SBRT-SG-01: final results of a prospective multicenter study on stereotactic body radiotherapy for liver metastases.

OBJECTIVE: This study aimed to assess the efficacy and tolerability of stereotactic body radiation therapy (SBRT) for the treatment of liver metastases. METHODS: Patients with up to 5 liver metastases were enrolled in this prospective multicenter study and underwent SBRT. Efficacy outcomes included in-field local control (LC), progression-free survival (PFS), and overall survival (OS). Acute and late toxicities were evaluated using CTCAE v.4.0. RESULTS: A total of 52 patients with 105 liver metastases were treated between 2015 and 2018. The most common primary tumor was colorectal cancer (72% of cases). Liver metastases were synchronous with the primary tumor diagnosis in 24 patients (46.2%), and 21 patients (40.4%) presented with other extrahepatic oligometastases. All patients underwent intensity-modulated radiation therapy (IMRT)/volumetric-modulated arc therapy (VMAT) with image-guided radiation therapy (IGRT) and respiratory gating, and a minimum biologically effective dose (BED10Gy) of 100 Gy was delivered to all lesions. With a median follow-up of 23.1 months (range: 13.4-30.9 months) since liver SBRT, the median actuarial local progression-free survival (local-PFS) was not reached. The actuarial in-field LC rates were 84.9% and 78.4% at 24 and 48 months, respectively. The median actuarial liver-PFS and distant-PFS were 11 and 10.8 months, respectively. The actuarial median overall survival (OS) was 27.7 months from SBRT and 52.5 months from metastases diagnosis. Patients with lesion diameter ≤ 5 cm had significantly better median liver-PFS (p = 0.006) and OS (p = 0.018). No acute or late toxicities of grade ≥ 3 were observed. CONCLUSIONS: This prospective multicenter study confirms that liver SBRT is an effective alternative for the treatment of liver metastases, demonstrating high rates of local control and survival while maintaining a low toxicity profile.

Impact of Standard Versus Low Pneumoperitoneum Pressure on Peritoneal Environment in Laparoscopic Cholecystectomy. Randomized Clinical Trial.

BACKGROUND: High CO 2 pneumoperitoneum pressure during laparoscopy adversely affects the peritoneal environment. This study hypothesized that low pneumoperitoneum pressure may be linked to less peritoneal damage and possibly to better clinical outcomes. MATERIALS AND METHODS: One hundred patients undergoing scheduled laparoscopic cholecystectomy were randomized 1:1 to low or to standard pneumoperitoneum pressure. Peritoneal biopsies were performed at baseline time and 1 hour after peritoneum insufflation in all patients. The primary outcome was peritoneal remodeling biomarkers and apoptotic index. Secondary outcomes included biomarker differences at the studied times and some clinical variables such as length of hospital stay, and quality and safety issues related to the procedure. RESULTS: Peritoneal IL6 after 1 hour of surgery was significantly higher in the standard than in the low-pressure group (4.26±1.34 vs. 3.24±1.21; P =0.001). On the contrary, levels of connective tissue growth factor and plasminogen activator inhibitor-I were higher in the low-pressure group (0.89±0.61 vs. 0.61±0.84; P =0.025, and 0.74±0.89 vs. 0.24±1.15; P =0.028, respectively). Regarding apoptotic index, similar levels were found in both groups and were 44.0±10.9 and 42.5±17.8 in low and standard pressure groups, respectively. None of the secondary outcomes showed differences between the 2 groups. CONCLUSIONS: Peritoneal inflammation after laparoscopic cholecystectomy is higher when surgery is performed under standard pressure. Adhesion formation seems to be less in this group. The majority of patients undergoing surgery under low pressure were operated under optimal workspace conditions, regardless of the surgeon's expertise.

A time-efficient workflow to purify a library of alanine mutants of surface-exposed residues of the domain III of the envelope protein of dengue virus serotype 1.

