Submicroscopic Plasmodium infection during pregnancy is associated with reduced antibody levels to tetanus toxoid.

Submicroscopic Plasmodium infections in pregnancy are common in endemic areas, and it is important to understand the impact of these low-level infections. Asymptomatic, chronic infections are advantageous for parasite persistence, particularly in areas where the optimal eco-epidemiological conditions for parasite transmission fluctuate. In chronic infections, the persistence of the antigenic stimulus changes the expression of immune mediators and promotes constant immune regulation, including increases in regulatory T cell populations. These alterations of the immune system could compromise the response to routine vaccination. This study aimed to evaluate the effect of submicroscopic plasmodial infection with P. falciparum and P. vivax during pregnancy on the immune response to the tetanus toxoid vaccine in Colombian women. Expression of different cytokines and mediators of immune regulation and levels of anti-tetanus toxoid (TT) immunoglobulin (Ig)G were quantified in pregnant women with and without submicroscopic plasmodial infection. The anti-TT IgG levels were significantly lower in the infected group compared with the uninfected group. The expression of interferon (IFN)-γ, tumour necrosis factor (TNF) and forkhead box protein 3 (FoxP3) was significantly higher in the infected group, while the expression of cytotoxic T lymphocyte antigen 4 (CTLA-4) and transforming growth factor (TGF)-ß was lower in the group of infected. In conclusion, submicroscopic Plasmodium infection altered the development of the immune response to the TT vaccine in Colombian pregnant women. The impact of Plasmodium infections on the immune regulatory pathways warrants further exploration.

Effect of Plasmodium Infection during Pregnancy on Passive Neonatal Immunity against Tetanus Toxoid and Rotavirus.

Passive immunity acquired through transplacental IgG transport is essential to protect infants against pathogens as childhood vaccination programs begins. Diarrhea caused by rotavirus and neonatal tetanus are common and potentially fatal childhood infections that can be prevented by transplacental IgG. However, it is not known whether maternal infections in pregnancy can reduce the transfer of these antibodies to the fetus. This study evaluated the effect of submicroscopic Plasmodium infection during pregnancy on the transfer of maternal IgG antibodies against rotavirus (anti-RV) and tetanus toxoid (anti-TT) to newborns of pregnant women residing in Puerto Libertador and Tierralta, Colombia. Expression of different immune mediators and levels of IgG against rotavirus and tetanus toxoid were quantified in pregnant women with and without Plasmodium infection during pregnancy. Submicroscopic infection at the time of delivery was associated with a cord-to-maternal ratio (CMR) > 1 for anti-RV and < 1 for anti-TT IgG, as well as with an increase in the expression of immune mediators of inflammation (IFN-γ), anti-inflammation (IL-10, TGF-ß), and regulation (FoxP3, CTLA-4). When compared by species, these findings (CMR > 1 for anti-RV and < 1 for anti-TT IgG) were conserved in submicroscopic Plasmodium vivax infections at delivery. The impact of Plasmodium infections on neonatal susceptibility to other infections warrants further exploration.

Effect of 0.2% carbomer ophthalmic ointment on eye discomfort after general anesthesia: A non-randomized cohort study.

BACKGROUND AND OBJECTIVE: Eye lesions during surgery are rare. Its common causes include direct trauma, chemical damage, and corneal exposure. Eye discomfort may present after surgery in the absence of structural damage. In our hospital, every patient under general anesthesia receives eye protection with eye occlusion associated in most cases with ophthalmic ointment application. We aim to analyze the incidence of eye discomfort with 0.2% carbomer application. METHODS: A cohort study was conducted. Patients who underwent surgery under general anesthesia lasting less than 4h between February and November 2017 were enrolled. We excluded patients with previous ophthalmologic pathology, those undergoing eye, otolaryngology, face or head surgery, and patients in which eye occlusion was not possible. For analysis, patients were divided into two groups: simple eyelid occlusion (Group 1) and eyelid occlusion plus ophthalmic ointment (Group 2). Primary outcome was the incidence of eye discomfort and secondary outcomes were to stablish associated risk factors. RESULTS: 400 patients were analyzed, 50% were exposed to 0.2% carbomer. There was no difference in patients' demographics. During the first 24h post-surgery 7.25% of patients showed visual symptoms, and at one-week postoperative no patient referred symptoms. Most frequent symptoms were blurry vision, pruritus, epiphora and red-eye. On multivariate analysis, the main risk factor associated with eye discomfort was 0.2% carbomer application (RR 13.5 CI 3.27-56.2). Emergent surgery and age were also found to be risk factors. CONCLUSION: 0.2% carbomer does not prevent ophthalmologic symptoms after surgery and it may even increase them in short procedures.

