Cuidado del paciente con insuficiencia renal crónica

Resumen: La magnitud del problema aumenta si se piensa en la carga económica y social que demanda la realización de tres hemodiálisis semanales por tiempo ilimitado puesto que es la pérdida progresiva e irreversible de la función renal. Se inicia con el deterioro progresivo del volumen de filtrado glomerular por el reclutamiento de nefronas dañadas, al que se agregan los trastornos tubulares de homeostasis y la falla de las funciones hormonales del órgano. Este reclutamiento es progresivo, donde se hallan las nefronas en grados variables de daño estructural y funcional, donde se abona el concepto de masa funcional crítica, que confiere a esta enfermedad fases evolutivas que van desde la etapa subclínica hasta el deterioro terminal, conocido como uremia o fase descompensada de características terminales.[AU]

Comparative study of the primary cilia in thyrocytes of adult mammals.

Since their discovery in different human tissues by Zimmermann in 1898, primary cilia have been found in the vast majority of cell types in vertebrates. Primary cilia are considered to be cellular antennae that occupy an ideal cellular location for the interpretation of information both from the environment and from other cells. To date, in mammalian thyroid gland, primary cilia have been found in the thyrocytes of humans and dogs (fetuses and adults) and in rat embryos. The present study investigated whether the existence of this organelle in follicular cells is a general event in the postnatal thyroid gland of different mammals, using both immunolabeling by immunofluorescence and electron microscopy. Furthermore, we aimed to analyse the presence of primary cilia in various thyroid cell lines. According to our results, primary cilia are present in the adult thyroid gland of most mammal species we studied (human, pig, guinea pig and rabbit), usually as a single copy per follicular cell. Strikingly, they were not found in rat or mouse thyroid tissues. Similarly, cilia were also observed in all human thyroid cell lines tested, both normal and neoplastic follicular cells, but not in cultured thyrocytes of rat origin. We hypothesize that primary cilia could be involved in the regulation of normal thyroid function through specific signaling pathways. Nevertheless, further studies are needed to shed light on the permanence of these organelles in the thyroid gland of most species during postnatal life.

[Comparison of the effectiveness of two different pharmacologic approaches to prevent intraoperative floppy iris syndrome]. / Comparación de la efectividad de dos estrategias farmacológicas para la prevención del síndrome de iris flácido intraquirúrgico.

OBJECTIVE: To compare the effectiveness of two strategies to prevent the appearance of intraoperative floppy iris syndrome (IFIS) in patients exposed to a-blockers. METHODS: We compared retrospectively the presence and severity of the appearance of IFIS in 29 patients subjected to cataract surgery, establishing two groups of 12 patients (22 eyes) and 17 patients (33 eyes). The strategy applied to group one consisted of suspending the exposure to a-blockers for at least one week prior to the intervention, the topical application of 1% atropine three times a day for two days before the intervention and the use of intracameral lidocaine. The strategy for group two consisted of suspending use of the drug for at least one week before the intervention and the intracameral application at the beginning of surgery of a solution of physiological serum, adrenaline and lidocaine. RESULTS: Six patients from group one showed no evidence of IFIS, 2 exhibited bilateral mild symptoms, 2 bilateral moderate and 2 unilateral severe symptoms of IFIS. In total, 45.5% eyes suffered from IFIS. In group two, only 3 eyes (9.1%) from 2 patients exhibited mild symptoms. Statistical analysis showed a significant difference between both groups (p=0.002). If only those exhibiting moderate and severe symptoms are taken into account the result was highly statistically significant (p=0.0002). CONCLUSION: The study shows a greater statistical effectiveness of the strategy applied to group two compared to the strategy applied to group one (Arch Soc Esp Oftalmol 2009; 84: 549-556).

