RESUMEN
OBJECTIVE: Cerebral oxygenation monitoring via near-infrared spectroscopy (NIRS) during cardiopulmonary bypass (CPB) is increasingly becoming an accepted and valued component of intraoperative monitoring. In recent years, new devices have become available which all make different claims. The purpose of this study is to examine the research on these individual devices to establish the levels of evidence for each and formulate a research path for further evaluation of this technology in cardiac surgery. METHODS: This study is a systematic review of published research on cerebral oximetry. We searched PubMed, CINAHL and Scopus for full-length, peer-reviewed articles containing original data resulting from the study of patient neurologic outcomes based on the use of FDA-approved near-infrared spectroscopy devices. The studies were then grouped and classified based on the device used and the levels of evidence each study provided. RESULTS: Only a very limited number of high-level clinical evidence research papers are currently available, with nearly all of those papers based on the INVOS system. This is likely due to the different lengths of time each device has been on the market and its availability for use in clinical trials. Challenges to testing include the expense of testing various devices, the lack of a globally accepted gold standard for cerebral oxygenation saturation, the limited availability of patient frontal surface area and the gradual adoption of this technology. Despite these limitations, significant results have been identified in relation to patient outcomes. CONCLUSION: At this time, there is limited high-level evidence available for all of the NIRS devices on the market despite significant outcomes found in these studies. Additional prospective randomized studies should be conducted in order to establish the potential role NIRS may play in patient monitoring as well as assessing the efficacy of the multiple devices on the market.
Asunto(s)
Encéfalo/metabolismo , Paro Cardíaco , Monitoreo Fisiológico , Oximetría , Oxígeno/sangre , Animales , Humanos , Monitoreo Fisiológico/instrumentación , Monitoreo Fisiológico/métodos , Oximetría/instrumentación , Oximetría/métodos , PubMed , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND AND PURPOSE: TASK1 (K(2P)3.1) two-pore-domain K(+) channels contribute substantially to the resting membrane potential in human pulmonary artery smooth muscle cells (hPASMC), modulating vascular tone and diameter. The endothelin-1 (ET-1) pathway mediates vasoconstriction and is an established target of pulmonary arterial hypertension (PAH) therapy. ET-1-mediated inhibition of TASK1 currents in hPASMC is implicated in the pathophysiology of PAH. This study was designed to elucidate molecular mechanisms underlying inhibition of TASK1 channels by ET-1. EXPERIMENTAL APPROACH: Two-electrode voltage clamp and whole-cell patch clamp electrophysiology was used to record TASK1 currents from hPASMC and Xenopus oocytes. KEY RESULTS: ET-1 inhibited TASK1-mediated I(KN) currents in hPASMC, an effect attenuated by Rho kinase inhibition with Y-27632. In Xenopus oocytes, TASK1 current reduction by ET-1 was mediated by endothelin receptors ET(A) (IC(50) = 0.08 nM) and ET(B) (IC(50) = 0.23 nM) via Rho kinase signalling. TASK1 channels contain two putative Rho kinase phosphorylation sites, Ser(336) and Ser(393) . Mutation of Ser(393) rendered TASK1 channels insensitive to ET(A) - or ET(B)-mediated current inhibition. In contrast, removal of Ser(336) selectively attenuated ET(A) -dependent TASK1 regulation without affecting the ET(B) pathway. CONCLUSIONS AND IMPLICATIONS: ET-1 regulated vascular TASK1 currents through ET(A) and ET(B) receptors mediated by downstream activation of Rho kinase and direct channel phosphorylation. The Rho kinase pathway in PASMC may provide a more specific therapeutic target in pulmonary arterial hypertension treatment.
