Evaluation of the anorectal motor response after percutaneous stimulation of the posterior tibial nerve in patients with fecal incontinence.

BACKGROUND: The effect of posterior tibial nerve stimulation (PTNS) on the mechanisms of anal continence has not been fully demonstrated. The aim of this study was to assess the anal manometric response after percutaneous PTNS in patients with fecal incontinence (FI). METHODS: This was a prospective study in patients with FI undergoing 1 weekly session of percutaneous PTNS for 8 weeks. A clinical assessment (Wexner scale) and a complete study of up to 22 manometric parameters were carried out prior to treatment and 2-4 weeks after the end of treatment. RESULTS: A total of 32 patients were evaluated. After therapy, there was a decrease in the average Wexner score [12.6 (± 5.2) to 9.5 (± 5.2) (P < 0.005)] and an increase in the "anal canal length at rest" [4.55 (± 0.60) to 4.95 (± 0.21) P = 0.004], without observing variations in other manometric parameters. The decrease in the Wexner score was significantly correlated with an increase in the "pressure at 5 cm at rest" after therapy (r = 0.464 P = 0.030). CONCLUSIONS: In our study, PTNS was associated with a significant decrease in the Wexner score and with an increase in the functional length of the anal canal at rest. The improvement in the Wexner scale was correlated with an increase in pressure at rest in the theoretical area of the anorectal junction.

Assessment of essential and nonessential metals and different metal exposure biomarkers in the human placenta in a population from the south of Portugal.

The general population is exposed to metals as trace amounts of metallic compounds are present in air, water, and food. Information on background exposures and biomarker concentrations of environmental chemicals in the general Portuguese population is limited. Therefore, the purpose of this study was to determine the levels of important nonessential metals with recognized toxicity cadmium (Cd) and lead (Pb) and essential metals copper (Cu), nickel (Ni), chromium (Cr), and zinc (Zn) in placentas of mothers living in south Portugal (Algarve). Due to the difficulty in establishing the effects of chemicals in a complex and variable environment, this study also aimed to examine the response of biomarkers, such as biochemical changes that occurs at subcellular levels in the presence of contaminants. The investigated biomarkers in placentas indicative of metal exposure or damage included the metallothioneins (MT), delta-aminolevulinic acid dehydratase (ALAD) (specific for Pb), and lipid peroxidation (LPO) as an index of oxidative stress damage. Moreover, HJ-BIPLOT was applied in order to identify and categorize mothers vulnerable to environmental contamination in this region. Metal concentrations in the placenta were not excessive but within the range found in most European studies. In general, the biomarkers MT and LPO were positively correlated with metal levels, while with ALAD the opposite occurred, indicating the selected battery of biomarkers were suitable to study the effects of metals on human placenta. Further, the application of multivariate analysis with HJ-BIPLOT showed that most significant factors contributing to maternal and fetal exposures via placenta were dietary and smoking habits.

Long-term results of artificial bowel sphincter for the treatment of severe faecal incontinence. Are they what we hoped for?

OBJECTIVE: This study evaluates the long-term morbidity, functional results and quality of life (QOL) after treatment of severe faecal incontinence (FI) with the Acticon Neosphincter (American Medical Systems, Minneapolis, Minnesota, USA). METHOD: Between 1996 and 2002, 17 consecutive patients (14 female, 3 male; median age 46) underwent sphincter implantation. Clinical evaluation, incontinence severity and QOL were assessed. Anorectal manometry, endoanal ultrasound and pudendal nerve latency were performed preoperatively and at several stages of follow-up. The study was completed in December 2007. RESULTS: Mean follow-up was 68 months (range: 3-133). Morbidity occurred in 100% of patients from which 65% required at least one re-operation. After the first implant, 11 devices had to be removed (65%). Seven patients had a new implant. At the final stage, Acticon was activated in 9 cases (53%). Severity of FI improved from a median of 17.5 preoperatively to 9 (P = 0.005), 5.5 (P = 0.005) and 10 (P = 0.092) at 6, 12 months and at the end of follow-up, respectively. There was a significant improvement in QOL in all postoperative controls (P < 0.05). Severity of FI did not show a correlation with QOL in the preoperative period, but did at 6, 12 months and at the end of follow-up. Mean maximum resting pressure significantly increased with the full anal cuff. CONCLUSION: There is a high rate of morbidity, surgical re-interventions and explants after Acticon implant. Patients should be clearly informed about this before surgery. However, patients who have not had Acticon Neosphincter explanted, experience a significant improvement in anal continence and QOL.