Studies on antimalarial drug susceptibility in Colombia, in relation to Pfmdr1 and Pfcrt.

In Colombia, Plasmodium resistance to antimalarials such as chloroquine and antifolates is a serious problem. As a result, the national Colombian health authorities are monitoring the efficacy of alternative drugs and schemes. The study of genetic polymorphisms related with drug resistance is required in the region. In vitro responses to chloroquine, quinine, mefloquine, amodiaquine, desethylamodiaquine, artesunate and dihydroartesunate were carried out by HRP ELISA. SNP analysis in Pfcrt and Pfmdr1 genes was performed by PCR-RFLP in 77 samples from the North West region of Colombia. In vitro resistance to chloroquine was high (74%), followed by mefloquine (30%) and desethylamodiaquine (30%). A positive correlation between the IC(50) of paired drugs was also detected. The allele Pfmdr1 N86 (wild) was present in 100% of the samples and 1246Y (mutant) in 92%. However, their presence did not correlate with in vitro drug resistance. Presence of the mutations K76T and N75E in Pfcrt was confirmed in all samples. Analysis of 4 codons (72, 74, 75 and 76) in pfcrt confirmed the presence of the haplotypes CMET in 91% and SMET in 9% of the samples.

Genetic analysis of ID1-DBL2X predicts its validity as a vaccine candidate in Colombia and supports at least two independently introduced Plasmodium falciparum populations in the region.

Pregnancy-associated malaria (PAM) poses a threat to both the mother and fetus, increasing the risk of severe maternal anemia, fetal growth restriction and low birth weight infants. Two vaccines are currently in development to protect women from Plasmodium falciparum in pregnancy. Both vaccine constructs target the ID1-DBL2X domain of VAR2CSA, a protein expressed on the surface of infected erythrocytes (IEs) that mediates parasite sequestration in the placenta. Although development of an effective vaccine may be hampered by ID1-DBL2X polymorphisms expressed by field isolates, a recent study showed that genetic variation of this domain in South American parasite populations is much lower than in other geographical locations. This suggests that a recombinant vaccine designed to be efficacious in Africa and Asia is likely to be efficacious in South America. However, these studies did not include Colombian parasite populations in their analyses, which are known to be genetically distinct from other South American parasite populations due to their independent introduction from Africa. Therefore, we sought to determine the genetic variation of the ID1-DBL2X domain in Colombian parasites to assess the potential efficacy of the vaccine against PAM in this region. Through sequence analysis and population genetics, we show that there is a low degree of genetic variation amongst Colombian parasite populations and that a vaccine containing conserved antigen variants for worldwide populations is likely to be protective against PAM in Colombia. Our analysis also points towards an African origin for Colombian parasite populations, and suggests that their introduction into Colombia was a recurrent process encompassing multiple introduction events.

Cloning, sequence analysis and expression in Escherichia coli of the cDNA encoding a precursor of peanut agglutinin.

The cDNA coding for pre-peanut agglutinin (PNA) was isolated from a bacterial expression library. It codes for a polypeptide of 273 amino acids composed of a hydrophobic signal peptide of 23 amino acids and a mature protein of 250 amino acids. The sequence of the latter is identical to that of native PNA, determined very recently by conventional methods, except that it contains 14 additional amino acids at the C-terminus. Bacterial cells harboring a plasmid with the prePNA-cDNA, produced two PNA cross-reacting proteins: one migrated on SDS-PAGE identically with the native lectin (apparent mol. wt. 31 kDa); the other, at 35 kDa, was a beta-galactosidase pre-PNA fusion protein. The former protein possessed an N-terminal sequence identical to that of the mature, native PNA, suggesting that it was processed from the 35 kDa prePNA precursor. Only the 31 kDa protein was exported into the bacterial periplasmic space, and had the ability to bind to galactose-Sepharose. The isolated processed protein had the same hemagglutinating activity as the native lectin, when assayed with sialidase-treated human erythrocytes. Like the native lectin, it did not agglutinate the untreated cells, was not inhibited by N-acetylgalactosamine, and was inhibited by Gal beta 1----3GalNAc 30-times more strongly than by galactose.

Modification by site-directed mutagenesis of the specificity of Erythrina corallodendron lectin for galactose derivatives with bulky substituents at C-2.

