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Donkeys have been used as working animals for transport and farm activities worldwide. Recently, in European countries, there has been an increasing interest in donkeys due to their use as pets, onotherapy or milk production. During 2014-2016, a countrywide survey was conducted to determine prevalence and risk factors of principal helminth infections in 1775 donkeys in 77 Italian farms. A questionnaire on management and parasite control practices was filled out for each farm. Faecal samples were examined using a modified McMaster technique, a centrifugation/flotation method and a sedimentation technique. Pooled coprocultures were performed for differentiation of strongylid eggs. Strongyles were the most common parasites detected (84.9%), followed by Dictyocaulus arnfieldi (6.9%), Oxyuris equi (5.8%), Parascaris spp. (3.6%), Anoplocephala spp. (1.0%), Strongyloides westeri (0.3%). Coprocultures revealed an omnipresence of cyathostomins (100%), followed by Strongylus vulgaris (31.0%), Poteriostomum spp. (25.0%), Triodontophorus spp. (9.0%), Strongylus edentatus (7.0%), Strongylus equinus (5.0%). Logistic regression analysis identified breed, co-pasture with horses, living area, herd size and number of treatments as significantly associated with strongyles. Sex, age, living area and herd size were significantly associated with Parascaris spp. Dictyocaulus arnfieldi was significantly associated with sex, grass, co-pasture with horses, living area and herd size. Strongylus vulgaris was significantly associated with living area and herd size. The mean number of anthelmintic treatments/year was 1.4; most of the donkeys (71.8%) were dewormed using an ivermectin drug. It is important to design parasite programs to specifically address both D. arnfieldi and S. vulgaris in donkeys, and this is especially important if donkeys co-graze with horses.
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Dictyocaulus , Equidae/parasitología , Helmintiasis Animal/epidemiología , Strongylus , Animales , Italia , Recuento de Huevos de ParásitosRESUMEN
Aim of the study was to get in-depth information on Aelurostrongylus abstrusus first-stage larvae (L1s) survival at different temperatures and to assess the capability of these larvae to develop into the third infective stage (L3s). Faeces of a naturally infected cat were split into two aliquots: the first was divided in subsamples assigned to four groups (F1-F4); from the second aliquot, L1s were extracted by Baermann technique, suspended in water and divided into four groups (W1-W4). Groups were stored at different temperatures (F1/W1 -20 ± 1°C; F2/W2 +4 ± 1°C; F3/W3 +14 ± 1°C; and F4/W4 +28 ± 1°C) and L1s vitality assessed every seven days. The capability of L1s stored in water to develop into L3s in snails was evaluated at the beginning and every 21 days. The L1s of W2 and F2 groups remained viable for a longer period (231 and 56 days, respectively) compared to those of other groups. The capability of L1s to moult into L3s in snails showed a decreasing trend; the group W2's L1s maintained the capability to moult into L3s for the longest time (day 189) compared to the other groups. The time of survival of A. abstrusus L1s is influenced by temperature. However, the species seems to be more resistant to temperature variations than other feline lungworms, and this may explain its wider distribution across Europe.
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Larva/crecimiento & desarrollo , Metastrongyloidea , Infecciones por Strongylida/veterinaria , Animales , Enfermedades de los Gatos/parasitología , Gatos , Heces/parasitología , Larva/parasitología , Estadios del Ciclo de Vida , Metastrongyloidea/crecimiento & desarrollo , Metastrongyloidea/aislamiento & purificación , Metastrongyloidea/parasitología , Caracoles/parasitología , Infecciones por Strongylida/parasitología , TemperaturaRESUMEN
The National Institute of Standards and Technology (NIST) measured the internal pair production branching ratio of 90Y using two sources and four high purity germanium (HPGe) detectors to detect the resulting annihilation radiation. The internal pair production branching ratio determined from these measurements, (32.0⯱â¯1.5)â¯×â¯10-6 (kâ¯=â¯1), agrees within 1 standard uncertainty with the recommended value of (32.6⯱â¯0.7)â¯×â¯10-6 (kâ¯=â¯1) from the DDEP database.
