosal pH were also obtained. We registered the mean arterial and abdominal perfusion pressures, and the correlation of the latter with gastric mucosal pH and lactic acid concentrations. The parameters were registered for a total of 3 hours. RESULTS: We observed a high correlation between transvesical and transperitoneal measurements of intra-abdominal pressure (R2 = 0.98). In the 20 mmHg pressure group, lactic acid concentrations increased significantly at 180 min (p < 0.011). Gastric mucosal pH differed significantly between the 2 groups from the beginning of the study (p = 0.004) and significantly decreased from 120 min onward. Mean arterial and abdominal perfusion pressures gradually decreased during the trial, with early significant changes in the abdominal perfusion pressure (p = 0.001), and a good correlation with the remaining study parameters. There were no significant changes in hepatic indicators. CONCLUSIONS: We believe the transvesical approach to be the technique of choice to determine intra-abdominal pressure. Abdominal perfusion pressure is a sensitive marker of intra-abdominal hypertension, and gastric mucosal pH is the first parameter to be affected

[Intra-abdominal hypertension: effects on the splanchnic circulation. Preliminary study in a model of ascites]. / Hipertensión intraabdominal: consecuencias sobre la circulación esplácnica. Estudio preliminar en un modelo de ascitis.

INTRODUCTION: Intra-abdominal hypertension is defined as a rise in intra-abdominal pressure leading to progressive dysfunction of the abdominal organs. OBJECTIVE: To evaluate the effects of intra-abdominal hypertension on the splanchnic circulation in a porcine animal model with a view to determining the diagnostic method of choice. MATERIAL AND METHODS: A total of 10 swine were divided into 2 groups: a control group and a group with an ascites pressure of 20mmHg. Transvesical and transperitoneal intra-abdominal pressures were registered, and the correlation between the measurements obtained was determined. Concentrations of lactic acid, alanine aminotransferase, glucose and gastric mucosal pH were also obtained. We registered the mean arterial and abdominal perfusion pressures, and the correlation of the latter with gastric mucosal pH and lactic acid concentrations. The parameters were registered for a total of 3hours. RESULTS: We observed a high correlation between transvesical and transperitoneal measurements of intra-abdominal pressure (R(2)=0.98). In the 20mmHg pressure group, lactic acid concentrations increased significantly at 180min (p<0.011). Gastric mucosal pH differed significantly between the 2 groups from the beginning of the study (p=0.004) and significantly decreased from 120min onward. Mean arterial and abdominal perfusion pressures gradually decreased during the trial, with early significant changes in the abdominal perfusion pressure (p=0.001), and a good correlation with the remaining study parameters. There were no significant changes in hepatic indicators. CONCLUSIONS: We believe the transvesical approach to be the technique of choice to determine intra-abdominal pressure. Abdominal perfusion pressure is a sensitive marker of intra-abdominal hypertension, and gastric mucosal pH is the first parameter to be affected.

Tonometry as a predictor of inadequate splanchnic perfusion in an intra-abdominal hypertension animal model.

BACKGROUND: The gastrointestinal system is the most sensitive to the presence of intra-abdominal hypertension. We aimed to assess the early prognostic value of gastric air tonometry as a predictor of inadequate splanchnic perfusion and determine its relation with abdominal perfusion pressure (APP). METHODS: Twenty-five Large White swine were used for this study. A control group and two study groups were included, in which intra-abdominal pressure (IAP) was elevated with Co2 to 20 and 30 mmHg during 5 h. We measured the intramucosal gastric pH (pHim) and determined gastric luminal PCO2 (PgCO2) and PgCO2gap (gastric luminal CO2-arterial CO2) to evaluate gastric acidity. APP was indirectly obtained through IAP and mean arterial pressure. Additionally, histopathologic samples of small intestine were obtained and analyzed. RESULTS: pHim showed a decrease in IAP groups, with statistical significance in the 30 mmHg group, 90 min after stabilization period (P < 0.01). Serum lactate showed delayed alteration when compared with pHim, with significant increase, 180 min after stabilization (P < 0.05). The values of PgCO2 and PCO2gap were increased in IAP groups, being statistically significant in the 30 mmHg group, 120 and 150 min, respectively, after stabilization. In increased IAP groups, there was a time progressive decrease of APP, with statistically significant differences observed between groups at 20 min (P < 0.001). The histopathology study revealed parenchymal injury of the intestine at 30 mmHg. CONCLUSIONS: Tonometry is sensitive to the increase in IAP and relates to the reduction of APP generated by splanchnic hypoperfusion.

