Cuidados intensivos de pacientes oncológicos en la era del tratamiento multidisciplinar: la perspectiva desde la oncología radioterápica / Intensive care in cancer patients in the age of the multidisciplinary approach of cancer treatments: The radiotherapy perspective

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Effectiveness and toxicity of helical tomotherapy for patients with locally recurrent nasopharyngeal carcinoma

Purpose. We assessed therapeutic outcomes of reirradiation with helical tomotherapy (HT) for locoregional recurrent nasopharyngeal carcinoma (LRNPC) patients. Methods and materials. Treatment outcomes were evaluated retrospectively in 17 consecutive LRNPC patients receiving HT between 2006 and 2012. Median age was 57 years and most patients (n = 13) were male. Simultaneous systemic therapy was applied in 5 patients. Initial treatment covered the gross tumor volume with a median dose of 70 Gy (60–81.6 Gy). Reirradiation was confined to the local relapse region with a median dose of 63 Gy (50–70.2 Gy), resulting in a median cumulative dose of 134 Gy (122–148.2 Gy). The median time interval between initial and subsequent treatment was 42 months (11–126). Results. The median follow-up for the entire cohort was 23 and 35 months for survivors. Three patients (18 %) developed both local and distant recurrences and only one patient (6 %) suffered from isolated local recurrence. Two-year actuarial DFS and LC rates were 74 and 82 %, respectively. Two-year OS rate was 79 %. Acute and late grade 2 toxicities were observed in 8 patients (47 %). No patient experienced late grade ≥3 toxicity. Late toxicity included fibrosis of skin, hypoacusia, dysphagia, and xerostomia. Patients with higher Karnofsky performance status scores associated with a lower risk of mortality (HR 0.85, p = 0.015). Conclusion. Reirradiation with HT in patients with LRNPC is feasible and yields encouraging results in terms of local control and overall survival with acceptable toxicity (AU)

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Capnografía no invasiva: valoración del estado ventilatorio en niños diagnosticados de neumonía / Assessment of ventilatory status with capnography in children diagnosed with pneumonia

Objetivo: Determinar si la medición de la capnografía en los pacientes pediátricos diagnosticados de neumonía tiene valor predictivo sobre la necesidad de ingreso hospitalario y el tiempo de hospitalización. Material y métodos: Estudio observacional de 1 año de duración en el que se incluyeron pacientes de 2-16 años de edad diagnosticados de neumonía en el servicio de urgencias. En todos ellos se determinó la temperatura, la frecuencia respiratoria, la frecuencia cardiaca, la saturación de oxígeno (SatO2) y el dióxido de carbono al final de la espiración (end tidal carbon dioxide [EtCO2]) mediante capnografía con gafas nasales en el momento del diagnóstico y a las 48 horas. Se excluyeron del estudio los pacientes con broncoespasmo asociado, los que habían recibido tratamiento antibiótico en las 48 horas previas y los que tenían alguna enfermedad crónica. Resultados: Se incluyeron 101 pacientes (un 59% mujeres), con una media de edad de 5,7 años. Precisaron ingreso 20 pacientes (19,8%). La media ± desviación estándar del EtCO2 en el momento del diagnóstico fue de 29,2 ± 2,8 mmHg en los pacientes ingresados y de 30 ± 3,6 mmHg en los no ingresados (p >0,05). A las 48 horas del inicio del tratamiento, el EtCO2 fue de 35,5 ± 0,7 mmHg en los pacientes ingresados y de 30,7 ± 3,3 mmHg en los no ingresados (p >0,05). No se encontraron diferencias significativas entre el EtCO2 en el momento del diagnóstico y a las 48 horas de tratamiento en el total de pacientes, ni en el grupo de ingresados ni en el de no ingresados. El EtCO2 en el momento del diagnóstico no se correlacionó significativamente con la duración del ingreso ni con la SatO2. Se observó una correlación inversa significativa entre el EtCO2 y la frecuencia respiratoria, independiente de la temperatura en dicha correlación. Conclusiones: En nuestro estudio, el EtCO2 medido mediante capnografía no invasiva en niños diagnosticados de neumonía no ha demostrado ser un parámetro útil para predecir la necesidad de ingreso ni la evolución clínica de los pacientes (AU)