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Objective: To evaluate chemical compositions, antioxidant and wound healing properties of Algerian Artemisia absinthium essential oil.Methods: The chemical composition of the essential oil from Artemisia absinthium was analyzed by a combination of GC-FID and GC/MS. The antioxidant capacities including the total antioxidant capacity, DPPH? and ABTS+? scavenging capacities were measured. The wound healing potential was assessed by the excision wound model of rats. The wounds were treated daily with an ointment prepared with two concentrations (5% and 10%) of Artemisia absinthium essential oil. The percentage of wound contraction was determined and wound healing was also evaluated by histological examination of the healed skin. Results: The main component of Artemisia absinthium essential oil was camphor (48%) followed by chamazulene (10%) that was responsible for the dark blue color of the oil. Artemisia absinthium essential oil exhibited moderate antioxidant activity compared with BHT and Trolox. All preparations showed significant effects on wound contraction and the ointment prepared with 10% of essential oil was effective as the reference drug Cicatryl. Conclusions: The essential oil of Artemisia absinthium shows moderate antioxidant activity. The 10% ointment enhances skin wound re-epithelialization and speeds up the healing process. The essential oil of Artemisia absinthium may be used as an alternative drug for wound healing.
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Tarocco "Sant'Alfio" is a late ripening blood orange cultivar. Blood oranges are more and more appreciated from consumers for their high nutraceutical value due to the presence of bioactive compounds including vitamin C, polyphenols, flavonoids and hydroxycinnamic acids. The aim of this work is to set up a reliable protocol for postharvest storage of the very-late Tarocco "Sant'Alfio" orange to prolong the availability of this product in the market to be used for fresh chilled orange juice production. Fruits were subjected to three storage treatments (20days at 1°C plus 50days at 4°C; 70days at 4°C; 70days at 20°C). The results indicate that cold treatments, in particular at 4°C constantly, can extend Tarocco "Sant'Alfio" shelf life enhancing total anthocyanin content. The defined protocols allow prolonging market availability of a high value product and could induce relevant benefits for the citrus industry and consumers.
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Citrus sinensis/química , Jugos de Frutas y Vegetales/análisis , Frutas/química , Extractos Vegetales/química , Antocianinas/análisis , Extractos Vegetales/análisisRESUMEN
The feline genotype of Tritrichomonas foetus is a widespread cause of large-bowel diarrhoea in cats. The aim of this study was to determine the prevalence of the T. foetus infection in cat populations across Italy. Fresh, individual faecal samples were collected from 267 cats, kept in different environments (i.e., private households, breeding structures, municipal catteries and colonies) in three different sites across Italy. The faecal samples were tested by PCR to detect T. foetus. Moreover, the same samples were subjected to a concentration-flotation technique and a commercial direct fluorescent-antibody (DFA) test to detect additional enteric parasites, including Giardia duodenalis. The overall prevalence of T. foetus infection was 5.2%. All the infected cats showed diarrhoea at the time of sampling: 9 out of 14 positive cats were co-infected with G. duodenalis, 1 with Toxocara cati and 3 with Dipylidium caninum. The risk factor analysis showed that not only the breed, but also co-infections with G. duodenalis and Dipylidium caninum were significantly associated with the presence of T. foetus. This study confirms the presence of T. foetus in cats living in Italy, suggesting that this protozoan parasite should always be included in the differential diagnosis of patients referred with large-bowel disease symptoms, especially if they were purebred animals, or affected by other enteric protozoa, such as G. duodenalis.
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This paper presents a short review of the evidence - both experimental and theoretical - of the formation of dissipative structures in liquid water induced by three kinds of physical perturbations having a low energy content: extremely diluted solution (EDS), iteratively filtered water (IFW), and iteratively nafionated water (INW). Particular attention is devoted to the very recent discovery that such structures are tremendously persistent even in the solid phase: large ponderal quantities of supramolecular aggregates of water (with each nucleus hundreds of nanometers in size) have been observed - at ambient pressure and temperature - using easily-reproducible experimental methods. The nature of these dissipative structures is analyzed and explained in terms of the thermodynamics of far-from-equilibrium systems and irreversible processes, showing their spontaneous quantum origin. Are these kinds of structures the matrix itself of life?.