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Endotelina-1/metabolismo , Proteínas del Tejido Nervioso/antagonistas & inhibidores , Canales de Potasio de Dominio Poro en Tándem/antagonistas & inhibidores , Quinasas Asociadas a rho/metabolismo , Animales , Células Cultivadas , Femenino , GTP Fosfohidrolasas/metabolismo , Humanos , Hipertensión Pulmonar/genética , Hipertensión Pulmonar/metabolismo , Hipertensión Pulmonar/fisiopatología , Potenciales de la Membrana/genética , Potenciales de la Membrana/fisiología , Músculo Liso Vascular/metabolismo , Músculo Liso Vascular/fisiología , Mutación , Miocitos del Músculo Liso/metabolismo , Miocitos del Músculo Liso/fisiología , Proteínas del Tejido Nervioso/genética , Proteínas del Tejido Nervioso/metabolismo , Fosforilación , Canales de Potasio de Dominio Poro en Tándem/genética , Canales de Potasio de Dominio Poro en Tándem/metabolismo , Arteria Pulmonar/metabolismo , Arteria Pulmonar/fisiología , Receptor de Endotelina A/metabolismo , Receptor de Endotelina B/metabolismo , Transducción de Señal , Vasoconstricción/genética , Vasoconstricción/fisiología , Xenopus laevis , Quinasas Asociadas a rho/antagonistas & inhibidoresAsunto(s)
Colectomía/métodos , Neoplasias Colorrectales/cirugía , Laparoscopios , Laparoscopía/métodos , Femenino , Humanos , MasculinoRESUMEN
Colonic surgery is feasible with the single-port technique using standard laparoscopic instruments. Operative time and complication rates are comparable to conventional standard laparoscopic procedures. Position of instruments (crossed over) and orientation are somewhat different and need to be trained and practiced. In this patient collective 200 colon resections covering the complete spectrum of colonic surgery were done in our department. Of these 120 patients were operated on because of sigma diverticulitis. The average operative time was 149 min whereby 6 patients (5.0%) had to be converted to an open procedure, 12 (10.0%) patients had early complications, of which 6 (5.0%) had minor wound complications which were treated conservatively and 4 (3.3%) patients had late complications (2 stenoses and 2 hernias) during the mean follow-up time of 7.5 months (range 6-14 months). The cosmetic effect was very good and functional results were good. Single-port colon operations are the least invasive procedure available at the moment.
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Enfermedades del Colon/cirugía , Laparoscopía/instrumentación , Laparoscopía/métodos , Colectomía/instrumentación , Colectomía/métodos , Neoplasias del Colon/cirugía , Reservorios Cólicos , Diverticulitis del Colon/cirugía , Estudios de Factibilidad , Hernia Abdominal/etiología , Hernia Abdominal/prevención & control , Humanos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/prevención & control , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Proctocolectomía Restauradora/instrumentación , Proctocolectomía Restauradora/métodos , Enfermedades del Sigmoide/cirugía , Equipo Quirúrgico , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/prevención & control , Estudios de Tiempo y MovimientoRESUMEN
BACKGROUND: The appearance of a carcinoma in the ileal pouch after restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative proctocolitis is rare. Most of these adenocarcinomas previously described in literature develop from residual viable rectal mucosa. We report a case of an adenocarcinoma arising in all probability from the ileal pouch after malignant transformation of the ileal pouch mucosa based on a chronic atrophic pouchitis. PATIENT AND METHODS: A 34-year-old man developed an adenocarcinoma after a double-stapled ileorectal J-pouch for ulcerative colitis (UC) proceeded from malignant ileal transformation. Before surgery, he had a 20-year history of UC refractory to medical therapy, but no occurrence of backwash ileitis, dysplasia or colitis-associated illness. He experienced severe pouchitis after IPAA since the ileostomy closure. Carcinoma was ensured by endoscopy, and the patient underwent an abdominoperineal pouch extirpation combined with excision of perirectal tissues and anal canal. Histology after surgery showed a pT4,pN2(4/16)pM0,G3 adenocarcinoma with global severe chronic atrophic pouchitis (CAP), villous atrophy and malignant ileal transformation. No metaplasia of the rectal mucosa was found, not even malignant epithelial transformation of the anal canal. CONCLUSION: This case suggests that a malignant transformation of the ileal pouch mucosa may occur as a pure complication of severe CAP, even in the absence of backwash ileitis or a previous history of cancer. The absence of metaplasia of the rectal mucosa revealed the passage from CAP to dysplastic epithelium and to cancer. A multifactorial development of carcinogenesis is supposed, but we emphasize the importance of severe CAP, and that careful surveillance is needed in patients after IPAA. We must submit that this is just a case report and cannot stand for general cancer development in ulcerative colitis, but it may point out the risk factor of chronic inflammation and leads the surgeon to skillful working when building the pouch.
