Acceso venoso central mediante cápsulas de inyección subcutáneas. Serie de 124 dispositivos

Presentamos una serie de 111 pacientes (límites: 9 meses - 78 años) en los que se colocaron 124 dispositivos como modalidad de acceso venoso central. Se analizan las complicaciones aparecidas durante su utilización, que actualmente sobrepasa los 1.100 meses, y se comentan aspectos técnicos de colocación con influencia sobre la morbilidad del sistema. La media actual de funcionamiento se sitúa en 9,9 meses por persona, con una tasa de complicaciones del 19 %

Sistemas de acceso venoso central (SAVC) en pacientes pediátricos. Experiencia de seis años

The need for an access to the venous system, in order to infuse chemotherapeutic treatments or parenteral nutrition, has increased the number of central venous access systems (CVAS) implanted in the past years. Between February 1985 and December 1990, 87 devices were implanted in 76 patients (from 11 months to 15 years of age), with a median function time of 349 days (range: 7 to 1887 days). The overall incidence of complications was 0.10 per 10 days of catheterization, with complication rates for infection and thrombosis of 0.02 and 0.03, respectively. Nineteen systems were removed because of complications and 11 because of completion of the treatment. Of the cases, 97.7% included a follow-up period. The present study confirms the advantages of these devices, with a long working life and a low complication rate, being a good alternative for chronically ill children requiring long-term and/or cyclic intravenous therapy

Cirugía derivativa más radioterapia intraoperatoria y externa en el carcinoma de páncreas localizado e irresecable

Presentamos una serie de 25 casos de carcinomas de páncreas localmente avanzados e irresecables, sin metástasis a distancia, tratados con cirugía derivativa, radioterapia intraoperatoria e irradiación externa: 18 tumores de cabeza (16 con ictericia obstructiva) y 7 de cuerpo. Se realizó derivación biliar en 18 y gastroyeyunostomía en 19. La mortalidad operatoria fue nula, con una morbilidad del 16%. A largo plazo se produjeron 3 hemorragias digestivas, 2 ictericias obstructivas, una colangitis y una obstrucción intestinal. Se obtuvo un 72% de control local de la enfermedad y todos los fallecidos por progresión tumoral desarrollaron metástasis hepáticas y/o peritoneales. Presentaban dolor pancreático 22 pacientes y 20 experimentaron remisión del mismo en una a 2 semanas. La analgesia fue definitiva en 12 y reapareció el dolor tardíamente en ocho. La supervivencia media fue de 9 meses (rango 4-24). La revisión de la literatura pone de manifiesto la indicación de la radioterapia externa tanto en el carcinoma de páncreas irresecable y no metastásico como en los resecados. La asociación de radioterapia intraoperatoria tiene, así mismo, un papel importante en cuanto a supervivencia, paliación del dolor y de la progresión local. El 5-fluorouracilo asociado al tratamiento radioterápico prolonga significativamente la supervivencia con una morbilidad razonable

Leukotriene C4 detection as an early graft function marker in liver transplantation

Leukotrienes are a group of compounds belonging to the eicosanoid family that are formed from the metabolism of arachidonic acid by means of 5-lipoxigenase. Leukotriene C4 (LTC4) has a pronounced proinflammatory character and is formed by combining leukotriene A4 with glutation. This step is catalyzed mainly by the isoenzyme 4-4 of the hepatic glutation transferases, although other enzymes may participate in its formation. The liver plays a decisive part in the formation of this compound despite the fact that it can be synthesized along other cellular lines. In orthotopic liver transplant (OLT), the evaluation of the early functioning of the graft is, in many cases, complex. The difficulty of evaluation lies in the absence of specific markers to indicate when the transplanted organ will prove viable notwithstanding the damage resulting from preservation, and when these lesions are irreversible. The aim of this study is to determine whether there is a relationship between the ability to synthesize LTC4 immediately after OLT and the early functioning of the graft

Sistemas de acceso venoso central (SAVC) en pacientes pediátricos. Experiencia de seis años

The need for an access to the venous system, in order to infuse chemotherapeutic treatments or parenteral nutrition, has increased the number of central venous access systems (CVAS) implanted in the past years. Between February 1985 and December 1990, 87 devices were implanted in 76 patients (from 11 months to 15 years of age), with a median function time of 349 days (range: 7 to 1887 days). The overall incidence of complications was 0.10 per 10 days of catheterization, with complication rates for infection and thrombosis of 0.02 and 0.03, respectively. Nineteen systems were removed because of complications and 11 because of completion of the treatment. Of the cases, 97.7% included a follow-up period. The present study confirms the advantages of these devices, with a long working life and a low complication rate, being a good alternative for chronically ill children requiring long-term and/or cyclic intravenous therapy

Leukotriene C4 detection as an early graft function marker in liver transplantation

Leukotrienes are a group of compounds belonging to the eicosanoid family that are formed from the metabolism of arachidonic acid by means of 5-lipoxigenase. Leukotriene C4 (LTC4) has a pronounced proinflammatory character and is formed by combining leukotriene A4 with glutation. This step is catalyzed mainly by the isoenzyme 4-4 of the hepatic glutation transferases, although other enzymes may participate in its formation. The liver plays a decisive part in the formation of this compound despite the fact that it can be synthesized along other cellular lines. In orthotopic liver transplant (OLT), the evaluation of the early functioning of the graft is, in many cases, complex. The difficulty of evaluation lies in the absence of specific markers to indicate when the transplanted organ will prove viable notwithstanding the damage resulting from preservation, and when these lesions are irreversible. The aim of this study is to determine whether there is a relationship between the ability to synthesize LTC4 immediately after OLT and the early functioning of the graft