Examination of the three-dimensional structure of Erythrina corallodendron lectin (ECorL) in complex with a ligand (lactose), the first of its kind for a Gal/GalNAc-specific lectin [(1991) Science 254, 862-866], revealed the presence of a hydrophobic cavity, surrounded by Tyr108 and Pro134-Trp135, which can accommodate bulky substituents such as acetamido or dansylamido (NDns) at C-2 of the lectin-bound galactose. Comparison of the primary sequence of ECorL with that of soybean agglutinin, specific for galactose and its C-2 substituted derivatives, and of peanut agglutinin, specific for galactose only, showed that in soybean agglutinin, Tyr108 is retained, and Pro134-Trp135 is replaced by Ser-Trp, whereas in peanut agglutinin, the former residue is replaced by Thr and the dipeptide by Ser-Glu- Tyr-Asn. Three mutants of ECorL were therefore constructed: L2, in which Pro134-Trp135 was replaced by Ser-Glu-Tyr-Asn; Y108T, in which Tyr108 was replaced by Thr and the double mutant L2; Y108T. They were expressed in Escherichia coli, as done for recombinant ECorL [(1992) Eur. J. Biochem. 205, 575-581]. The mutants had the same hemagglutinating activity as native or rECorL. Their specificity for galactose, GalNAc and Me beta GalNDns was examined by inhibition of hemagglutination and of the binding of the lectin to immobilized asialofetuin; in addition, their association constants with Me alpha GalNDns and Me beta GalNDns were measured by spectrofluorimetric titration. The results showed that Y108T had essentially similar specificity as the native and recombinant lectins. The affinity of L2 and L2;Y108T for galactose was also the same as ECorL, but they had a lower affinity for GalNAc and markedly diminished affinity for the dansyl sugars (up to 43 times, or 2 kcal, less). This appears to be largely due to steric hindrance by the two additional amino acids present in the cavity region in these mutants. Our findings also provide an explanation for the inability of PNA to accommodate C-2-substituted galactose derivatives at its primary subsite.

Protective effect of D-003 on experimental spinal cord ischemia in rabbits.

D-003 is a natural mixture of long chain aliphatic acids isolated and purified from sugar cane wax. It possesses antiplatelet and antithrombotic effects as well as decreases plasma and serum levels of thromboxane B(2) (TxB(2)), meanwhile significantly and markedly raises prostacyclin (PgI(2)) levels in rats. This study was undertaken to investigate the effects of D-003 on spinal cord injury in rabbits. New Zealand rabbits were treated during 10 days with D-003 (25 and 200 mg kg(-1)) and ASA (2 mg kg(-1)) before spinal cord ischemia. Animals were subjected to 20 min of aortic occlusion and 24h of reperfusion. Clinical symptoms and histopathological changes of spinal cord were observed. The PgI(2) levels in thoracic aorta were quantified by bioassay. D-003 (25 and 200 mg kg(-1)) significantly increased the mean scores reached 4h after reperfusion, although no dose relation was observed. Twenty-four hours after reperfusion, no deaths occurred in both sham and D-003 treated groups, meanwhile in positive controls and ASA the mortality rate was 38.5% and 7.69% respectively. In addition, 100% of sham, 69% and 77% of rabbits treated with D-003 at 25 and 200 mg kg(-1), respectively, did not show histopathological changes. By the contrary, 100% of positive control animals showed severe damage and ASA-treated rabbits showed only a partial protection. Animals treated with both doses of D-003 showed PgI(2) levels significantly larger than those of positive and negative controls, an effect dose-related, while ASA 2 mg kg(-1) did not change PgI(2) values. The increase of PgI(2) levels achieved in the D-003 treated animals could be an important mechanism in the protection against the spinal cord ischemia.

Botulinum toxin A in management of cerebral palsy.

The efficacy of local injection of botulinum toxin A in selected skeletal muscles to relieve muscle hypertonia and muscle contracture, and increase range of motion in children with cerebral palsy was studied in an open ABA (baseline-treatment-posttreatment phase) type of study. The first 6 months were the baseline phase, the day of injection the treatment phase, and the next 6 months the posttreatment phase. The patients acted as their own controls. Fifteen children with cerebral palsy (mean age: 6 years, 8 months) were included in the study. All had limb deformities associated with non-fixed joint contractures that had not responded to physical therapy. Clinical assessment of passive and active muscle tone was performed using a modified Ashworth scale. The range of motion to passive movement was measured with a manual goniometer. Botulinum toxin was injected directly into the muscle at several sites. The postinjection scores of muscle hypertonia were significantly lower (P < .01) and the range-of-motion values demonstrated a significant increase (P < .001). Functional improvement was measured by decreased scissoring on standing in all 6 children with adductor muscles injected; all 6 children with knee flexor muscles injected were able to straighten the knees. The 3 children with injected gastrocnemius muscles were able to achieve heel-strike while bare-footed. The study provides evidence that the intramuscular injection of botulinum toxin A in selected skeletal muscles decreases muscle tone and contractures, and increases range of motion and motor function.