Consecuencias renales de la hipertensión intraabdominal en modelo porcino. Búsqueda de la técnica indirecta de elección de la medida de la presión intraabdominal / Renal Consequences of Intraabdominal Hypertension in a Porcine Model. Search for the Choice Indirect Technique for Intraabdominal Pressure Measurement

Objetivo: Estudiar las consecuencias renales en un modelo porcino de hipertensión intraabdominal y determinar la técnica indirecta de elección para la medida de la presión intraabdominal. Material y métodos: Se utilizaron 30 cerdos divididos en 2 grupos, presión intraabdominal incrementada en 20 mm Hg y en 30 mm Hg. En ambos las presiones se registraron en 8 tiempos hasta3 horas con un insuflador de CO2. Se realizaron 3 medidas de la presión intraabdominal, una directa transperitoneal, empleando un catéter de Jackson-Prat conectado a un traductor depresión, y 2 indirectas, una transvesical mediante un sistema de Foley manómetro y otra transgástrica introduciendo en el estómago un catéter conectado a un monitor de presión con hardware electrónico. Se calculó la presión arterial media, el gasto cardiaco, la producción de orina y la creatinina sérica. Resultados: Hubo una mayor correlación entre la presión intraabdominal transvesical y la transperitoneal (R2 = 0,95). La media de la presión intraabdominal transgástrica fue menor quela transperitoneal en todos los tiempos. La presión arterial media descendió en ambos grupos observando diferencias significativas más precoces a 30 mm Hg (p < 0,020). La producción de orina fue menor a 30 mm Hg (9,63±1,57) vs. (3,26 ml±1,73). La creatinina aumentó en ambos grupos, siendo patológica a 30 mm Hg a partir de 1 h 20 min, existiendo diferencias entre presiones precoces (p < 0,027).Conclusiones: Hubo afectación renal más marcada a presiones de 30 mm Hg. La técnica transvesical mostró una mayor correlación con la técnica directa empleada, por lo que consideramos esta como la de elección (AU)

Objective: To study the effects on the renal system in a porcine model of intraabdominal hypertension, and to determine the indirect technique of choice for determination of the intraabdominal pressure. Material and methods: 30 pigs were used divided in two groups according with increased intraabdominal pressure values (20 mm Hg and 30 mm Hg). In both groups pressures were registered 8 times, summing up to 3 hours, with a CO2 insufflator. Three different measures of the intraabdominal pressure were taken: a direct transperitoneal measure, using a catheter of Jackson-Pratt connected to a pressure transducer, and two indirect measures, a transvesical by means of a Foley to manometer system, and a transgastric by introducing in the stomacha catheter connected to a pressure monitor with electronic hardware. Mean arterial pressure was calculated, along with the cardiac index, production of urine and serum creatinine. Results: There was a greater correlation between the transvesical and the transperitoneal intraabdominal pressures (R2 = 0,95). Average transgastric intraabdominal pressure was inferior to the transperitoneal indicator in all taken measurements. The average arterial pressure descended in both groups, with earlier significant differences observed at 30 mm Hg (p < 0,020).Urine production was lower at 30 mm Hg compared with the 20 mm Hg group (9,63±1,57 versus3.26 ml±1,73). Serum creatinine increased in both groups being pathological at 30 mm Hg after1 h 20 min, with existing differences between early pressures (p < 0,027).Conclusions: This study revealed marked renal affectation with higher severity at 30 mmHg pressures. The transvesical technique showed a greater correlation with the direct measurement technique used, defining this as the method of choice for determination of intraabdominal pressure (AU)

Renal consequences of intraabdominal hypertension in a porcine model. Search for the choice indirect technique for intraabdominal pressure measurement.

OBJECTIVE: To study the effects on the renal system in a porcine model of intraabdominal hypertension, and to determine the indirect technique of choice for determination of the intraabdominal pressure. MATERIAL AND METHODS: 30 pigs were used divided in two groups according with increased intraabdominal pressure values (20 mmHg and 30 mmHg). In both groups pressures were registered 8 times, summing up to 3 hours, with a CO2 insufflator. Three different measures of the intraabdominal pressure were taken: a direct transperitoneal measure, using a catheter of Jackson-Pratt connected to a pressure transducer, and two indirect measures, a transvesical by means of a Foley to manometer system, and a transgastric by introducing in the stomach a catheter connected to a pressure monitor with electronic hardware. Mean arterial pressure was calculated, along with the cardiac index, production of urine and serum creatinine. RESULTS: There was a greater correlation between the transvesical and the transperitoneal intraabdominal pressures (R(2)=0,95). Average transgastric intraabdominal pressure was inferior to the transperitoneal indicator in all taken measurements. The average arterial pressure descended in both groups, with earlier significant differences observed at 30 mmHg (p<0,020). Urine production was lower at 30 mmHg compared with the 20 mmHg group (9,63 ± 1,57 versus 3.26 ml ± 1,73). Serum creatinine increased in both groups being pathological at 30 mmHg after 1h 20 min, with existing differences between early pressures (p<0,027). CONCLUSIONS: This study revealed marked renal affectation with higher severity at 30 mmHg pressures. The transvesical technique showed a greater correlation with the direct measurement technique used, defining this as the method of choice for determination of intraabdominal pressure.

