RESUMEN

OBJECTIVE: To determine if transversus abdominis plane anesthetic blockage (TAP block) diminishes early postoperative pain scores and facilitates ambulatory management following total laparoscopic hysterectomy. DESIGN: Randomized triple blind trial. SETTING: Gynecological endoscopy unit at a referral center for laparoscopic surgery. POPULATION: A total of 197 patients. METHODS: Comparison of a treatment group receiving TAP block with bupivacaine 0.25% and placebo group with comparably placed bilateral injection of sterile saline solution. MAIN OUTCOME MEASURES: Pain scores at discharge 24, 48 and 72 h after surgery, opioid requirement after procedure. RESULTS: Patients who had TAP block had a significant reduction in their pain score at discharge compared with the placebo group (p = 0.017). There were no significant differences in the pain scores between groups at 24 h (95% CI 1.36-0.133, p = 0.237), 48 h (95% CI 0.689-0.465, p = 0.702) and 72 h (95% CI -0.631 to 0.223, p = 0.347). No differences were found between the groups regarding opioid requirements following the procedure (χ(2)  = 3.62, p = 0.46). CONCLUSION: Although TAP block after a total laparoscopic hysterectomy reduced the pain score at discharge compared with placebo, its role in this setting is debatable due to the possible lack of clinical significance of the small difference found.

Asunto(s)

RESUMEN

Copper is used for household drinking water distribution systems given its physical and chemical properties that make it resistant to corrosion. However, there is evidence that, under certain conditions, it can corrode and release unsafe concentrations of copper to the water. Research on drinking water copper pipes has developed conceptual models that include several physical-chemical mechanisms. Nevertheless, there is still a necessity for the development of mathematical models of this phenomenon, which consider the interaction among physical-chemical processes at different spatial scales. We developed a conceptual and a mathematical model that reproduces the main processes in copper release from copper pipes subject to stagnation and flow cycles, and corrosion is associated with biofilm growth on the surface of the pipes. We discuss the influence of the reactive surface and the copper release curves observed. The modeling and experimental observations indicated that after 10h stagnation, the main concentration of copper is located close to the surface of the pipe. This copper is associated with the reactive surface, which acts as a reservoir of labile copper. Thus, for pipes with the presence of biofilm the complexation of copper with the biomass and the hydrodynamics are the main mechanisms for copper release.

Asunto(s)

RESUMEN

OBJECTIVE: To evaluate the diagnostic utility of routine gastric biopsies taken at random versus targeted biopsies with methylene blue staining for the diagnosis of intestinal metaplasia. MATERIAL AND METHODS: We performed a validation study in 376 patients. We performed 2 antral biopsies, 2 gastric body biopsies, 1 biopsy for urease test and additional biopsies if demanded. One hundred and one patients underwent 2 biopsies after methylene blue staining. A total of 1,486 biopsies were analyzed. Frequencies of histological and endoscopic diagnosis and the validation of endoscopic diagnosis of intestinal metaplasia with and without staining against histology, which followed updated Sydney and Vienna criteria, were determined RESULTS: Metaplasia was found in 37.23% ofcases and in 6.38% was incomplete in antrum and body, moderate or severe. The endoscopic diagnosis had: sensitivity 46%, specificity 91%, positive predictive value (PPV) 75% and negative predictive value (NPV) 74%. The low sensitivity indicates the need for gastric biopsies. Staining had: sensitivity 95%, specificity 67%, PPV 84% and NPV 89%, with significant difference for staining (P < 0.05). The typical endoscopic appearance of intestinal metaplasia always coincided with staining and histology. Dysplasia was found in 0.53% ofcases, gastric cancer in 1.8% and Helicobacter pylori in 56%. CONCLUSION: Directed biopsy staining is superior to those taken at random for diagnosing metaplasia. Metaplasia was not found when endoscopy was normal and typical endoscopic appearance of metaplasia agreed with staining and histology.

Asunto(s)

RESUMEN

Sciatic hernia constitutes the scarcest group of hernias of pelvic floor; however, they should be considered in the origin of chronic pelvic pain. The proper diagnosis of sciatic hernias has allowed to surgeons treating successfully patients with acute or chronic pelvic pain, with intestinal or ureteral obstruction and with urinary or gluteus sepsis. It has to be considered as differential diagnosis before the finding of a congenital or acquired gluteus mass. Laparoscopist gynecologist should know the existence of this defect, to be familiar with its aspect in laparoscopic view and to know the laparoscopic treatment of this disease.

