Resultado de los primeros tratamientos por Video Laparoscopia del Cáncer de Colon. Hospital Central "Dr. Emilio Cubas". Instituto de Previsión Social. / Result of the first treatments for Video Laparoscopy Colon Cancer. Hospital Central "Dr. Emilio Cubas". Instituto de Previsión Social.

Introducción: El cáncer de colon es la tercera neoplasia más común y la segunda causa de mortalidad por cáncer en los países desarrollados. Las técnicas nuevas para el tratamiento del cáncer de colon como video laparoscopia deben producir mejores resultados clínicos que los de la técnica convencional para llegar a convertirse en una alternativa aceptable. Objetivo: Caracterizar los resultados obtenidos con el tratamiento por video laparoscopia en pacientes con cáncer de colon en el Servicio de Cirugía General de Hospital Central "Dr. Emilio Cubas" del Instituto de Previsión Social, de enero 2008 a julio 2013. Metodología: Estudio observacional descriptivo, de corte transversal; en pacientes internados con diagnóstico de cáncer de colon que fueron sometidos al tratamiento quirúrgico por la técnica video laparoscópica. Resultados: Fueron evaluados 30 pacientes, siendo el 53,33% de sexo femenino, con un promedio de edad de 61 años. La localización más frecuente fue el colon sigmoides con 33,33%. La sigmoidectomia fue la cirugía más efectuada en 33,33% de los pacientes. Se presentó complicación de la cirugía video laparoscópica en el 16,67% de los casos, éstas fueron: sangrado, dehiscencia y complicaciones clínicas; siendo la localización más frecuente el cáncer ciego. Conclusión: Esta técnica es de reciente aplicación en la Institución, cuya ventaja radica en la disminución de las infecciones del sitio quirúrgico, pudiendo de esta manera reducir el costo con respecto al tratamiento convencional. Palabras claves: Neoplasias del colon - Laparoscopía - Paraguay

Introduction: Colon cancer is the third most common malignancy and the second leading cause of cancer mortality in developed countries. Video laparoscopy techniques should produce better clinical results over conventional technique results if it is to eventually become an acceptable alternative in the treatment of colon cancer. Objective: To characterize the results obtained by video laparoscopy treatment of colon cancer at the Department of General Surgery at the Central Hospital "Dr. Emilio Cubas" of the Institute for Social Welfare, from January 2008 to July 2013 Methods: This was a descriptive, observational and cross-sectional study, performed in patients who were hospitalized with a diagnosis of colon cancer and who underwent surgical treatment for cancer using video laparoscopic technique. Results: A total of 30 patients were included in this study, with 53,33% being female, and an average age of 61 years. The most frequent location of the cancer was the sigmoid colon (33,33%). Sigmoid colon resection was the most common procedure performed (33,33% of patients). Complications of video laparoscopic surgery occurred in 16,67% of cases, the most common were bleeding, dehiscence and non-surgical complications; the most common cancer site was the cecum. Conclusion: This newly-implemented technique in our institution hasthe advantage of a decrease in surgical site infections, thusreducing the cost compared to conventional treatment. Keywords: Colonic Neoplasms- Laparoscopy ­Paraguay

Vacunación contra Hepatitis B en una población de riesgo / Hepatitis B vaccination in a high-risk population

La hepatitis B constituye un problema serio de salud pública. La vacuna antihepatitis B, administrada en tres dosis, induce una respuesta protectora con formación de anticuerpos en el 95-98% de los vacunados. El Centro Nacional para Control y Enfermedad de EEUU (CDC) recomienda vacunación contra la hepatitis B en grupos de riesgo. Objetivo general: Determinar el nivel de cobertura vacunal para Hepatitis B en médicos residentes en el Hospital Central del Instituto de Previsión Social. Metodología: Estudio de diseño descriptivo, corte transversal realizado en médicos residentes del Hospital Central del Instituto de Previsión Social, en el período 2013. Resultados: De la población estudiada, 49 (32%) fueron del sexo masculino. Desempeña labor como médico: 40 (26,14%) de primer año de residencia, 37 (24,1%) de segundo año, 35(22,8%) de tercer año, 20 (13%) 4 años, 16(10,4%) de cinco años y 5(3,2%) de 6 años de residencia. Desempeña labor realizando procedimientos quirúrgicos/ invasivos 49(32%). De los 153 médicos, 102 (66,6) vacunación completa. 80 (52,2%) refirieron accidente corto punzante. Conclusión: Queda demostrada una aceptable cobertura de vacunación contra la hepatitis B, aunque es insuficiente teniendo en cuenta la accesibilidad de la misma en este Hospital. Palabras claves. Hepatitis B. Vacuna contra la Hepatitis B. Grupo de riesgo

