RESUMO
Introducción: La cirugía de resección hepática se ha caracterizado desde sus inicios por una alta tasa de morbimortalidad, relacionada esencialmente con el riesgo de hemorragias y con la necesidad de transfusiones masivas. La experiencia acumulada en 900 intervenciones permitió el desarrollo de una conducta quirúrgico-anestésica que incorpora métodos más modernos y elementos propios, con el objetivo de disminuir el consumo de sangre. Objetivo: Conocer el impacto de las modificaciones en la técnica anestésica, quirúrgica y en las indicaciones de transfusión de hemocomponentes, en enfermos sometidos a resecciones hepáticas, practicadas por el mismo equipo anestésico, quirúrgico y transfusional, en 18 años de experiencia. Material y método: Dos grupos de enfermos sometidos a resecciones hepáticas comparables. Grupo 1: 45 enfermos consecutivos intervenidos entre 1983 y 1987. Técnica anestésica, neuroleptoanestesia y anestesia inhalatoria. Transfusión de hemocomponentes a demanda. El parámetro intraoperatorio más importante fue la tensión arterial. Grupo 2: 45 enfermos consecutivos intervenidos en el año 2000. Técnica anestésica endovenosa. Transfusión de sangre separada en hemocomponentes y sangre autóloga, de acuerdo con las guías de la Asociación Americana de Anestesia (ASA) y de los Servicios de Anestesia y Medicina Transfusional. Parámetros intraoperatorios más importantes: tensión arterial media y presión venosa central. La última variable debe permanecer por debajo de 5 cm de H2O. Se utilizaron además drogas vasoactivas. Resultados: Grupo 1: transfundidos 778 por ciento; grupo 2: 53,3 por ciento (p=0,027). Promedio de horas en respirador: grupo 1: 19 horas; grupo 2: 4 horas (p=0,0001). Promedio de horas en la unidad de cuidados intensivos: grupo 1: 36 horas; grupo 2: 2:30 horas (p=0,06). Promedio de días de internación: grupo 1: 12; grupo 2: 7 (p=0,006). Morbilidad del grupo 1: 71 por ciento; grupo 2: 26,7 por ciento (p=0,0001). Mortalidad: grupo 1: 6,7 por ciento; grupo 2: 0 por ciento (p=0,24). Conclusiones: Las modificaciones en la técnica quirúrgica, anestésica y transfusional permitieron disminuir el consumo de hemocomponentes, una desconexión precoz del respirador, menor cantidad de tiempo en la unidad de cuidados intensivos, menor estadía hospitalaria y una disminución en la morbimortalidad. (AU)
Assuntos
Humanos , Masculino , Pré-Escolar , Adolescente , Adulto , Estudo Comparativo , Feminino , Lactente , Pessoa de Meia-Idade , Idoso , Hepatectomia/métodos , Hepatectomia/estatística & dados numéricos , Hepatectomia/efeitos adversos , Hepatectomia , Hepatectomia/mortalidade , Transfusão de Sangue/métodos , Transfusão de Sangue Autóloga/métodos , Anestesia Intravenosa , Hemorragia/prevenção & controle , Pressão Sanguínea , Complicações Intraoperatórias , Complicações Pós-Operatórias , Mortalidade , Fatores de RiscoRESUMO
Introducción: La cirugía de resección hepática se ha caracterizado desde sus inicios por una alta tasa de morbimortalidad, relacionada esencialmente con el riesgo de hemorragias y con la necesidad de transfusiones masivas. La experiencia acumulada en 900 intervenciones permitió el desarrollo de una conducta quirúrgico-anestésica que incorpora métodos más modernos y elementos propios, con el objetivo de disminuir el consumo de sangre. Objetivo: Conocer el impacto de las modificaciones en la técnica anestésica, quirúrgica y en las indicaciones de transfusión de hemocomponentes, en enfermos sometidos a resecciones hepáticas, practicadas por el mismo equipo