RESUMEN
Intensive abalone farming--specifically of the red abalone (Haliotis rufescens) and the green (or Japanese) abalone (Haliotis discus hannai)--has expanded rapidly in Chile since the late 1990s, and this article presents an overview of the challenges facing the industry and the factors which favour its development. At present, 100% of Chile's abalone enterprises farm the H. rufescens species, owing to its suitability for full-cycle culture. In the analysis of factors that facilitate the development of abalone farming in Chile, those that stand out include the characteristics of the aquatic ecosystem, existing entrepreneurial and professional skills, decisive government support in co-financing scientific and technological projects, infrastructure and associated services to support these development initiatives and a market where prices have remained stable and demand for abalone products has been steady. The greatest challenges facing intensive abalone farming in Chile are providing a constant supply of macroalgae for abalone feed and developing complementary feed, as well as updating current legislation on intensive abalone farming, strengthening producer associations and establishing health certification. The article discusses examples of the impact that native organisms can have on animals introduced into an aquatic ecosystem and the international transmission of agents such as withering syndrome and sabellid polychaete infestation disease, associated with the movement of abalone seeds and broodstock. The article also emphasises the importance of implementing the recommendations of the World Organisation for Animal Health.
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Bienestar del Animal , Acuicultura/organización & administración , Moluscos/fisiología , Alimentación Animal/normas , Fenómenos Fisiológicos Nutricionales de los Animales , Animales , Acuicultura/normas , Chile , Moluscos/crecimiento & desarrollo , Moluscos/microbiología , Mariscos/normasRESUMEN
The interictal hypometabolism in patients with focal epilepsy is usually regarded as stationary. In this study we investigated to which extent the hypometabolism may depend on the activity of the epileptic focus. In focal penicillin-induced epilepsy in rats the epileptic focus is hypermetabolic. This focus is accompanied by hypometabolism in widespread areas of adjacent cerebral cortex. The experiments revealed that these metabolic alterations are transient. Data from a patient experiencing a focal seizure during PET scanning gave similar results. They showed that the transition from interictal to ictal activity was accompanied by the development of hypermetabolic epileptic focus and the dynamic enlargement of the surrounding hypometabolism. Both, the experimental and clinical data provide evidence that the cerebral hypometabolism may vary in size depending on the activity of the epileptic focus. It is hypothesized that in human PET studies the large interictal hypometabolism may prevent the identification of hyperactive interictal epileptic foci due to the partial volume effects resulting from the limited spatial resolution of PET cameras.
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Corteza Cerebral/metabolismo , Epilepsias Parciales/metabolismo , Animales , Autorradiografía , Desoxiglucosa/análogos & derivados , Electroencefalografía , Femenino , Fluorodesoxiglucosa F18 , Glucosa/metabolismo , Humanos , Procesamiento de Imagen Asistido por Computador , Lactante , Imagen por Resonancia Magnética , Masculino , Penicilinas , Ratas , Ratas Wistar , Tomografía Computarizada de EmisiónRESUMEN
Postmortem concentrations of phenytoin (PHT) and phenobarbital (PB) were determined in 24 specimens of the frontal, temporal, occipital or neocerebellar cortex with different pathological changes and in the serum (total and free) from 11 epileptic patients. The cortical lesions were characterized by various degrees of neuronal loss or necrosis associated with other changes such as proliferated gliocytes, fibre gliosis, Rosenthal fibres or numerous corpora amylacea. According to other investigators neurons are the main binding sites of PHT and PB in rodent brains. The PHT and PB concentrations in 20 cortical lesions from nine patients were not significantly reduced as compared to the data of 46 deceased epileptic control patients. A significantly decreased PB value could only be demonstrated in the temporal specimen of an old scarred infarction with complete demyelination. On the other hand a slight but significant increase of PB was observed in three neocortical samples from a child exhibiting severe brain oedema and thrombosis of the sinuses. The results favour the unspecific binding of PHT and PB to cerebral tissue constituents and do not support the hypothesis of major binding to specific receptors.
