Ischemia-reperfusion (IR) liver injury is associated with temporary clamping of hepatoduodenal ligament during liver surgery, hypoperfusion shock and graft failure after liver transplantation. Mechanisms of IR liver injury include: i) loss of calcium homeostasis, ii) reactive oxygen and nitrogen species generation, iii) changes in microcirculation, iv) Kupffer cell activation, and (v) complement activation. Pre-exposure of the liver to transient ischemia increases the tolerance to IR injury, a phenomenon known as hepatic ischemic preconditioning (IP). IP involves: i) recovery of the energy supply and calcium, sodium and pH homeostasis, ii) enhancement in the antioxidant potential, and iii) expression of multiple stress-response proteins, including acute phase proteins, heat shock proteins, and heme oxygenase. These observations and preliminary studies in humans give a rationale for the assessment of IP in minimizing or preventing IR injury during surgery and non surgical conditions of tissue hypoperfusion.
Postoperative delirium. A window to quality improvement and safety in the care of surgical patients Postoperative delirium or acute confusional state is a common complication among older subjects. Many factors infl uence its appearance, such as preexistent problems of the patient, medication use, pain, the perioperative anesthetic management and the intensity of the infl ammatory reaction to surgical trauma. Its consequences are a longer hospital stay, higher risk of complications and a long term derangement of functional status and cognitive performance. The management of delirium is multifactorial, including the avoidance of precipitating factors, the maintenance of an adequate environment and the conscious use of neuroleptics. The prevention of delirium should be a priority that will improve health care standards.
Acute complicated diverticulitis. New trends in treatmentDiverticular disease refers to the presence of colon diverticula. Its prevalence increases with age and in a few cases present as diverticulitis. Acute complicated diverticulitis is potentially mortal, since it can perforate and require emergency surgery. the treatment of choice is the excision of the perforated segment and the creation of a proximal colostomy. there are other therapeutic alternatives such as excision with primary anastomosis and novel approaches such as laparoscopic peritoneal lavage. We herein review the new treatments of acute diverticulitis.Key words: Diverticular disease, diverticulitis, colectomy, laparoscopic lavage.
ResumenLa enfermedad diverticular se refiere a la presencia de divertículos en el colon. Su prevalencia aumenta con la edad y sólo en pocos casos se presenta como diverticulitis aguda. La diverticulitis aguda complicada es una condición potencialmente mortal, por la posibilidad de una perforación libre que requiera cirugía de urgencia. El tratamiento de elección en la mayoría de los casos es la resección del segmento colónico que incluya la perforación y la creación de una colostomía proximal. Existen otros tratamientos en el manejo quirúrgico de la diverticulitis perforada, como la resección con anastomosis primaria y nuevas aproximaciones, como el lavado peritoneal por vía laparoscópica. Se revisa y discute en este artículo la tendencia actual en el manejo de la diverticulitis aguda perforada.Palabras clave: Enfermedad diverticular, diverticulitis aguda, colectomía, lavado peritoneal laparoscópico.
Laparoscopic colorectal surgery in ChileThe development of laparoscopic colorectal surgery began 20 years ago; however it took several years before gaining its acceptance by the international surgical community. The fi rst report in Chile was published in 1995. However, were necessary many years, until the middle of this decade, to know the fi rst prospective series experiences. Out of these reports, no reliable data exist regarding the development of laparoscopic colorectal surgery in Chile, related to the number of centers performing laparoscopic colorectal surgery or the number of procedures performed. For record these data, a standardized questionnaire was send to colorectal chairmans of all hospitals that had reported to be developing laparoscopic colorectal surgery in our country. Ten of 15 hospitals responded to the survey. Most of the procedures performed were hemicolectomies, principally for cancer and diverticular disease. The average conversion rate was 7% and hospital stay was 5 days. Morbidity and mortality rates were 12% and 0.4% respectively. In the last year was seen an increase in the number of laparoscopic procedures in relation to the previous period. In conclusion, laparoscopic colorectal surgery is a recent technique in Chile, which is being implemented progressively, with good overall results.
ResumenEl desarrollo de la cirugía laparoscópica colorrectal (CLCR) se inició en la década de los 90, sin embargo, pasaron varios años antes de lograr su aceptación por la comunidad quirúrgica internacional. En Chile, los primeros relatos en congresos datan del año 1995 y las primeras experiencias de series prospectivas fueron Rev.
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