Biomarkers of exposure to metal contamination and lipid peroxidation in the benthic fish Cathorops spixii from two estuaries in South America, Brazil.

Biomarkers as lipid peroxidation, metallothionein and delta-aminolevulinic acid dehydratase were determined in Cathorops spixii to compare the biological responses of this fish from estuaries with distinct anthropogenic influence. Three areas were selected in two estuaries in accordance with the levels of contamination for the polluted (Santos/São Vicente) and with the hydrodynamic characteristics for the non-polluted (Cananéia) estuary. Water characteristics and mercury levels in C. spixii confirmed a high human influence in the polluted system. In general, the biomarkers showed differences between the estuaries, suggesting disturbances in the specific cell mechanisms due to the presence of multiple xenobiotics in the contaminated system. Therefore, these biomarkers are recommended to promote more accurate information about the exposure to pollutants. Additionally, the study of the effect of the multiple xenobiotics on resident species such as the benthic fish C. spixii can favor a better assessment of the environmental quality of these systems.

Variability of oil content and of major fatty acid composition in almond (Prunus amygdalus Batsch) and its relationship with kernel quality.

Oil content and fatty acid composition were determined for two years in the kernel oil of eight cultivars and 47 advanced self-compatible almond genotypes developed in an almond breeding program. Considerable variation between genotypes was found for all parameters. Oil content ranged from 48% to 67% of the total kernel dry weight but was consistent over the two years. Fatty acid composition was also very variable, with significant differences between genotypes, even in genotypes of the same progeny. Oleic acid, ranging from 63% to 78%, and linoleic acid, ranging from 12% to 27%, were the major fatty acids, showing higher values in some selections than in their parents. The large variability observed for all fatty acids and the presence of selections with higher oil and fatty acid contents than the commercial cultivars represents a very promising base to obtain new almond cultivars with oil of higher quality, satisfying the industrial and consumer sectors.

Using biochemical and isotope geochemistry to understand the environmental and public health implications of lead pollution in the lower Guadiana River, Iberia: a freshwater bivalve study.

Lead is a natural component of aquatic ecosystems with no known biological role and is highly toxic. Its toxicity stems from its ability to mimic biologically important metals and to produce membrane damage through lipid peroxidation (LPO). Most lead poisoning symptoms are thought to occur by interfering with an essential enzyme, delta-aminolevulinic acid dehydratase (ALAD), the activity of which is markedly inhibited by lead. The purpose of this work was to study the levels and effects of lead pollution (responses of ALAD and oxidative stress biomarker LPO) in the freshwater bivalve Corbicula fluminea along the lower Guadiana River (Portugal and Spain); a major river system impacted by historic mining pollution and more recent anthropogenic inputs. The results show that the enzymatic activity of ALAD is negatively correlated with the total Pb concentration of the whole tissue suggesting that ALAD has considerable potential as a biomarker of lead exposure in C. fluminea. To identify the sources of lead to which bivalves have been exposed, high precision (206)Pb/(204)Pb, (207)Pb/(204)Pb, (208)Pb/(204)/Pb ratios for C. fluminea confirm that historical mining activities in the Iberian Pyrite Belt are the dominant source of lead pollution in the lower Guadiana River. The isotope patterns however exhibit marked seasonal and geographic variation in response to rainfall and river water management. Locally, other anthropogenic sources of lead have been detected in C. fluminea close to population centres, thus adding to its versatility as a freshwater bio-indicator. Overall, the study highlights the value of natural ecosystems as monitors of water quality and their importance for public health assessment and surveillance.