Hepatitis B is a serious public health problem. The hepatitis B vaccine, administered in three doses, induces a protective response with antibody formation in 95-98% of vaccinees. The United States Center for Disease Control (CDC) recommends vaccination against hepatitis B in high-risk groups. Objective: To determine the level of Hepatitis B vaccine coverage for medical residents at the Central Hospital of the Institute for Social Welfare. Methods: Descriptive, cross-sectional survey of medical residents conducted in at the Central Hospital of the Institute for Social Welfare during 2013. Results: Of the study population, 49 (32%) were male. 40 (26.14%) respondents were in their first year of residency, 37 (24.1%) in their second year of residency, 35 (22.8%) in their third year of residency, 20 (13%) were in their fourth year of residency, 16 (10.4%) were in their fifth year of residency and 5 (3.2%) were in their 6th year of residency. 49 (32%) of respondents were in surgical/ invasive procedural training programs. Of the 153 respondents, 102 (66.6%) were fully immunized. 80 (52.2%) reported a needle-stick or sharps injury. Conclusions: There is an acceptable rate of vaccination coverage against hepatitis B in the study population, but it is insufficient considering the ready availability of the vaccine at this hospital. Keywords: Hepatitis B. Hepatitis B vaccine. High-risk group

Ethanol elimination kinetics following massive ingestion in an ethanol naive child.

OBJECTIVE: At low-to-moderate concentrations, ethanol elimination follows zero-order kinetics. It is unknown whether renal, pulmonary or other first-order processes become significant in patients with very high serum ethanol concentrations. Additionally, it is unclear whether ethanol naive subjects induce their metabolism during acute intoxication. We present the toxicokinetic analysis in a child with a massive ingestion of ethanol. CASE REPORT: A 15-year-old girl without significant medical history presented to the Emergency Department after drinking 24 ounces of tequila. She was found unresponsive at home with a Glasgow Coma Score of 3. Her presenting vitals were as follows: 118/69 mmHg blood pressure; pulse rate was 88 beats per minute; respiratory rate of 20 breaths per minute; pulse-oximetry is 96% on room air. Other than obtundation, her physical examination was normal. She was intubated for airway protection and admitted to the ICU. Her initial serum ethanol concentration was 543 mg/dL. A repeat level 3 h later was 722 mg/dL. Post-absorptive ethanol concentrations decreased from 693 mg/dL to 291 mg/dL over the following 15.5 h. The patient had spontaneous eye opening 24 h after presentation. Her projected serum ethanol concentration at that time was 215 mg/dL. She was extubated 2 h later and had an uneventful recovery. RESULTS: The elimination of ethanol in the post-absorptive phase remained zero-order at a rate of 26.3 mg/dL/h (5.7 mmol/L/h) with a Pearson's correlation coefficient (R (2)) of 0.9968 (p < 0.01). There was no evidence of acute induction in metabolism although pharmacodynamic tolerance likely occurred. CONCLUSION: Even at very high ethanol concentrations in ethanol naive subjects, elimination of ethanol follows a zero-order toxicokinetic model.

Inconsistent approach to the treatment of chronic digoxin toxicity in the United States.

Evidence-based guidelines do not exist for the treatment of patients with chronic mild-moderate digoxin toxicity. We sought to evaluate differences among specialists in the use of digoxin-specific antibody fragments and the decision to admit these patients. A sample of cardiologists, emergency physicians, and medical toxicologists was surveyed. The survey detailed four hypothetical cases of chronic digoxin toxicity created by consensus among authors. All cases had the same digoxin concentration, but signs and symptoms varied in an attempt to explore four different thresholds. For each scenario, clinicians made decisions about admission and treatment. Survey response varied: cardiologists 17%, emergency physicians 6.7%, and toxicologists 39%. Statistically significant difference was found in the administration of Fab among cardiologists (67%), emergency physicians (82%), or toxicologists (91.5%) and admission rate (cardiologists 34%, emergency physicians 28%, and toxicologists 46%). Differences exist among clinicians of various specialties regarding treatment of chronic digoxin toxicity. These differences may reflect diverse perspectives or knowledge gaps and may translate into excess cost or less than ideal care. Exploring these differences may improve patient care, improve interactions among providers, and set the stage for development of consensus guidelines and research.