Evaluation of the reproductive and developmental toxicity of the D-003, a mixture of long-chain fatty acids, in rats and rabbits.

D-003 is a mixture of long-chain fatty acids isolated and purified from sugar cane wax with cholesterol-lowering properties. D-003 given orally (500 and 1000 mg/kg/day) to female rats for 15 days prior to mating, through mating and gestation to day 21 of lactation and male rats for 4 weeks prior and during mating did not induce toxic effects on reproduction. There were no significant reductions in the number of animals that conceived, in the numbers of pups born to those that did conceive, in the numbers of pups that survived until weaning, and in their body weights at weaning. Drug-treated and control groups' offspring were comparable in growth, physical and behavioral development, spontaneous activity and reproductive performance. Pregnant New Zealand rabbits were given D-003 as oral doses of 500 and 1000 mg/kg/day on days 6 through 18 of gestation without any evidence of embryotoxicity or teratogenicity. The no-observed-effect dose in these two experimental studies was 1000 mg/kg/day. After assessment of the potential of high doses of D-003 to act on developing embryo and reproduction process, no evidence supports the conclusion that D-003 is a reproductive and developmental toxicant/teratogen.

Efecto del ungüento oftálmico de carbómero al 02% sobre molestias oculares en pacientes sometidos a anestesia general: Estudio de cohorte no aleatorizado / Effect of 0.2% carbomer ophthalmic ointment on eye discomfort after general anesthesia: A non-randomized cohort study

Introducción y objetivo: Las lesiones oculares durante cirugía son raras. Las causas comunes incluyen trauma directo, lesión química y exposición corneal. Las molestias oculares se pueden presentar después de la cirugía en ausencia de daño estructural del ojo. En nuestro hospital todos los pacientes sometidos a anestesia general reciben protección con oclusión ocular asociado en la mayoría de los casos con la aplicación de gel oftálmico. En este estudio buscamos analizar la incidencia de molestias oculares con la aplicación de gel oftálmico de carbómero 0,2%. Métodos: Se llevó a cabo un estudio tipo cohorte. Se incluyeron los pacientes sometidos a cirugía bajo anestesia general con duración menor a cuatro horas entre febrero y noviembre de 2017. Se excluyeron a los pacientes con patologías oculares previas, los llevados a cirugía oftálmica, facial o de cabeza, y aquellos en los que la oclusión ocular no fue posible. Para el análisis, los pacientes se dividieron en dos grupos: oclusión ocular simple (Grupo 1) y oclusión ocular más gel oftálmico de carbómero al 0,2% (Grupo 2). Nuestro desenlace primario fue la incidencia de molestias oculares y el desenlace secundario fue determinar los factores de riesgo. Resultados: Se analizaron 400 pacientes, de los cuales la mitad (50%) recibieron el gel oftálmico de carbómero 0,2%. No se encontraron diferencias en las características demográficas entre grupos. Durante las primeras 24 horas postoperatorias, el 7,25% de los pacientes presentaron síntomas visuales, y a los siete días postoperatorios ningún paciente refirió síntomas. Los síntomas más frecuentes fueron visión borrosa, prurito, epífora y ojo rojo. En el análisis multivariado el principal factor de riesgo asociado con la aparición de molestias oculares fue la aplicación de gel oftálmico de carbómero 0,2% (RR 13,5; IC 95% 3,27–56,2). Otros factores asociados a molestias oculares fueron cirugía de urgencia y la edad.(AU)