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Cerebelo/metabolismo , Corteza Cerebral/metabolismo , Epilepsia/metabolismo , Fenobarbital/metabolismo , Fenitoína/metabolismo , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Cerebelo/patología , Preescolar , Epilepsia/patología , Femenino , Humanos , Lactante , Modelos Lineales , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Intrahepatic extraductal biliary collections are a rare complication of abdominal trauma. OBJECTIVE: To describe two patients with diagnosis of posttraumatic intrahepatic extraductal biliary collections. CASE REPORT: Two male patients suffered multiple severe injuries, one of them from blunt trauma and the other from penetrating trauma; their main clinical manifestations were fever and jaundice. CT scan was the best suited diagnostic tool for evidencing the intrahepatic collections. Both patients underwent surgical drainage, only one of them had a satisfactory evolution. CONCLUSIONS: Posttraumatic intrahepatic extraductal biliary collections are a rare complication of abdominal trauma, its presence should be suspected in patients with hepatic trauma showing jaundice, fever and/or right upper quadrant pain between the second and sixth week following abdominal trauma.
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Bilis , Sistema Biliar/lesiones , Hígado/lesiones , Heridas no Penetrantes , Heridas Penetrantes , Adulto , Sistema Biliar/diagnóstico por imagen , Colangiopancreatografia Retrógrada Endoscópica , Drenaje , Humanos , Hígado/diagnóstico por imagen , Masculino , Radiografía Abdominal , Tomografía Computarizada por Rayos XRESUMEN
Postoperative acute urinary retention was evaluated in the patients who underwent Pereyra procedure. Comparison of suprapubic and urethral catheterization. Between January 1994 and July 1995, fifty two patients with urinary stress incontinence underwent Pereyra procedure, 31 female patient with suprapubic drainage (cistofix Ch 15) and 17 urethral catherization with a latex foley catheter. Sponatneous micturition and urinary retention was evaluated until the catheter was removed. Mean age was 43.8 years (32 a 66), the duration of suprapubic vesical drainage with suprapubic catheter were 3 days in 58.6% of the patients, and more than 3 days in 41.29%. Recatheterizacion in the patients with urethral drainage was more frequent. Urinary retention after 7 days was present in 23.99% with suprapubic vesical drainage and 28.5% with urethral catheter. Recatheterization is more frequent in patients with urethral catheter.
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Drenaje/métodos , Complicaciones Posoperatorias/prevención & control , Incontinencia Urinaria/cirugía , Retención Urinaria/prevención & control , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
A case of thoracic diastematomyelia associated with acute disc herniation is reported. The female patient noted sensory and motor symptoms at 49 years of age, four months before hospitalization. Myelography, myelo-computerized tomography and nuclear resonance tomography of the thoracic spine and cord showed the region of diastematomyelia with an additional disc herniation at T 6/7. The bone spur and the disc was successfully excised. Post-operatively, the patient's deficits improved.
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Desplazamiento del Disco Intervertebral/complicaciones , Defectos del Tubo Neural/complicaciones , Femenino , Humanos , Desplazamiento del Disco Intervertebral/diagnóstico , Desplazamiento del Disco Intervertebral/cirugía , Imagen por Resonancia Magnética , Persona de Mediana Edad , Defectos del Tubo Neural/diagnóstico , Defectos del Tubo Neural/cirugíaRESUMEN
Postmortem concentrations of phenobarbital (PB), carbamazepine (CBZ), and its metabolite carbamazepine-10,11-epoxide (CE) were determined by high-performance liquid chromatography in the serum (total and free) and in specified areas of the brain (frontal, temporal, occipital cortex, and white matter, as well as cerebellum) of 51 deceased epileptic patients. The concentrations of PB and CBZ in the frontal cortex were approximately 1.4 times higher, and of CE were 1.1 times higher than the total concentrations in the serum. Furthermore, the concentrations of PB in the frontal cortex were approximately 2.1 times, of CBZ were 4.5 times, and of CE were 2.1 times higher than the free concentrations in the serum. The distribution of the three substances in the brain is rather homogeneous and seems to follow basic physicochemical principles. This means that the concentrations of the substances in the white matter are, depending on their lipophilicity, modestly but significantly higher than in the cortex. Small and in part statistically significant concentration differences between different regions of the cortex and also of the white matter may be explained by differences in the lipid content of the respective regions and by the lipophilicity of the respective substance. The concentrations in the cerebellar hemisphere (neocerebellum) were nearly identical to those in the frontal cortex. Remarkably increased or decreased concentrations were not observed in any region of the brain.
