Discusiones en torno a la necesidad de debatir la defensa nacional

En este breve ensayo, presentaré algunos comentarios que surgen de mi lectura del trabajo publicado por Sergio Eissa en el número 53 de la revista Relaciones Internacionales. Ante todo, quiero señalar el importante aporte que significa iniciar un debate sobre la Defensa Nacional, tarea que los argentinos nos debemos hace décadas.Instituto de Relaciones Internacionale

Discusiones en torno a la necesidad de debatir la Defensa Nacional

En este breve ensayo, presentaré algunos comentarios que surgen de mi lectura del trabajo publicado por Sergio Eissa en el número 53 de la revista Relaciones Internacionales. Ante todo, quiero señalar el importante aporte que significa iniciar un debate sobre la Defensa Nacional, tarea que los argentinos nos debemos hace décadas

Discusiones en torno a la necesidad de debatir la defensa nacional

En este breve ensayo, presentaré algunos comentarios que surgen de mi lectura del trabajo publicado por Sergio Eissa en el número 53 de la revista Relaciones Internacionales. Ante todo, quiero señalar el importante aporte que significa iniciar un debate sobre la Defensa Nacional, tarea que los argentinos nos debemos hace décadas.Instituto de Relaciones Internacionale

Ketamine does not inhibit interleukin-6 synthesis in hepatic resections requiring a temporary porto-arterial occlusion (Pringle manoeuvre): a controlled, prospective, randomized, double-blinded study

AbstractIntroductionPrevious studies have shown that interleukin-6 (IL-6) levels correlated with mortality in critically ill patients.GoalTo determine the effect of ketamine on IL-6 levels in liver resections patients with a temporary porto-arterial occlusion (Pringle manoeuvre).Materials and methodsControlled, prospective, randomized, double-blinded study. One group (n=21) received ketamine whereas the other group (n=17) received placebo. IL-6 levels were obtained at baseline, 4, 12, 24h, 3 and 5 days.ResultsThere were no significant differences in IL-6 levels between the groups (basal P=089, 4h P=0.83, 12h P=0.39, 24h, P=0.55, 3 days P=0.80 and 5 days P=0.45). Both groups had elevated IL-6 levels that became almost undetectable by day 5. There was no major morbidity and no mortality in either group.ConclusionsKetamine does not seem to have an effect on plasma levels of IL-6. This could be interpreted as a potential finding associated with outcome as we did not encounter any deaths or major complications. Further studies will likely be needed to determine the range of IL-6 levels associated with survival and mortality, and whether it could be a predictor of survival

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Pushing the Limits of Surgical Resection in Colorectal Liver Metastasis: How Far Can We Go?

Colorectal cancer is the third most common cancer worldwide, and up to 50% of all patients diagnosed will develop metastatic disease. Management of colorectal liver metastases (CRLM) has been constantly improving, aided by newer and more effective chemotherapy agents and the use of multidisciplinary teams. However, the only curative treatment remains surgical resection of the CRLM. Although survival for surgically resected patients has shown modest improvement, this is mostly because of the fact that what is constantly evolving is the indication for resection. Surgeons are constantly pushing the limits of what is considered resectable or not, thus enhancing and enlarging the pool of patients who can be potentially benefited and even cured with aggressive surgical procedures. There are a variety of procedures that have been developed, which range from procedures to stimulate hepatic growth, such as portal vein embolization, two-staged hepatectomy, or the association of both, to technically challenging procedures such as simultaneous approaches for synchronous metastasis, ex-vivo or in-situ perfusion with total vascular exclusion, or even liver transplant. This article reviewed the major breakthroughs in liver surgery for CRLM, showing how much has changed and what has been achieved in the field of CRLM