[Albumin dialysis MARS (Molecular Adsorbent Recirculating System) as a bridge for liver transplantation in acute liver failure. Report of three cases]. / Diálisis con albúmina MARS (Molecular Adsorbent Recirculating System) como puente para el trasplante hepático en insuficiencia hepática fulminante: presentación de 3 casos.

The most successful therapy for acute liver failure is liver transplantation. However, due to the low number of donors, organ support therapies need to be used as a bridge to liver transplantation. Molecular Adsorbents Recirculating System (MARS) is a dialysis treatment that uses a recirculating dialysate containing albumin. This allows the removal of both hydrosoluble and albumin-related substances. This system improves hepatic encephalopathy, renal dysfunction and some clinical parameters in acute liver failure, but there is no clear decrease in mortality. We report three women aged 23, 21 and 61 years, that were subjected to liver transplantation, in whom this therapy was successfully used.

[Intrarenal arterial doppler ultrasonography in cirrhotic patients with ascites, with and without hepatorenal syndrome]. / Ecotomografía Doppler arterial intrarrenal en pacientes cirróticos con ascitis, con y sin síndrome hepatorrenal.

BACKGROUND: The pathophysiological hallmark of the hepatorenal syndrome (HRS) is renal vasoconstriction. Doppler ultrasonography can be used to assess the vascular resistance in small renal intraparenchymal vessels through analysis of the Doppler waveform by a parameter termed Resistive Index (RI). We postulated that the RI could be important for the diagnosis and prognosis of HRS. AIMS: To assess the RI in cirrhotic patients with ascites, with and without HRS. PATIENTS AND METHODS: We studied 48 cirrhotics with ascites, of whom 12 were with and 36 without HRS and other 23 were normal subjects. We measured the intrarenal arterial RI (Resistive index = Peak systolic velocity - Minimum diastolic velocity/Peak systolic velocity) with color Doppler ultrasonography after visualization of interlobular or arcuate arteries. It was considered abnormal when higher than 0.70. RESULTS: The RI values, mean and SD) were: normal subjects: 0.58 +/- 0.05, cirrhotics with ascites: 0.65 +/- 0.05 and cirrhotics with ascites and HRS: 0.78 +/- 0.11. Patients with HRS had significantly higher values than those without HRS (p < 0.001). The Relative Risk of developing the HRS in patients with a RI > or = 0.70 were 3.32 (CI 95% = 1.79-6.2) CONCLUSIONS: The RI was useful in patients with cirrhosis and ascites for the prognosis of HRS and could suggest diagnosis of HRS with values of 0.78 or higher, if other clinical conditions that produce renal vasoconstriction are excluded.

Descripción de variables que inciden sobre el tiempo de hospitalización en el Hospital Psiquiátrico José Horwitz Barak / Variables description that incide upon the length of stay in the Psychiatric Hospital José Horwitz Barak

En el presente trabajo se estudia una serie de variables que podrían incidir sobre la duración de la hospitalización en Sectores de Agudo del Hospital Psiquiátrico José Horwitz Barak. Para esto se escogió una muestra de 106 pacientes egresados del hospital durante 1986, revisando sus fichas clínicas y haciendo un análisis descriptivo de las siguientes variables: datos generales, características diagnósticas, actitud familiar, personalidad premórbida, antecedentes de hospitalizaciones anteriores, tratamientos, adhesión al tratamiento post alta, rehospitalizaciones. Se observa que sólo algunas de éstas influyen en forma significativa sobre el tiempo de hospitalización y en un número importante de casos los datos requeridos no aparecen consignados en las fichas. Por último, se logra construir un perfil del tipo del paciente que excede el tiempo máximo de hospitalización normado por el servicio, que corresponde a 90 días