Asunto(s)
Química Encefálica , Carbamazepina/análogos & derivados , Carbamazepina/análisis , Epilepsia/metabolismo , Fenobarbital/análisis , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Autopsia , Carbamazepina/sangre , Niño , Preescolar , Epilepsia/patología , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Fenobarbital/sangre , Distribución TisularRESUMEN
Postmortem concentrations of phenytoin (PHT) were determined by high-performance liquid chromatography in the serum (total and free) and in specified areas of the brain (frontal, temporal, occipital cortex and white matter, as well as cerebellum) of 18 epileptic patients who died following chronic diseases (group A) and of six otherwise healthy epileptic patients who died suddenly and unexpectedly (group B). The free concentrations in the serum correlated considerably better (r = 0.987) than the total concentrations in the serum (r = 0.871) with the concentrations in the frontal cortex. The concentrations in the frontal cortex were about nine times that of the free serum concentrations. The data show that the PHT concentrations in the frontal, temporal and occipital cortex largely agree. The concentrations in the white matter were significantly higher (frontal region 54%, temporal region 30%, occipital region 36%) than in the cortex. The concentrations in the cerebellar hemisphere (neocerebellum) were nearly identical with those in the frontal cortex. Regression analysis showed that on comparable total serum concentration the patients of group A had significantly higher free serum concentrations and significantly higher concentrations in the frontal cortex than the patients of group B. In respect of the concentration ratios cortex to serum free and in regard of the local distribution of PHT in the brain no difference, however, was found between those patients who died from chronic diseases and those who died suddenly.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Encéfalo/metabolismo , Epilepsia/metabolismo , Fenitoína/farmacocinética , Adulto , Anciano , Anciano de 80 o más Años , Cromatografía Líquida de Alta Presión , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fenitoína/sangre , Análisis de RegresiónRESUMEN
The free fraction of antiepileptic drugs can, in certain diseases, be greatly increased in the serum. In order to study the significance of this increase for the concentration in the brain, the postmortem concentrations of phenytoin (PT), phenobarbital (PB), carbamazepine (CBZ), and its metabolite carbamazepine-10,11-epoxide (CE) in the serum (total and free), as well as in specimens of the frontal cortex of 45 epileptic patients who died from various causes, were determined. The postmortem free fractions were higher than reported in the literature and varied considerably from subject to subject. For PT the free fraction was 21.7% (median), for PB 68.0%, for CBZ 33.4%, and for its metabolite CE 53.6%. The values for a control group of 236 otherwise healthy epileptic patients were in agreement with those given in the literature, namely 10.4% for PT, 55.6% for PB, 20.9% for CBZ, and 42.5% for CE. Using a nonparametric correlation coefficient (Kendall T), the concentrations in the frontal cortex of the autopsied patients correlated with the postmortem free serum concentrations, especially for the substances with high protein binding (PT and CBZ), better (PT r = 0.88, PB r = 0.86, CBZ r = 0.87, CE r = 0.79) than with the total concentrations (PT r = 0.69, PB r = 0.80, CBZ r = 0.77, CE r = 0.77). The study indicates that in critically ill patients the determination of the free concentration in serum is indispensable. If treatment is orientated solely on the total concentration, unexpectedly high concentrations in the brain and hence possible intoxication of the patient in the critical or final state can result.