Background and objective: Eye lesions during surgery are rare. Its common causes include direct trauma, chemical damage, and corneal exposure. Eye discomfort may present after surgery in the absence of structural damage. In our hospital, every patient under general anesthesia receives eye protection with eye occlusion associated in most cases with ophthalmic ointment application. We aim to analyze the incidence of eye discomfort with 0.2% carbomer application. Methods: A cohort study was conducted. Patients who underwent surgery under general anesthesia lasting less than 4hours between February and November 2017 were enrolled. We excluded patients with previous ophthalmologic pathology, those undergoing eye, otolaryngology, face or head surgery, and patients in which eye occlusion was not possible. For analysis, patients were divided into two groups: simple eyelid occlusion (Group 1) and eyelid occlusion plus ophthalmic ointment (Group 2). Primary outcome was the incidence of eye discomfort and secondary outcomes were to stablish associated risk factors. Results: 400 patients were analyzed, 50% were exposed to 0.2% carbomer. There was no difference in patients’ demographics. During the first 24hours post-surgery 7.25% of patients showed visual symptoms, and at one-week postoperative no patient referred symptoms. Most frequent symptoms were blurry vision, pruritus, epiphora and red-eye. On multivariate analysis, the main risk factor associated with eye discomfort was 0.2% carbomer application (RR 13.5 CI 3.27 – 56.2). Emergent surgery and age were also found to be risk factors. Conclusion: 0.2% carbomer does not prevent ophthalmologic symptoms after surgery and it may even increase them in short procedures.(AU)

Lung volume reduction surgery after lung transplantation for emphysema-chronic obstructive pulmonary disease.

Lung Volume Reduction Surgery (LVRS) has become a palliative treatment for patients with advanced emphysema and disabling dyspnea. After single lung transplantation in chronic obstructive pulmonary disease, LVRS may be indicated to improve graft dysfunction caused by native lung hyperinflation compressing the grafted lung. This common complication is the subject of our study, which showed LVRS to be helpful to manage this situation. We performed an observational retrospective and descriptive study using the data of 293 patients transplanted in our center between January 1996 and October 2011. Some of the patients who underwent a single lung transplantation developed native lung hyperinflation years after the transplantation, interfering with respiratory function due to graft compression.

Lung cancer in patients with lung transplants.

OBJECTIVE: The aim of our study was to describe the incidence of lung cancer in patients after lung transplantation (LT). MATERIALS AND METHODS: We performed an observational, retrospective, descriptive study based on data from 340 patients undergoing lung transplantation between October 1993 and December 2010. We collected data about the donors, recipients, intra- and postoperative periods, and survivals. RESULTS: We identified 9 (2.6%) patients who developed lung cancer after LT. Their average age was 56 ± 9.3 years (range, 18-63). All cases were men with 8/9 (88.8%) having received a single lung transplant. All cancers developed in the native lung. The indications for transplantation were: emphysema type chronic obstructive pulmonary disease (COPD; n = 5), idiopathic pulmonary fibrosis (n = 3), or cystic fibrosis (n = 1); 77% of them were former smokers. All of the COPD patient were affected. The interval from transplantation to diagnosis was 53.3 ± 12 months (range 24-86). Survival after cancer diagnosis was 49.3 ± 6.3 (range = 0-180) months. CONCLUSIONS: LT was associated with a relatively high incidence of lung cancer, particularly in the native lung. In our series, lung cancer was related more to patients with emphysema-type COPD and a history of smoking. We believe that these patients should be closely followed to establish the diagnosis and apply early treatment.

[Toxoplasmosis. Clinical, radiological and pathological aspects. Report of 44 cases]. / Toxoplasmosis. Aspectos clínicos radiológicos y patológicos. Presentación de 44 casos.

Forty four cases of toxoplasmosis seen in a 20 years span are reviewed. The largest number of cases corresponded to the neonatal group. The most important clinical findings usually involve the central nervous system, reticulum endothelium, skin and eyes. The disease is compared to an equivalent group of congenital lues (Torch complex). Clinical and radiological criteria for the differentiation are established. The most important finding is the presence of intracraneal calcifications. The different patterns and distribution are discussed. The radiologist plays an important role in the diagnosis of this condition, particularly, in the neonatal group of patients where the incidence of intravenous calcification appears to be higher.

C-terminal post-translational proteolysis of plant lectins and their recombinant forms expressed in Escherichia coli. Characterization of "ragged ends" by mass spectrometry.