Objective: To determine whether using capnography for pediatric can predict the need for admission to hospital and length of hospital stay. Material and methods: We performed an observational prospective study for one year, in pediatric patients aged over 2 years with a diagnosis of pneumonia. The parameters measured (at diagnosis and 48 hours later) were: temperature, respiratory rate, heart rate, oxygen saturation, and end tidal carbon dioxide (EtCO2) measured using capnography via a nasal cannula. The exclusion criteria were antibiotic treatment before diagnosis, bronchospasm at the time of diagnosis, and underlying chronic disease. Results: 101 patients were enrolled (mean age, 5.7 years) of whom 59% were girls. Twenty patients (19.8%) were admitted to hospital. The mean ± standar deviation value of EtCO2 was 29.2 ± 2.8 mmHg in admitted patients and 30 ± 3.6 mmHg in those who were not admitted (p >0.05). The mean EtCO2 48 hours after starting antibiotic treatment was 35.5 ± 0.7 mmHg in admitted patients and 30.7 ± 3.3 mmHg in those who were not admitted (p >0.05). No significant differences were found for body temperature. Conclusions: EtCO2 measured in children diagnosed children with pneumonia was not useful for predicting the need for admission in hospital or length of stay (AU)

Effectiveness and toxicity of helical tomotherapy for patients with locally recurrent nasopharyngeal carcinoma.

PURPOSE: We assessed therapeutic outcomes of reirradiation with helical tomotherapy (HT) for locoregional recurrent nasopharyngeal carcinoma (LRNPC) patients. METHODS AND MATERIALS: Treatment outcomes were evaluated retrospectively in 17 consecutive LRNPC patients receiving HT between 2006 and 2012. Median age was 57 years and most patients (n = 13) were male. Simultaneous systemic therapy was applied in 5 patients. Initial treatment covered the gross tumor volume with a median dose of 70 Gy (60-81.6 Gy). Reirradiation was confined to the local relapse region with a median dose of 63 Gy (50-70.2 Gy), resulting in a median cumulative dose of 134 Gy (122-148.2 Gy). The median time interval between initial and subsequent treatment was 42 months (11-126). RESULTS: The median follow-up for the entire cohort was 23 and 35 months for survivors. Three patients (18 %) developed both local and distant recurrences and only one patient (6 %) suffered from isolated local recurrence. Two-year actuarial DFS and LC rates were 74 and 82 %, respectively. Two-year OS rate was 79 %. Acute and late grade 2 toxicities were observed in 8 patients (47 %). No patient experienced late grade ≥3 toxicity. Late toxicity included fibrosis of skin, hypoacusia, dysphagia, and xerostomia. Patients with higher Karnofsky performance status scores associated with a lower risk of mortality (HR 0.85, p = 0.015). CONCLUSION: Reirradiation with HT in patients with LRNPC is feasible and yields encouraging results in terms of local control and overall survival with acceptable toxicity.

Pilot study: Gelafundin (polygeline) 4% plus antibiotics in the treatment of high-risk cirrhotic patients with spontaneous bacterial peritonitis.