A study of the relationships among consumer acceptance, oxidation chemical indicators, and sensory attributes in high-oleic and normal peanuts.

The purpose of this study was to determine the relationships between overall acceptance, chemical indicators, and sensory attributes in roasted peanuts harvested from high-oleic peanut genotypes produced in Argentina. Oleic/linoleic ratio (O/L), peroxide value, p-anisidine value, conjugated dienes, consumer acceptance, and descriptive analysis were performed on roasted peanuts prepared using 16 genotypes of normal and high-oleic peanuts. Principal component and cluster analysis were performed on the chemical and sensory data from peanut genotypes. Acceptance was positively associated with O/L, crunchiness, sweetness, roasted peanutty flavor, and hardness. Acceptability was negatively associated with cardboard, oxidized, and sour flavors. The high-oleic genotypes, 4896-11-C, and 9399-10 showed high consumer acceptance with 7 or "like moderately" in a hedonic scale of 9 points. Some high-oleic peanut lines, such as 9399-10, could be used to replace normal peanuts without affecting consumer acceptance of peanut products processed from them and more stability due to the high-oleic condition.

[MARS (Molecular Absorbent Recirculating System) as hepatic extracorporeal care in serious acute liver failure of alcoholic etiology]. / MARS (molecular adsorbent recirculating system) como asistencia extracorporea hepatica en el fracaso hepatica en el fracaso hepatico agudo grave de etiologia enolica.

Acute liver failure with criteria of seriousness and alcoholic etiology is a picture of worldwide distribution, with an elevated mortality, of approximately 50%, that requires admission to the ICU. Acute serious alcoholic hepatitis is defined by a Maddrey score value > 32 and/or spontaneous encephalopathy. Together with the classical treatment with corticosteroids and nutritional supplements, alcoholic abstinence and others such as anti-TNF therapy, we introduce MARS (Molecular Adsorbent recirculating System) as a extracorporeal liver assistance system with detoxification function, that is presented as a support measure that makes it possible to maintain the patient in good conditions until an organ becomes available or until the functional recovery of the native liver. In our case, MARS has shown some spectacular results and above all, results maintained over time, associated to the rest of the therapeutic measures characteristic of this disease.

MARS (molecular adsorbent recirculating system) como asistencia extracorpórea hepática en el fracaso hepático agudo grave de etiología enólica / MARS (molecular absorbent recirculatingsystem) as hepatic extracorporeal carein serious acute liver failure of alcoholicetiology

La insuficiencia hepática aguda con criterios de gravedad y etiología enólica es un cuadro de amplia distribución mundial, con una elevada mortalidad, aproximadamente el 50%, y requiere ingreso en la Unidad de Cuidados Intensivos (UCI). La hepatitis alcohólica aguda grave está definida por un valor de Maddrey score > 32 y/o encefalopatía espontánea. Junto al tratamiento clásico con corticoides y suplementos nutricionales, abstinencia alcohólica y otros, como las terapias anti-factor de necrosis tumoral (anti-TNF) introducimos el MARS (molecular adsorbent recirculating system) como sistema de asistencia extracorpórea hepática con función de detoxificación, que se presenta como una medida de soporte que permite mantener al paciente en buenas condiciones hasta la disponibilidad de un órgano o hasta la recuperación funcional del hígado nativo. En nuestro caso, el MARS ha mostrado unos resultados espectaculares y, sobre todo, mantenidos en el tiempo, asociado al resto de las medidas terapéuticas propias a esta patología

Acute liver failure with criteria of seriousness and alcoholic etiology is a picture of worldwide distribution, with an elevated mortality, of approximately 50%, that requires admission to the ICU. Acute serious alcoholic hepatitis is defined by a Maddrey score value > 32 and/or spontaneous encephalopathy. Together with the classical treatment with corticosteroids and nutritional supplements, alcoholic abstinence and others such as anti-TNF therapy, we introduce MARS (Molecular Adsorbent recirculating System) as a extracorporeal liver assistance system with detoxification function, that is presented as a support measure that makes it possible to maintain the patient in good conditions until an organ becomes available or until the functional recovery of the native liver. In our case, MARS has shown some spectacular results and above all, results maintained over time, associated to the rest of the therapeutic measures characteristic of this disease

Is surgical decontamination definitive treatment of "body-packers"?