Asunto(s)
Anticonvulsivantes/metabolismo , Proteínas Sanguíneas/metabolismo , Encéfalo/metabolismo , Epilepsia/metabolismo , Anticonvulsivantes/sangre , Encéfalo/patología , Carbamazepina/análogos & derivados , Carbamazepina/sangre , Carbamazepina/metabolismo , Epilepsia/sangre , Epilepsia/patología , Femenino , Humanos , Masculino , Fenobarbital/sangre , Fenobarbital/metabolismo , Fenitoína/sangre , Fenitoína/metabolismo , Unión Proteica , Ácido Valproico/metabolismoRESUMEN
A 75-year old patient was admitted to hospital in June 1989. She was suffering from headache since three months. In the neurological examination a mild hemiparesis on the left side, personal changes and apractic disturbances could be found. 10 years before a granulosa-cell tumour of the left ovary was extirpated, postoperatively the patient received radiation and polychemotherapy. CT-scan and MRI of the head showed a tumour parieto-occipital on the right hemisphere with multiple cystic and solid areas. The tumour was extirpated in toto. The postoperative course was uneventful. Primary tumour of the left ovary and intracranial metastasis showed the same histological findings.
Asunto(s)
Neoplasias Encefálicas/secundario , Tumor de Células de la Granulosa/secundario , Lóbulo Occipital , Neoplasias Ováricas/cirugía , Lóbulo Parietal , Anciano , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/cirugía , Femenino , Estudios de Seguimiento , Tumor de Células de la Granulosa/patología , Tumor de Células de la Granulosa/cirugía , Humanos , Imagen por Resonancia Magnética , Lóbulo Occipital/patología , Lóbulo Occipital/cirugía , Neoplasias Ováricas/patología , Ovario/patología , Lóbulo Parietal/patología , Lóbulo Parietal/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Los schwannomas del nervio facial son lesiones benignas originadas de las células de Schwann, de crecimiento lento y predecible, generalmente asintomáticas. Sólo el 9 por ciento de los casos se ubica en la porción intraparotídea del nervio facial, lo cual obliga al diagnóstico diferencial con otros tumores parotídeos. Reportamos un caso de schwannoma del nervio facial izquierdo de ubicación intraparotídea, el cual fue confirmado mediante estimulación eléctrica intraoperatoria y resecado con intención conservadora del nervio facial. Además, se revisa la literatura actual sobre el tema.
Facial nerve Schwannomas are benign tumors that originate from Schwann cells, with a slow and predictable growth, and that are generally asymptomatic. Only 9 percent of these tumors are located in the intraparotid segment of the facial nerve. We report a 26 years old female presenting with a mass in the left parotid region lasting four months. The patient was subjected to a parotidectomy. During surgery, an encapsulated tumor whose origin was in the seventh cranial nerve and associated to a lymph node was found. The tumor was excised, trying to preserve the integrity of the nerve. The pathological diagnosis of the surgical piece disclosed a benign Schwannoma. The patient had a facial paralysis in the postoperative period.