Metal concentrations in the shell of Bathymodiolus azoricus from contrasting hydrothermal vent fields on the Mid-Atlantic Ridge.

Specimens of Bathymodiolus azoricus were sampled along the Mid-Atlantic Ridge at the Menez Gwen, Lucky Strike and Rainbow hydrothermal fields. Individual shells (n = 51), through the weight range 0.62 to 15.70 g, were analyzed for their magnesium, strontium, iron, manganese, copper, zinc and cadmium concentrations. Amongst the marine molluscs the shell of B. azoricus is confirmed as being particularly impoverished in strontium (mean 943 microg g(-1)). Trace metal concentrations in the shells decreased in the order Fe> Mn> Zn> Cu> Cd. Despite originating from trace metal rich environments mean concentrations were low (37.9, 13.2, 10.7, 1.1 and 0.7 microg g(-1), respectively). Irrespective of geographical origin magnesium, strontium and copper concentrations were primarily dictated by shell weight. In contrast cadmium concentrations were elevated in shells from the Rainbow field and ambient seawater chemistry imparted site specific chemical fingerprints to the shells with respect to the iron to manganese ratio.

Comparative petroleum hydrocarbons levels and biochemical responses in mussels from hydrothermal vents (Bathymodiolus azoricus) and coastal environments (Mytilus galloprovincialis).

Aliphatic hydrocarbons and PAHs in the whole soft tissues of Bathymodiolus azoricus from three Mid-Atlantic Ridge hydrothermal vents (Menez-Gwen, Lucky Strike and Rainbow), and Mytilus galloprovincialis from three contaminated coastal sites in South Portugal were analysed, and its effects on the digestive gland microsomes mixed-function oxygenase system (MFO) were assessed. Aliphatic hydrocarbons levels were present in the same magnitude in both coastal and hydrothermal environments, while the UCM (unresolved complex mixture) for coastal mussels were higher than in vent mussels. In general, significantly higher PAHs concentrations were found in coastal mussels, compared to B. azoricus where low molecular weight PAHs (2-3 rings) represented the majority of PAHs contrarily to what was observed in M. galloprovincialis. The MFO components were present in both mussel species, and were detected in vent mussels for the first time. However this system seems to have different roles in species from these contrasting environments. In coastal mussels MFO responded to hydrocarbon contamination while response in hydrothermal organisms appeared to be related mainly to endogenous factors.

[Postoperative analgesia in knee arthroplasty using an anterior sciatic nerve block and a femoral nerve block]. / Analgesia postoperatoria en la artroplastia de rodilla mediante los bloqueos ciático por vía anterior y femoral.

OBJECTIVE: To evaluate the efficacy of a nerve block as an alternative technique for analgesia after knee arthroplasty and to indicate the usefulness and advantages of the anterior approach to the sciatic nerve block. MATERIAL AND METHODS: Between April 2004 and March 2006, we studied a series of consecutive patients undergoing knee arthroplasty in which a subarachnoid block was used as the anesthetic technique and postoperative analgesia was provided by means of a combined peripheral femoral nerve block and an anterior sciatic nerve block. We evaluated the mean length of time free from pain, quality of analgesia, and length of stay in hospital. RESULTS: Seventy-eight patients were included in the study. The mean (SD) length of time free from pain for the group was 42.1 (3.9) hours. Patients reported mild pain after 34.8 (4.1) hours and moderate to severe pain after 42.4 (3.5) hours. By the third day, 62.8% of patients were able to bend the knee to 90 degrees. There were no complications resulting from the technique and the level of patient satisfaction was high. CONCLUSIONS: A combined femoral-sciatic nerve block is effective in knee arthroplasty. It controls postoperative pain and allows for early rehabilitation. The anterior approach to the sciatic nerve is relatively simple to perform without removing the pressure bandaging from the thigh after surgery. This approach also makes it unnecessary to move the patient.