Asunto(s)

RESUMEN

OBJECTIVE: To evaluate the diagnostic utility of routine gastric biopsies taken at random versus targeted biopsies with methylene blue staining for the diagnosis of intestinal metaplasia. MATERIAL AND METHODS: We performed a validation study in 376 patients. We performed 2 antral biopsies, 2 gastric body biopsies, 1 biopsy for urease test and additional biopsies if demanded. One hundred and one patients underwent 2 biopsies after methylene blue staining. A total of 1,486 biopsies were analyzed. Frequencies of histological and endoscopic diagnosis and the validation of endoscopic diagnosis of intestinal metaplasia with and without staining against histology, which followed updated Sydney and Vienna criteria, were determined RESULTS: Metaplasia was found in 37.23

ofcases and in 6.38

was incomplete in antrum and body, moderate or severe. The endoscopic diagnosis had: sensitivity 46

, specificity 91

, positive predictive value (PPV) 75

and negative predictive value (NPV) 74

. The low sensitivity indicates the need for gastric biopsies. Staining had: sensitivity 95

, specificity 67

, PPV 84

and NPV 89

, with significant difference for staining (P < 0.05). The typical endoscopic appearance of intestinal metaplasia always coincided with staining and histology. Dysplasia was found in 0.53

ofcases, gastric cancer in 1.8

and Helicobacter pylori in 56

. CONCLUSION: Directed biopsy staining is superior to those taken at random for diagnosing metaplasia. Metaplasia was not found when endoscopy was normal and typical endoscopic appearance of metaplasia agreed with staining and histology.

Asunto(s)

RESUMEN

OBJECTIVE: To evaluate the diagnostic utility of routine gastric biopsies taken at random versus targeted biopsies with methylene blue staining for the diagnosis of intestinal metaplasia. MATERIAL AND METHODS: We performed a validation study in 376 patients. We performed 2 antral biopsies, 2 gastric body biopsies, 1 biopsy for urease test and additional biopsies if demanded. One hundred and one patients underwent 2 biopsies after methylene blue staining. A total of 1,486 biopsies were analyzed. Frequencies of histological and endoscopic diagnosis and the validation of endoscopic diagnosis of intestinal metaplasia with and without staining against histology, which followed updated Sydney and Vienna criteria, were determined RESULTS: Metaplasia was found in 37.23

ofcases and in 6.38

was incomplete in antrum and body, moderate or severe. The endoscopic diagnosis had: sensitivity 46

. The low sensitivity indicates the need for gastric biopsies. Staining had: sensitivity 95

, with significant difference for staining (P < 0.05). The typical endoscopic appearance of intestinal metaplasia always coincided with staining and histology. Dysplasia was found in 0.53

ofcases, gastric cancer in 1.8

and Helicobacter pylori in 56

. CONCLUSION: Directed biopsy staining is superior to those taken at random for diagnosing metaplasia. Metaplasia was not found when endoscopy was normal and typical endoscopic appearance of metaplasia agreed with staining and histology.

Asunto(s)

RESUMEN

BACKGROUND: The BISAP score is a simple system, which englobes clinical features (laboratory and imagenology tests) allowing to predict the mortality in acute pancreatitis within the first 24 hours of hospitalization. OBJECTIVE: To determine the validity of the BISAP score in the prediction of prognosis and severity of acute pancreatitis. METHOD: In order to validate the BISAP score, a study was performed in 57 patients with a diagnosis of acute pancreatitis at the moment of admission. The reference test was the Atlanta criteria which confirmed severe clinical course beyond the fifth day, in many cases supported by CT. RESULTS: 71.9% were women. The mean age was 45.33 years. Biliary lithiasis was the most frequent cause (66.7%). According to the reference test 71.9% were mild and 28.1% severe. According to the BISAP score 77.2% mild and 22.8% severe. The sensitivity and specificity for the BISAP score was of 75% and 97.56% respectively. The predictive positive value was 92.31% and the predictive negative value was 90.91%. CONCLUSIONS: The BISAP score allows to predict the severity of the acute pancreatitis.