Comparación de la efectividad de dos estrategias farmacológicas para la prevención del síndrome de iris flácido intraquirúrgico / Comparison of the effectiveness of two different pharmacologic approaches to prevent intraoperative floppy iris syndrome

Objetivo: Comparar la efectividad de dos estrategiasdiseñadas para prevenir la aparición del síndromede iris flácido intraquirúrgico (IFIS) en pacientesexpuestos a α-bloqueantes.Métodos: Comparamos retrospectivamente la presenciay severidad de aparición del síndrome en 29pacientes intervenidos de cataratas, estableciendodos grupos de 12 pacientes (22 ojos) y 17 pacientes(33 ojos). La estrategia aplicada al grupo uno consistióen suspender le exposición a los α-bloqueantesun mínimo de una semana antes de la intervención,atropina tópica 1% 3 veces al día desde dosdías antes, y adrenalina intracamerular. La estrategiadel grupo dos fue la suspensión del fármaco unmínimo de una semana antes y la aplicación intracamerularal inicio de la cirugía de una solución formadapor suero fisiológico, adrenalina y lidocaína.Resultados: En el grupo uno 6 pacientes no tuvieronIFIS, 2 padecieron IFIS leve bilateral, 2 moderadobilateral y 2 severo (unilaterales); es decir, un45,5% de ojos lo padecieron. En el grupo dos, 3 ojos (9,1%) de dos pacientes lo padecieron en gradoleve. Existen diferencias estadísticamente significativasen los dos grupos (p=0,002). Si consideramosque un paciente sufre el síndrome sólo cuandotiene un grado moderado o grave, también existendiferencias significativas entre la proporción decasos con IFIS en el grupo uno con respecto al grupodos (p=0,0002).Conclusiones: El estudio demuestra la mayor efectividadestadísticamente significativa de la estrategiaaplicada en el grupo dos comparada a la aplicada al grupo uno(AU)

Objective: To compare the effectiveness of twostrategies to prevent the appearance of intraoperativefloppy iris syndrome (IFIS) in patients exposedto α-blockers.Methods: We compared retrospectively the presenceand severity of the appearance of IFIS in 29patients subjected to cataract surgery, establishingtwo groups of 12 patients (22 eyes) and 17 patients(33 eyes). The strategy applied to group one consistedof suspending the exposure to α-blockers for atleast one week prior to the intervention, the topicalapplication of 1% atropine three times a day for twodays before the intervention and the use of intracamerallidocaine. The strategy for group two consistedof suspending use of the drug for at least oneweek before the intervention and the intracameralapplication at the beginning of surgery of a solutionof physiological serum, adrenaline and lidocaine.Results: Six patients from group one showed noevidence of IFIS, 2 exhibited bilateral mildsymptoms, 2 bilateral moderate and 2 unilateral severe symptoms of IFIS. In total, 45.5% eyes sufferedfrom IFIS. In group two, only 3 eyes (9.1%)from 2 patients exhibited mild symptoms. Statisticalanalysis showed a significant difference betweenboth groups (p=0.002). If only those exhibitingmoderate and severe symptoms are taken intoaccount the result was highly statistically significant(p=0.0002).Conclusion: The study shows a greater statisticaleffectiveness of the strategy applied to group twocompared to the strategy applied to group one(AU)

[Renal hyperparathyroidism's control after subtotal parathyroidectomy]. / Control del hiperparatiroidismo renal tras paratiroidectomía subtotal.

UNLABELLED: Parathyroidectomy, in any of its forms, is considered an effective short-term treatment of renal hyperparathyroidism in patients who are not being controlled with drugs. Nevertheless, the outcome in the medium and long term of the various surgical procedures is still unclear and seems a controversial issue. We conducted a prospective study of 15 patients undergoing subtotal parathyroidectomy who were followed up for a period of 48 months after surgery. All patients were included in hemodialysis programmes. Elevated levels of parathyroid hormone which did not decrease with drug therapy recommended parathyroidectomy. The aim of our study is to determine whether subtotal parathyroidectomy is an effective technique in the medium and long term. As regards the results obtained, the levels of parathyroid hormone and calcemia remarkably decreased during the follow-up period, if compared to pre-surgery levels. The level of alkaline phosphatase also showed a reduction and the "hungry bone effect" was observed. The phosphorus and Ca-P product levels only showed a significant reduction immediately after surgery but showed an increment from the first year after surgery onwards. Hemoglobin levels did not show any alteration after parathyroidectomy. In two patients we observed a relapse of hyperparathyroidism. The anatomopathological examination revealed nodular hyperplasia in most of the cases, including the two relapses. CONCLUSION: Subtotal parathyroidectomy is an effective surgical procedure in the medium-term treatment of renal hyperparathyroidism.