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Adenocarcinoma/etiología , Neoplasias del Colon/etiología , Reservorios Cólicos/patología , Reservoritis/complicaciones , Adenocarcinoma/patología , Adulto , Atrofia , Enfermedad Crónica , Neoplasias del Colon/patología , Humanos , Masculino , Proctocolectomía RestauradoraRESUMEN
OBJECTIVE: To investigate the patterns of disclosure and perceptions of human immunodeficiency virus (HIV) status in a group of HIV-infected elementary school-age children. DESIGN: A survey. SETTING: A referred care university hospital center. PATIENTS: All HIV-infected children born before August 31, 1985, and scheduled for ambulatory follow-up between 1984 and 1993 were eligible for the study. A total of 35 HIV-infected (21 asymptomatic and 14 symptomatic) elementary school-age children (aged 5-10 years) were examined between 1990 and 1993. MAIN OUTCOME MEASURES: Semistructured qualitative interviews were used, 1 with the children and 1 with their parents or caregivers. In addition, 3 drawings per child were also analyzed. RESULTS: Partial disclosure was observed in 14 (40%) of the children, and full disclosure of the diagnosis of acquired immunodeficiency syndrome was given to 6 (17%) of the children. Secrecy regarding serostatus was the strategy used by 15 (43%) of the parents or caregivers involving either complete nondisclosure (n = 8) or deception by means of attributing the symptoms to another condition, medical or other (n = 7). Perceived health status and clinical status differed for 11 (31%) of the children. Eight children did not identify any illness causality, and most of the others gave prelogical or concrete-logical explanations. Few children were aware of their parent's infection or disease. CONCLUSION: Human immunodeficiency virus-infected elementary school-age children were exposed to various disclosure patterns regarding their HIV infection or disease, and most children (26/35 [74%]) reported stressful experiences due to HIV regardless of the disclosure patterns.
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Actitud Frente a la Salud , Infecciones por VIH/diagnóstico , Infecciones por VIH/psicología , Psicología Infantil , Revelación de la Verdad , Arte , Niño , Comunicación , Decepción , Femenino , Estado de Salud , Humanos , Masculino , Padres/psicología , Factores Socioeconómicos , Estrés Psicológico/psicología , Encuestas y CuestionariosRESUMEN
Thirty-three children vertically infected with human immunodeficiency virus type 1 (HIV-1), who were born before 1985, were followed in a single center, and had reached the age of 6 years, were studied and tested for school achievement. Of these 33 children, 24 were also tested for cognitive abilities, fine motor and language skills, and emotional adaptation. Of the 33 patients, 22 (67%) had normal school achievement at a mean age of 9.5 +/- 1.6 years. The mean IQ was 95 +/- 11, but 54% of the patients (13/24) had abnormal results on visual-spatial and time orientation tests, 44% had speech and/or language delay or articulation disorders, and 29% of the children and 42% of the parents had psychoaffective disturbances of intermediate or high severity. Normal school performance was positively correlated with results of the different cognitive tests and to a lesser extent with the absence of psychoaffective symptoms, but was independent of the mode of maternal infection or the parents' educational level. Children with normal school achievement had a higher percentage of circulating CD4+ lymphocytes during the course of infection. We conclude that children whose HIV-1 infection is maternally acquired have better cognitive abilities and school achievement than was initially thought, and that the percentage of circulating CD4+ lymphocytes during the first years of life appears to be predictive of future school adaptation or cognitive abilities.