Asunto(s)

RESUMEN

INTRODUCCIÓN: El score de BISAP es un sistema no complicado y factible de realizar en hospitales de referencia como el nuestro, engloba variables clínicas, de laboratorio y de imagen, permitiendo predecir la mortalidad por pancreatitis aguda, dentro de las 24 horas de inicio del cuadro clínico. OBJETIVO: Determinar la validez del score de BISAP en la gravedad y el pronóstico de la Pancreatitis Aguda. MÉTODO: Estudio de validación del score de BISAP en 57 pacientes consecutivos con diagnóstico de pancreatitis aguda al ingreso. Prueba de referencia: los criterios de Atlanta confirmados por evolución clínica grave más allá del quinto día, apoyados en muchos casos por TAC. RESULTADOS: El 71.9% fueron de sexo femenino. La media de edad fue de 45.33 años. La litiasis biliar fue la causa más frecuente (66.7%). Según la prueba de referencia, el 71.9% de casos fueron leves y el 28.1% graves. Según el score de BISAP el 77.2% leves y el 22.8% graves. La sensibilidad y especificidad para el score de BISAP fue del 75% y del 97.56% respectivamente. El valor predictivo positivo fue del 92.31% y el valor predictivo negativo, del 90.91%. CONCLUSIONES: El score de BISAP permite predecir la severidad en la pancreatitis aguda.

BACKGROUND: The BISAP score is a simple system, which englobes clinical features (laboratory and imagenology tests) allowing to predict the mortality in acute pancreatitis within the first 24 hours of hospitalization. OBJECTIVE: To determine the validity of the BISAP score in the prediction of prognosis and severity of acute pancreatitis. METHOD: In order to validate the BISAP score, a study was performed in 57 patients with a diagnosis of acute pancreatitis at the moment of admission. The reference test was the Atlanta criteria which confirmed severe clinical course beyond the fifth day, in many cases supported by CT. RESULTS: 71.9% were women. The mean age was 45.33 years. Biliary lithiasis was the most frequent cause (66.7%). According to the reference test 71.9% were mild and 28.1% severe. According to the BISAP score 77.2% mild and 22.8% severe. The sensitivity and specificity for the BISAP score was of 75% and 97.56% respectively. The predictive positive value was 92.31% and the predictive negative value was 90.91%. CONCLUSIONS: The BISAP score allows to predict the severity of the acute pancreatitis.

Asunto(s)

RESUMEN

Objetivo: conocer la evolución a un año de las pacientes a quienes se les ha realizado tratamiento quirúrgico laparoscópico de la endometriosis profunda infiltrante. Metodología: cohorte de 24 pacientes con edades comprendidas entre 22 y 51 años a quienes se les realizó tratamiento quirúrgico de la endometriosis profunda infiltrante en la Unidad de Endoscopia Ginecológica de la Clínica del Prado y Profamilia, en Medellín, entre septiembre del 2007 y febrero del 2008. Se evaluaron las variables sociodemográficas, síntomas dolorosos, localización anatómica de la endometriosis profunda infiltrante, características de la lesión, tratamiento, tiempo quirúrgico, complicaciones. Resultados: se presentó una lesión de recto como única complicación en esta serie (4,1%). Hubo una disminución estadísticamente significativa de los síntomas dolorosos. Tres pacientes (12%) tuvieron recurrencias al año de seguimiento. Conclusión: el tratamiento laparoscópico de la endometriosis profunda infiltrante surge como una alternativa para el tratamiento de la endometriosis infiltrativa profunda.

Objective: making a one-year evaluation of the evolution of patients who underwent laparoscopic surgery for treating deep infiltrating endometriosis.Methodology: a cohort of twenty-four patients aged between 22 and 51 was included; they had had been diagnosed as suffering from deep infiltrating endometriosis. This took place in Clínica del Prado’s gynaecological endoscopy unit and in Profamilia in Medellín between September 2007 and February 2008. Minimally invasive treatment was undertaken with one-year follow-up. The following variables were evaluated: sociodemographic data, painful symptoms, anatomical localization of deep infiltrating endometriosis, lesion characteristics, surgical treatment, surgical time and complications. Results: colonic lesion was the only complication reported in this series (4.1%). There was a statistically significant reduction in painful symptoms. Three patients (12%) suffered recurrences during the year-long follow-up. Conclusions: laparoscopic treatment of deep infiltrating endometriosis is an option which alleviates the painful symptoms of endometriosis.

Asunto(s)

RESUMEN

Objetivos: evaluar la posible asociación entre el mayor índice de masa corporal (IMC) y los resultados peri y posoperatorios en pacientes a las que se les realizó histerectomía laparoscópica total (HLT). Metodología: cohorte histórica de pacientes a quienes se les practicó HLT en un período de 5 años en un centro de referencia para endoscopia ginecológica. Fueron incluidas todas las pacientes con HLT y con la información completa. Las pacientes fueron divididas en tres grupos según su masa corporal: IMC menor de 24,9 kg/m2, normal (n = 339); IMC entre 25-29,9 kg/m2, sobrepeso (n = 243) e IMC mayor de 30 kg/m2, obesidad (n = 94). Se compararon el tiempo quirúrgico, las complicaciones, la pérdida sanguínea, la necesidad de transfusión, la tasa de laparoconversión y el tiempo de estancia hospitalaria. Los tres grupos se contrastaron por medio de la prueba ANOVA. Resultados: 676 pacientes cumplieron los requisitos para el estudio. No hubo diferencias significativas en cuanto a la pérdida sanguínea, el tiempo quirúrgico, la estancia hospitalaria, la tasa de complicaciones o de laparoconversión. Conclusión: no se encontró asociación entre el índice de masa corporal y malos resultados peri y posoperatorios.