BACKGROUND: Cirrhotic patients with spontaneous bacterial peritonitis (SBP) have elevated rates of renal impairment and mortality. It has been shown that cefotaxime plus albumin infusion decrease renal impairment compared with antibiotic treatment alone, in patients with serum bilirubin >4 mg/dL or creatinine >1 mg/dL. AIM: To assess clinical outcomes of high-risk cirrhotic patients with SBP who were treated with antibiotics associated with Gelafundin (polygeline) 4%. METHODS: Twenty nine cirrhotic patients with SBP and serum bilirubin >4 mg/dL or creatinine >1 mg/dL were enrolled. Ceftriaxone was administered in doses of 2 g/day and Gelafundin 4% was given intravenously at 1.5 g/kg of body weight at the time of the diagnosis, followed by 1 g/kg on day 3. Renal impairment was defined as nonreversible deterioration of renal function during hospitalization. RESULTS: Eight patients (27.5%) had basal renal failure. Infection resolved in 28 (96.6%) patients. Renal impairment occurred in four patients (13.8%), and three patients (10.4%) died during hospitalization. Mortality within 90 days after discharge was 34.5% (10 patients). CONCLUSION: The rates of renal impairment and mortality in high-risk patients with SBP suggest that Gelafundin 4% administration given with ceftriaxone may be a less expensive therapeutic alternative to albumin.

Production of heterologous protein by Methylobacterium extorquens in high cell density fermentation.

The green fluorescent protein (GFP) was used as a model protein to study the recombinant protein production by the strain Methylobacterium extorquens ATCC 55366. Scale-up from shake flasks to 20 l fed-batch fermentation was achieved using methanol as a sole carbon and energy source and a completely minimal culture medium. Two different expression vectors were used to express GFP. Clone PCM-GFP containing the vector pCM110 with native promoter of the methanol dehydrogenase PmxaF produced approximately 100-fold more GFP than the clone PRK-GFP containing the vector pRK310 with the heterogeneous promoter Plac. Several fed-batch fermentations with and without selective pressure (tetracycline) were run in a 20 l stirred tank fermenter using the two different clones of M. extorquens. The methanol concentration was monitored with an on-line semiconductor gas sensor in the culture broth. It was maintained at a non-toxic level of 1.4 g l(-1) with an adaptative control which regulates the methanol feed rate. The same growth profile was achieved in all fermentations. The maximum growth rate (micro(max)) was 0.18 h(-1) with an overall yield (Y(X/S)) of 0.3 g g(-1) methanol. With this high cell density fermentation process, we obtained high levels (up to 4 g l(-1)) of GFP with the clone PCM-GFP. The maximum specific GFP production (Y(GFP/X)) with this clone was 80 mg g(-1) representing approximately 16% of the total cell protein. Additional feeding of pure oxygen to the fermenter permitted a longer phase of exponential growth but had no effect on the total yields of biomass and GFP. The specific GFP production of clone PCM-GFP remained unaffected in the presence or absence of selective pressure (tetracycline), within the initial 50 h of the fermentation culture. These results suggest that M. extorquens ATCC 55366 could be an interesting candidate for overexpression of recombinant proteins.

Encondroma gigante / Giant enchondroma

El encondroma es un tumor óseo benigno de origen cartilaginosos poco frecuente. La clínica en estadios precoces es escasa y poco específica, lo que provoca un retraso en su diagnóstico. Las técnicas de imagen proporcionan el diagnóstico final y su tratamiento puede llegar a requerir resección quirúrgica. Presentamos el caso de una paciente de 16 años, que fue derivada al Servicio de Traumatología y Ortopedia Infantil de nuestro Centro por presentar dolor y limitación funcional del hombro derecho de 3 meses de evolución , y fue diagnosticada de encondroma gigante (AU)

Long-term efficacy of torsemide compared with frusemide in cirrhotic patients with ascites.