Dengue complex is formed by four viral serotypes that cause the disease of the same name. Dengue is the arthropod-borne disease with the highest incidence worldwide. The envelope glycoprotein comprises three structural domains. The domain III (DIII) induces neutralizing antibodies and is involved in the interactions with soluble plasma factors from human host. Recombinant DIII proteins have been used as analytical tools for the characterization of virus-host interactions and have been evaluated as sub-unit vaccines. Here, we report a purification procedure of recombinant DIII protein and seventy-four alanine mutants refolding by size exclusion chromatography that allows obtaining highly homogeneous protein preparations and suitable for efficient purification and folding check. Four positions are identified that significantly affect either the protein expression or folding of recombinant DIIIE1, K310, G304, D330 and P332.

Fidel Pagés, el auténtico descubridor de la anestesia epidural, en el centenario de su publicación Anestesia metamérica (1921-2021) / Fidel Pagés, the true discoverer of epidural anesthesia, on the centenary of his publication Anestesia metamérica (1921-2021)

Resumen: Pocas han sido las Figuras españolas que han aportado alguna interesante novedad al mundo de la anestesia, pero ninguna tan injustamente tratada y olvidada como la de Pagés, verdadero pionero de la anestesia epidural, que él denominaría «anestesia metamérica¼ en su artículo publicado en el mes de marzo de 1921 en la Revista Española de Cirugía, fundada por él mismo. Años después, en 1931, Dogliotti, profesor de Cirugía de Módena publicó sus experiencias sobre la anestesia epidural, a la que llamó «anestesia peridural segmentaria¼, ignorando el trabajo de Pagés publicado 10 años antes. El trabajo de Dogliotti fue rápidamente reconocido, asumiendo todos los méritos de la paternidad de la técnica epidural, quedando Pagés relegado a un olvido injusto que con este trabajo tratamos de reparar. La idea central de este texto versará sobre el reconocimiento de Pagés como verdadero promotor del abordaje epidural con fines quirúrgicos. Destacar sus ideas innovadoras sobre el bienestar del paciente y la minimización de los efectos adversos de las técnicas anestésicas y quirúrgicas, así como valorar una obra que, aunque corta, bien podría incluirse entre los mejores cirujanos españoles de principio del siglo XX, un cirujano con alma de anestesiólogo.

Abstract: Few Spanish Figures have contributed any interesting novelty to the world of anesthesia. But none so unjustly treated and forgotten such as Pagés, a true pioneer of epidural anesthesia, which he would call «metameric anesthesia¼ in his article published in March 1921 in the Spanish Journal of Surgery, founded by himself. Later, in 1931, Dogliotti, Modena Professor of Surgery published his experiences on epidural anesthesia, which he called «segmental peridural anesthesia¼, ignoring Pagés work published 10 years earlier. Dogliotti's work was quickly recognized, assuming all the merits of the paternity of the epidural technique, leaving Pagés relegated to an unjust oblivion that with this work we try to repair. The central idea of this text will focus on the recognition of Pagés as a true promoter of the epidural approach for surgical purposes. Highlight his innovative ideas about patient well-being and minimizing the adverse effects of anesthetic and surgical techniques. As well as assessing a work that, although short, could well be included among the best Spanish surgeons of the early twentieth century, a surgeon with the soul of an anesthesiologist.

Preoperative clinical model to predict myocardial injury after non-cardiac surgery: a retrospective analysis from the MANAGE cohort in a Spanish hospital.

OBJECTIVES: To determine preoperative factors associated to myocardial injury after non-cardiac surgery (MINS) and to develop a prediction model of MINS. DESIGN: Retrospective analysis. SETTING: Tertiary hospital in Spain. PARTICIPANTS: Patients aged ≥45 years undergoing major non-cardiac surgery and with at least two measures of troponin levels within the first 3 days of the postoperative period. All patients were screened for the MANAGE trial. PRIMARY AND SECONDARY OUTCOME MEASURES: We used multivariable logistic regression analysis to study risk factors associated with MINS and created a score predicting the preoperative risk for MINS and a nomogram to facilitate bed-side use. We used Least Absolute Shrinkage and Selection Operator method to choose the factors included in the predictive model with MINS as dependent variable. The predictive ability of the model was evaluated. Discrimination was assessed with the area under the receiver operating characteristic curve (AUC) and calibration was visually assessed using calibration plots representing deciles of predicted probability of MINS against the observed rate in each risk group and the calibration-in-the-large (CITL) and the calibration slope. We created a nomogram to facilitate obtaining risk estimates for patients at pre-anaesthesia evaluation. RESULTS: Our cohort included 3633 patients recruited from 9 September 2014 to 17 July 2017. The incidence of MINS was 9%. Preoperative risk factors that increased the risk of MINS were age, American Status Anaesthesiology classification and vascular surgery. The predictive model showed good performance in terms of discrimination (AUC=0.720; 95% CI: 0.69 to 0.75) and calibration slope=1.043 (95% CI: 0.90 to 1.18) and CITL=0.00 (95% CI: -0.12 to 0.12). CONCLUSIONS: Our predictive model based on routinely preoperative information is highly affordable and might be a useful tool to identify moderate-high risk patients before surgery. However, external validation is needed before implementation.