Objectives: evaluating the possible association between body mass index (BMI) and peri-and post-operative results in patients undergoing total laparoscopic hysterectomy (TLH). Methodology: a historical cohort of patients was taken over a 5-year period; they had undergone TLH in a referral centre for gynaecological laparoscopy. All patients who had undergone TLH and about whom complete information was available were included. Patients were divided into three groups according to body mass as follows: BMI below 24.9 kg/m2: “normal” (n = 339), BMI 25 -29.9 kg/m2: “overweight” (n = 243) and BMI greater than 30 kg/m2: “obese” (n = 94). Surgical time, complications, blood loss, transfusion requirement, laparoconversion rate and length of hospital stay were compared. ANOVA was used for comparing the three groups. Results: 676 patients met the study requirements. No significant differences regarding blood loss, operating time, hospital stay, complication rate or laparoconversion were found. Conclusion: no association was found between BMI and poor results during peri-and postoperative periods.

Asunto(s)

RESUMEN

Objetivo: describir la experiencia en la práctica de Histerectomía Laparoscópica Total (HLT) con énfasis en las complicaciones presentadas. Metodología: el presente es un estudio de cohorte histórica en el cual se incluyeron las pacientes que fueron intervenidas entre diciembre de 2002 y abril de 2008 y en quienes, además, se completó al menos 90% de la información requerida en un formulario prediseñado. Durante la investigación, se evaluaron las características sociodemográficas, las indicaciones de cirugía, el porcentaje de laparoconversión y las causas de la misma, el tiempo quirúrgico, la pérdida sanguínea estimada, el tiempo de hospitalización, el número de dosis de analgésicos requeridos, los días de incapacidad y las complicaciones intraoperatorias y postoperatorias. Resultados: en total se incluyeron 837 pacientes, cuya edad promedio fue 42,7 años. 83,8% de las mujeres eran ASA I (American Society of Anesthesiologists) y la principal enfermedad de base fue la hipertensión arterial (9,9%). En 822 de ellas, el procedimiento se llevó a cabo por laparoscopia mientras que 15 (1,7%) requirieron laparoconversión. Las indicaciones más frecuentes para la cirugía fueron miomatosis (43,8%) y hemorragia uterina anormal (36,1%). Adicional a esto, el tiempo quirúrgico promedio fue 85,9 minutos, la pérdida sanguínea media fue de 60,6 mL y la tasa total decomplicaciones llegó a ser 12,5%; de lacuales, 3,1% lo constituyeron complicaciones mayores. Conclusiones: la tasa de complicaciones de la histerectomía laparoscópica total es similar a la informada en la literatura y está acompañada de una estancia hospitalaria breve.

Objective: describing accumulated experience gained from performing Total Laparoscopic Hysterectomy (TLH) at the Clínica del Prado. Methodology: this was a descriptive, retrospective study (evidence level III) which involved patients who underwent TLH in the Gynaecological Endoscopic Unit at Clínica del Prado, Medellín, Colombia. 1,150 medical records from patients operated on between December 2002 and April 2008 were reviewed; those in which at least 90% of the data required by a predesigned instrument could be recovered were included for analysis. Main outcomes measured: demographic data, surgical indication, laparoconversion rate and causes, surgical time, estimated blood loss, uterine weight and height, time of hospital stay and complications. Results: 837 patients were included; TLH was entirely performed on 822 of them by laparoscopy whilst 15 (1.7%) required laparoconversion. The most frequent indications for surgery were fibroids (43.8%) and abnormal uterine bleeding (36.1%). Mean age was 42.7. 83.8% of the patients were ASA I (American Society of Anesthesiologists); the main comorbidity found was hypertension (9.9%). Mean surgical time was 85.9 minutes; mean estimated blood loss was 60.6 mL. The commonest histological diagnosis was fibroids (57.1%). Mean uterine weight was 180 grams and mean uterine height 10.2 cm. Complications affected 12.5% of the 837 patients, 3.1% of them being major ones.