Electrospray mass spectrometry was used to accurately measure the molecular masses of single chain lectins from legume seeds and also of three recombinant lectins, expressed in Escherichia coli. The five single chain lectins, Erythrina corallodendron lectin, soybean and peanut agglutinins, Dolichos biflorus lectin, and Phaseolus vulgaris hemagglutinin E, all showed evidence of C-terminal proteolytic processing, in some cases to "ragged" ends, when their masses were compared to those expected from their cDNA sequences and their known carbohydrate chains. Recombinant forms of the lectins from E. corallodendron, soybean, and peanut also showed C-terminal trimming, but not to the same points as the natural forms. Discrepancies between the protein and cDNA sequences of the E. corallodendron lectin were resolved by combined liquid chromatography-mass spectrometry peptide mapping and protein sequencing experiments, and the presence of a second glycosylation site was demonstrated. Our data show that all of these lectins undergo C-terminal proteolytic processing of a readily attacked peptide segment. This trimming is frequently imprecise, and the resulting heterogeneity may be a major contributor to the appearance of isolectin forms of these proteins.

Bloqueador endobronquial de Arndt para ventilación de un solo pulmón / Endobronchial blockers of Arnt in ventilation of one lung

Existen diferentes técnicas para la ventilación diferencial selectiva o ventilación selectiva pulmonar. Para ello es necesario el uso de tubos de doble luz o tubos endobronquiales. Estos tubos fueron diseñados por Carlens en 1949 y Bjrok en 1952. El principal objetivo era aislar el pulmón enfermo con el propósito de evitar la contaminación con sangre o material purulento proveniente del otro pulmón. Posteriormente, estos tubos se han usado en cirugía de tórax para lograr el colapso de un pulmón y facilitar el acto quirúrgico. Los tubos de Carlens. fueron utilizados por varias décadas hasta cuando que apareció el tubo diseñado por Robertshaw en la década del 60. Este tubo tiene algunas ventajas sobre el tubo de Carlens como son el material de construcción, vienen preformados tanto derechos como izquierdos por lo cual se adaptan en su diseño a la anatomía de los bronquios, neumotaponadores de alto volumen-baja presión y línea radiopaca para su visualización por rayos X principalmente. Sin embargo, a pesar de ser mejor diseñados, con el uso de la técnica, para su colocación, denominada "a ciegas" muchas veces los tubos quedaban mal posicionados, lo cual se correlaciona con reportes de diferentes estudios que refieren mal posición de los tubos hasta en un 48por ciento de los casos. Lo anterior puede estar acompañado por complicaciones que van desde inestabilidad hemodinámica, lesión de bronquios, hasta la imposibilidad de realizar la cirugía. Gracias al advenimiento del fibronbroncoscopio, la colocación del tubo se ha hecho más precisa y menos azarosa disminuyendo asilos diferentes inconvenientes. Además existe un grupo de pacientes en los que se dificulta la colocación del tubo de doble luz como son los que presentan distorsión de la anatomía, vía aérea difícil anticipada, baja talla y los pacientes laringuectomizados o traqueostomizados. En estos pacientes el uso de los bloqueadores bronquiales ha facilitado en forma importante la cirugía pulmonar cuando se requiere aislar un pulmón. Estos elementos se han venido utilizando desde hace mas de 50 años, inicialmente colocados con dificultad debido a su consistencia blanda y principalmente por la falta del fibronbroncoscopio. Estas técnicas han evolucionado considerablemente hasta llegar al bloqueador endobronquial de ARNDT el cual se coloca a través de un tubo orotraqueal convencional, por medio de un adaptador multipuerto...

Anestesia y trasplante cardíaco / Anesthesia and heart trasplantation

Desde 1905 se comezó a trabajar en forma experimental sobre el trasplante cardiaco y solo hasta 1967 el cirujano Cristian Barnard realizó con exito el primer trasplante ortotopico en humanos, con lo cual surgio un incremento mundial en la realizacion de esta cirugia, pero el entusiasmo decayo muy pronto en razon a que la sobrevida era muy corta debido al rechazo del organo trasplantado, En 1980 se introdujo la ciclosporina como agente inmunosupresor, con lo cual los porcentajes de sobrevida mejoraron hasta alcanzar un 80 por ciento a un año y un 67 por ciento a 3 años. Los pacientes aceptados para trasplante cardiaco, presentan un estado muy avanzado de enfermedad cardiaca no susceptible de tratamiento medico ni quirurgico diferente al trasplante, y su pronostico de supervivencia es de semanas o de pocos meses. Los diagnosticos primarios más frecuentes son: enfermedad isquemica y cardiopatia idiopatica. Un 44 por ciento de los donantes provienen de victimas de accidentes ocasionados por automotores pesados y un 18 por ciento por motocicletas. La tecnica quirurgica ha tenido varlaciones desde 1960 cuando fue descrita por Lower y Shumway. El gran enemigo de la supervivencia a largo plazo es la arterioesclerosis y a corto y mediano plazo son la infección y el rechazo.