Asunto(s)
Humanos , Adulto , Femenino , Nervio Facial , Neoplasias de los Nervios Craneales/cirugía , Neoplasias de los Nervios Craneales/diagnóstico , Neurilemoma/cirugía , Neurilemoma/diagnóstico , Glándula Parótida , Diagnóstico Diferencial , Resultado del TratamientoRESUMEN
Antecedentes: La fisura labiopalatina (FLP) es la malformación facial más común, afectando a 1,8/1000 nacimientos. En sus inicios, la ultrasonografía 2D (US2D) diagnosticaba FLP en 5,3 por ciento de los casos, siendo actualmente el 71,5-95 por ciento. Se ha reportado la utilidad de la ultrasonografía 3D (US3D) y del doppler color (DC) para evaluar el compromiso palatino. Objetivo: Reportar la utilidad de US3D y del DC en el estudio de FLP durante el control fetal prenatal. Pacientes: Estudio de serie de casos de labio leporino pesquisados prenatalmente por US2D, que concurrieron a ecografía rutinaria del segundo trimestre del embarazo a la Clínica de la Mujer de Viña del Mar, entre enero de 1997 y abril de 2009. A todos se les realizó US3D por un operador. Se realizó consejo genético, apoyo psicológico y educación prenatal. Resultados: Se detectaron 7 casos de fetos con labio leporino, siendo confirmados al nacer. Uno presentó compromiso palatino. En un caso se realizó imagen DC, que permitió descartar la presencia de compromiso palatino, lo cual se correspondió con la US3D, siendo comprobado al nacimiento. Conclusión: La US3D permite estudiar la región facial, complementando la US2D en la observación del defecto labial y compromiso palatino. La detección prenatal de FLP disminuye el impacto psicológico que provoca en los padres.
Background: The cleft of lip and palate (CLP) are the commonest facial malformation, which affects 1.8/1000 births. In the beginning, CLP was detected in 5.3 percent by 2D ultrasonography (2DUS). This value had increased to 71.5-95 percent. 3D ultrasonography (3DUS) and color doppler (CD) utility had been reported to evaluate palate integrity. Objective: To report the utility of 3DUS and DC in CLP detection during prenatal evaluation. Patients: A case series study was conducted with review of prenatal screening CLP cases by 2DUS which perform routine second trimester ultrasonography in Clínica de la Mujer, Viña del Mar, between January 1997 and April 2009. All 3DUS were performed by one observer. Genetic counseling, psychology support and prenatal education were realized in all cases. Results: Seven cleft labial were detected, which was confirmed at birth. In one case was detected cleft palate. In one case, cleft palate was excluded with CD, which was supported by 3DUS. This finding was confirmed at birth. Conclusion: The 3DUS complements 2DUS in facial, labial and palate evaluation. The prenatal diagnosis decreases psychological impact in parents.
Asunto(s)
Humanos , Fisura del Paladar , Labio Leporino , Ultrasonografía Prenatal/métodos , Imagenología Tridimensional , Ultrasonografía Doppler en ColorRESUMEN
Background: Anaplastic Thyroid Carcinoma corresponds 2 to 5 percent of all thyroid cancers. It affects mainly women in the sixth or seventh decade of life, appearing as a hard, fast growing cervical mass that is adhered to surrounding structures. Treatment includes surgery, chemotherapy and radiotherapy. Aim: to report a series of patients with anaplastic thyroid carcinoma. Patients and Methods: Review of medical records of patients with anaplastic thyroid cancer operated between 2002 and 2008. Results: The records of six patients aged 46 to 82 years (four males), were retrieved. A bilateral total thyroidectomy was performed in four patients. Two patients required tracheostomy during the postoperative period. Mean hospital stay was six days. None received neoadjuvant or adjuvant radio-chemotherapy. Three patients died within one month of the operation. The rest died at 115, 184 and 283 days after surgery. Conclusions: All these patients were diagnosed in advanced stages of the disease, a fact that can explain the dismal evolution observed.