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Síndrome de Inmunodeficiencia Adquirida/psicología , Cognición , VIH-1 , Transmisión Vertical de Enfermedad Infecciosa , Síndrome de Inmunodeficiencia Adquirida/inmunología , Síndrome de Inmunodeficiencia Adquirida/transmisión , Recuento de Linfocito CD4 , Niño , Trastornos de la Conducta Infantil/etiología , Lenguaje Infantil , Evaluación Educacional , Femenino , Humanos , Inteligencia , Estudios Longitudinales , Madres , Destreza Motora , Pruebas PsicológicasRESUMEN
In 34 children overcoming a severe head injury (coma greater than 1 d, mean: 10 d), the follow-up (mean: 25 m) has been correlated with several data. 1) The quality of life, according to a 3 grade-score, is mostly dependent upon the degree of neuropsychological sequelae. By decreasing frequency were noted disturbances of: memory, intelligence (the most significantly correlated with the quality of life), attention, rapidity of performances, behaviour, visuoconstructive activities. Most often several disturbances were associated, but without systematization. 2) Correlations between general outcome and early findings: a coma greater than 10 d, a subdural collection on the CT scan at 2-6 weeks have a pejorative meaning. Age does not appear to be relevant. 3) In a sequential study of neuropsychological functions, an early evaluation is poorly predictive, except in case of rapid normalization. Evaluation at 6 months gives a good picture of the outcome. Sectorial improvements can occur beyond the 1st year but do not appear to modify dramatically the general outcome.
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Traumatismos Craneocerebrales/fisiopatología , Adolescente , Niño , Trastornos de la Conducta Infantil/etiología , Preescolar , Trastornos del Conocimiento/etiología , Traumatismos Craneocerebrales/complicaciones , Femenino , Estudios de Seguimiento , Humanos , Masculino , PronósticoRESUMEN
The central issue in the pathophysiology of adhesions is the shift of the dynamic balance between fibrinolysis and fibrinogenesis to the side of fibrinogenesis. Permanent adhesions with the most varied morphology are formed by invasion of the fibrin network by fibroblasts and fibroid organization. Their classification by four degrees of severity is based on histological and morphological criteria. This classification has been shown useful and practicable for the objective examination and evaluation of relaparotomies in connection with expert opinion reports and animal experiments on adhesion research.
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Abdomen/cirugía , Complicaciones Posoperatorias/clasificación , Complicaciones Posoperatorias/fisiopatología , Adherencias Tisulares/clasificación , Adherencias Tisulares/fisiopatología , Abdomen/patología , Animales , Humanos , Peritoneo/patología , Peritoneo/fisiopatología , Complicaciones Posoperatorias/patología , Técnicas de Sutura , Adherencias Tisulares/patología , Cicatrización de Heridas/fisiologíaRESUMEN
Infection of ABAF hybride mice with MengoM viruses prepared as a suspension of mouse brain tissue (0.1 ml 10 LD50) after a series of more than 90 animal passages produced a severe panencephalitis and pancreatitis 60 h after inoculation. Histological examinations of the brain, pancreas, and heart revealed damage to the central nervous system and the acinar cells of the pancreas, consisting of a degeneration of the specific cells and their organelles, with little involvement of the heart muscle cells detectable with the electron microscope. This was consistent with high virus titers in the tissues in the period immediately following infection. The acute damage of exocrine tissues was without evidence of diabetes-like changes in the islets of Langerhans.
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Encéfalo/patología , Infecciones por Enterovirus/patología , Miocardio/patología , Páncreas/patología , Animales , Encéfalo/ultraestructura , Masculino , Mengovirus/patogenicidad , Ratones , Ratones Endogámicos , Microscopía Electrónica , Miocardio/ultraestructura , Organoides/ultraestructura , Páncreas/ultraestructuraRESUMEN
Experience with ureterosigmoidostomy (US) using a reflux prevention technique in 38 of 48 cases of bladder exstrophy is reviewed. During a follow-up period of 14 years, the results were excellent as to morphological changes of the upper urinary tract, incontinence, psychological development and social behavior. Within their families the patients are considered healthy. Even in children with benign disease, US with reflux prevention performed during the second year of life is the operation of choice for urinary diversion. In the postoperative follow-up it is recommended that sigmoidoscopy be performed once a year in addition to routine controls of the upper urinary tract and metabolic balance.