BACKGROUND: Torsemide is a new loop diuretic that has shown, in short-term studies, to induce a longer and higher diuretic and natriuretic action than frusemide. However, torsemide long-term effects and complications have not been sufficiently investigated. The aim was to compare the efficacy and safety of torsemide versus frusemide in cirrhotic patients with uncomplicated ascites. METHODS: Forty-six patients were randomized in two groups to receive torsemide 20 mg/day (n = 22) or frusemide 40 mg/day (n = 24). Both drugs were administered in association with spironolactone 200 mg/day. The initial doses of diuretics were increased every 3 days up to 60, 120 and 400 mg/day, respectively, if the body weight loss was less than 300 g/day or natriuresis was below 50 mEq/day. RESULTS: Torsemide induced a significantly greater diuretic response than frusemide at 24 h and the maximum diuresis while mean diuresis was similar in both groups. Natriuresis was also higher with torsemide but the difference was not significant. The body weight loss, the treatment period, the ascites resolution and complications were similar in both groups. Diuretic doses were increased in two patients treated with torsemide and in nine patients treated with frusemide (P < 0.05). CONCLUSIONS: These results show that torsemide is as effective and safe as frusemide for long-term treatment of cirrhotic patients with ascites.

Production of green fluorescent protein by the methylotrophic bacterium methylobacterium extorquens.

The production of green fluorescent protein (GFP) in Methylobacterium extorquens was studied by creating four different constructs using pJB3KmD, pRK310 and pVK101 vectors, as well as pLac and soluble methane monooxygenase (sMMO) promoters. Plasmids were introduced into the cells by electroporation. Expression of GFP by selected clones was evaluated by growing cells in complex or defined media. The use of pRK310 as an expression vector containing the lacZ promoter resulted in a 100-fold increase of GFP production when compared to cells containing the pLac-GFP-pJB3KmD construct. Higher production of GFP was observed also in cells containing pLac-GFP-pRK310 and pmmoX-GFP-pVK101 constructs. While the transcriptional regulation of the smmo gene in Methylosinus trichosporium OB3b is known to be copper-dependent, expression of GFP by M. extorquens clones harboring pmmoX-promoters was not strongly controlled by the presence of copper in the medium. The production of GFP was generally constant throughout the growth of M. extorquens carrying the pLac-GFP-pRK310 construct. GFP yields varied between 850 and 1000 microg of GFP g biomass(-1). However, the yield of GFP in cells carrying pmmoX-GFP-pVK101 was somewhat reduced after the mid-exponential phase of growth.

Purification and characterization of the soluble methane monooxygenase of the type II methanotrophic bacterium Methylocystis sp. strain WI 14.

Methane monooxygenase (MMO) catalyzes the oxidation of methane to methanol as the first step of methane degradation. A soluble NAD(P)H-dependent methane monooxygenase (sMMO) from the type II methanotrophic bacterium WI 14 was purified to homogeneity. Sequencing of the 16S rDNA and comparison with that of other known methanotrophic bacteria confirmed that strain WI 14 is very close to the genus Methylocystis. The sMMO is expressed only during growth under copper limitation (<0.1 microM) and with ammonium or nitrate ions as the nitrogen source. The enzyme exhibits a low substrate specificity and is able to oxidize several alkanes and alkenes, cyclic hydrocarbons, aromatics, and halogenic aromatics. It has three components, hydroxylase, reductase and protein B, which is involved in enzyme regulation and increases sMMO activity about 10-fold. The relative molecular masses of the native components were estimated to be 229, 41, and 18 kDa, respectively. The hydroxylase contains three subunits with relative molecular masses of 57, 43, and 23 kDa, which are present in stoichiometric amounts, suggesting that the native protein has an alpha(2)beta(2)gamma(2) structure. We detected 3.6 mol of iron per mol of hydroxylase by atomic absorption spectrometry. sMMO is strongly inhibited by Hg(2+) ions (with a total loss of enzyme activity at 0.01 mM Hg(2+)) and Cu(2+), Zn(2+), and Ni(2+) ions (95, 80, and 40% loss of activity at 1 mM ions). The complete sMMO gene sequence has been determined. sMMO genes from strain WI 14 are clustered on the chromosome and show a high degree of homology (at both the nucleotide and amino acid levels) to the corresponding genes from Methylosinus trichosporium OB3b, Methylocystis sp. strain M, and Methylococcus capsulatus (Bath).

Lidocaine and monoethylglycinexylidide serum determinations to analyze liver function of cirrhotic patients after oral administration.