Asunto(s)

RESUMEN

Traditional studies of copper release in plumbing systems assume that the water extracted from a pipe follows a plug-type flow and that the pipe surface does not interact with the bulk water under flow conditions. We characterized actual stagnation-flushing cycles in a household pipe undergoing corrosion in the presence of a microbial biofilm. The mass of copper released in 10 experiments was on average 8 times the value estimated by using the plug-flow assumption. The experimental copper release pattern was explained by an advection-diffusion model only if a high copper concentration occurs near the pipe surface after stagnation. Microscopic examination of the pipe surface showed a complex assemblage of biotic and abiotic features. X-ray diffraction analyses identified only malachite, while X-ray absorption spectroscopy also revealed cupric hydroxide and cuprite. These results indicate that the surface serves as a storage compartment of labile copper that may be released under flow conditions. Thus, the diffusive transport from the pipe surface to the bulk during stagnation is not the only control of the flux of copper to the tap water when porous reactive microstructures cover the pipe. Our results highlight the need for models that consider the interaction between the hydrodynamics, chemistry, and structure at the solid-water interface to predict the release of corrosion byproducts into drinking water.

Asunto(s)

RESUMEN

Induction of apoptosis and necrosis by enterohemorrhagic Escherichia coli (EHEC) has been reported in vivo and in vitro, but features of cell death were not noted in those reports. Since tumor necrosis factor-alpha (TNF-alpha) has been implicated in the apoptosis of invasive bacteria, we investigated the role of this cytokine in EHEC-induced apoptosis. We hypothesize that the probiotic yeast strain Saccharomyces boulardii that interferes with EHEC-induced pro-inflammatory pathways delays EHEC-induced apoptosis. By 6 h of infection, flow cytometry analysis of T84 cells demonstrated that 40% of cells were FITC-annexin-V-positive and 40% of cells incorporated both annexin and propidium iodide (PI). Simultaneously, western blot analysis demonstrated that procaspases-8 and -3 were cleaved. Fragmentation of internucleosomal DNA revealed evidence of apoptotic leader formation after 8 and 9 h of infection. Procaspase-9 activation and 3',3-dihexyloxacarbocyanine iodide (DiOC(6)) incorporation were observed at 3 h of infection. In cells preincubated with S. boulardii and infected with EHEC in the presence of yeast, the quantities of procaspases-8, -9 and -3 did not vary, and no DNA fragmentation was observed. The TNF-alpha transcript level and the level of secreted TNF-alpha increased considerably (P<0.001vs control cells) at 6 h of infection in EHEC-alone-infected cells, but were significantly reduced in cells infected in the presence of S. boulardii (P<0.001vs EHEC-alone-infected cells). The presence of anti-TNF-alpha antibody during infection reduced by 30% the level of FITC-annexin V-positive cells. Altogether, these findings demonstrated that: (i) EHEC infection stimulated TNF-alpha synthesis that is implicated in apoptosis of T84 cells; and (ii) S. boulardii induced a decrease in TNF-alpha and related apoptosis in EHEC-infected T84 cells.

Asunto(s)

RESUMEN

OBJECTIVE: To assess the diagnostic accuracy of a rapid urine-screening test (Multistix8SG) for spontaneous bacterial peritonitis (SBP) in cirrhotic patients. METHODS: Seventy-two consecutive patients (44 males, 28 females; mean age 61.6 years) with cirrhosis and ascites were included in the study. A diagnostic paracentesis was performed on hospital admission in all patients and 2 days after antibiotic treatment in the case of SBP (polymorphonuclear [PMN] count over 250/mm in ascitic fluid). Each fresh sample of ascitic fluid was also tested using the Multistix8SG urine test, and the results were scored as negative, trace or positive. RESULTS: Nine of the 72 patients had SBP and the Multistix8SG urine test was positive. After 48 h of antibiotic therapy, the PMN count of three of these nine patients was still above 250/mm and the Multistix8SG test remained positive. In three other patients with SBP, the PMN count dropped below 250/mm and the Multistix8SG test result had become negative. Two of the nine SBP patients died before 48 h, and paracentesis was not performed in the ninth case. In the other 63 patients, the PMN count in ascitic fluid was below 250/mm; the Multistix8SG test revealed 17 trace results and 46 negative results. At the threshold of 250 PMN/mm in ascitic fluid, this test had a sensitivity and a specificity of 100%. CONCLUSION: A positive Multistix8SG urine test result in ascitic fluid appears to be an indication for antibiotic treatment.

Asunto(s)