Metals in the shell of Bathymodiolus azoricus from a hydrothermal vent site on the Mid-Atlantic Ridge.

Specimens of the mussel Bathymodiolus azoricus were collected from Menez Gwen, a relatively shallow (850 m) hydrothermal vent field on the Mid-Atlantic Ridge. Each bivalve shell (n = 21) was individually cleaned by selective chemical. The residual crystal matrix of each shell was individually analysed for the concentrations of the minor elements magnesium and strontium and the trace elements iron, manganese, copper and zinc. The chemical composition of the crystal matrix is unusual. B. azoricus is identified as a species having one of the most strontium impoverished shells amongst the marine molluscs. For a bimineral species the magnesium concentration is also extraordinary low. Despite originating from a trace metal rich environment; the metal concentrations in the shells were exceptionally low. Mean concentrations of iron, manganese, copper and zinc were 20.6, 3.7, 0.6 and 9.4 microg g(-1) respectively. Minor and trace element concentrations exhibited a marked intra-population variability. Copper concentrations increased and iron and zinc concentrations decreased with increasing shell weight. Due to its insensitivity to the high environmental levels of trace elements and the variability in intra-population concentrations induced by shell weight the crystal matrix of the shell of B. azoricus has little potential for use in environmental trace metal monitoring in areas contiguous to deep-sea hydrothermal vents.

Antioxidant systems and lipid peroxidation in Bathymodiolus azoricus from Mid-Atlantic Ridge hydrothermal vent fields.

Enzymatic defenses involved in protection from oxygen radical damage were determined in gills and mantle of Bathymodiolus azoricus collected from three contrasting Mid-Atlantic Ridge (MAR) hydrothermal vent fields (Menez-Gwen, Lucky Strike and Rainbow). The activities of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidases (GPx) (total and Se-dependent), and levels of total oxyradical scavenging capacity (TOSC), metallothioneins (MT) and lipid peroxidation (LPO) were determined in B. azoricus tissues and the impact of metal concentrations on these antioxidant systems and lipid peroxidation assessed. SOD, CAT, TOSC, MTs and LPO levels were higher in B. azoricus gills while glutathione peroxidases (total and Se-dependent) were higher in the mantle, and with the exception of CAT, were of the same order of magnitude as in other molluscs. TOSC levels from Menez-Gwen indicate that the vent environment at this site is less stressful and the formation of ROS in mussels is effectively counteracted by the antioxidant defense system. TOSC depletion indicates an elevated ROS production in molluscs at the other two vent sites. Cytosolic SOD, GPx and LPO were more relevant at Lucky Strike (Bairro Alto) where levels of essential (Cu and Zn) and toxic metals (Cd and Ag) were highest in the organisms. CAT activity and LPO were predominant at the Rainbow vent site, where an excess of Fe in mussel tissues and in vent fluids (the highest of all three vent sites) may have contributed to increased LPO. Therefore, three distinct pathways for antioxidant enzyme systems and LPO based on environmental metal speciation of MAR vent fields are proposed for Bathymodiolus gills. At Menez-Gwen, TOSC towards peroxyl and hydroxyl radicals and peroxynitrite are predominant, while at Lucky Strike cytosolic SOD activity and GPx are the main antioxidant mechanisms. Finally at Rainbow, catalase and lipid peroxidation are dominant, suggesting that resistance of mussels to metal toxicity at these vent fields decreases in the sequence Menez-Gwen > Lucky Strike and Rainbow.

CDNA cloning and sequence of European sea bass (Dicentrarchus labrax) somatolactin.

