Optimization of the ellagic acid synthesis process at the bioreactor level using non-conventional yeasts

Abstract Ellagic acid (EA) is a phenolic biomolecule. For its biosynthesis, a source of ellagitannins is required, such as strawberries and yeasts, as precursors of the tannase and ß-glucosidase enzymes responsible for hydrolysis of ellagitannins. Two experimental mixture designs were applied., varying the yeast concentration and the number of ellagitannins in the culture medium, evaluating the enzymatic activity and ellagic acid biosynthesis. Aiming to find the optimal compositions of the non-conventional yeasts assessed in the research to biosynthesize ellagic acid feasibly and efficiently using a response surface performing the statistical analysis in the StatGraphics® program for obtaining a higher yield and optimizing the ellagic acid synthesis process, the results indicate that the strains Candida parapsilosis ITM LB33 and Debaryomyces hansenii ISA 1510 have a positive effect on the synthesis of ellagic acid, since as its concentration increases in the mixture the concentration of ellagic acid in the medium also increases; on the other hand, the addition of Candida utilis ITM LB02 causes a negative effect, resulting in the compositions of 0.516876, 0.483124 and 2.58687E-9 respectively, for a treatment under the same conditions, an optimal value of ellagic acid production would be obtained. With an approximate value of 7.33036 mg/mL

Thymoglobulin Versus Alemtuzumab Versus Basiliximab Kidney Transplantation From Donors After Circulatory Death.

Introduction: The Campath, Calcineurin inhibitor (CNI) reduction, and Chronic allograft nephropathy (3C), a study comparing alemtuzumab versus basiliximab induction immunosuppression in kidney transplants, has found lower acute rejection rate with alemtuzumab but same graft survival. The aim of the current study is to evaluate the effect of induction immunosuppression (thymoglobulin, alemtuzumab, basiliximab) on the outcome of kidneys of donors after circulatory death (DCD). Methods: Data of the 274 DCD patients of the 3C obtained from the sponsor were compounded with the 140 DCD patients who received thymoglobulin in a single center with the same entry criteria as the 3C, giving 414 patients on 3 induction regimes. Results: There were more male donors (P < 0.05) and human leukocyte antigen and DR mismatched patients in the thymoglobulin group (P < 0.001). Death-censored graft survival at 6 months was 98.6% in the thymoglobulin, 95.5% in the alemtuzumab (P = 0.08), and 95.7% in the basiliximab group (P = 0.09) and at 2 years 97.9% versus 94.8% (P = 0.13, hazard ratio [HR] 2.8, 95% CI 0.7-10.9) versus 94.3% (P = 0.06, HR 3.5, 95% CI 0.9-13.6), respectively.The 2-year overall graft survival was 95% in the thymoglobulin versus 88% in the alemtuzumab (unadjusted P = 0.038, adjusted HR 2.4, 95% CI 0.99-5.9) and 91.4% in the basiliximab group (P = 0.21). The 2-year patient survival was numerically less in the alemtuzumab compared with the thymoglobulin group (91.8% vs. 97.1%, P = 0.052, HR 2.90, 95% CI 0.93-9.2). Acute rejection was 17% in the basiliximab, 4.3% in the thymoglobulin, and 6% in the alemtuzumab group (P < 0.001). Conclusion: In DCD transplants, thymoglobulin induction may provide advantage over alemtuzumab in patient survival and the same advantage as alemtuzumab over basiliximab in terms of acute rejection. Differing maintenance immunosuppression may contribute to the difference found.

Determination of a microRNA signature of protective kidney ischemic preconditioning originating from proximal tubules.