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Extrofia de la Vejiga/cirugía , Derivación Urinaria , Adolescente , Adulto , Niño , Preescolar , Colon Sigmoide/cirugía , Epispadias/cirugía , Femenino , Humanos , Lactante , Masculino , Complicaciones Posoperatorias , PronósticoRESUMEN
A procedure for the reconstitution of the lactose carrier protein, a galactoside:proton symporter in Escherichia coli, is described. Starting from cytoplasmic membranes derived from carrier-overproducing strains, essentially all proteins including 89% of the carrier are solubilized by a mixture of dodecyl/tetradecyl polyoxyethylene (n = 9.5) ether and dodecyl O-beta-D-maltoside. In the micellar state the carrier binds substrates with reduced affinity. Addition of E. coli phospholipids and removal of detergents by a hydrophobic column yields small vesicles (50-60-nm diameter). In these vesicles, about 70% of the carrier is recovered and reconstituted carrier is identical to native carrier in terms of substrate binding. After fusion of the small vesicles into larger vesicles (1-5 micrometers), rapid countertransport of galactosides is demonstrated. Attempts to show active galactoside transport by the imposition of artificial electrical potential or pH gradients were unsuccessful, most likely because the reconstituted vesicles are in fact highly permeable to protons.
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Proteínas Bacterianas/metabolismo , Proteínas de Escherichia coli , Escherichia coli/metabolismo , Galactósidos/metabolismo , Glicósidos/metabolismo , Proteínas de Transporte de Membrana/metabolismo , Proteínas de Transporte de Monosacáridos , Simportadores , Transporte Biológico Activo , Detergentes/farmacología , Concentración de Iones de Hidrógeno , Liposomas/metabolismo , Lípidos de la Membrana/metabolismo , Fosfolípidos/metabolismo , Unión ProteicaAsunto(s)
Síndrome del Abdomen en Ciruela Pasa/embriología , Urografía , Adulto , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Síndrome del Abdomen en Ciruela Pasa/diagnóstico por imagen , Síndrome del Abdomen en Ciruela Pasa/etiología , Obstrucción Uretral/complicaciones , Sistema Urinario/embriologíaRESUMEN
Familial juvenile nephronophthisis (FJN) is an autosomal-recessive disease which may exist as an isolated nephropathy or in combination with degenerative involvement of certain oran systems. The case reported describes a new variant of this lethal syndrome consisting of FJN, hepatic fibrosis, and neurocutaneous dysplasia (hypoplastic vermis of the cerebellum, choroid coloboma, and naevus flammeus). The same condition was probably present in the patient's sister who had also died at 6 years of age.
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Cerebelo/anomalías , Enfermedades Renales/genética , Cirrosis Hepática/complicaciones , Ataxia Cerebelosa/complicaciones , Niño , Preescolar , Femenino , HumanosRESUMEN
The urine output and the change in excretion of electrolytes (sodium, potassium, calcium, chloride, inorganic phosphate) in rats following mercury-induced acute tubular lesions showed marked recovery during L-thyroxine therapy. The kidney mechanisms responsible for this effect are discussed, considering especially the observation that rats treated with L-thyroxine have a reduced urinary output, unlike other species, including man, which react with polyuria. The oliguric effect of thyroid hormone in rats is attributed to the greater length of the vasa recta and loops of Henle.
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Intoxicación por Mercurio/tratamiento farmacológico , Tiroxina/uso terapéutico , Equilibrio Hidroelectrolítico/efectos de los fármacos , Animales , Masculino , Intoxicación por Mercurio/metabolismo , RatasRESUMEN
A significant increase in arterial blood pressure is considerably less common in childhood (as compared with adults), and, to a larger degree, is high-grade. The mild forms more frequently reverse spontaneously, and severe cases are more often asymptomatic. It is of a secondary nature in a much larger percentage (preponderantly of renal, but also of vascular, adrenal or other demonstrable etiology), i.e., susceptible to causal therapy. The growing interest within pediatrics in problems of primary (essential) hypertension with regard to epidemiology, etiology, pathogenetics and prognosis (!), lends additional importance to the particular difficulties involved in reliable blood pressure measurement and control, and additionally, the question of a useful definition of the criteria for pathological blood pressure increases, which is relatively uncertain in children (moreover, the normal values are highly age-dependent). The symptomatology of arterial hypertension shows certain age-specific characteristics. In the secondary forms, the underlying disease is ofter far advanced at the moment of manifestation and, even more so, of completion of the diagnosis. Certain risk factors (obviously also relevant for the later years of life) related to primary hypertension, the incidence of which is still quite controversial, can already be detected in childhood (familial and hereditary factors).