Introducción: El Cáncer Anaplásico de Tiroides corresponde al 2 a 5 por ciento del total de cánceres tiroideos. Afecta a mujeres en la sexta o séptima década de la vida, presentándose como masa cervical pétrea de crecimiento rápido, adherida a planos profundos. El tratamiento incluye cirugía, quimioterapia y radioterapia, siendo de elección el tratamiento multimodal. Objetivo: Conocer los resultados de una serie de casos manejados quirúrgicamente en el Hospital Dr. Gustavo Fricke de Viña del Mar. Pacientes y Método: Estudio de serie de casos de Cáncer Anaplásico de Tiroides tratados exclusivamente con cirugía entre los años 2002 y 2008. Se registraron características generales, técnica operatoria, complicaciones, uso de otras terapias y sobrevida. Resultados: Se manejaron 6 pacientes, cuatro hombres y dos mujeres. El promedio de edad fue de 59 años. La estadía hospitalaria promedio fue de 6 días. Se realizó tiroidectomía total bilateral en 4 pacientes. Dos pacientes requirieron traqueostomía durante el postoperatorio. En ninguno de ellos se realizó radioquimioterapia neoadyuvante o adyuvante. La sobrevida promedio fue de 108 días. Discusión: Destaca en esta serie el diagnóstico en etapas avanzadas de la enfermedad, lo cual determina la imposibilidad de realizar terapia multimodal y la sobrevida observada. Por lo anterior, es de importancia la sospecha y la derivación inmediata para el manejo especializado, aumentando así la posibilidad del uso de terapia multimodal con mejores resultados en términos de sobrevida. Se observó una sobrevida menor a la reportada en la literatura.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano de 80 o más Años , Carcinoma/cirugía , Neoplasias de la Tiroides/cirugía , Neoplasias de la Tiroides/mortalidad , Análisis de Supervivencia , TiroidectomíaRESUMEN
INTRODUCCIÓN: La obstrucción arterial aguda (OAA) de extremidades es un cuadro grave, con una mortalidad cercana al 20 por ciento, por lo que requiere un diagnostico etiológico y manejo oportuno. El objetivo del presente estudio fue analizar sobrevida y variables clínicas según etiología. MATERIAL Y MÉTODO: Estudio observacional analítico de casos de OAA no traumáticos atendidos entre años 2003 y 2007 en el Hospital Dr. Gustavo Fricke, con seguimiento vía registro civil y telefónico para obtener datos actualizados. RESULTADOS: Hubo 65 episodios de OAA en 60 pacientes durante el período. Se registraron 42 embolías (64,6 por ciento), 17 trombosis (26,1 por ciento), y 6 trombosis de by pass (9,2 por ciento). Se apreciaron diferencias significativas en edad (p=0,031) y género (p=0,033). El tabaquismo presentó un LR(+) de 2,61 y claudicación intermitente LR(+) 6,67para predecir etiología trombótica. El antecedente de accidente cerebrovascular presentó un LR(+) 4,65, el de arritmia LR(+) 12,05 y el de insuficiencia cardíaca LR(+) 8,76 para predecir etiología embólica. La sobrevida libre de amputación a 6 meses fue 90 por ciento. La sobrevida a 5 años fue 54,2 por ciento, siendo 37,8 por ciento en el grupo con embolía y 81,8 por ciento en el con trombosis (p<0,001). Pacientes con OAAde etiología embólica tenían un OR de 5,42 (IC95 por ciento 1,53-19,12) de fallecer comparados con pacientes con etiología trombótica. DISCUSIÓN: Las variables clínicas analizadas se comportarían como factores predictores de la etiologia de OAA, y por tanto del pronóstico y sobrevida de los pacientes. La mayor mortalidad del grupo de embolías se puede explicar por mayor edad, comorbilidades cardiovasculares, y embolías fatales a otros territorios.