Three cDNA clones encoding for European sea bass somatolactin (SL) were obtained by RT-PCR and 3' RACE of RNA of pituitary origin. Clone 1 was 582 bp in length, and included a part of the signal peptide and the 5' end of the mature protein. Clone 2 (1075 bp) included a fragment of the coding sequence and the 3' untranslated region, which was 888 bp in length and contained two putative polyadenylation signals (AATAAA) at 12-17, and 202-207 nucleotides upstream of the poly (A) tail. Clone 3 was 624 bp in length and its nucleotide sequence encoding for the entire mature protein confirmed the sequence already determined from the first two clones. The size of SL mRNA transcripts was estimated by Northern blot analysis and a single band of approximately 1.6 kb was observed with pituitary RNAs. No band was found with RNAs of brain and liver origin. Alignment of the deduced amino acid sequence revealed that European sea bass SL shared 90-84% identity with perciform, pleuronectiform and scorpaeniform fish SLs, and 77-57% with other SLs of more distant fish orders, with a strict conservation of Cys residues and the N-glycosylation site (Asn-Lys-Thr) at 121-123 amino acid positions. The reconstruction of the phylogenetic tree based on SL nucleotide sequences. and analyzed by maximum likelihood distances, showed the same clustering as the present hierarchy of fish. When comparisons were made among SL, prolactin and growth hormone of European sea bass, the overall amino identity was relatively low (22-23%). However, a high degree of amino acid homology was found at the C-terminus, which contains three of the four Cys residues strictly conserved in all the members of GH/PRL family.

Effect of cadmium, copper and mercury on antioxidant enzyme activities and lipid peroxidation in the gills of the hydrothermal vent mussel Bathymodiolus azoricus.

Metals are known to influence lipid peroxidation and oxidative status of marine organisms. Hydrothermal vent mussels Bathymodiolus azoricus live in deep-sea environments with anomalous conditions, including high metal concentrations. Although B. azoricus are aerobic organisms they possess abundant methano and thioautotrophic symbiotic bacteria in the gills. The enzymatic defences (superoxide dismutase (SOD), catalase (CAT), total glutathione peroxidase (Total GPx) and selenium-dependent glutathione peroxidase (Se-GPx)) and lipid peroxidation were determined in the gills of B. azoricus exposed to Cd (0.9 microM), Cu (0.4 microM) and Hg (0.1 microM) with different times of exposure. The experiments were performed in pressurized containers at 9+/-1 degrees C and 85 bars. Results show that vent mussels possess antioxidant enzymatic protection in the gills. Cd and Cu had an inhibitory effect in the enzymatic defence system, contrarily to Hg. These enzymatic systems are not completely understood in the B. azoricus, since reactive oxygen species might be produced through other processes than natural redox cycling, due to hydrogen sulphide and oxygen content present. Also the symbiotic bacteria may play an important contribution in the antioxidant protection of the gills.

Molecular cloning of superoxide dismutase (Cu/Zn-SOD) from aquatic molluscs.

The potential of the first line of the active oxygen-scavenging system, partial cDNA encoding Cu/Zn superoxide dismutase (SOD) was isolated in three aquatic mollusc species: Ruditapes decussatus (marine clam), Dreissena polymorpha (continental water mussel) and Bathymodiolus azoricus (hydrothermal vent mussel). These SOD cDNA fragments were amplified by PCR with degenerate oligonucleotide primers derived from the amino acid sequence conserved in the Cu/Zn-SOD from several other organisms. A partial cDNA of CuZn-SOD was obtained for R. decussates (510 bp), D. polymorpha (510 bp) and B. azoricus (195 bp). The deduced amino acid sequence showed high similarity among the three mollusc species (57-63%) and among other species (50-65%). The residues involved in coordinating copper (His-47, 49, 64, 121) and zinc (His-64, 72, 81 and Asp-84) were well conserved among the three Cu/Zn-SOD sequences.