Our aim was to compare standard liver function tests (serum bilirubin, serum albumin and prothrombin concentration), with lidocaine and monoethylglycinexylidide pharmacokinetic parameters, after oral lidocaine administration, to assess hepatic function of cirrhotic individuals. Twenty-one consecutive cirrhotic patients, nine consecutive acute hepatitis patients, and nine healthy individuals received oral lidocaine. Lidocaine and monoethylglycinexylidide serum concentrations were determined by the TDx system. Cirrhotic patients had higher lidocaine and lower monoethylglycinexylidide serum concentrations and differences in its pharmacokinetic variables, compared to control and hepatitis groups (P < 0.05). Sensitivity of lidocaine serum determinations (100%) was greater than sensitivity of serum bilirubin (57%), serum albumin (62%), and prothrombin concentrations (43%) and monoethylglycinexylidide serum concentrations (57%) in differentiating cirrhotic individuals from controls. In conclusion, after oral administration, lidocaine and monoethylglycinexylidide pharmacokinetic parameters are significantly altered in cirrhotic patients compared to normal and acute hepatitis subjects. Lidocaine pharmacokinetic parameters would be better than those of monoethylglycinexylidide and standard liver function tests in the evaluation of liver function of cirrhotic patients.

Monitoring methanotrophic bacteria in hybrid anaerobic-aerobic reactors with PCR and a catabolic gene probe.

We attempted to mimic in small upflow anaerobic sludge bed (UASB) bioreactors the metabolic association found in nature between methanogens and methanotrophs. UASB bioreactors were inoculated with pure cultures of methanotrophs, and the bioreactors were operated by using continuous low-level oxygenation in order to favor growth and/or survival of methanotrophs. Unlike the reactors in other similar studies, the hybrid anaerobic-aerobic bioreactors which we used were operated synchronously, not sequentially. Here, emphasis was placed on monitoring various methanotrophic populations by using classical methods and also a PCR amplification assay based on the mmoX gene fragment of the soluble methane monooxygenase (sMMO). The following results were obtained: (i) under the conditions used, Methylosinus sporium appeared to survive better than Methylosinus trichosporium; (ii) the PCR method which we used could detect as few as about 2,000 sMMO gene-containing methanotrophs per g (wet weight) of granular sludge; (iii) inoculation of the bioreactors with pure cultures of methanotrophs contributed greatly to increases in the sMMO-containing population (although the sMMO-containing population decreased gradually with time, at the end of an experiment it was always at least 2 logs larger than the initial population before inoculation); (iv) in general, there was a good correlation between populations with the sMMO gene and populations that exhibited sMMO activity; and (v) inoculation with sMMO-positive cultures helped increase significantly the proportion of sMMO-positive methanotrophs in reactors, even after several weeks of operation under various regimes. At some point, anaerobic-aerobic bioreactors like those described here might be used for biodegradation of various chlorinated pollutants.

Pharmacokinetics of Dextran-70 in patients with cirrhosis and ascites undergoing therapeutic paracentesis.

BACKGROUND/AIM: Dextran-70 is frequently used as a plasma expander in patients with cirrhosis treated with large-volume paracentesis to prevent post-paracentesis hypovolemia, which is thought to develop after 24 h following the procedure. However, there are no studies on Dextran-70 pharmacokinetics in cirrhosis. METHODS: Nine patients with alcoholic cirrhosis and tense ascites treated with a 5-1 paracentesis were given 500 ml of Dextran-70. Blood samples to measure the plasma concentration of dextran were obtained 15 and 30 min, 1, 2, 3, 6, 12 and 24 h and 2 and 6 days after the end of the infusion. Nine healthy volunteers were studied in identical fashion after infusion of 100 ml of Dextran-70. The plasma concentration of dextran was determined by the anthrone method. A bicompartmental model was used to analyze the pharmacokinetic parameters. RESULTS: There were no significant differences between patients with cirrhosis and controls in the volume of distribution (7.7 +/- 0.6 vs. 7.3 +/- 1.21), half-life of the first and second component of plasma disappearance (2.96 +/- 0.69 and 80.3 5.9 h in patients with cirrhosis vs 2.82 +/- 0.69 and 67.1 +/- 10.7 h in controls). CONCLUSIONS: The pharmacokinetics of Dextran-70 in patients with cirrhosis and ascites after large-volume paracentesis is similar to that in controls. This may explain why Dextran-70 is less effective than albumin in preventing paracentesis-induced hypovolemia, which starts after most Dextran fraction has disappeared from plasma.