INTRODUCTION: The acute arterial obstruction (AAO) of a limb is a severe condition, with almost 20 percent mortality, and therefore requires an appropriate diagnosis and treatment. The objective of this study was to analyze survival rates according to etiology and clinical variables. MATERIAL AND METHODS: Analytic observational study of non-traumatic AAO cases treated between 2003 and 2007 at Hospital Dr. Gustavo Fricke, confirming survival through the Office of Civil Registration and telephonic follow up. RESULTS: There were 65 episodes of AAO in 60 patients during this period; 42 of these were embolism episodes (64.6 percent), 17 thrombosis episodes (26.1 percent) and 6 by-pass thrombosis (9.2 percent). There was significant difference in age (p=0.031) and gender (p=0.033). Smoking had a LR (+) of 2.61 for predicting thrombotic etiology whereas intermitent claudication had a LR (+) of 6.67. History of stroke, arrhythmia, and heart failure showed LR (+) for predicting embolic etiology of 4.65, 12.05, and 8.76 respectively. The amputation-free survival at 6 months was 90 percent. The 5 years survival was 54.2 percent 37.8 percent in the group with embolic etiology and 81.8 percent for thrombosis etiology (p <0.001). Patients with AAO with embolic etiology had an OR of 5.42 (IC95 percent 1,53-19,12) for decease compared with patients with thrombotic etiology. DISCUSSION: The clinical variables analyzed were proven to be good predictors for AAO etiology, hence for patients´ prognosis and survival. Higher mortality in the embolic etiology group could be explained by older age, cardiovascular comorbidities, and fatal stroke in other territories.
Asunto(s)
Humanos , Masculino , Femenino , Arteriopatías Oclusivas/epidemiología , Arteriopatías Oclusivas/etiología , Enfermedad Aguda , Accidente Cerebrovascular/epidemiología , Arritmias Cardíacas/epidemiología , Arteriopatías Oclusivas/mortalidad , Chile , Comorbilidad , Embolia/complicaciones , Estudios de Seguimiento , Predicción , Hipertensión/epidemiología , Análisis de Supervivencia , Tabaquismo , Trombosis/complicacionesRESUMEN
INTRODUCCION: La proteína C reactiva (PCR) es un examen simple y de bajo costo que según la literatura tiene buena asociación para la evaluación pronóstica en Pancreatitis Aguda (PA). OBJETIVO: Determinar valor pronóstico de PCR para severidad, presencia de complicaciones y mortalidad intrahospitalaria de PA. MATERIAL Y METODO: Estudio de cohorte retrospectiva de pacientes adultos ingresados al Hospital Dr. Gustavo Fricke, Viña del Mar durante el año 2007. Se identificaron características generales, etiología, score de Balthazar, PCR, complicaciones y mortalidad. Se utilizó test de Mann Whitney para comparación de medianas y curvas ROC. RESULTADOS: Se incluyeron 59 pacientes, siendo el 54,23 por ciento hombres. La mediana de edad fue 51 años. La etiología biliar se observó en 57,62 por ciento. La mediana de hospitalización fueron 12 días. El 40,67 por ciento presentó complicaciones, siendo más frecuente la necrosis pancreática (20,33 por ciento). El nivel de PCR mostró diferencias significativas entre pacientes con y sin gravedad imagenológica (33,5mg/dL vs 15,9mg/dL, p=0,0009), complicaciones intrahospitalarias (40mg/dL vs 15,9mg/dL, p<0,0001) y mortalidad intrahospitalaria (66mg/dL vs 22mg/dL, p=0,0061). El área bajo la curva ROC fue de 0,75; 0,84 y 0,91 respectivamente, todos estadísticamente significativos. La sensibilidad, especificidad, likelihood ratio (LR) positivo, LR negativo para gravedad imagenológica con un punto de corte de 13,14mg/dL fue 88 por ciento, 54 por ciento, 1,83 y 0,28 respectivamente. Para predecir mortalidad con un valor de 32,76mg/dL, estos fueron 100 por ciento, 71 por ciento, 3,43 y 0 respectivamente. DISCUSION. Un valor de PCR de 40mg/dL es buen marcador pronóstico de complicaciones intrahospitalarias. Niveles aumentados tienen alta sensibilidad para predecir gravedad imagenológica y mortalidad intrahospitalaria.