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Teoría Cuántica , Agua/química , Estructura Molecular , Presión , TermodinámicaRESUMEN
Among male patients affected by Kallmann syndrome, a genetically determined disease due to defective neural migration leading to hypogonadropic hypogonadism and hypo/anosmia, about 40% present the peculiar phenomenon of mirror movements, i.e. involuntary movements mirroring contralateral voluntary hand movements. Several pathogenic hypotheses have been proposed, but the ultimate neurological mechanisms are still elusive. The aim of the present study was to investigate brain anatomical substrates of mirror movements in Kallmann syndrome by means of a panel of quantitative MRI analyses. Forty-nine male Kallmann syndrome patients underwent brain MRI. The study protocol included 3D-T1-weighted gradient echo, fluid attenuated inversion recovery and diffusion tensor imaging. Voxel-based morphometry, sulcation, curvature and cortical thickness analyses and tract based spatial statistics were performed using SPM8, Freesurfer and FSL. All patients underwent a complete physical and neurological examination including the evaluation of mirror movements (according to the Woods and Teuber criteria). Kallmann syndrome patients presenting with mirror movements (16/49, 32%) displayed the following brain changes: 1) increased gray matter density in the depth of the left precentral sulcus behind the middle frontal gyrus; 2) decreased cortical thickness in the precentral gyrus bilaterally, in the depth of right precentral sulcus and in the posterior portion of the right superior frontal gyrus; and 3) decreased fractional anisotropy in the left hemisphere involving the temporal lobe and peritrigonal white matter. No differences were shown by cortical curvature and sulcation analyses. The composite array of brain changes observed in Kallmann syndrome patients with mirror movements likely represents the anatomical-structural underpinnings leading to the peculiar derangement of the complex circuitry committed to unilateral hand voluntary movements.
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Encéfalo/patología , Encéfalo/fisiopatología , Síndrome de Kallmann/patología , Síndrome de Kallmann/fisiopatología , Adolescente , Adulto , Corteza Cerebral/patología , Corteza Cerebral/fisiopatología , Imagen de Difusión Tensora , Globo Pálido/patología , Globo Pálido/fisiopatología , Humanos , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Corteza Motora/patología , Corteza Motora/fisiopatología , Desempeño Psicomotor/fisiología , Tractos Piramidales/patología , Tractos Piramidales/fisiopatología , Adulto JovenRESUMEN
The increasing reports of Troglostrongylus brevior lungworm in domestic cats from Italy and Spain raised questions on its factual distribution and on the role wildcats play as reservoirs of these parasites. Carcasses of 21 wildcats were collected in natural parks of southern Italy (i.e., Catania, Sicily n=5 and Matera, Basilicata n=16) and biometrically and genetically identified as Felis silvestris silvestris, but two as hybrids. Troglostrongylus brevior and Eucoleus aerophilus lungworms were found in 15 (71.4%) and 7 (33.3%) individuals, respectively, being five (23.8%) co-infected by the two species. Both lungworms showed an aggregated distribution in the host population, assessed by k-index (i.e., 0.69 for T. brevior and 0.42 for E. aerophilus). Although no statistical significant difference was recorded among age, gender and geographical location of wildcats, a larger rate of infection by T. brevior was assessed in yearlings (85.7%) than adults (64.3%). This is the first epidemiological study reporting T. brevior infection in the European wildcat and discusses the potential threat this may represent for the conservation of this endangered species of felids. In addition, given the large frequency of lungworm infection herein recorded, the role of wildcats as reservoir hosts of these parasites to domestic cats is discussed.