Uptake of Benzoic Acid and Chloro-Substituted Benzoic Acids by Alcaligenes denitrificans BRI 3010 and BRI 6011.

The mechanism of uptake of benzoic and 2,4-dichlorobenzoic acid (2,4-DCBA) by Alcaligenes denitrificans BRI 3010 and BRI 6011 and Pseudomonas sp. strain B13, three organisms capable of degrading various isomers of chlorinated benzoic acids, was investigated. In all three organisms, uptake of benzoic acid was inducible. For benzoic acid uptake into BRI 3010, monophasic saturation kinetics with apparent K(infm) and V(infmax) values of 1.4 (mu)M and 3.2 nmol/min/mg of cell dry weight, respectively, were obtained. For BRI 6011, biphasic saturation kinetics were observed, suggesting the presence of two uptake systems for benzoic acid with distinct K(infm) (0.72 and 5.3 (mu)M) and V(infmax) (3.3 and 4.6 nmol/min/mg of cell dry weight) values. BRI 3010 and BRI 6011 accumulated benzoic acid against a concentration gradient by a factor of 8 and 10, respectively. A wide range of structural analogs, at 50-fold excess concentrations, inhibited benzoic acid uptake by BRI 3010 and BRI 6011, whereas with B13, only 3-chlorobenzoic acid was an effective inhibitor. For BRI 3010 and BRI 6011, the inhibition by the structural analogs was not of a competitive nature. Uptake of benzoic acid by BRI 3010 and BRI 6011 was inhibited by KCN, by the protonophore 3,5,3(prm1), 4(prm1)-tetrachlorosalicylanilide (TCS), and, for BRI 6011, by anaerobiosis unless nitrate was present, thus indicating that energy was required for the uptake process. Uptake of 2,4-DCBA by BRI 6011 was constitutive and saturation uptake kinetics were not observed. Uptake of 2,4-DCBA by BRI 6011 was inhibited by KCN, TCS, and anaerobiosis even if nitrate was present, but the compound was not accumulated intracellularly against a concentration gradient. Uptake of 2,4-DCBA by BRI 6011 appears to occur by passive diffusion into the cell down its concentration gradient, which is maintained by the intracellular metabolism of the compound. This process could play an important role in the degradation of xenobiotic compounds by microorganisms.

Postprandial vascular response in patients with cirrhosis. Short-term effects of propranolol administration.

Systemic and portal hemodynamic parameters were evaluated in eight cirrhotic patients in basal conditions and after food intake and placebo. Following seven days of oral propranolol administration, hemodynamic parameters were reevaluated in the fasting and postprandial states under similar conditions. Cardiac output and portal blood flow were measured by Doppler technique. Intraobserver variability of repeated measurements was less than 10%. Food intake caused a significant increase of portal blood flow (+28%, P < 0.05). No significant changes were observed in the other hemodynamic parameters studied. Propranolol at doses achieving effective beta blockade (84 +/- 14 mg/day) (mean +/- SD) reduced portal blood flow (-24%, P < 0.05). Food intake caused a significant increase in portal blood flow (+35%, P < 0.05) in propranolol treated patients. However, in absolute values, postprandial portal blood flow during propranolol treatment was significantly lower (986 +/- 402 ml/min) than that obtained after the initial food intake (1214 +/- 537 ml/min, P < 0.05). Placebo administration had no significant hemodynamic effects in either group. This study demonstrates that chronic propranolol administration could protect from portal hemodynamic changes following food intake. Doppler technique is a reliable technique to evaluate changes on portal and systemic hemodynamic parameters during a short period of time in patients with cirrhosis.

