Revista Medica Clinica Las Condes最新文献

Acute kidney injury (AKI) is defined as the abrupt deterioration of renal excretory function, often observed in critically ill patients. The incidence of AKI worldwide ranges between 20 and 200 cases per million population. Sepsis and septic shock contribute to 25-75% of AKI cases. Regardless of the cause, loss of fluid and electrolyte homeostasis and the accumulation of nitrogenous wastes lead to uremia, hyperkalemia, water and sodium retention, and metabolic acidosis. Renal replacement therapies (RRT) aim to mitigate these effects and prevent death associated with kidney failure. There are various modalities of RRT, including intermittent hemodialysis, continuous RRT, as well as different solute elimination techniques. There have been significant advances in membrane technologies and the addition of substances to improve biocompatibility, in addition to new anticoagulation strategies. The aim of this article is to review current RRT alternatives and comment on recommendations regarding their dosage and timing for starting and discontinuing therapy.

One of the great obstacles for organ transplantation is the time in which the ischemic organ can be preserved in a viable state before being implanted. With the use of the standard static cold preservation technique (4 °C) preservation times are limited to 6-8 hours, a time known as cold ischemia time. This begins from the moment the “cross-clamp” or complete cessation of circulation in the donor is performed until the organ is irrigated in the recipient.

Preclinical and clinical studies have recently been published demonstrating benefits of graft conservation at 10 °C compared to standard storage, in addition to allowing ischemia times to be prolonged with the same safety standards for the recipient. These new lines of development aim to facilitate the logistics of lung transplantation, transforming it from an emergency surgery to a semi-elective surgical procedure, a change that has demonstrated benefits in surgical safety and even in implant survival results.

Introduction

Swallowing is an essential process in maintaining body homeostasis. With aging, changes occur in both central and peripheral structures, giving rise to presbyphagia, which involves morphological and functional alterations in the swallowing process. However, reports on the prevalence of swallowing difficulties in older adults are currently scarce.

Objectives

To determine the prevalence of swallowing difficulties due to aging, and how self-reported difficulties are related to safety, efficiency, competence, and comfort parameters.

Method

To this end, exploratory-descriptive research was carried out considering the self-perception assessment of 18 older adults from the city of Iquique, Chile.

Results

A prevalence of 27.78% was reported in terms of self-perceived swallowing difficulties.

Conclusions

Results inform the need for greater use of early screening instruments, such as self-report questionnaires.

Extracorporeal circulation (ECC) is an essential component of cardiac surgery since it allows life support to be maintained during the induced cardiac arrest necessary to perform cardiosurgical interventions. However, CPB presents adverse effects at a local and systemic level because its components produce alterations at the macro- and microcirculation levels, potentially leading to hypoperfusion. The goal-directed perfusion (GDP) technique seeks to personalize hemodynamic management according to predefined goals, thereby optimizing tissue oxygenation and perfusion during CPB. This implies constant monitoring of key parameters, to make real-time changes to perfusion strategies. Over the past 10 years, the benefits of using GDP have been explored and its superiority over the traditional approach visualized. The objective of this article is to describe GDP practice in monitoring during CPB. We will focus on the existing variables monitored under the GDP concept, applying and manipulating them to optimize tissue perfusion in real-time.

Extracorporeal membrane oxygenation (ECMO) is used in patients with catastrophic respiratory and cardiac failure. In this article, the physiologic similarities and differences between normal and ECMO cardiopulmonary function are reviewed. The processes involved in gas transfer are described, as well as the factors that influence the efficiency of oxygenation and elimination of carbon dioxide. Emphasis is placed on the clinical relevance of the physiology of ECMO for critically ill patients.

A 43-year-old man with no relevant medical history or known risk factors, who developed a symptomatic probable coinfection with Legionella pneumophila and hantavirus Andes lineage, with the appearance of abdominal and respiratory symptoms that progressed to multiple organ dysfunction with respiratory, myocardial, renal, and endothelial failure. Is this the first reported coinfection?

Objectives

We aimed to evaluate the characteristics of patients with incidental kidney tumors detected in the pathological examination performed after simple nephrectomy due to a non-functioning kidney.

Patients and methods

The pathology results of nephrectomy specimens from patients who underwent simple nephrectomy with the diagnosis of non-functioning kidney between January 2012 and March 2021 were retrospectively analyzed. Data regarding demographic information, imaging methods, and clinical and histopathological features of the patients were collected. The number of patients with incidental renal tumors was determined.

Results

A total of 163 patients with nonfunctioning kidneys who underwent simple nephrectomy between January 2012 and March 2021 were included in the study. Sixty-nine (42.3%) patients were male and 94 (57.7%) patients were female. The most common complaint was flank pain (60.7%). The cause of the nonfunctioning kidney was urinary stones in 116 (71.2%) patients and ureteropelvic/ureterovesical junction stenosis in 21 (10.1%) patients. Incidental renal tumors were detected in 21 (12.9%) patients. Papillary adenoma was the most common renal tumor and was detected in 11 patients. Four patients had renal cell carcinoma and 4 patients had urothelial cell carcinoma (UCC). Three of the patients with UCC had high grade invasive UCC with squamous differentiation and 1 patient had low grade papillary UCC.

Conclusion

In non-functioning kidneys, kidney tumors may be overlooked due to radiological and clinical diagnostic difficulties. Therefore, careful macroscopic and microscopic histopathological evaluation is necessary to detect incidental renal tumors.

Enterocolonic fistula is a rare complication of lymphoma of mesenteric origin and an unusual cause of chronic diarrhea in patients without immunosuppression or inflammatory bowel disease. We report the case of a 68-year-old female patient with abdominal pain and chronic diarrhea that revealed a jejunocolonic fistula on imaging and endoscopic evaluation. Surgical block resection was performed and the histological and immunohistochemical analysis of the surgical specimen evidenced a high-grade B non-Hodgkin lymphoma originating from a lymph node of the mesentery with secondary extension to the jejunum and colon. The diagnosis is challenging due to the non-specific clinical picture and the wide differential diagnosis, for which an adequate anamnesis, physical examination and imaging evaluation are essential in order to characterize the lesion and schedule surgery. The prognosis and adjuvant treatment will depend on the type of tumor and its staging. This is the first local case report of a patient with a jejuno-colonic fistula secondary to a high-grade B-type non-Hodgkin lymphoma originating from a mesenteric lymph node with extension to the small intestine and colon.