The current recommendations for body-packers are based on packet content, the presence of drug toxicity, or of bowel obstruction. Asymptomatic patients are usually treated with activated charcoal and whole bowel irrigation (WBI). Surgical removal of packets is advocated in symptomatic cocaine body-packers and in those with bowel obstruction. Currently, surgery is regarded as definitive. However, we report 2 body-packers who show the limitations of this technique. These cases show the importance of confirming the absence of drug packets in the gastrointestinal (GI) tract as the definitive end-point in the treatment of body-packers.

Withdrawal syndromes.

The pathophysiology of substance withdrawal is elucidated by a review of classic and cutting-edge research. The manifestation and evaluation of the associated withdrawal syndromes from ethanol, sedative-hypnotics, opioids, and baclofen, are compared. The general management of and pharmacotherapy for these patients are discussed.

Prospective confirmation of low arrest rates among intoxicated drivers in motor vehicle crashes.

OBJECTIVE: Several states have legally sanctioned or mandated physician reporting of drivers who were driving while intoxicated (DWI). Valid prospective evidence demonstrating extremely poor performance of the criminal justice system seems ethically and scientifically essential if overriding public health considerations are to abrogate the fundamental principles of patient-physician confidentiality. No such evidence is available. The authors reasoned that poor performance of the judicial system would be most evident if drivers who were DWI were not arrested under conditions selected to optimize legal intervention. The authors therefore wished to estimate the unbiased proportion of DWI drivers brought to an emergency department (ED) under these optimized conditions who escape detection by law enforcement officials. METHODS: Prospective, consecutive cohort of drivers transported to an urban ED following a motor vehicle crash (MVC). Conditions selected to optimize legal intervention included: police at scene; inebriation of driver clinically evident to out-of-hospital personnel; and confirmatory blood ethanol level > or =100 mg/dL (> or =22 mmol/L). Main outcome measure was arrest for DWI. RESULTS: Of 294 drivers in MVCs, 270 had ethanol levels, of whom 18 met criteria for optimum likelihood of legal intervention. Of these, 22% were arrested for DWI (95% CI = 6% to 48%). Adjustment for missing data, under assumptions designed to maximize arrest frequency for DWI, did not materially alter these findings. No patients were lost to follow-up. CONCLUSION: These findings prospectively confirm that, even under conditions selected to optimize detection by law enforcement officials, only about one of every five drivers who were DWI and were brought to an ED following an MVC-and almost certainly no more than a minority-comes to the attention of the criminal justice system.

Reduction in lactate accumulation correlates with differentiation-induced terminal cell division of leukemia cells.

Lactate accumulation in the medium and glucose utilization decreased during the induction of in vitro differentiation of mouse erythroleukemia (MEL) and human myeloid leukemia (HL-60) cells. The decrease in lactate accumulation occurred as early as 24 h after inducer treatment was initiated and occurred prior to the decrease in glucose utilization. The decrease in lactate accumulation was greater than that predicted by the decrease in glucose utilization, i.e., the ratio of glucose used glycolytically, as measured by lactate accumulation, to glucose used in other pathways ('glycolytic ratio') markedly decreased during differentiation in these cell lines. Differentiation correlated with the abrogation of the high levels of lactate accumulation first described by Warburg as characteristic of some transformed and neoplastic cells. Studies on both parental and differentiation-resistant variant MEL cell lines indicated that the changes in lactate accumulation were not dependent on the changes in glucose utilization and could be dissociated from them. Moreover, the changes in lactate accumulation only occurred in cells able to undergo differentiation-induced terminal cell division. This regulatable expression of lactate accumulation in MEL and HL-60 cells in vitro may make them useful model systems for the elucidation of the molecular mechanisms controlling lactate formation in malignant cells.

[Biologico-periodontal considerations in restoration of teeth partially destroyed by caries or traumatism]. / Consideraciones biológico-periodontales para restaurar dientes parcialmente destruidos por caries on traumatismos.

Since a great number of teeth could be rehabilitated and not extracted, in this paper we analyze the relation Perio-protesis by the point of the biology of marginal periodontal ligament, and the different options to establish this relations when are lost by decay or traumatism. We discuss the contraindications to avoid greater problems than benefits when intend to rehabilitate lost teeth.