Determinación de anticuerpos y aloanticuerpos linfocitoxicos en pacientes candidatos a trasplante renal

Las pruebas cruzadas para detectar la presencia de anticuerpos linfocitotóxicos en el suero de candidatos a trasplante renal, son decisivas en el estudio pretrasplante. En el presente estudio se reportan los hallazgos en 97 pacientes con insificiencia renal crónica, candidatos a trasplantes y 127 posibles donantes vivos relacionados. Las pruebas incluyerón detección de anticuerpos antilifocitos T y B separadamente a 4,20 y 37 grados contra linfocitos del posible donante y contra las células autólogas. Se incluye además el tratamiento con ditiotreitol (DTT) para diferenciar entre los isotopos IgM e IgG. Los resultados muestran que 40.2 por ciento de los pacientes y 16.5 por ciento (p<=0.04) de los donantes clínicamente sanos tiene anticuerpos que pueden reaccionar con células alogénicas. Los aloanticuerpos se dectectaron en 38 por ciento de los pacientes. La mayoria de los anticuerpos estaban dirigidos contra los linfocitos B (71.7 por ciento) y correspondieron al isotipo IgM (66.7 por ciento), aunque tambien se detectaron tanto auto como aloanticuerpos IgG.No se detectó un efecto significativo de las trasfuciones o embarazos previos en el desarrollo de anticuerpos ni de aloanticuerpos. De otro lado se observó una frecuencia significativamente mayor (p=0.0009) de donantes intrafamiliares con autoanticuerpos positivos, en pacientes tambien positivos para autoanticuerpos que de receptores negativos para autoanticuerpos positivos que fueron trasplantados con riñones provenientes de sus donantes intrafamiliares o de cadáver, tienen sus injertos funcionantes hasta un año después. Los pacientes sin autoanticuerpos presentaron una menor sobrevida de sus injertos especialmente en el caso de los injertos de cadáver, de los cuales soló sobrevivió la tercera parte después de un año. Los resultados hacen énfasis en la necesidad de realizar las pruebas cruzadas previas al trasplante en condiciones que permitan obtener la mayor información posible sobre los anticuerpos linfocitotóxicos presentes en el suero de los pacientes candidatos a trasplante renal.

Citomegalovirus humano. Inmunopatogénesis y asociación con rechazo de trasplantes / Human cytomegalovirus. Immunopathogenesis and related with rebound trasplantation

El citomegalovirus humano es un virus tipo herpes frecuentemente relacionado con enfermedad cuando la infección se desarrolla en utero o en huéspedes inmunocomprometidos. Aunque casi todo el sistema inmunitario es dirigido eficientemente contra la infección de tal manera que no se presenta enfermedad sino en contados casos, el virus permanece latente de por vida y se puede desencadenar una reactivacion viral si ocurre inmunosupresión relativa o absoluta en presencia o no de enfermedad evidente. En los pacientes trasplantados, el citomegalovirus humano es la complicación infecciosa más frecuente y la infección activa se asocia en forma desconocida con el rechazo. Parece que la reacción de rechazo es inducida por el virus, aunque algunos investigadores han postulado lo contratio. El virus es, por sí mismo, inmunosupresor y, puesto que la infeccion y el rechazo en los pacientes trasplantados tienen cuadros clínicos similares, es frecuente que su presencia se preste a confusión.

Interferón gamma y factor necrosante de tumores/linfotoxina en el cultivo de linfocitos de candidatos y donadores de trasplante renal

Basados en el papel central que ejercen el interferón gamma (INF-gamma) y el factor necrazante de tumores (FNT) en los procesos de acitivación e inflamación y en los efectos antivirales de éstos, nos propusimos determinar sus niveles en cultivos mixtos de linfocitos (CML) de parejas de candidatos receptores/donadores de trasplante renal. Mediante radioinminoanálisis y ensayo biológico correlacionamos estos niveles con la presencia de episodios de rechazo e infección por Citomegalovirus (CMV) en el período postrasplante

Histocompatibilidad, citomegalovirus y trasplante renal

Se utilizó el cultivo mixto de linfocitos (CML) para tratar de establecer la correlación entre alorreactividad, rechazo e infección por citomegalovirus (CMV) y la posible reactivación del virus in vitro. Se practicaron CML clásicos para estudiar la respuesta proliferativa y en paralelo, CML para los estudios de reactivación viral. El período de seguimineto clínico de los pacientes osciló entre tres meses y un año y durante el cual se pudo corroborar la fuerte asociación entre rechazo e infección por CMV (p=0.001). Se probaron, por aislamiento viral, 144 sobrenadantes de combinaciones de CML con resultados negativos. En general, la correlación entre CML y HLA fue pobre; si bien fue significativa para HLA-(A+B), no fue la DR. Tampoco hubo asociación entre el rechazo y los parámetros clínicos rutinarios para el seguimineto de los pacientes (BUN, creatinina, depuración de creatinina), al igual que con la clase y el número de transfusiones. El porcentaje promedio de respuesta relativa (por cientoRR) fue mayor cuando la relación con el donante era paternal que cuando era fraternal (p=0.05) y la mayoría de los episodios de infección por CMV y rechazo se presentaron en los pacientes que recibieron trasplante de origen paterno