anestésico, quirúrgico y transfusional, en 18 años de experiencia. Material y método: Dos grupos de enfermos sometidos a resecciones hepáticas comparables. Grupo 1: 45 enfermos consecutivos intervenidos entre 1983 y 1987. Técnica anestésica, neuroleptoanestesia y anestesia inhalatoria. Transfusión de hemocomponentes a demanda. El parámetro intraoperatorio más importante fue la tensión arterial. Grupo 2: 45 enfermos consecutivos intervenidos en el año 2000. Técnica anestésica endovenosa. Transfusión de sangre separada en hemocomponentes y sangre autóloga, de acuerdo con las guías de la Asociación Americana de Anestesia (ASA) y de los Servicios de Anestesia y Medicina Transfusional. Parámetros intraoperatorios más importantes: tensión arterial media y presión venosa central. La última variable debe permanecer por debajo de 5 cm de H2O. Se utilizaron además drogas vasoactivas. Resultados: Grupo 1: transfundidos 778 por ciento; grupo 2: 53,3 por ciento (p=0,027). Promedio de horas en respirador: grupo 1: 19 horas; grupo 2: 4 horas (p=0,0001). Promedio de horas en la unidad de cuidados intensivos: grupo 1: 36 horas; grupo 2: 2:30 horas (p=0,06). Promedio de días de internación: grupo 1: 12; grupo 2: 7 (p=0,006). Morbilidad del grupo 1: 71 por ciento; grupo 2: 26,7 por ciento (p=0,0001). Mortalidad: grupo 1: 6,7 por ciento; grupo 2: 0 por ciento (p=0,24). Conclusiones: Las modificaciones en la técnica quirúrgica, anestésica y transfusional permitieron disminuir el consumo de hemocomponentes, una desconexión precoz del respirador, menor cantidad de tiempo en la unidad de cuidados intensivos, menor estadía hospitalaria y una disminución en la morbimortalidad.
Assuntos
Humanos , Masculino , Pré-Escolar , Adolescente , Adulto , Feminino , Lactente , Pessoa de Meia-Idade , Anestesia Intravenosa , Pressão Sanguínea , Hemorragia , Hepatectomia , Transfusão de Sangue Autóloga/métodos , Transfusão de Sangue/métodos , Complicações Intraoperatórias , Complicações Pós-Operatórias , Fatores de RiscoRESUMO
The opossum of the genus Didelphis is one of the principal wild reservoirs of Trypanosoma cruzi and is widely distributed in the Western Hemisphere. Didelphis albiventris is the most common marsupial in Amamá and Trinidad, two communities in the province of Santiago del Estero, Argentina. The D. albiventris population is replaced every year, and the opossum normally has two reproductive periods, one at the beginning of the spring and another at the beginning of the summer. The two litters are weaned, and they leave the mother's marsupial pouch to join the population, the first (G1) at the beginning of the summer and the second (G2) at the beginning of the fall. Between 1988 and 1991 409 D. albiventris opossums were studied, and xenodiagnoses showed that 35% of them were infected with T. cruzi. Annual cycles of renewed infection were observed, with prevalences that ranged between 22% and 43%. The acquisition of the parasite occurred over the entire year, from the summer through the spring. The prevalence of infection increased with age. The G1 individuals tended to present higher prevalences than the G2 individuals, probably from being exposed to transmission for a longer period of time. In the first two (younger) age categories for the opossums, G2 individuals showed higher prevalences than did the G1 individuals. This indicates a significant increase in transmission intensity during the fall. Opossums should be regarded as a potential source of T. cruzi entry to the domestic transmission cycle.