Control del hiperparatiroidismo renal tras paratiroidectomía subtotal / Renal hyperparathyroidism's control after subtotal parathyroidectomy

La paratiroidectomía en cualquiera de sus modalidades se considera un tratamiento eficaz a corto plazo en el hiperparatiroidismo renal no controlado medicamente. Sin embargo, no queda claro y parece controvertido el resultado a medio- largo plazo de las diferentes técnicas quirúrgicas. Realizamos un estudio prospectivo de 15 pacientes sometidos a paratiroidectomía subtotal. El seguimiento postoperatorio fue de 48 meses. Todos los pacientes estaban en programa de hemodiálisis. La indicación de paratiroidectomía fue una hormona paratiroidea elevada a pesar de tratamiento médico. El objetivo del estudio fue determinar si la paratiroidectomía subtotal es un procedimiento eficaz a medio-largo plazo. En cuanto a los resultados obtenidos, podemos decir que la paratohormona descendió con respecto a los niveles precirugía de forma significativa durante los años de seguimiento, al igual que ocurrió con la calcemia. La Fosfatasa Alcalina también se vio afectada considerándose el «efecto del hueso hambriento». Tanto el fósforo como el producto Ca-P sólo sufren un descenso significativo en el control postcirugía elevándose a partir del primer año de la intervención. La hemoglobina no se ve afectada por la paratiroidectomía. En dos casos hubo recurrencia del hiperparatiroidismo. El resultado anatomopatológico de la mayoría de los casos fue Hiperplasia Nodular, incluidos los casos de recurrencia. Conclusión: La paratiroidectomía subtotal es una técnica quirúrgica efectiva en el tratamiento a medio plazo del hiperparatiroidismo renal

Parathyroidectomy, in any of its forms, is considered an effective short-term treatment of renal hyperparathyroidism in patients who are not being controlled with drugs. Nevertheless, the outcome in the medium and long term of the various surgical procedures is still unclear and seems a controversial issue. We conducted a prospective study of 15 patients undergoing subtotal parathyroidectomy who were followed up for a period of 48 months after surgery. All patients were included in hemodialysis programmes. Elevated levels of parathyroid hormone which did not decrease with drug therapy recommended parathyroidectomy. The aim of our study is to determine whether subtotal parathyroidectomy is an effective technique in the medium and long term. As regards the results obtained, the levels of parathyroid hormone and calcemia remarkably decreased during the follow-up period, if compared to pre-surgery levels. The level of alkaline phosphatase also showed a reduction and the «hungry bone effect» was observed. The phosphorus and Ca-P product levels only showed a significant reduction immediately after surgery but showed an increment from the first year after surgery onwards. Hemoglobin levels did not show any alteration after parathyroidectomy. In two patients we observed a relapse of hyperparathyroidism. The anatomopathological examination revealed nodular hyperplasia in most of the cases, including the two relapses

Síndrome de Cushing secundario a displasia adrenal micronodular familiar / Familial micronodular adrenal dysplasia originating Cushing's sindrome

Dos hermanas (14 y 18 años) estudiadas por hipercortisolismo en nuestro servicio en el último año presentaron datos analíticos y bioquímicos de síndrome de Cushing independiente del ACTH, aun cuando los estudios de localización realizados no pudieron poner de manifiesto un agrandamiento uni o bilateral de las glándulas adrenales. En sus antecedentes figuraba una tía materna con hallazgos "similares". La clínica de hipercortisolismo sólo fue evidente en la mayor de las hermanas, mientras que la hiperfunción adrenal fue demostrada tras un estudio de secreción espontánea en 24 h en la más pequeña. Fueron remitidas a cirugía siendo practicada en ambas una adrenalectomía bilateral. El estudio anatomopatológico reveló la presencia de múltiples nódulos entre 1 y 3 mm, de coloración oscura y atrofia perinodular confirmando la existencia de displasia micronodular pigmentaria. No se objetivaron datos de presencia de síndrome de Carney en ellas. Presentamos la clínica, los hallazgos analíticos e histológicos de nuestras pacientes afectadas de esta inusual enfermedad y una revisión de la bibliografía científica (AU)

La terapia ocupacional

La terapia ocupacional es el uso terapéutico de las actividades de cuidado, trabajo y juego para incrementar la independencia funcional, aumentar el desarrollo y prevenir la incapacidad; puede incluir la adaptación de tareas o del entorno para alcanzar la máxima independencia y para aumentar la calidad de vida. Se valora el grado de independencia, se potencian habilidades para las situaciones cotidianas y para mejorar la función general, dando importancia a las capacidades residuales. El terapeuta ocupacional utiliza actividades terapéuticas, de cuidado personal, de cuidado del hogar y recreativas para facilitar o aumentar al máximo el nivel de función del paciente. Se evalúan tanto los aspectos psicosociales como los aspectos físicos del estado del paciente en función del contexto total del tratamiento (AU)

[Effect of somatostatin-14 in simple mechanical obstruction of the small intestine]. / Action de la somastostatine-14 dans l'occlusion mécanique simple de l'intestin grêle.

