Rectosigmoidectomía perineal para el tratamiento del prolapso rectal completo / Perineal rectosigmoidectomy for the treatment of rectal prolapse

Objetivo: Presentamos nuestra experiencia en el tratamiento quirúrgico de esta patología con la técnica de la rectosigmoidectomía perineal. Material y método: Se trata de una serie retrospectiva, consecutiva de 17 pacientes. Resultados: Predomina el género femenino y el promedio de edad es de 62 años. La morbilidad alcanza el 23%, aunque casi toda de menor gravedad, con solo un paciente reoperado. La recidiva es del 6%, con mejoría de los síntomas en un 88%. Conclusión: Concluimos que es una técnica segura, con una morbilidad controlada y con buenos resultados a mediano plazo con un adecuado control de la recidiva y mejoría de la continencia en un alto porcentaje de los pacientes.

Aim: We present our experience with perineal rectosigmoidectomy for the treatment of rectal prolapse. Material and method: It is a retrospective, consecutive series of 17 patients. Results: Predominantly female and the average age is 62 years. Morbidity reached 23%, but almost all less serious, with only one reoperation. Recurrence is 6%, and the improvement in continence is 88%. Conclusion: We conclude that it is a safe technique with a controlled morbidity and good results with low recurrence and improvement of continence in a high percentage of patients.

Caracterización clínica de pacientes con infarto agudo al miocardio sin lesiones coronarias significativas: estudio GEMI 2011-2013 / Clinical characteristics of patients with acute myocardial Infarction and no significant coronary artery lesions: GEMI study (2011-1013)

Antecedentes: El infarto agudo del miocardio (IAM) es consecuencia de la disrupción del endotelio vascular que lleva a oclusión del vaso coronario por un trombo. En la coronariografía de algunos de estos pacientes es posible encontrar arterias coronarias sin lesiones significativas. Objetivo: Comparar características basales, presentación clínica, tratamiento y mortalidad intrahospitalaria de pacientes con IAM, con y sin lesiones significativas. Métodos: Se incluyeron 3.194 pacientes registrados en la ficha electrónica GEMI que además del diagnóstico de IAM, hubiesen sido sometidos a estudio coronariográfico. Se consideró "sin lesiones significativas" si ninguna estenosis era > al 50 por ciento. Resultados: El grupo sin lesiones significativas correspondió a 116 pacientes (3,6 por ciento). La edad promedio en este grupo fue menor (60+/-14 años vs 62+/-12 años, p<0,024) y con una mayor proporción de mujeres. En este grupo se observó menor prevalencia de dislipidemia (30,2 por ciento vs 42,8 por ciento, p<0.007), diabetes mellitus (14,7 por ciento vs 28,9 por ciento, p<0.001) y tabaquismo (40,5 por ciento vs 61,3 por ciento, p<0.0001). En el ECG de ingreso predominó el IAM sin SDST y menor elevación de CK y CK-MB, junto a una mejor fracción de eyección. Durante la hospitalización se utilizó menos aspirina, clopidogrel, betabloqueadores, heparina ev y HBPM. Existió un mayor uso de antagonistas de Calcio. Conclusiones: Los pacientes con IAM sin lesiones significativas tienen una menor carga de factores de riesgo coronario, es más frecuente encontrar al ingreso ECG SSDST, menor grado de daño miocárdico y mejor fracción de eyección. Además, se observan diferencias en el tratamiento farmacológico en este grupo de pacientes.

Background: Acute myocardial infarction (AMI) is a consequence of disruption of coronary artery lesions leading to intracoronary thrombosis. Some patients with AMI show no significant lesions in a coronary angiography. Aim: To compare clinical characteristics, treatment and intrahospital mortality in patients with AMI with or without coronary artery lesions. Methods: 3194 patients from a clinical registry of AMI (GEMI) were included. AMI with no significant coronary artery lesions was defined as the abscense of any lesion >50 percent. Results: 116 patients (3.6 percent) had no significant coronary lesions (NSL). Compared to the group with significant lesions (SL), they were younger (60+/-14 years vs 62+/-12 years, p<0,024) and the proportion of women was higher. NSL patients lower prevalence of hyperlipidemia (30,2 percent vs 42,8 percent, p<0.007), diabetes mellitus (14,7 percent vs 28,9 percent, p<0.001) and smoking habit (40,5 percent vs 61,3 percent, p<0.0001). NSL patients had a higher prevalence of non ST elevation AMI and lower levels of CK and CK-MB, as well as a lower ejection fraction. During hospitalization, NSL patients received aspirin, clopidogrel, betablockers, iv heparin and LMW heparin, less frequently tan SL patients. In contrast, they received calcium antagonists more frequently. Conclusion: Patients with AMI and no significant coronary lesions have a lower prevalence of coronary artery disease risk factors. A greater frequency of non ST elevation AMI, lower indices of myocardial necrosis and better EF was also observed. The intensity of pharmacologic therapy was lower.

Extraction of nitrofurantoin and its toxic metabolite from urine by supercritical fluids. Quantitation by high performance liquid chromatography with UV detection.

A procedure is described for the determination of nitrofurantoin and its toxic metabolite in urine from patients with urinary infection using supercritical fluid extraction (SFE) and liquid chromatography. The standard solution of toxic metabolite (radical anion) was obtained by electrochemical reduction of nitrofurantoin in an aprotic medium and chemical reoxidation with oxygen. In our initial SFE studies to find the adequate extraction parameters, drug solutions were impregnated onto filter paper. Quantitative extractions were achieved when the experiments were carried out under 2500 psi of pressure at a temperature of 80 degrees C (oven and restrictor) after 20 min of static extraction and 5 min of dynamic extraction. The modifier used was acetonitrile (2.0 ml in a 10 ml extraction column). Nitrofurantoin and its toxic metabolite were detected in urine samples. Both compounds were quantified in the extracts by high performance liquid chromatography (HPLC) with detection at 310 nm. The calibration graph of these compounds in acetonitrile was linear between 10.9 and 378.0 muM (R=0.9995) for nitrofurantoin and between 3.0x10(-3) and 21.0 muM (R=0.9992) for the metabolite. The detection limits (LOD) were 12.1 and 0.9 muM, respectively. The drug was administered to two patients during 7 days, and all the urine eliminated between 1 day before and 2 days after administration was analyzed. One patient consumed the drug in the form of microcrystals and the other as macrocrystals.