Assuntos
Doença de Chagas/epidemiologia , Gambás , Animais , Argentina/epidemiologia , PrevalênciaRESUMO
his paper reports on the standardization of four serological reactions currently used in human serodiagnosis for the detection of anti-Trypanosoma cruzi antibodies in naturally and experimentally infected dogs. Indirect immunofluorescence test (IFAT) and hemagglutination test (IHAT) were standardized, and complement fixation test (CFT) and direct agglutination test (DAT) were used for diagnostic confirmation. Four hundred and eighty one mongrel dogs that were studied by xenodiagnosis were used: (1) parasitemic dogs of two localities of endemic area (EA) of Santiago del Estero province in Argentina (n = 134); (2) non-parasitemic dogs of the same area (n = 285); (3) dogs experimentally infected with T. cruzi in the patent period (n = 6); (4) non-infected dogs (n = 56) which were born in the city of Buenos Aires (BA), one non-EA for Chagas' disease. For IFAT, parasitemic dogs EA showed 95 per cent of reactive sera. Non parasitemic dogs EA showed 77 per cent of non reactive sera. None sera from BA were reactive for dilutions higher than four. For IHAT, 84 per cent of sera of parasitemic dogs EA showed serological reactivity and among non parasitemic dogs BA, 61 per cent were non reactive, while the remainder showed at most titres of 1/16. The cut-off titres for IFAT and IHAT were 1/16 and 1/32 respectively, and for CFT and DAT 1/1 and 1/128 respectively. Sensitivity for IFAT, IHAT, CF and DAT were 95 per cent , 84 per cent , 97 per cent and 95 per cent respectively
Assuntos
Animais , Cães , Anticorpos Antiprotozoários/análise , Testes Sorológicos/normas , Trypanosoma cruzi/imunologia , Testes de Aglutinação , Testes de Fixação de Complemento , Doença de Chagas/diagnóstico , Imunofluorescência , Testes de Hemaglutinação , Sensibilidade e EspecificidadeRESUMO
This paper reports on the standardization of four serological reactions currently used in human serodiagnosis for the detection of anti-Trypanosoma cruzi antibodies in naturally and experimentally infected dogs. Indirect immunofluorescence test (IFAT) and hemagglutination test (IHAT) were standardized, and complement fixation test (CFT) and direct agglutination test (DAT) were used for diagnostic confirmation. Four hundred and eighty one mongrel dogs that were studied by xenodiagnosis were used: (1) parasitemic dogs of two localities of endemic area (EA) of Santiago del Estero province in Argentina (n = 134); (2) non-parasitemic dogs of the same area (n = 285); (3) dogs experimentally infected with T. cruzi in the patent period (n = 6); (4) non-infected dogs (n = 56) which were born in the city of Buenos Aires (BA), one non-EA for Chagas' disease. For IFAT, parasitemic dogs EA showed 95% of reactive sera. Non parasitemic dogs EA showed 77% of non reactive sera. None sera from BA were reactive for dilutions higher than four. For IHAT, 84% of sera of parasitemic dogs EA showed serological reactivity and among non parasitemic dogs BA, 61% were non reactive, while the remainder showed at most titres of 1/16. The cut-off titres for IFAT and IHAT were 1/16 and 1/32 respectively, and for CFT and DAT 1/1 and 1/128 respectively. Sensitivity for IFAT, IHAT, CF and DAT were 95%, 84%, 97% and 95% respectively.
Assuntos
Anticorpos Antiprotozoários/análise , Testes Sorológicos/normas , Trypanosoma cruzi/imunologia , Testes de Aglutinação , Animais , Doença de Chagas/diagnóstico , Testes de Fixação de Complemento , Cães , Imunofluorescência , Testes de Hemaglutinação , Sensibilidade e EspecificidadeRESUMO
The association between household seroreactivity to Trypanosoma cruzi in dogs and children and T. cruzi infection rates in domestic Triatoma infestans was investigated in 1988-1989 in the rural community of Amamá, north-west Argentina, where house spraying with residual pyrethroids was carried out in 1985. Three years after spraying, a greater reduction of the average T. cruzi prevalence rate in dogs (from 83% to 40%) than in children (from 48% to 30%) was accompanied by a substantial decrease in vector infection rates from 51%-63% to 21%. At a household level, in homes with or without seroreactive children, the percentage of infected T. infestans was 4.5-4.7 times higher when seroreactive dogs were present (27.1%-34.8%) than when they were not (5.8%-7.7%; stratified relative risk [RR] = 4.58). The contribution of seroreactive children to bug infection rates was not significant (RR = 1.29). The combined effect of both seroreactive dogs and seroreactive children fitted equally well with additive or multiplicative transmission models. Bug infection rates showed an increasing trend with the number of seroreactive dogs and an inverse association with the age of the youngest seroreactive dog. Our study supports the hypothesis of a causal association between the presence and number of infected dogs and increased levels of T. cruzi transmission to domestic T. infestans.