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Reservorios de Enfermedades/veterinaria , Felis , Enfermedades Pulmonares/veterinaria , Infecciones por Strongylida/veterinaria , Estrongílidos/clasificación , Animales , Reservorios de Enfermedades/parasitología , Italia/epidemiología , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/parasitología , Infecciones por Strongylida/epidemiologíaRESUMEN
The life cycles of filarioids of dogs presenting dermal microfilariae have been little studied. Following the recent retrieval of dermal microfilariae identified as Cercopithifilaria sp. in a dog from Sicily (Italy), this study was designed to assess the role of the brown dog tick Rhipicephalus sanguineus as an intermediate host of this filarial species. An experimental tick infestation was performed on an infected dog using 300 nymphs of R. sanguineus. Engorged nymphs were collected and examined by both microscopic dissection and molecular analysis at five time points (i.e., the same day of tick detachment and 10, 20, 30 and 50 days post-detachment) to detect the presence and developmental stage of filariae in the ticks. A total of 270 engorged nymphs were collected from the dog and developing filarioid larvae detected in 10 (5%) out of 200 ticks dissected. Infective third-stage larvae were observed in 4 (2%) of the all dissected ticks, 30 days post-detachment. Twelve (6.6%) out of 181 samples molecularly tested were positive for Cercopithifilaria sp. This study demonstrates that nymphs of R. sanguineus feeding on a dog naturally infected by Cercopithifilaria sp. can ingest microfilariae, which develop up to the third infective stage thus suggesting that this tick species might act as an intermediate host of this little known canine filarioid.
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Enfermedades de los Perros/epidemiología , Filariasis/veterinaria , Filarioidea/anatomía & histología , Filarioidea/genética , Rhipicephalus sanguineus/parasitología , Animales , Enfermedades de los Perros/parasitología , Perros , Filariasis/epidemiología , Filariasis/parasitología , Filarioidea/clasificación , Interacciones Huésped-Parásitos , Microfilarias/anatomía & histología , Microfilarias/clasificación , Microfilarias/genética , Datos de Secuencia Molecular , Análisis de Secuencia de ADN , Sicilia/epidemiología , PielRESUMEN
AIM OF THE WORK: Aim of the work was to execute a review of the international literature about the cementation of zirconia restorations, analyzing the properties of the cements most commonly used in clinical activities. MATERIALS AND METHODS: It was performed, through PubMed, a bibliographic search on the international literature of the last 10 years using the following limits: studies in English, in vitro studies, randomized clinical trial, reviews, meta-analysis, guide-lines. Were excluded from the search: descriptive studies, case reports, discussion articles, opinion's leader. RESULTS: From studies results that common surface treatments (silanization, acid etching) are ineffective on zirconia because it has an inert surface without glassy component (on which this surface treatments act primarily), instead the sandblasting at 1atm with aluminium oxide (Al(2)O(3)) results significantly effective for the resulting roughening that increase the surface energy and the wettability of the material. Furthermore it has been shown that zinc phosphate-based cements, Bis-GMA-based and glass-ionomer cements can't guarantee a stable long-term adhesion, instead resin cements containing phosphate monomer 10-methacryloyloxyidecyl-dihyidrogenphosphate (MDP) have shown higher adhesion and stability values than the other cements. In particular, it has seen that bond strength of zirconia copings on dentin, using MDP-based cement, is about 6,9MPa; this value is comparable to that obtained with gold copings cementation. CONCLUSIONS: ANALYZED STUDIES HAVE LED TO THE FOLLOWING CONCLUSIONS: sandblasting with aluminium oxide (Al(2)O(3)) is the best surface treatment to improve adhesion between resin cements and zirconia; resin cements containing phosphate ester monomers 10-methacryloyloxyidecyl-dihyidrogenphosphate (MDP) have shown in the studies an higher bond strength and stability after ageing treatment; the best procedure for cementing zirconia restorations results the combination of sandblasting with aluminium oxide (Al(2)O(3)) at 50µm and MDP-based cements.
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BACKGROUND: Failure of endoscopic sphincterotomy (ES) for retained bile duct stones occurs in 4% to 10% of cases and was traditionally managed with open bile duct reexploration. METHODS: This study uses retrospective analysis of a consecutive series of cases of laparoscopic bile duct reexploration for retained bile duct stones after unsuccessful ES. RESULTS: Thirty-one cases were operated over a 7-year period. Seventy percent had a previous open cholecystectomy. Ten cases were successfully treated with a transcystic approach and 19 with laparoscopic choledochotomy. Two patients were converted to open surgery. Morbidity was 3.22% with no mortality. CONCLUSION: Laparoscopic bile duct reexploration can be safely performed and should be considered as an alternative to open surgery.