Peritonitis espontanea en el cirrótico: nuestra experiencia / Spontaneus peritonitis in cirrhosis: our experience

Debido a la escasez de publicaciones en nuestro país, se analiza retrospectivamente la incidencia de peritonitis espontánea (PE) observados durante 2 años, en 76 episodios de ascitis provenientes de 63 pacientes con cirrosis hepática. Trece pacientes (17%) presentaron PE y la relación hombre-mujer fue de 5 a 1; el 70% de los gérmenes encontrados en el líquido ascítico fue de origen entérico, principalmente Escherichia Coli. En tres pacientes el diagnóstico se efectuó por el recuento de polinucleares y la clínica, a pesar del cultivo negativo. No hubo diferencias significativas en la presencia de complicaciones o alteraciones humorales al ingreso entre pacientes con ascitis estériles y con PE, pero sí con la mortalidad que fue de 7,9% (5/63) en los primeros y de 38% (5/13) en las ascitis infectadas. El 80% de los fallecidos presentaban falla renal en el final de la evolución y una vinculación con el uso de aminoglucósidos no puede ser descartado. La peritonitis espontánea en el cirrótico, buscada rutinariamente, parece tener la misma incidencia en nuestro medio que la descripta en la literatura

Peritonitis espontanea en el cirrótico: nuestra experiencia / Spontaneus peritonitis in cirrhosis: our experience

Debido a la escasez de publicaciones en nuestro país, se analiza retrospectivamente la incidencia de peritonitis espontánea (PE) observados durante 2 años, en 76 episodios de ascitis provenientes de 63 pacientes con cirrosis hepática. Trece pacientes (17%) presentaron PE y la relación hombre-mujer fue de 5 a 1; el 70% de los gérmenes encontrados en el líquido ascítico fue de origen entérico, principalmente Escherichia Coli. En tres pacientes el diagnóstico se efectuó por el recuento de polinucleares y la clínica, a pesar del cultivo negativo. No hubo diferencias significativas en la presencia de complicaciones o alteraciones humorales al ingreso entre pacientes con ascitis estériles y con PE, pero sí con la mortalidad que fue de 7,9% (5/63) en los primeros y de 38% (5/13) en las ascitis infectadas. El 80% de los fallecidos presentaban falla renal en el final de la evolución y una vinculación con el uso de aminoglucósidos no puede ser descartado. La peritonitis espontánea en el cirrótico, buscada rutinariamente, parece tener la misma incidencia en nuestro medio que la descripta en la literatura (AU)

[Spontaneous peritonitis in the patient with cirrhosis, our experience]. / Peritonitis espontánea en el cirrótico, nuestra experiencia.

Due to scarce printed information in our country, the incidence regarding spontaneous peritonitis observed during two years in 76 ascites episodes, found in 63 patients with hepatic cirrhosis, is analysed retrospectively. Thirteen patients (17%), showed spontaneous peritonitis and the relationship man-woman was 5 to 1; 70% of the germs found in the ascites fluid was of enteric origin, mainly Escherichia Coli. In three patients the diagnosis was made by both counting the leucocytes and the clinical symptoms, in spite of the negative culture. There were no significant differences in the presence of humoral complications or alterations when patients appeared with sterile ascites and spontaneous peritonitis, but there were differences with the death rate which was 7.9% (5/63), in the former and 38% (5/13), in infected ascites; 80% of the dead patients showed renal deficiency at the end of the evolution and a relationship with the use of aminoglucosides can not be discarded. The search for spontaneous peritonitis in the cirrhotic patient, as a routine, seems to have the same incidence among as, as the one described in the literature.