Effect of temperature and size on metallothionein synthesis in the gill of Mytilus galloprovincialis exposed to cadmium.

Although the degree of metal contamination is expected to be a primary determinant of metallothionein (MT) induction in marine mussels, at least at polluted sites, variability caused by temperature, and biotic factors such as size, may need to be considered when interpreting field data. To test the effects of these variables, mussels, Mytilus galloprovincialis, of different sizes (small: 3.5 +/- 0.5 cm and large: 5.2 +/- 0.7 cm) were exposed to Cd (100 microg l(-1)) at different water temperatures (5, 18 and 25 degrees C) for 34 days. Resultant Cd and MT concentrations in gills were shown to be size dependent and increased significantly with temperature. At the highest temperature tested (25 degrees C) there appears to be a disproportionate effect on Cd accumulation, which raises MT synthesis to exceptionally high levels. The effect of size on MT concentrations was also temperature-dependent: at 18 and 25 degrees C, large mussels exhibited higher MT levels than smaller individuals, whilst at 5 degrees C there were no significant differences between contaminated and control mussels, in either size-group, as a result of the reduced level of MT production at this temperature. When considering the use of MT levels in mussels as a biochemical indicator of metal contamination, the potential influence of factors such as size and temperature on MT-metal relationships needs to be considered. Samples should be of uniform size as far as possible, and collection should be limited to a fixed season (avoiding climatic extremes) to ensure that the effects of these factors on baseline levels of MT is minimised.

Experience and results on the surgical and medical treatment of ischaemic colitis.

OBJECTIVE: To analyse differences between patients with transient forms of ischemic colitis managed with medical treatment and those developing gangrenous forms subsidiaries of surgical treatment. MATERIAL AND METHODS: Retrospective study (1991-1998) of the ischemic colitis cases occurred in our center separating into two groups according to treatment received (A group: medical, 19 patients; B group: surgical, 10 patients). RESULTS: Hypertension mainly appear in B group being average age higher in this group than in A group (p < 0.05). Other risk factors analysed such as diabetes, cardiovascular disease, renal failure or consume of different drugs appear in similar way in both groups. In A group patients clinical presentation hematochezia is typical while B group use to start with acute abdomen associated to abdominal distension and hyperleukocytosis (p < 0.05). In group B average estance, morbidity and mortality have been higher than in A (17.4 vs 8.6 days 70 vs 5%, 40 vs 0%, respectively). CONCLUSION: Hypertension and advanced age are associated risk factors of gangrenous ischemic colitis. The classic clinical presentation of abdominal pain and hematochezia is typical in transient forms. Patients who need a surgical operation for ischemic colitis have a high morbimortality.

[Performance analysis of a new anesthetic system: the Temel Supra--part I]. / Análisis funcional de un nuevo sistema de anestesia: Temel Supra (I).

OBJECTIVES: To evaluate the performance of a new anesthetic system that purports to provide novel advantages in ventilating the anesthetized patient. MATERIAL AND METHODS: A performance analysis was carried out in our respirator function laboratory using lung simulators to assess the system, its degree of compliance with current regulations, and the degree of compliance with the manufacturer's claims. RESULTS: The system is 100% effective. The internal compliance of the respirator was 0.13 +/- 0.01 mL/cm H2O, inspiratory resistance was 1.9 +/- 0.1 cm H2O/L/s, expiratory resistance was 3.1 +/- 0.3 cm H2O/L/s, and internal volume was 130 mL. CONCLUSIONS: The Temel Supra device is versatile and meets the anesthetic requirements of patients undergoing any type of surgery. The possibility of using an open circuit, a low flow, a closed circuit, or a continuous flow without having to change to another system allows the anesthesiologist to make use of the advantages of each circuit without its drawbacks. The efficacy of the circuit is 100%. The low internal volume means that internal compliance is negligible and time constants are low, guaranteeing that the volume programmed is the same as the volume delivered and facilitating alveolar redistribution of gases. The monitoring and warning systems assure safe patient ventilation and accurate dosing of gases and anesthetic agents.