A novel role for kynurenine 3-monooxygenase in mitochondrial dynamics.

The enzyme kynurenine 3-monooxygenase (KMO) operates at a critical branch-point in the kynurenine pathway (KP), the major route of tryptophan metabolism. As the KP has been implicated in the pathogenesis of several human diseases, KMO and other enzymes that control metabolic flux through the pathway are potential therapeutic targets for these disorders. While KMO is localized to the outer mitochondrial membrane in eukaryotic organisms, no mitochondrial role for KMO has been described. In this study, KMO deficient Drosophila melanogaster were investigated for mitochondrial phenotypes in vitro and in vivo. We find that a loss of function allele or RNAi knockdown of the Drosophila KMO ortholog (cinnabar) causes a range of morphological and functional alterations to mitochondria, which are independent of changes to levels of KP metabolites. Notably, cinnabar genetically interacts with the Parkinson's disease associated genes Pink1 and parkin, as well as the mitochondrial fission gene Drp1, implicating KMO in mitochondrial dynamics and mitophagy, mechanisms which govern the maintenance of a healthy mitochondrial network. Overexpression of human KMO in mammalian cells finds that KMO plays a role in the post-translational regulation of DRP1. These findings reveal a novel mitochondrial role for KMO, independent from its enzymatic role in the kynurenine pathway.

Effects of pneumoperitoneum on severe hypernatremia in an adult patient who underwent laparoscopic surgery of hydatid cysts.

We describe the first case of severe hypernatremia associated to laparoscopic surgery for hydatid cyst in an adult patient after the use of hypertonic saline solution with complete resolution. Severe hypernatremia is an unusual fact at the immediate postoperative period but may have fatal consequences for the patient and need immediate action. The patient reached a serum sodium concentration of 179 mmol/L without adverse effects after 6 days of treatment. Laparoscopy could play a crucial role in Na+ absorption due to high intraabdominal pressure caused by the pneumoperitoneum and its limitations to avoid peritoneal absorption of hypertonic saline solution. The relation between this surgical technique and the severe complication is discussed. More experience is needed in terms of safety for the patient.

Randomized double-blind comparison of remifentanil and alfentanil in patients undergoing laparoscopic cholecystectomy using total intravenous anesthesia.

BACKGROUND AND AIMS: To compare the use of remifentanil and alfentanil to suppress intraoperative adrenergic response of pain and the influence of these drugs on the recovery profile in patients undergoing laparoscopic cholecystectomy using a total intravenous anesthesia (TIVA) technique. MATERIAL AND METHODS: One hundred patients undergoing elective laparoscopic cholecystectomy were randomized to be managed with either remifentanil (group R) or alfentanil (group A). During general anesthesia, we evaluated adrenergic responses to intubation to first surgical incision and over the surgical procedure. We also recorded time to first spontaneous breathing, time to successful ventilation, time to respond to verbal orders, and time to extubation. RESULTS: The R group reported a significantly lower number of responses to intubation and responses to first surgical incision (14% vs. 30%; P = 0.013 and 8% vs. 18%; P = 0,037, respectively). The event of one or more responses during the surgical procedure was also lower in the R group (56% vs. 70%; P = 0.017). Hypertensive response to surgical stimuli during the procedure was lower in the R group as well as a lower frequency of tachycardia episodes in this group (34% vs. 56%; P = 0.033 and 28% vs. 44%; P = 0.041, respectively). No differences were found between groups relating to the percentage of hypotensive episodes and no episodes of bradycardia were appreciated. Both groups were similar relating to recovery times: time to the first spontaneous breathing, time to successful ventilation, time to respond to verbal orders, and time to extubation. CONCLUSION: Remifentanil showed a more stable hemodynamic response during the surgery compared with the use of alfentanil in anesthetized patients undergoing laparoscopic cholecystectomy using TIVA. Both opioids, alfentanil and remifentanil, have a similar recovery profile, and they do not delay time to awakening.