Ischemic preconditioning (IPC) is effective in limiting subsequent ischemic acute kidney injury in experimental models. MicroRNAs are an important class of post-transcriptional regulator and show promise as biomarkers of kidney injury. We evaluated the time- and dose-dependence of benefit from IPC in a rat model of functional (bilateral) ischemia-reperfusion injury (IRI). We found optimal protection from subsequent injury following short, repetitive sequences of preconditioning insult. We subsequently used hybridization array and microRNA sequencing to characterize microRNA signatures of protective IPC and of IRI. These approaches identified a profile of microRNA changes consequent on IRI, that were limited by prior IPC. To localize these signals within the kidney, we used laser capture microdissection and RT-qPCR to measure microRNA abundance in nephron segments, pinpointing microRNA changes principally to glomeruli and proximal tubules. Our data describe a unique microRNA signature for IRI in the rat kidney. Pulsatile IPC reduces kidney damage following IRI and diminishes this microRNA signal. We have also identified candidate microRNAs that may act as biomarkers of injury and therapeutic targets in this context.

Induction with ATG in DCD kidney transplantation; efficacy and relation of dose and cell markers on delayed graft function and renal function.

AIM: We aimed to analyse the efficacy of the Thymoglobulin dose used for induction in controlled DCD kidneys, and its initial impact on blood cell and CD3 count, as predictors of efficacy. METHODS: 140 DCD patients who received ATG induction, were analysed. Intended dose was 1.25 mg/kg/day over 5 days, rounded to nearest 25 mg and not exceeding 125 mg/dose. Outcomes included the total dose in relation with rejection, DGF, graft survival, eGFR. The cell count response to ATG was assessed as predictors of outcome. RESULTS: Graft survival, was 96.2%, 92.4%, 85% at 1, 3 and 5 years. Rejection was 7% at 1 year and associated with eGFR at 3 (p = 0.003) and 5 years. ATG dose was not predictive of rejection but was associated with the day5 leucocyte and lymphocyte count (p < 0.001) and negatively with DGF (p = 0.05). In 31 patients day3 CD3 count was available and it was associated with rejection (p = 0.002), less DGF (p = 0.09), and 3 years eGFR (p = 0.01). CONCLUSION: Thymoglobulin provides excellent results in DCD kidneys that do not significantly differ with small dose variations. In higher doses it reduces DGF. Lymphocytes and CD3 count, may be useful surrogate markers of efficacy and outcome.

Hyaluronidase-2 Regulates RhoA Signaling, Myofibroblast Contractility, and Other Key Profibrotic Myofibroblast Functions.

Hyaluronidase (HYAL)-2 is a weak, acid-active, hyaluronan-degrading enzyme broadly expressed in somatic tissues. Aberrant HYAL2 expression is implicated in diverse pathology. However, a significant proportion of HYAL2 is enzymatically inactive; thus the mechanisms through which HYAL2 dysregulation influences pathobiology are unclear. Recently, nonenzymatic HYAL2 functions have been described, and nuclear HYAL2 has been shown to influence mRNA splicing to prevent myofibroblast differentiation. Myofibroblasts drive fibrosis, thereby promoting progressive tissue damage and leading to multimorbidity. This study identifies a novel HYAL2 cytoplasmic function in myofibroblasts that is unrelated to its enzymatic activity. In fibroblasts and myofibroblasts, HYAL2 interacts with the GTPase-signaling small molecule ras homolog family member A (RhoA). Transforming growth factor beta 1-driven fibroblast-to-myofibroblast differentiation promotes HYAL2 cytoplasmic relocalization to bind to the actin cytoskeleton. Cytoskeletal-bound HYAL2 functions as a key regulator of downstream RhoA signaling and influences profibrotic myofibroblast functions, including myosin light-chain kinase-mediated myofibroblast contractility, myofibroblast migration, myofibroblast collagen/fibronectin deposition, as well as connective tissue growth factor and matrix metalloproteinase-2 expression. These data demonstrate that, in certain biological contexts, the nonenzymatic effects of HYAL2 are crucial in orchestrating RhoA signaling and downstream pathways that are important for full profibrotic myofibroblast functionality. In conjunction with previous data demonstrating the influence of HYAL2 on RNA splicing, these findings begin to explain the broad biological effects of HYAL2.