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Cálculos Biliares/diagnóstico , Cálculos Biliares/cirugía , Laparoscopía/métodos , Esfinterotomía Endoscópica/efectos adversos , Adulto , Anciano , Colangiopancreatografia Retrógrada Endoscópica/métodos , Femenino , Estudios de Seguimiento , Humanos , Laparoscopía/mortalidad , Tiempo de Internación , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/fisiopatología , Neumoperitoneo Artificial , Complicaciones Posoperatorias/cirugía , Recurrencia , Reoperación , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Esfinterotomía Endoscópica/métodos , Resultado del TratamientoRESUMEN
In the last decade, we have investigated from the physicochemical point of view, whether water prepared by the procedures of homeopathic medicine (leading inexorably to systems without any molecule different from the solvent) results in water different from the initial water? The answer, unexpectedly, but strongly supported by many experimental results is positive. We used well-established physicochemical techniques: flux calorimetry, conductometry, pHmetry and galvanic cell electrodes potential. Unexpectedly the physicochemical parameters evolve in time. The water solvent exhibits large changes in measurable physicochemical properties as a function of its history, the solute previously dissolved, and time. In particular we found evidence of two new phenomena, both totally unpredicted, in homeopathic dilutions: the presence of a maximum in the measured physicochemical parameters vs sample age, and their dependence on the volume in which the dilution is stored. These new experimental results strongly suggest the presence of an extended and 'ordered' dynamics involving liquid water molecules.
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Homeopatía/métodos , Materia Medica/química , Soluciones/química , Solventes/química , Agua , Calorimetría , Conductividad Eléctrica , Humanos , Modelos Químicos , Reproducibilidad de los Resultados , Proyectos de InvestigaciónRESUMEN
Antecedentes: Diversos métodos son utilizados para el entrenamiento en cirugía laparoscópica. Se define la enseñanza tutorizada como el apredizaje en la sala de operaciones bajo la supervisión de un cirujano entrenado, prescindiendo de otro método de entrenamiento previo. Objetivo: Evaluar resultados de un programa de enseñanza progresiva y tutorizada de cirugía biliar laparoscópica para una residencia de cirugía general de 4 años de duración. Lugar de aplicación: Centro Terciario de Referencia. Diseño: Prospectivo. Población: 10 residentes evaluados entre los años 2000 y 2003. Método: Rotación exclusiva e intensiva en cirugía biliar laparoscópica durante tercer año de residencia. Tutorización por tres cirujanos entrenados siguiendo los mismos preceptos tácticos y técnicos. Primer período (2000-2001) rotación corta (4,3 meses). Segundo período (2000-2003) rotación prolongada (7 meses). Medidas de evaluación: Fueron comparadas el tiempo operatorio y las lesiones de vía biliar (entre residentes tutorizados y tutores) y el porcentaje de operaciones básicas y avanzadas (entre residentes de rotación corta y rotación prolongada). Resultados: No hubo diferencias significativas en tiempo operatorio e incidencia de lesiones de vía biliar. Los residentes cuya rotación fue más prolongada operaron más casos avanzados. Conclusiones. El método de enseñanza progresiva y tutorizada favorece la realización de casos avanzados sin acompañarse de un aumento en el tiempo operatorio ni en la incidencia de complicaciones mayores
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Masculino , Humanos , Femenino , Cirugía General/educación , Enseñanza/métodos , Procedimientos Quirúrgicos del Sistema Biliar , Educación de Postgrado en Medicina/métodos , Internado y Residencia , Laparoscopía , Estudios ProspectivosRESUMEN