[Functional analysis of the high frequency jet respirator on a normal lung model. Ergojet CVT]. / Análisis functional en un modelo de pulmón normal del ventilador con jet a alta frecuencia. Ergojet CVT.

In this paper the results of the functional analysis of the Ergojet CVT, which is the high-frequency jet ventilation (HFJV) module of the Ergotronic 3 ventilator (Temel S.A.) are described. For a better understanding a detailed description of the module has been included. The functional analysis was performed on a standard lung model of normal compliance and resistance (C: 50 ml/cmH2O and R: 8 cmH2O.1-1.seg-1). High frequency jet ventilation was applied using the jet with and without additional gas entrainment, at frequencies of 90, 120, 150, 180, 210, 240, 270 and 300 rpm; for each frequency changes were made on the driving pressure (Pdriv: 1-2-3 kg.cm-2) and the inspiratory time (Ti: 33-50%). The combination of these parameters produced 96 different ventilatory circumstances. In each of them, airway and alveolar pressures (Paw and PA) were measured. Tidal and alveolar gas-trapped volumes (VT and Vtrap) were calculated from the previous PA measurements. These values were compared with those displayed by the ventilator. Following the results of the functional analysis of the Ergojet CVT, the VT delivered by the jet is the primary determinant of the VT, being little de increment due to the entrainment of gas. In the normal lung model, an adequate VT is obtained until frequencies of 240 rpm, using a Pdriv of 3 kg.cm-2. Vtrap, as in conventional ventilation, depend on VT and Te. The Pdriv and Ti, can be adequatelly combined in order to obtain a minimal Vtrap. Peak Paw depends on VT and Paw min on Vtrap.(ABSTRACT TRUNCATED AT 250 WORDS)

[Surgical risk assessment using multivariate analysis]. / Estimación del riesgo quirúrgico por medio del análisis multivariante.

INTRODUCTION: Over and above the risk of a disease itself, surgical treatment implies additional risk involving possible temporary or permanent deterioration in a patient's health. Most studies of anesthetic-surgical risk are based on mortality or serious morbidity (severe, permanent deterioration). They may therefore be of limited applicability in hospitals where such outcomes are rare due to the types of patients treated. In order to compare and classify patients as well as improve outcome in such health care settings other parameters must be evaluated. PATIENTS AND METHODS: Indicators presaging adverse situations related directly to surgery in our postoperative intensive care units involve blood transfusion and perioperative events. By applying multivariate (regression) analysis we can determine the factors that condition these unfavorable situations. RESULTS: In the setting we studied, the main determinants of unfavorable events after surgery are patient health as shown by ASA classification, duration of operation and type of surgery. CONCLUSIONS: 1) Peripheral surgery in patients in good health is very safe. 2) Easily obtained parameters can be used to obtain a fairly efficient prediction of risk. 3) Single-setting risk studies are easy to carry out and useful for providing information about a specific hospital center.

[Bilateral compartment syndrome after surgical perfusion for chronic ischemia of the lower extremities]. / Síndrome compartimental bilateral tras reperfusión quirúrgica en la isquemia crónica de miembros inferiores.

A 61-year-old man diagnosed with advanced stage Leriche syndrome underwent revascularization surgery with placement of an aortobifemoral shunt and prosthesis under combined general and lumbar epidural anesthesia. After 6 hours he developed bilateral lower extremity compartment syndrome with acute anuric kidney failure caused by severe rhabdomyolysis. Thirty hours after surgery the patient suffered cardiac arrest due to hyperkalemia and was unresponsive to advanced cardiopulmonary resuscitation. The delay in diagnosis, in part owing to the epidural block provided for surgery, and loss of muscle mass led to the unfavorable outcome in this case.