A urinary microRNA panel that is an early predictive biomarker of delayed graft function following kidney transplantation.

Predicting immediate and subsequent graft function is important in clinical decision-making around kidney transplantation, but is difficult using available approaches. Here we have evaluated urinary microRNAs as biomarkers in this context. Profiling of 377 microRNAs in the first urine passed post-transplantation identified 6 microRNAs, confirmed to be upregulated by RT-qPCR in an expanded cohort (miR-9, -10a, -21, -29a, -221, and -429, n = 33, P < 0.05 for each). Receiver operating characteristic analysis showed Area Under the Curve 0.94 for this panel. To establish whether this early signal was sustained, miR-21 was measured daily for 5 days post-transplant, and was consistently elevated in those developing Delayed Graft Function (n = 165 samples from 33 patients, p < 0.05). The biomarker panel was then evaluated in an independent cohort, sampled at varying times in the first week post-transplantation in a separate transplant center. When considered individually, all miRs in the panel showed a trend to increase or a significant increase in those developing delayed Graft Function (miR-9: P = 0.068, mIR-10a: P = 0.397, miR-21: P = 0.003, miR-29a: P = 0.019, miR-221: P = 0.1, and miR-429: P = 0.013, n = 47) with Area Under the Curve 0.75 for the panel. In conclusion, combined measurement of six microRNAs had predictive value for delayed graft function following kidney transplantation.

MicroRNA-21 (miR-21) expression in hypothermic machine perfusate may be predictive of early outcomes in kidney transplantation.

Hypothermic machine perfusion is effective in improving outcome following kidney transplantation. Molecular analyses of hypothermic machine perfusate (HMP) have the potential to identify biomarkers of organ viability prior to transplantation, offering significant advantages to the transplant surgeon, and leading to a potential increase in the organ donor pool. MicroRNAs are emerging as important biomarkers in the context of kidney injury and transplantation. Recent data demonstrate increased microRNA-21 (miR-21) expression in the kidney following acute kidney injury. This study investigated the potential of miR-21 detected in HMP to act as a sentinel for early kidney transplant outcomes. MiR-21 was found to be readily detectable in HMP by RT-qPCR. Eleven ECD kidneys were maintained on a hypothermic machine perfusion system for a median 627 (range 117-1027) minutes, and evaluation of flow and resistance characteristics suggested stability on the machine from 60 min post-perfusion. MiR-21 quantification at 60 min post-perfusion correlated with eGFR at 6 and 12 months post-transplantation. These data suggest that miR-21 expression in HMP may be predictive of early outcomes following kidney transplantation. In the era of ECD kidneys, a reliable measure of organ quality is urgently needed, and this study suggests miR-21 may be such a marker.

A Localized Ischemic Preconditioning Regimen Increases Tumor Necrosis Factor α Expression in a Rat Model of Kidney Ischemia-Reperfusion Injury.

OBJECTIVES: We evaluated a continuous, immediate, localized ischemic preconditioning regimen in a rat model of ischemia-reperfusion injury and assessed whether it attenuated injury at the histologic and molecular levels. MATERIALS AND METHODS: Fifteen adult male Lewis rats received sham operation, left unilateral warm ischemia (45 minutes of cross-clamping of the renal pedicle; ischemia-reperfusion injury group), or 15 minutes of ischemia followed by a 20-minute reperfusion period, 45 minutes of ischemia-reperfusion injury, and subsequent reperfusion (ischemic preconditioning/ischemia-reperfusion injury group). Kidney tissue was retrieved 48 hours later, sectioned, stained with hematoxylin and eosin, and examined. We used RNA extraction and real-time quantitative polymerase chain reaction analysis to assess acute kidney injury markers, cytokines, and microRNA-21. RESULTS: Forty-five minutes of unilateral ischemia-reperfusion injury caused marked changes in histology at 48 hours, characterized by endothelial loss, tubulointerstitial damage (inflammation, cast formation), tubular cell necrosis, and glomerular capsule thickening. The ischemia-reperfusion injury and ischemic preconditioning/ischemia-reperfusion injury groups showed no measurable differences in histology. Expression of the acute kidney injury markers was significantly increased in the ischemia-reperfusion injury versus Sham group; however, no difference was found between the ischemia reperfusion injury and ischemic preconditioning/ischemia-reperfusion injury groups. Similarly, expression of interleukin 17, interleukin 18, and tumor necrosis factor ? was significantly increased in the ischemia-reperfusion injury versus Sham group. No significant difference was found between the ischemia-reperfusion injury and ischemic preconditioning/ischemia-reperfusion injury groups for interleukin 17 and interleukin 18; however, tumor necrosis factor ? expression was significantly increased in the ischemic preconditioning/ischemia-reperfusion injury versus ischemia-reperfusion injury group. CONCLUSIONS: In our ischemic preconditioning model, tumor necrosis factor α expression was increased without altering the sequelae of ischemia-reperfusion injury. The long-term consequences of this augmented early inflammatory response and whether these consequences are altered by variations in ischemic preconditioning or a subsequent injury require further study.