Role of laryngeal mask airway in laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is one of the most commonly performed surgical procedures and the laryngeal mask airway (LMA) is the most common supraglottic airway device used by the anesthesiologists to manage airway during general anesthesia. Use of LMA has some advantages when compared to endotracheal intubation, such as quick and ease of placement, a lesser requirement for neuromuscular blockade and a lower incidence of postoperative morbididy. However, the use of the LMA in laparoscopy is controversial, based on a concern about increased risk of regurgitation and pulmonary aspiration. The ability of these devices to provide optimal ventilation during laparoscopic procedures has been also questioned. The most important parameter to secure an adequate ventilation and oxygenation for the LMA under pneumoperitoneum condition is its seal pressure of airway. A good sealing pressure, not only state correct patient ventilation, but it reduces the potential risk of aspiration due to the better seal of airway. In addition, the LMAs incorporating a gastric access, permitting a safe anesthesia based on these commented points. We did a literature search to clarify if the use of LMA in preference to intubation provides inadequate ventilation or increase the risk of aspiration in patients undergoing laparoscopic cholecystectomy. We found evidence stating that LMA with drain channel achieves adequate ventilation for these procedures. Limited evidence was found to consider these devices completely safe against aspiration. However, we observed that the incidence of regurgitation and aspiration associated with the use of the LMA in laparoscopic surgery is very low.

Multiple Skeletal Deformities in a Middle-Aged Man.

A 54-year-old man was seen in our endocrinology clinic with evidence of a limited range of motion in his left foot. He had a history of diabetes mellitus type 2 and atrial fibrillation. His family history included evidence of skeletal deformities in some of his relatives. This could imply the potential existence of a hereditary condition. It is worth noting that spontaneous mutations have been reported in some cases. A pertinent physical examination revealed a surgical scar on the patient's left knee, a hallux valgus deformity on his left foot with compromised joint function, and painless bony prominences on that same foot. The skeletal survey findings were consistent with multiple hereditary exostoses. Multiple osteochondromatosis (MO) is a rare genetic disorder associated with serious complications that may significantly affect the health related quality of life of anyone having the disorder. To prevent further complications, these patients require long-term follow-up with regular clinical and radiological examinations.

Laryngeal mask, laryngeal tube, and Frova introducer in simulated difficult airway.

BACKGROUND: The use of supraglottic devices is rising in the prehospital management of difficult airway; moreover, we think that patients with multiple trauma or cervical instability can take advantage of these devices without opening or retiring the cervical collar. OBJECTIVE: To compare speed and ease of use between Laryngeal Tube S (LTS) and the Ambu AuraOnce laryngeal mask (LMA).Our second objective was to evaluate changing these devices to an endotracheal tube (ETT) using a Frova introducer. METHODS: We studied the use of LTS and LMA in an experimental model, represented by a manikin with a rigid cervical collar and a limited mouth opening. This study was carried out in Complutense University of Madrid with 145 2(nd)-year students for the degree in Dentistry who have knowledge of the airway but lack experience in intubation. Number of attempts and time for the device's insertion were measured, as well as time for the exchange maneuver using the Frova introducer. RESULTS: Insertion of all devices was possible on the first attempt; time for insertion was LTS 12.2 ± 1.28 s and LMA 6.87 ± 0.97 s. Once these devices were inserted, a Frova introducer is used to perform an exchange by an endotracheal tube; all devices could be exchanged on the first attempt, and exchange time was LTS 26.9 ± 1.2 s and LMA 16.79 ± 1.32 s. Results for both time for insertion and exchange of the LMA were significantly lower than those for the LTS (p < 0.001). CONCLUSION: The method used can be considered quick and easy, even for personnel inexperienced in intubation. This exchange maneuver has not been described previously, so we can consider it as a new application of the Frova introducer.