Antecedentes: Diversos métodos son utilizados para el entrenamiento en cirugía laparoscópica. Se define la enseñanza tutorizada como el apredizaje en la sala de operaciones bajo la supervisión de un cirujano entrenado, prescindiendo de otro método de entrenamiento previo. Objetivo: Evaluar resultados de un programa de enseñanza progresiva y tutorizada de cirugía biliar laparoscópica para una residencia de cirugía general de 4 años de duración. Lugar de aplicación: Centro Terciario de Referencia. Diseño: Prospectivo. Población: 10 residentes evaluados entre los años 2000 y 2003. Método: Rotación exclusiva e intensiva en cirugía biliar laparoscópica durante tercer año de residencia. Tutorización por tres cirujanos entrenados siguiendo los mismos preceptos tácticos y técnicos. Primer período (2000-2001) rotación corta (4,3 meses). Segundo período (2000-2003) rotación prolongada (7 meses). Medidas de evaluación: Fueron comparadas el tiempo operatorio y las lesiones de vía biliar (entre residentes tutorizados y tutores) y el porcentaje de operaciones básicas y avanzadas (entre residentes de rotación corta y rotación prolongada). Resultados: No hubo diferencias significativas en tiempo operatorio e incidencia de lesiones de vía biliar. Los residentes cuya rotación fue más prolongada operaron más casos avanzados. Conclusiones. El método de enseñanza progresiva y tutorizada favorece la realización de casos avanzados sin acompañarse de un aumento en el tiempo operatorio ni en la incidencia de complicaciones mayores (AU)
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Masculino , Humanos , Femenino , Enseñanza/métodos , Cirugía General/educación , Procedimientos Quirúrgicos del Sistema Biliar , Estudios Prospectivos , Internado y Residencia , Educación de Postgrado en Medicina/métodos , LaparoscopíaRESUMEN
The purpose of this study was to obtain information about the influence of successive dilutions and succussions on the water structure. 'Extremely diluted solutions' (EDS) are solutions obtained through the iteration of two processes: dilution in stages of 1:100 and succussion, typically used in homeopathic medicine. The iteration is repeated until extreme dilutions are reached, so that the chemical composition of the solution is identical to that of the solvent. Nine different preparations, were studied from the 3cH to 30cH (Hahnemannian Centesimal Dilution). Four of those were without the active principle (potentized water). Two different active principles were used: Arsenicum sulphuratum rubrum (ASR), As4S4, 2,4-dichlorophenoxyacetic acid (2,4D). The solvents were: a solution of sodium bicarbonate and of silicic acid at 5 x 10(-5) M (mol/l) each, and solutions of sodium bicarbonate 5 x 10(-5), 7.5 x 10(-5) and 10 x 10(-5) M (mol/l) in double-distilled water. The containers were Pyrex glass to avoid the release of alkaline oxide and silica from the walls. Conductivity measurements of the solutions were carried out as a function of the age of the potencies. We found increases of electrical conductivity compared to untreated solvent. Successive dilution and succussion can permanently alter the physico-chemical properties of the aqueous solvent. But we also detected changes in physio-chemical parameters with time. This has not previously been reported. The modification of the solvent could provide an important support to the validity of homeopathic medicine, that employs 'medicines without molecules'. The nature of the phenomena here described remains still unexplained, nevertheless some significant experimental results were obtained.