Impact of expanded criteria variables on outcomes of kidney transplantation from donors after cardiac death.

INTRODUCTION: To expand the donor pool, kidney transplants are being performed using donors who were previously considered unacceptable. We applied the United Network for Organ Sharing criteria to define expanded criteria donors (ECD) within the donation after cardiac death (DCD) and donation after brain stem death (DBD) cohorts. We compared outcomes of DCD and DBD transplants with and without (standard criteria donor [SCD]) the ECD criteria. METHODS: This was a single-center retrospective study of all deceased donor transplants from 2004 to 2010 (n=359). Four groups were identified--DBD-SCD (n=154), DBD-ECD (n=93), DCD-SCD (n=78), and DCD-ECD (n=34). Kaplan-Meier analysis of graft and patient survival and multiple regression analysis of 1-year graft function were performed. RESULTS: One-year and two-year uncensored graft survivals were similar between DCD-ECD and DCD-SCD cohorts (1 year, 90% and 93%; 2 years, 81% and 93% respectively; log-rank test P=0.2). Median estimated glomerular filtration rate (eGFR) was lower in DCD-ECD recipients at 12 months (41 vs. 53 mL/min, P=0.003) and 24 months (33 vs. 54 mL/min, P<0.001) compared with DCD-SCD recipients. Compared with DBD-ECD recipients also at 24 months, DCD-ECD recipients showed a lower graft function (median, eGFR 33 vs. 47 mL/min; P=0.007) but similar graft survival. Expanded criteria donor status (B=-9.7, P=0.01) was associated with a lower 1-year eGFR within the DCD cohort, with donor age (B=-0.42, P=0.002) being the only significant ECD variable. CONCLUSION: Short-term graft survival in DCD-ECD transplants was comparable to DCD-SCD and DBD-ECD transplants albeit with poorer allograft function at 2 years. Quality-of-life studies are needed to determine the true value of these transplants, particularly when performed to older recipients.

Complex modulation of the expression of PKC isoforms in the rat brain during chronic type 1 diabetes mellitus.