Assuntos
Doença de Chagas/transmissão , Doença de Chagas/veterinária , Reservatórios de Doenças/veterinária , Doenças do Cão/epidemiologia , Adolescente , Animais , Argentina/epidemiologia , Criança , Cães , Humanos , Insetos Vetores , Prevalência , Fatores de Risco , Triatoma/parasitologiaRESUMO
A serologic and electrocardiographic study was carried out in people living in 18 households in La Invernada (LI), Departamento Figueroa, and in 20 houses in Amamá (A), Departamento Moreno, both in the province of Santiago del Estero, Argentina. Serological tests performed were indirect hemagglutination (IHAT) and indirect immunofluorescence antibody tests (IFAT). Complement fixation, direct agglutination and ELISA tests were also done for those sera, showing discordant results for either IHAT or IFAT. All people in LI and children up to 12 years old in A were studied by xenodiagnosis. Approximately 50% of the whole population was infected (50% in LI and 50.9% in A) and a similar prevalence rate was already recorded in children below 10 years. A moderate increase of infection rates was observed in successively older age groups, indicating that most of the people became infected in the first decade of life. Comparison of serological profiles of both populations suggests a protective effect of insecticidal control campaigns in those individuals born between 1961 and 1971. New surveys carried out in both populations 2 years later rendered a 4 times greater annual incidence rate in A as compared with LI (7.9% vs 1.8% respectively). No differences were found in the percentages of abnormal electrocardiograms among seropositive and seronegative individuals from both settlements. The prevalence of complete right bundle branch block (RBBB) was higher in seropositive than in seronegative people (4.8% vs 2.3%) but lower than those figures recorded for other parts of the country and the continent. This suggests that in spite of its high prevalence, Chagas' disease has low morbidity in both localities.
Assuntos
Doença de Chagas/epidemiologia , Adolescente , Adulto , Argentina/epidemiologia , Doença de Chagas/diagnóstico , Doença de Chagas/transmissão , Criança , Pré-Escolar , Eletrocardiografia , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Saúde da População Rural , Testes Sorológicos/métodosRESUMO
Se realizó un estudio epidemiológico y electrocardiográfico de los habitantes de La Invernada (LI), Depto. Figueroa, y de Amamá, Depto. Moreno, Pcia. Figueroa, y de Amamá, Depto. Moreno, Pcia. de Santiado del Estero. LI fue tratada con insecticidas en varias oportunidades durante las décadas del 60 y 70 mientras que Amamá no entró en la programación de las campañas de control. Todos los individuos de la vivienda fueron estudiados serológicamente por hemoaglutinación indirecta, e inmunofluorescencia indirecta, utilizándose fijación del complemento o aglutinación directa y Elisa para confirmar resultados discordantes. Se realizaron xenodiagnósticos a todas las personas en LI y a los menores de 13 años en Amamá. Los resultados indican que la mitad de la población estudiada estaba infectada con T. cruzi (50% en LI y en Amamá) y dichas prevalencias aparecieron ya en los niños menores de 10 años, notándose apenas un ligero incremento en la proporción de infectados en los siguientes grupos etarios. Se compararon los perfiles serológicos de ambas poblaciones destacándose el efecto protector de las campañas de control realizadas en LI sobre la población nacida entre 1961 y 1971. Una nueva encuesta serológica realizada dos años después en ambas poblaciones reveló que la tasa de incidencia anual fue 4 veces mayor en Amamá que en LI (7,9% vs. 1,8%). Los estudios electrocardiográficos no mostraron diferencias significativas entre individuos seropositivos y seronegativos en ambos caseríos en cuanto...