INTRODUCTION: C-reactive protein (CRP) is a simple and low price test with good association in acute pancreatitis (AP) prognosis evaluation. OBJECTIVE: To determine predictive value of PCR for severity, complications and hospital mortality of AP. MATERIAL AND METHODS: Retrospective cohort study of adult patients admitted to Dr. Gustavo Fricke Hospital, Viña del Mar in 2007. General characteristics, etiology, Balthazar score, CRP, and mortality rates were identified. Mann Whitney U test for comparison of medians and ROC curves were used for the analysis. RESULTS: 59 patients were included, 54.23 percent were males. The median age was 51 years. The biliary etiology was observed in 57.62 percent. The average hospitalization period was 12days. Complications were observed in 40.67 percent, being pancreatic necrosis the most frequent one (20.33 percent). The CRP level showed significant differences between patients with and without imaging severity (33.5 mg/dL vs 15.9 mg/dL, p=0.0009), hospital complications (40mg/dL vs 15.9mg/dL, p<0,0001) and hospital mortality (66mg/dL vs 22mg/dL, p=0.0061). The area under the ROC curve was 0.75, 0.84 and 0.91 respectively, all statistically significant. The sensitivity, specificity, positive likelihood ratio (LR), negative LR gravity imaging with a cut off of 13.14 mg/dL was 88 percent, 54 percent, 1.83 and 0.28 respectively. To predict mortality with a value of 32.76 mg/dL, they were 100 percent, 71 percent, 3.43 and 0 respectively. DISCUSSION: The 40mg/dL CRP value is a good prognostic marker of hospital complications. Increased level has high sensitivity to predict imaging severity and hospital mortality.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Pancreatitis/diagnóstico , Pancreatitis/sangre , Proteína C-Reactiva/análisis , Enfermedad Aguda , Alcoholismo/complicaciones , Enfermedades de las Vías Biliares/complicaciones , Mortalidad Hospitalaria , Biomarcadores/sangre , Valor Predictivo de las Pruebas , Pancreatitis/etiología , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
La cirugía del cáncer gástrico es un procedimiento complejo que no está libre de complicaciones graves y letales. El objetivo del presente estudio es describir la morbimortalidad asociada a gastrectomía por cáncer en los últimos años. Se revisan las historias de los pacientes operados de gastrectomía en un período de 5 años. Se encuentran 107 casos, de los cuales, se realiza cirugía con intención curativa en 90 (84,1 por ciento). La cifra global de morbilidad es 25,2 por ciento y la mortalidad 7,5 por ciento. La principal complicación post operatoria es la fístula esófago-yeyunal post gastrectomía total, con una incidencia de 17,6 por ciento y una letalidad de 44 por ciento. Otras complicaciones incluyen la peritonitis post operatoria, absceso intraabdominal, infección de herida operatoria y retardo del vaciamiento gástrico, entre otros. Destaca una baja incidencia de neumonía. Se encontró una tendencia favorable en gastrectomías con intención curativa vs. paliativa y en el uso de suturas mecánicas vs. manuales. La morbimortalidad se compara favorablemente a lo encontrado en la literatura y se mantiene una tendencia a la reducción al compararla con la experiencia ya publicada por el mismo grupo quirúrgico.
Asunto(s)
Masculino , Humanos , Femenino , Fístula Esofágica/cirugía , Gastrectomía/mortalidad , Neoplasias Gástricas , Absceso Abdominal/complicaciones , Chile , Cirugía General , Vaciamiento Gástrico , Infección de la Herida Quirúrgica/complicaciones , Peritonitis/complicacionesRESUMEN
El enterobius vermicularis, es un parásito que comúnmente infesta el lumen intestinal, en raras ocasiones es posible encontrarlo en otras localizaciones. Se presenta caso clínico, en el que se encontraron granulomas por enterobius vermicularis en serosa de trompa uterina, que se habrían instalado allí por fístula rectal secundaria a perforación por un dispositivo intrauterino. Se describen las lesiones histopatológicas, sus implicancias clínicas y revisión de la literatura