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Ácido 2,4-Diclorofenoxiacético/química , Arsenicales/química , Homeopatía , Materia Medica/química , Conductividad Eléctrica , Homeopatía/métodos , Homeopatía/normas , Humanos , Reproducibilidad de los Resultados , Proyectos de Investigación/normas , Ácido Silícico/química , Bicarbonato de Sodio/química , SolventesRESUMEN
Antecedentes: El cierre primario laparoscópico (CPC) por videolaparoscopía es una técnica cada vez más empleada en el tratamiento de la coledocolitiasis. En los últimos años se han utilizado stents transpapilares para disminuir la morbilidad. Objetivo: Evaluar en una serie consecutiva de pacientes los resultados del CPC con y sin stent transpapilar, investigando las modificaciones de la presión biliar mediante ecografía postoperatoria. Lugar de aplicación: Centro Terciario de Referencia. Diseño: Observacional prospectivo. Población: Entre 1996 y 2002 se realizaron 64 CPC por videolaparoscopía. Método: En los primeros 16 (Grupo preliminar) no se realizó monitoreo ecográfico postoperatorio de la vía biliar. A partir de 1999 en los 48 restantes (Grupo de Estudio) se realizó monitoreo ecográfico de la vía biliar. Veinticuatro fueron tratados sin drenaje transpapilar (Grupo I) y los 24 restantes con drenaje transpapilar (Grupo II). Resultados: En el grupo preliminar se detectó litiasis residual en 1 paciente y bilirragia postoperatoria en 3 (18,5 por ciento). Uno de los tres enfermos debió ser reoperado por coleperitoneo provocado por una distonía papilar prolongada. No hubo mortalidad en este grupo. En los 24 pacientes del Grupo I el monitoreo ecográfico postoperatorio demostró falta de descompresión inmediata de la vía biliar en 8 (33 por ciento). Tres de ellos (12,5 por ciento) presentaron bilirragia autolimitada que se agotó a las 48 horas. No hubo reoperaciones ni mortalidad en el Grupo I. En los 24 pacientes del Grupo II el monitoreo ecográfico demostró descompresión postoperatoria inmediata en todos los casos. No se detectó bilirragia postoperatoria en ninguno de los casos. Una enferma presentó 36 horas después de la operación una pancreatitis aguda fulminante que le provocó la muerte. La morbilidad global de la serie fue del 12,6 por ciento y la mortalidad del 1,5 por ciento. Conclusiones: La hipertensión biliar podría ser uno de los factores relacionados con la bilirragia luego del CPC. El drenaje transpapilar descomprime adecuadamente la vía biliar durante el postoperatorio inmediato. El riesgo de pancreatitis aguda es un factor limitante del drenaje transpapilar
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Humanos , Masculino , Adulto , Femenino , Persona de Mediana Edad , Cálculos Biliares/cirugía , Conducto Colédoco/cirugía , Laparoscopía , Complicaciones Posoperatorias , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Antecedentes: El cierre primario laparoscópico (CPC) por videolaparoscopía es una técnica cada vez más empleada en el tratamiento de la coledocolitiasis. En los últimos años se han utilizado stents transpapilares para disminuir la morbilidad. Objetivo: Evaluar en una serie consecutiva de pacientes los resultados del CPC con y sin stent transpapilar, investigando las modificaciones de la presión biliar mediante ecografía postoperatoria. Lugar de aplicación: Centro Terciario de Referencia. Diseño: Observacional prospectivo. Población: Entre 1996 y 2002 se realizaron 64 CPC por videolaparoscopía. Método: En los primeros 16 (Grupo preliminar) no se realizó monitoreo ecográfico postoperatorio de la vía biliar. A partir de 1999 en los 48 restantes (Grupo de Estudio) se realizó monitoreo ecográfico de la vía biliar. Veinticuatro fueron tratados sin drenaje transpapilar (Grupo I) y los 24 restantes con drenaje transpapilar (Grupo II). Resultados: En el grupo preliminar se detectó litiasis residual en 1 paciente y bilirragia postoperatoria en 3 (18,5 por ciento). Uno de los tres enfermos debió ser reoperado por coleperitoneo provocado por una distonía papilar prolongada. No hubo mortalidad en este grupo. En los 24 pacientes del Grupo I el monitoreo ecográfico postoperatorio demostró falta de descompresión inmediata de la vía biliar en 8 (33 por ciento). Tres de ellos (12,5 por ciento) presentaron bilirragia autolimitada que se agotó a las 48 horas. No hubo reoperaciones ni mortalidad en el Grupo I. En los 24 pacientes del Grupo II el monitoreo ecográfico demostró descompresión postoperatoria inmediata en todos los casos. No se detectó bilirragia postoperatoria en ninguno de los casos. Una enferma presentó 36 horas después de la operación una pancreatitis aguda fulminante que le provocó la muerte. La morbilidad global de la serie fue del 12,6 por ciento y la mortalidad del 1,5 por ciento. Conclusiones: La hipertensión biliar podría ser uno de los factores relacionados con la bilirragia luego del CPC. El drenaje transpapilar descomprime adecuadamente la vía biliar durante el postoperatorio inmediato. El riesgo de pancreatitis aguda es un factor limitante del drenaje transpapilar (AU)