In order to investigate the properties of somatostatin-14 we studied an experimental model of simple mechanical and closed loop occlusion. Forty-eight New Zealand rabbits were assigned randomly to three groups of 16: group C (controls) was operated and treated with saline solution (4 cc/Kg/h); group A was operated and initially treated with saline solution and an equal dose of somatostatin-14 (3.5 micrograms/Kg/h; and group B was operated and treated in the same manner as group A, but later, 8 hours after the laparotomy. The animals were sacrificed 24 hours later; intestinal secretion was quantified, blood and intestinal fluid chemistries were performed and specimens of the intestine were prepared for histological examination. Descriptive statistical analysis of the results was performed with the ANOVA, a semi-quantitative test and the covariance test. Somatostatin-14 produced an improvement in the volume of intestinal secretion in the treated groups compared with the control group. The results were statistically significant in group B treated after an 8-hour delay: closed loop (ml): 6.40 +/- 1.12, 2.50 +/- 0.94, 1.85 +/- 0.83 and simple mechanical occlusion (ml): 175 +/- 33.05, 89.50 +/- 9.27, 57.18 +/- 21.23, p < 0.01 for groups C, A and B C, A and B respectively. Net secretion of Cl and Na ions was also improved, p < 0.01.(ABSTRACT TRUNCATED AT 250 WORDS)

[Postoperative gastritis due to alkaline reflux. Our results]. / Gastritis postquirúrgica por reflujo alcalino. Nuestros resultados.

We present the results of a retrospective study carried out on 23 patients with alkaline gastric reflux (AGR) verified through endoscopy, biopsies and Tc99m HIDA, which were operated on in our department with Y of Roux, Braun, Henley as the correction techniques of this pathology. The criteria of surgical indications were evaluated in these patients as also the results obtained in reference to residual symptoms and changes in the histologic and gammagraphic patterns.

[IgG2 deficiency associated with recurrent pneumonia and asthma (review of an IgG subclass)]. / Déficit de IgG2 asociado a neumonías de repetición y asma. (Revisión de subclases de IgG).

Very low levels of IgG2 were detected in a 7 1/2 years old girl affected by recurrent pneumonias and atopic related disease. A similar clinical picture was present in two siblings (of 9 and 4 years old), although their of IgG subclass deficiencies is made, with special emphasis on IgG2 and their relationship with recurrent sinopulmonary infections, atopy and other immunodeficiencies.

[Angiodysplasia of the colon. Apropos of 2 cases]. / Angiodisplasia de colon. A propósito de dos observaciones.

Angiodysplasia of the colon is a vascular lesion which involves the arterioles, venules and small venous vessels; usually it is a lesion of the aged and presents with rectorrhagia, melena or chronic anemia due to chronic blood loss. We present two cases of angiodysplasia of the colon in two female patients in the eighth decade of their lives, treated in the Servicio de Cirugía del Hospital Universitario Virgen Macarena de Sevilla. We emphasize the value of the angiographic study for the diagnosis of this lesion, and also the usefulness of isotopic study with labeled erythrocytes for the localization. The treatment of choice is surgical resection of the affected area. It was performed in both patients. One of them died.

Avaliacao qualitativa do refluxo entero-gastrico com o emprego de Tc99 HIDA. / Quantitative evaluation of entero-gastric reflux with the use of Tc99 HIDA

Os autores utilizaram o Tc99 HIDA para evidenciar o refluxo entero-gastrico em 24 pacientes, seis assintomaticos e 18 submetidos previamente a cirurgia por ulceras gastroduodenais, por varias tecnicas (vagotomia troncular e piloroplastia, gastrectomia com reconstrucao e BI e BII). Nos controles nao observaram refluxo em nenhum caso. Nos pacientes previamente operados observaram refluxo em sete dos 18 pacientes estudados.Concluem que o metodo e de facil realizacao, sem morbidade na serie e de boa resolucao na evidenciacao do refluxo entero-gastrico