We previously demonstrated that chronic hyperglycemia has a detrimental influence on neurovascular coupling in the brain-an effect linked to an alteration in the protein kinase C (PKC)-mediated phosphorylation pattern. Moreover, the activity of PKC was increased, in diabetic rat brain, in a tissue fraction composed primarily of the superficial glia limitans and pial vessels, but trended toward a decrease in cerebral cortical gray matter. However, that study did not examine the expression patterns of PKC isoforms in the rat brain. Thus, in a rat model of streptozotocin (STZ)-induced chronic type 1 diabetes mellitus (T1DM), and in non-diabetic (ND) controls, two hypotheses were addressed. First, chronic T1DM is accompanied by changes in the expression of PKC-α, ßII, γ, δ, and ε Second, those changes differ when comparing cerebral cortex and glio-pial tissue. In addition, we analyzed the expression of a form of PKC-γ, phosphorylated on threonine 514 (pT514-PKC-γ), as well as the receptor for activated C kinase 1 (RACK1). The expression pattern of different PKC isoforms was altered in a complex and tissue-specific manner during chronic hyperglycemia. Notably, in the gray matter, PKC-α expression significantly decreased, while pT514-PKC-γ expression increased. However, PKC-ßII, -γ, -δ, -ε, and RACK1 expressions did not change. Conversely, in glio-pial tissue, PKC-α and RACK1 were upregulated, whereas PKC-γ, pT514-PKC-γ, and PKC-ε were downregulated. PKC-ßII, and PKC-δ, were unchanged. These findings suggest that the PKC activity increase previously seen in the glio-pial tissue of diabetic rats may be due to the selective upregulation of PKC-α, and ultimately lead to the impairment of neurovascular coupling.

Influence of delayed graft function and acute rejection on outcomes after kidney transplantation from donors after cardiac death.

BACKGROUND: Delayed graft function (DGF) and acute rejection (AR) exert an adverse impact on graft outcomes after kidney transplantation using organs from donation after brain-stem death (DBD) donors. Here, we examine the impact of DGF and AR on graft survival in kidney transplants using organs from donation after cardiac death (DCD) donors. METHODS: We conducted a single-center retrospective study of DCD and DBD donor kidney transplants. We compared 1- and 4-year graft and patient survival rates, as well as death-censored graft survival (DCGS) rates, between the two groups using univariate analysis, and the impact of DGF and AR on graft function was compared using multivariate analysis. RESULTS: Eighty DCD and 206 DBD donor transplants were analyzed. Median follow-up was 4.5 years. The incidence of DGF was higher among DCD recipients (73% vs. 27%, P<0.001), and AR was higher among DBD recipients (23% vs. 9%, P<0.001). One-year and 4-year graft survival rates were similar (DCD 94% and 79% vs. DBD 90% and 82%). Among recipients with DGF, the 4-year DCGS rate was better for DCD recipients compared with DBD recipients (100% vs. 92%, P=0.04). Neither DGF nor AR affected the 1-year graft survival rate in DCD recipients, whereas in DBD recipients, the 1-year graft survival rate was worse in the presence of DGF (88% vs. 96%, P=0.04) and the 4-year DCGS rate was worse in the presence of AR (88% vs. 96%, P=0.04). CONCLUSION: Despite the high incidence of DGF, medium-term outcomes of DCD kidney transplants are comparable to those from DBD transplants. Short-term graft survival from DCD transplants is not adversely influenced by DGF and AR, unlike in DBD transplants.

Gestión de las unidades académicas universitarias de la UMSA, vinculadas con la prestación de Bienes y/o servicios a la sociedad. Caso: Clínicas Odontológicas y Departamento de Interacción Social / sss

El objetivo del trabajo es realizar un análisis de la gestión de los servicios ofrecidos por la Facultad de Odontología como producto de la interacción social estableciendo su aplicación y efectos en la población y plantear un modelo que permita un proceso de gestión adecuado a sus exigencias, si correspondiera

Estudio clínico e inmunólogico del xenorrechazo en el xenotrasplante ortotópico de hígado de cerdo a babuino / Clinical and immunological study of xenorejection in orthotopic liver xenotransplantation from pig to baboon