Generalized eruptive histiocytoma: a rare disease in an elderly patient.

Generalized eruptive histiocytoma is considered an extremely rare subtype of non-Langerhans cells histiocytosis. In the literature, there are few reports of this disease that mainly affects adults. In this report, we present a case of generalized eruptive histiocytoma in an elderly patient who had presented symptoms for over two months. Multiple erythematous papules, asymptomatic and symmetrically distributed were observed on the trunk and limbs. Histological examination showed a dense mononuclear cell dermal infiltrate. In the immunohistochemical analysis, the cells were CD68 positive, but CD1a, S100 and CD34 negative. A diagnosis of generalized eruptive histiocytoma was established. The aim of our paper is to report a case of a very rare disease, whose subtype and affected age group are even more unusual.

Diferente adaptación sensorio-motora a nuevas dentaduras, entre no portadores y portadores de dentaduras completas / Varied sensory-motor adaptation to new dentures among full denture wearers and non wearers

La pérdida de las piezas dentarias provoca cambios importantes en la actividad sensorio-motora de los pacientes que la sufren, cambios que a su vez pueden afectarse al colocar una dentadura completa (DC) y todos en conjunto pueden alterar el proceso de la masticación a tal grado que se afecten condiciones generales de salud como, por ejemplo, una adecuada alimentación, por lo que ha sido importante estudiar la respuesta de los músculos masticatorios ante la colocación de una DC y además comparar entre aquellos pacientes que previamente han usado DC y aquellos que la utilizan por vez primera, considerando que pudiera existir un estado funcional diferente. Para ello se hicieron registros electromiográficos (EMG) en los músculos maseteros de 29 pacientes, antes (1ª sesión), a los 8 y 30 días (2ª y 3ª sesión respectivamente) de la colocación de la DC. Formando dos grupos: el grupo 1 (G1) (n = 15; 12 ♀ , 5 ♂ , edad promedio 67.2 años) aquellos que previamente estaban usando ya una DC y el grupo 2 (G2) (n = 12; 8 ♀ , 4 ♂ , edad promedio 66.5 años) los que nunca antes la habían usado. Los resultados indican que existe una diferencia funcional entre los músculos de aquellos pacientes que previamente han usado una DC con respecto a la de los músculos de los pacientes que no han usado antes DC. Se registró menor amplitud EMG en la 1ª sesión en el G1 con respecto al G2 y una menor capacidad de generar los ciclos masticatorios, ello podría influir, también a largo plazo, en una disminución de la capacidad masticatoria y en la calidad de vida de los pacientes. Es necesario continuar este tipo de estudios tanto para corroborar los resultados reportados en el presente trabajo como para que, en su caso, se implementen medidas que coadyuven a una mejor adaptación a la DC.

Teeth loss elicits significant changes in the sensory-motor activity of patients thus afflicted. These changes can in turn be affected upon placement of a full denture (FD). Overall changes can alter mastication processes, to the point of affecting the patient's general state of health, as would be the case when impinging on proper feeding. This shows the importance of studying masticatory muscles response to the placement of a full denture. It is as well opportune to compare patients who have previously worn dentures with new denture wearers, since it must be borne in mind they could present different functional states. To this end, electromyographic records (EMR) were conducted in masseter muscles of 29 patients before (1st session) at 8 and 30 days (2nd and 3rd session) of FD placement. Two groups were tailored: Group 1 (G1) (n = 15, 12 ♀, 5 ♂, average age 67.2 years) those who had previously worn a full denture, and group 2 (G2), (n =12, 8 ♀, 4 ♂, average age 66.5 years) comprising individuals who had never before worn a full denture. Results indicated there was functional difference among muscles of patients having previously worn FD when compared to muscles of patients who had never worn a FD. Lesser EMG amplitude was found in G1 when compared to G2 in the first session as well as lesser ability to generate masticatory cycles. In the long run, this could also bear upon masticatory ability decrease and patients quality of life. It is necessary to continue this type of studies to substantiate recorded results of the present study, as well as to implement measures geared at contributing to improved FD adaptation.

