RESUMEN
Some studies have demonstrated that paracentesis for large-volume extraction of ascites produces renal failure and hyponatremia, and intravenous infusion of plasma expanders can overcome this complications. We performed a survey where we compared effectiveness of dextran 70 vs albumin on prevention of adverse effects and cost differences. Two random groups were formed, 8 cirrhotic patients with tense ascites in each group. Paracentesis with extraction of more than 5 liters was performed. The group A received human albumin and group B dextran 70, both received 6 g per liter of extracted liquid. 24 hours before and 48 hours after of ascites extraction, we performed hepatic function test, blood chemistry with renin and aldosterone. Clinical results and biochemistry test were similar in both groups without statistical significance (p > 0.05). Amount of plasma expander was almost the same, but the cost in group A was $266 USD and in group B $20.8 USD. Azotemia was present in 12.5% in group A and hyponatremia in 12.5% in both groups, without symptoms. The results show that dextran 70 produces the same effect like albumin in the treatment of ascites after large-volume paracentesis with lower cost.
Asunto(s)
Albúminas/administración & dosificación , Ascitis/terapia , Dextranos/administración & dosificación , Cirrosis Hepática/complicaciones , Punciones , Anciano , Femenino , Humanos , Cirrosis Hepática/diagnóstico , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Modelos BiológicosRESUMEN
Transjugular intrahepatic portosystemic shunt-stent (TIPS) was performed in 5 patients with cirrhosis and portal hypertension. Bleeding varices occurred in 4 patients and refractory ascites in one. We used 2 Wallstents and 3 Strecker stents. Shunt patency, recurrent variceal hemorrhage and ascites were evaluated. The shunts were created from a transjugular approach between the hepatic and portal vein, with diameters of 10 mm. Portal pressure was adequately decreased in all cases. The hospital stay, following TIPS was 3 days. Complete variceal decompression was identified endoscopically in 3 patients, and partial in one. Four shunts were patent by ultrasound and color Doppler at 1 to 6 months of follow up. One patient presented encephalopathy and one died at third day after TIPS. Initial results suggest that TIPS is an effective method of portal decompression for treatment of variceal hemorrhage and refractory ascites. The main complication was encephalopathy and only one patient died.
Asunto(s)
Hipertensión Portal/cirugía , Derivación Portosistémica Quirúrgica/métodos , Adulto , Anciano , Ascitis/etiología , Ascitis/cirugía , Procedimientos Quirúrgicos Electivos , Várices Esofágicas y Gástricas/etiología , Várices Esofágicas y Gástricas/cirugía , Femenino , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/cirugía , Humanos , Hipertensión Portal/complicaciones , Cirrosis Hepática/complicaciones , Cirrosis Hepática/cirugía , Masculino , Persona de Mediana Edad , Estudios Prospectivos , StentsRESUMEN
Se describe el tratamiento del coma diabetico com microdosis de insulina de accion rapida por via intramuscular, recomendandose una buena hidratacion.La dosis de insulina se calcula segun el peso del paciente en forma independiente del grado de hiperglucemia. Este metodo fue utilizado en viente pacientes adultos en coma diabetico, obteniendose el control de su trastorno metabolico en las primeras cuatro horas de iniciado el tratamiento. El metodo fue sencillo, clinicamente eficaz y elimino las posibilidades de hipoglucemia
Asunto(s)
Adulto , Persona de Mediana Edad , Humanos , Masculino , Femenino , Insulina , Coma Diabético , Infusiones ParenteralesRESUMEN
Stools from 109 patients with inflammatory bowel disease (13.4%) contained Clostridium difficile or its toxin, an incidence similar to the stools of 99 control patients with diarrhoea (11.9%), but significantly higher than the stools of 77 control patients with a normal bowel habit (1.4%). Sixty-six per cent of the diarrhoea controls, but only 11% of the inflammatory bowel disease patients, reported recent antibiotic use: however, 67% of inflammatory bowel disease patients were taking sulphasalazine. The presence of Cl difficile in the stool was not related to the clinical assessment of inflammatory bowel disease relapse, but it was related to hospital admission. During the one year study, 31 of the 109 patients (28%) with inflammatory bowel disease had one or more stool samples that were positive for Cl difficile.