Introducción. La experiencia de xenotrasplante hepático (Xtoh) de cerdo a primate no humano es muy limitada. Nuestros objetivos han sido: a) comprobar si el hígado de un cerdo transgénico h-DAF evita el rechazo hiperagudo; b) estudiar las funciones metabólicas del hígado porcino tras el Xtoh; y c) analizar el perfil clínico, bioquímico e inmunológico del rechazo vascular agudo retardado. Animales y métodos. Se realizaron 6 Xtoh de cerdo a babuino, 4 de cerdos no modificados y dos de cerdos transgénicos para h-DAF. Se llevaron a cabo determinaciones hematológicas, de coagulación, de xenoanticuerpos y del complemento. En el babuino que sobrevivió 8 días, se estudiaron durante los mismos las poblaciones linfocitarias y la actividad lítica de los linfocitos. Resultados. Los valores de xIgG e IgM descendieron drásticamente a los 3 min de la reperfusión, sobre todo del CH50, C3 y C4. En los hígados no modificados genéticamente apareció una coagulación intravascular diseminada por rechazo hiperagudo, con una supervivencia inferior a 12 h. Con los hígados h-DAF, la coagulación se normalizó, con una supervivencia de 8 y 4 días, falleciendo ambos por insuficiencia respiratoria, sin rechazo hiperagudo. El babuino que sobrevivió 8 días presentó a las 36 h un rechazo vascular agudo retardado, detectándose una estimulación de las HLA clase I sobre los linfocitos CD3+ y CD19+, que respondió al tratamiento. Conclusiones. El hígado transgénico h-DAAF previene el rechazo hiperagudo y mantiene la coagulación en rangos normales en el babuino. El rechazo vascular agudo provoca el cese en la producción de bilis y un patrón mixto de citólisis y colostasis. Los valores de expresión de HLA clase I en los linfocitos podrían ser útiles para diagnosticarlo (AU)

Pancreaticogastrostomía en una pancreatoduodenectomía con preservación del piloro: reporte de un caso / Pancreaticogastrostomy in a pancreatoduodenectomy with prevention of pyloric: presentation a case

La alta morbimortalidad asociada a la Operación de Whipple estandar se ha reducido en los últimos años, sin embargo, aún observan un gran número de complicaciones relacionadas con el muñon pancreático, tales como fugas de la anastomosis pancreatoyeyunal y disfunción endo y exocrina; otra serie de complicaciones se ven en relación a la gastrectomía como son el dumping, diarrea, alteraciones en la absorción y la úlcera marginal. La pancreaticogastrostomía acompañada a una pancreatoduodenectomía con preservación del píloto se presenta como una combinación excelente para reducir tales complicaciones. Nosotros presentamos el caso de un paciente masculino de 57 años de edad al cual se le realizó el procedimiento; posterior a ello, se realizó una valoración endoscópica y radiológica encontrando una mucosa de características normales y una función pilórica y vaciamiento gástrico adecuado. El quimismo gástrico resultó hiper-secretante, posiblemente debido a la alcalinización del antro gástrico por la secreción pancreática. La evaluación endocrina del páncreas determinado por una curva de tolerancia glucosada fue normal al igual que la evaluación exocrina a través del Test de Pancreolauryl

Anticuerpos anti-toxoplasma: análisis de los efectos que se logran con su presencia en las madres y recién nacidos en el momento del parto

La Toxoplasmosis congénita es el resultado de la infección por el Toxoplasmosis gondii debido a su paso a través de la placenta. Sin embargo, cuando la mujer está inmunizada antes del embarazo no puede trasmitir la infección a su hijo, pero si la adquiere durante este período la transmite al feto por medio de los enfermos (AU)

Cinta ajustable de Nylon su uso como material de síntesis de la pared abdominal: experiencia clínica / Adjustable Nylon ribbons used as material for the synthesis of the abdominal wall: clinical experience

Las cintas ajustables de Nylon fueron utilizadas como material de síntesis de la pared abdominal, como sutura única o de protección, sustituyendo las suturas de retención convencionales. La reacción tisular a este material fue evaluada experimentalmente en perros con resultados favorables. En 43 pacientes con indicación para colocar suturas de retención o realizar lavado postoperatorio de la cavidad abdominal, se utilizó este material. Los parámetros utilizados para la evaluación de resultados fueron las complicaciones propias del procedimiento: Dolor de la zona operatoria, lesiones de la piel, dehiscencia de la herida, lesiones a órganos intraabdominales y complicaciones del lavado peritoneal. De los 43 pacientes, 33 no tuvieron complicaciones, 8 presentaron dolor entre el tercero y quinto día del postoperatorio, uno presentó lesiones cortantes de la piel y otro una hernia incisional. Se concluye que las cintas ajustables de Nylon mostraron en este grupo de pacientes las siguientes características: Son de fácil colocación, son ajustables a los cambios de volúmen de la herida, pueden utilizarse para apertura, lavado y cierre de la cavidad abdominal en el postoperatorio sin perder su integridad. Estas prioridades hacen de las cintas ajustables de Nylon un material que puede sustituir con ventajas a las suturas convencionales