Comparison of Laryngeal Mask Airway Supreme and Laryngeal Mask Airway Proseal with respect to oropharyngeal leak pressure during laparoscopic cholecystectomy: a randomised controlled trial.

CONTEXT: A comparison of the efficacy and safety of the Laryngeal Mask Airway (LMA) Supreme (LMAS) versus the LMA Proseal (LMAP) in elective laparoscopic cholecystectomy. OBJECTIVES: To compare the LMAS with LMAP in terms of ventilatory efficacy, airway leak pressure (airway protection), ease-of-use and complications. DESIGN: Prospective, single-blind, randomised, controlled study. SETTING: The Hospital del Sureste and Hospital Ramon y Cajal, Madrid, between May 2009 and March 2011. The Hospital del Sureste is a secondary hospital and Hospital Ramon y Cajal is a tertiary hospital. PATIENTS: Patients undergoing elective laparoscopic cholecystectomy were studied following informed consent. Inclusion criteria were American Society of Anesthesiologists physical status I to III and age 18 or more. Exclusion criteria were BMI more than 40 kg m, symptomatic hiatus hernia or severe gastro-oesophageal reflux. INTERVENTIONS: Anaesthesiologists experienced in the use of LMAP and LMAS participated in the trial. One hundred twenty-two patients were randomly allocated to LMAS or LMAP. MAIN OUTCOME MEASURES: Our primary outcome measure was the oropharyngeal leak pressure (OLP). Secondary outcomes were the time and number of attempts for insertion, ease of insertion of the drain tube, adequacy of ventilation and the incidence of complication. Patients were interviewed postoperatively to evaluate the presence of sore throat, dysphagia or dysphonia. RESULTS: Two patients were excluded when surgery changed from laparoscopic to open. A total of 120 patients were finally included in the analysis. The mean OLP in the LMAP group was significantly higher than that in the LMAS group (30.7 ±â€Š6.2 versus 26.8 ±â€Š4.1 cmH2O;P < 0.01). This was consistent with a higher maximum tidal volume achieved with the LMAP compared to the LMAS (511 ±â€Š68 versus 475 ±â€Š55 ml; P = 0.04). The success rate of the first attempt insertion was higher for the LMAS group than the LMAP group (96.7 and 71.2%, respectively; P < 0.01). The time taken for insertion, ease of insertion of the drain tube, complications and postoperative pharyngolaryngeal adverse events were similar in both groups. CONCLUSION: The LMAP has a higher OLP and achieves a higher maximum tidal volume compared to the LMAS, in patients undergoing elective laparoscopic cholecystectomy. The success of the first attempt insertion was higher for the LMAS.

The Laryngeal Mask Airway Supreme for positive pressure ventilation during laparoscopic cholecystectomy.

STUDY OBJECTIVE: To evaluate the Laryngeal Mask Airway Supreme (SLMA) in patients undergoing laparoscopic cholecystectomy. DESIGN: Prospective observational study. SETTING: University-affiliated hospital. PATIENTS: 100 ASA physical status 1, 2, and 3 adult patients undergoing laparoscopic cholecystectomy with general anesthesia. INTERVENTIONS: The SLMA was inserted in all study patients. Patients were placed in the reverse Trendelenburg position. MEASUREMENTS: Ease of insertion of the device and the drain tube, oropharyngeal leak pressure, frequency of postoperative sore throat, and other adverse events were recorded. The surgeon scored stomach size on an ordinal scale of 0-10 at insertion of the laparoscope and before decompression of the pneumoperitoneum. MAIN RESULTS: Insertion of the SLMA was successful in all patients (91 pts on the first attempt, 9 pts on the second attempt). Gastric tube insertion was successful in all patients (easy in 97 pts, difficult in 3 pts). Initial mechanical ventilation was adequate in all cases. Mean oropharyngeal leak pressure at the 60 cm H(2)O cuff pressure level was 28.8 cm H(2)O (±5.2; range 18-40 cm H(2)O). Mean airway pressure before pneumoperitoneum was 17.5 cm H(2)O (±3.3; cm; range 11-26 cm H(2)O) and 22.9 cm H(2)O (±4 cm; range 16-32 cm H(2)O) after pneumoperitoneum. Median (range) stomach size on insertion of the laparoscope and change in stomach size during surgery did not interfere with the procedure in any patient. Twelve patients (12%) complained of a mild sore throat postoperatively. No other complications were reported. CONCLUSIONS: The SLMA is easy to insert and it is an effective ventilatory device for laparoscopic cholecystectomy.

