RESUMEN
OBJECTIVES: To study cardiopulmonary function in 30 ASA I and II patients undergoing laparoscopic cholecystectomy with CO2. PATIENTS AND METHODS: Fifteen patients were given total anesthesia with propofol (group PRO) and 15 inhaled isoflurane (group ISO). In addition to the usual monitoring, we used esophageal Doppler ultrasonogram (ED) to study the hemodynamic status after pneumoperitoneum (NP) at 15 mmHg, after the patient had been placed in anti-Trendelenburg (AT) position, and 10, 20 and 30 minutes after NP (series 1). We also studied response to reduction of NP from 15 mmHg to 12, 10, 8 and 6 mmHg (series 2), repeating this sequence when duration of surgery permitted (series 3). RESULTS: In group PRO, cardiac index (CI) decreased 17.96% (NS) after NP and 24.90% (p = 0.015; r = 0.71) after AT. In group ISO, the decreases were 15.86% (p = 0.02; r = 0.69) and 22.34% (p = 0.02; r = 0.80), respectively. Correlated flow time (FTc) and peak velocity (PV) decreased, while the index of total peripheral resistance (TPRI) increased with NP and AT. Recovery of CI was gradual and spontaneous (series 1). The decreases in NP pressure did not produce significant improvement in IC. CONCLUSIONS: Induction of NP and placement in AT position causes significant decreases in CI as measured by ED in ASA I and II patients, whether they inhale the anesthetic agent or are given total intravenous anesthesia. This effect seems to be related to the increase in afterload, measured in this study by TPRI and the ratio PV/FTc.
Asunto(s)
Anestesia por Inhalación , Anestesia Intravenosa , Anestésicos por Inhalación , Anestésicos Intravenosos , Colecistectomía Laparoscópica , Hemodinámica , Isoflurano , Neumoperitoneo Artificial/efectos adversos , Propofol , Respiración , Adulto , Anciano , Anestésicos por Inhalación/farmacología , Anestésicos Intravenosos/farmacología , Gasto Cardíaco Bajo/etiología , Femenino , Hemodinámica/efectos de los fármacos , Humanos , Complicaciones Intraoperatorias/etiología , Isoflurano/farmacología , Masculino , Persona de Mediana Edad , Postura , Propofol/farmacología , Respiración/efectos de los fármacosRESUMEN
The prevalence and risk factors of hepatitis B infection were studied in 354 non-drug abusing female prostitutes and 360 female controls in Tijuana, Mexico. Hepatitis B surface antigen (HBsAg) was found in the same percentage (0.8%) of prostitutes and controls. In contrast, antibody markers (anti-HBs or anti-HBc) were found in a significantly higher percentage of prostitutes than controls (8.2% vs. 2.2%, p = 0.0006). Prostitutes also had a higher prevalence of a positive RPR/FTA-ABS test for syphilis (p less than 0.0001). There was a significant association between the presence of hepatitis B markers and positive syphilis serology and a history of having had a STD. In this non-drug abusing population, prostitution was found to be a risk factor for total hepatitis B infection but not for surface antigenemia. Further studies are indicated to determine the incidence of chronic infection in adult women following sexual transmission of hepatitis B.
Asunto(s)
Hepatitis B/epidemiología , Trabajo Sexual , Adolescente , Adulto , Enfermedad Crónica , Femenino , Hepatitis B/complicaciones , Anticuerpos contra la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/sangre , Antígenos e de la Hepatitis B/sangre , Humanos , Incidencia , México/epidemiología , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Sífilis/complicaciones , Serodiagnóstico de la SífilisRESUMEN
Angioimmunoblastic lymphadenopathy is a rare clinical entity, first described in 1974, characterized by asthenia, anorexia, fever, sweating, generalized lymph node enlargement, hepatosplenomegaly, rash, hypergammaglobulinemia, and often Coomb's positive hemolytic anemia. Main histopathologic findings are lymphoplasmocytic and immunoblastic proliferations, increased vascular neshwork and interstitial granular PAS positive material deposits. A lymph node excised from a woman with angioimmunoblastic lymphadenopathy was examined under electron microscopy. Results of ultrastructural study are compared to the typical histologic pattern observed under light microscopy. Analysis of the cellularity and the significance of fibrous collagen found in the interstitial PAS positive material are commented on.