Assuntos
Humanos , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Masculino , Feminino , Lactente , Doença de Chagas/epidemiologia , Argentina/epidemiologia , Doença de Chagas/diagnóstico , Eletrocardiografia , Incidência , Saúde da População Rural , Testes Sorológicos/métodosRESUMO
Se realizó un estudio epidemiológico y electrocardiográfico de los habitantes de La Invernada (LI), Depto. Figueroa, y de Amamá, Depto. Moreno, Pcia. Figueroa, y de Amamá, Depto. Moreno, Pcia. de Santiado del Estero. LI fue tratada con insecticidas en varias oportunidades durante las décadas del 60 y 70 mientras que Amamá no entró en la programación de las campañas de control. Todos los individuos de la vivienda fueron estudiados serológicamente por hemoaglutinación indirecta, e inmunofluorescencia indirecta, utilizándose fijación del complemento o aglutinación directa y Elisa para confirmar resultados discordantes. Se realizaron xenodiagnósticos a todas las personas en LI y a los menores de 13 años en Amamá. Los resultados indican que la mitad de la población estudiada estaba infectada con T. cruzi (50% en LI y en Amamá) y dichas prevalencias aparecieron ya en los niños menores de 10 años, notándose apenas un ligero incremento en la proporción de infectados en los siguientes grupos etarios. Se compararon los perfiles serológicos de ambas poblaciones destacándose el efecto protector de las campañas de control realizadas en LI sobre la población nacida entre 1961 y 1971. Una nueva encuesta serológica realizada dos años después en ambas poblaciones reveló que la tasa de incidencia anual fue 4 veces mayor en Amamá que en LI (7,9% vs. 1,8%). Los estudios electrocardiográficos no mostraron diferencias significativas entre individuos seropositivos y seronegativos en ambos caseríos en cuanto... (AU)
Assuntos
Humanos , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Masculino , Feminino , Lactente , Estudo Comparativo , Doença de Chagas/epidemiologia , Doença de Chagas/diagnóstico , Incidência , Argentina/epidemiologia , Saúde da População Rural , Eletrocardiografia , Testes Sorológicos/métodosRESUMO
A serologic and electrocardiographic study was carried out in people living in 18 households in La Invernada (LI), Departamento Figueroa, and in 20 houses in Amamá (A), Departamento Moreno, both in the province of Santiago del Estero, Argentina. Serological tests performed were indirect hemagglutination (IHAT) and indirect immunofluorescence antibody tests (IFAT). Complement fixation, direct agglutination and ELISA tests were also done for those sera, showing discordant results for either IHAT or IFAT. All people in LI and children up to 12 years old in A were studied by xenodiagnosis. Approximately 50
of the whole population was infected (50
in LI and 50.9
in A) and a similar prevalence rate was already recorded in children below 10 years. A moderate increase of infection rates was observed in successively older age groups, indicating that most of the people became infected in the first decade of life. Comparison of serological profiles of both populations suggests a protective effect of insecticidal control campaigns in those individuals born between 1961 and 1971. New surveys carried out in both populations 2 years later rendered a 4 times greater annual incidence rate in A as compared with LI (7.9
vs 1.8
respectively). No differences were found in the percentages of abnormal electrocardiograms among seropositive and seronegative individuals from both settlements. The prevalence of complete right bundle branch block (RBBB) was higher in seropositive than in seronegative people (4.8
vs 2.3
) but lower than those figures recorded for other parts of the country and the continent. This suggests that in spite of its high prevalence, Chagas disease has low morbidity in both localities.