Bronchial compression due to stent placement in pulmonary artery in a child with congenital heart disease.

Congenital heart disease, such as transposition of the great vessels (TGV), requires surgical procedures which can lead to important complications. We report on a case of bronchial obstruction following placement of a pulmonary artery stent in a 4-year-old boy who had undergone a Rastelli procedure to correct TGV, ventricular septal defect and pulmonary stenosis. There are many complications that can arise as a consequence of intravascular stents in heart surgery, as well as many causes of bronchial compression. However we have not found any report which describes bronchial compression as a direct consequence of endovascular stent.

Síndrome metabólico en mujeres obesas: evaluación de biomarcadores de resistencia insulínica y lipoproteicos / Metabolic syndrome in obese women: evaluation of insulin resistance and lipoprotein biomarkers

El síndrome metabólico (SM) es un importante factor de riesgo aterogénico. Las mujeres, antes de la menopausia, presentan menor riesgo de padecer enfermedad cardiovascular que los hombres. Sin embargo, la presencia de obesidad se correlaciona con un aumento de dicho riesgo. Los objetivos del presente trabajo fueron determinar la frecuencia del SM en un grupo de mujeres obesas y evaluar la sensibilidad diagnóstica de distintas variables asociadas al SM. Se estudiaron 123 mujeres obesas (índice de masa corporal 30 Kg/m²). Se evaluaron índices antropométricos, presión arterial, indicadores del metabolismo de hidratos de carbono, niveles de fibrinógeno, ácido úrico, lípidos y lipoproteínas. En esta población, la frecuencia relativa del SM fue 40,7 por ciento, considerablemente superior a lo informado para la población femenina general. La presencia del SM se asoció con resistencia insulínica, hipertensión arterial, hiperuricemia, modificaciones del metabolismo de los hidratos de carbono y un perfil lipoproteico aterogénico que consistía en alteraciones de las lipoproteínas ricas en triglicéridos y las lipoproteínas de alta densidad (HDL). El valor de corte hallado para el modelo del registro homeostático (HOMA) fue 3,1. Este índice, junto con la presión arterial sistólica, los niveles plasmáticos de triglicéridos y el índice triglicéridos/colesterol-HDL resultaron ser los predictores más sensibles de la presencia del SM

Síndrome metabólico en mujeres obesas: evaluación de biomarcadores de resistencia insulínica y lipoproteicos / Metabolic syndrome in obese women: evaluation of insulin resistance and lipoprotein biomarkers

El síndrome metabólico (SM) es un importante factor de riesgo aterogénico. Las mujeres, antes de la menopausia, presentan menor riesgo de padecer enfermedad cardiovascular que los hombres. Sin embargo, la presencia de obesidad se correlaciona con un aumento de dicho riesgo. Los objetivos del presente trabajo fueron determinar la frecuencia del SM en un grupo de mujeres obesas y evaluar la sensibilidad diagnóstica de distintas variables asociadas al SM. Se estudiaron 123 mujeres obesas (índice de masa corporal 30 Kg/m²). Se evaluaron índices antropométricos, presión arterial, indicadores del metabolismo de hidratos de carbono, niveles de fibrinógeno, ácido úrico, lípidos y lipoproteínas. En esta población, la frecuencia relativa del SM fue 40,7 por ciento, considerablemente superior a lo informado para la población femenina general. La presencia del SM se asoció con resistencia insulínica, hipertensión arterial, hiperuricemia, modificaciones del metabolismo de los hidratos de carbono y un perfil lipoproteico aterogénico que consistía en alteraciones de las lipoproteínas ricas en triglicéridos y las lipoproteínas de alta densidad (HDL). El valor de corte hallado para el modelo del registro homeostático (HOMA) fue 3,1. Este índice, junto con la presión arterial sistólica, los niveles plasmáticos de triglicéridos y el índice triglicéridos/colesterol-HDL resultaron ser los predictores más sensibles de la presencia del SM (AU)