Vagotomía de células parietales: diez años de experiencia / Vagotomy of the parietal cells: 10 years' experience

Los autores presentan 10 años de experiencia con la vagotomía de células parietales en 156 pacientes intervenidos en el Servicio de Cirugía II del Hospital Vargas de Caracas. Fueron intervenidos por úlcera duodenal 102 pacientes, 30 pacientes con úlcera duodenal asociada a hernia hiatal y 24 pacientes con hernia hiatal solamente. Los controles clínicos, radiológicos y de secreción gástrica demostraron la utilidad de la intervención, fundamentalmente en la reducción de la secreción de Acido Clorhídrico, que alcanzó un descenso promedio de 67.79%. Se observaron recidivas, en el 9.6% de los casos. No se registró mortalidad operativa

Efectos del Yag-Laser sobre la mucosa del tracto digestivo superior: estudio in vitro / Effects of Yag-Laser on the wall of the upper gastrointestinal tract: in vitro study

Con el objeto de evaluar los efectos del YAG-LASER sobre la pared del tracto digestivo superior, se realiza un estudio in vitro, utilizando 5 piezas anatómicas de cadáveres frescos en las cuales se hacen aplicaciones en serie de LASER variando el tiempo y la intensidad del rayo. Los resultados obtenidos demuestran la seguridad y confiabilidad del aparato y permiten obtener los valores óptimos para su uso terapéutico

Infecciones por cateter en nutrición parenteral total / Infections by catheters in total parenteral nutrition

La infección debida al catéter venoso central empleado en pacientes que reciben Nutrición Parenteral Total, constituye un importante riesgo relacionado con este procedimiento. Con el objeto de evaluar esta situación, se estudiaron 32 casos en el curso de la Nutrición Parenteral Total, evaluándose los procedimentos de preparación y administración de las soluciones y los cuidados del catéter. Se cultivaron en medios sólidos las puntas de todos los catéteres que se retiraron durante o al final de la NPT. En los pacientes con signos de sepsis se hicieron hemocultivos y se compararon con los cultivos de los catéteres. De los 43 catéteres estudiados, 24 tuvieron cultivos positivos, en 12 pacientes. Del total de casos estudiados hubo 10 pacientes con sepsis diagnosticada clínicamente, entre los que hubo 2 hemocultivos positivos de los cuales uno coincidía con el germen obtenido del catéter, en un paciente con sepsis intra-abdominal, único caso, en nuestro grupo, que consideramos altamente sugestivo de sepsis por catéter (3.1%)

Cinco anos de experiencia con la vagotomia de celulas parietales / A 5 years' experience with vagotomy of parietal cells

Los autores presentan 5 anos de experiencia con la vagotomia de celulas parietales en 65 pacientes intervenidos en el Servicio de Cirurgia No. 2 del Hospital Vargas de Caracas, Venezuela. Fueron intervenidos por ulcera duodenal 54 pacientes, 7 pacientes con ulcera duodenal asociada a hernia hiatal y 4 pacientes con hernia hiatal solamente. Controles clinicos, radiologicos y de secrecion gastrica demostraron la utilidad de la intervencion, fundamentalmente en la reduccion de la concentracion de acido clorhidrico que alcanzo un descenso promedio de 87.6%. La recidiva fue observada en el 4.6% de los casos. La mortalidad fue del orden del 1.5% y no se registro mortalidad operatoria