Search

Introduction: Limited information is available about preoperative fasting abbreviation with administration of liquid enriched with carbohydrates (CHO) in cardiovascular surgeries., Objectives: To evaluate clinical variables, security of the method and effects on the metabolism of patients undergoing fasting abbreviation in coronary artery bypass graft (CABG) surgery., Methods: Forty patients undergoing CABG were randomized to receive 400 ml (6 hours before) and 200 ml (2 hours before) of maltodextrin at 12.5% (Group I, n=20) or just water (Group II, n=20) before anesthetic induction. Perioperative clinical variables were evaluated. Insulin resistance (IR) was evaluated by Homa-IR index and also by the need of exogenous insulin; pancreatic beta-cell excretory function by Homa-Beta index and glycemic control by tests of capillary glucose., Results: Deaths, bronchoaspiration, mediastinitis, stroke and acute myocardial infarction did not occur. Atrial fibrillation occurred in two patients of each group and infectious complications did not differ among groups (P=0.611). Patients of Group I presented two days less of hospital stay (P=0.025) and one day less in the ICU (P<0.001). The length of time using dobutamine was shorter in Group I (P=0.034). Glycemic control in the first 6h after surgery was worse for Group II (P=0.012). IR was verified and did not differ among groups (P>0.05). A decline in the endogenous production of insulin was observed in both groups (P<0.001)., Conclusion: Preoperative fasting abbreviation with the administration of CHO in the CABG was safe. The glycemic control improved in the ICU; there was less time in the use of dobutamine and length of hospital and ICU stay was reduced. However, neither IR nor morbimortality during hospital phase were influenced.

Two hundred and thirty five duodenal ulcer patients agreed to be treated with Misoprostol 400 mcg b.i.d. during four weeks. The influence of cigarette smoking, alcohol and coffee on the healing rate were determined. Endoscopic examinations were performed at the beginning of the study and after four weeks of treatment. Clinical evaluations were done at the beginning and after two and four weeks of treatment. According to the type of cohort the healing rate after four weeks of treatment was: a) 70.6% when all 235 patients intended to be treated were considered; b) 77.9% when all patients reexamined after four weeks + 5 withdrawn because of side effects (3) or worsening of symptoms (2) where analysed and, c) 79.8% when only the 208 patients that completed four weeks of treatment were considered. Loosen stools or diarrhea were observed in 37% of the patients but only in 2 (0.85%) severe diarrhea resulted in interruption of the treatment. The healing rates were not altered by the use of cigarettes, alcohol or coffee, suggesting that Misoprostol probably inhibited the deleterious effects of those risk factors.

In this revision article it was tried to focus on the role played by pepsinogen/pepsin since its discovery until its practical use. Pepsinogen determination as the gastric acid secretion has different basal or stimulated secretion levels in the peptic ulcer, gastritis, etc. The methods for pepsinogen determination are evaluated, verifying that, in spite of radioimmunoassay utilization another methods less sophisticated have been used successfully. The pepsinogen seric levels (PSL) after stimulation with Histalog, discriminate the patients suffering from duodenal ulcer from normal individuals, and they are higher among men than women. A parallelism is made between pepsinogen-I and II finding out pepsinogen-I higher level in smoking individuals. The pepsinogen-I is increased in the duodenal ulcer and II in the gastric ulcer and both of them bent to be characterized as a genetic marker for peptic ulcer. Finally, the main clinical applicability for PSL group I determination is the detection of atrophic gastritis considering its potential for gastric malignancy.