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Objective: To describe drug-related problems identified in hospitalized patients and to assess physicians' acceptance rate of pharmacists' recommendations., Methods: Retrospective observational study that included all drug-related problems detected in hospitalized patients during 2014-2015. Statistical analysis included a descriptive analysis of the data and a multivariate logistic regression to evaluate the association between pharmacists' recommendation acceptance rate and the variable of interest., Results: During the study period 4587 drug-related problems were identified in 44,870 hospitalized patients. Main drug-related problems were prescription errors due to incorrect use of the computerized physician order entry (18.1%), inappropriate drug-drug combination (13.3%) and dose adjustment by renal and/or hepatic function (11.5%). Acceptance rate of pharmacist therapy advice in evaluable cases was 81.0%. Medical versus surgical admitting department, specific types of intervention (addition of a new drug, drug discontinuation and correction of a prescription error) and oral communication of the recommendation were associated with a higher acceptance rate., Conclusions: The results of this study allow areas to be identified on which to implement optimization strategies. These include training courses for physicians on the computerized physician order entry, on drugs that need dose adjustment with renal impairment, and on relevant drug interactions., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Purpose: After radiopharmaceutical injection, a heightened 123 I-MIBG concentration is frequently observed in the left hepatic lobe compared to the right one, but the reason of this finding remains unknown. Our aim was to retrospectively analyze the different 123 I-MIBG uptake pattern between the two hepatic lobes and correlate our results with some epidemiological/clinical features., Material and Methods: Ninety-four 123 I-MIBG scintigraphies from 71 patients were selected. Regions of interest were drawn in the right and left lobes using transverse tomographic sections and left to right activity ratios (L/R ratio) were calculated at 6 and 24h after radiotracer administration., Results: Twenty-seven examinations were positive for hypermetabolic lesions while the remaining 67 were negative. In all cases mean early and delayed L/R ratios were greater than 1.00; average early L/R ratio was 1.37 and delayed L/R ratio 1.52. The delayed L/R ratio was significantly higher than the early one. There was no difference in the L/R ratios with regard to age, gender, primary disease and result of scintigraphy., Conclusions: 123 I-MIBG uptake was higher in left hepatic lobe compared to right and this ratio did not correlate with any epidemiological or clinical feature. The reason of this metabolic is not yet explained and some biomolecular hypotheses could be tested in 3D dynamic in vitro models., (Copyright © 2018 Sociedad Española de Medicina Nuclear e Imagen Molecular. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To compare the post-operative effects of sevoflurane versus propofol on liver and kidney function while maintaining anaesthesia in the orthotopic liver transplant (OLT), as well as to analyse the short-term survival as regards these functions., Patients and Methods: A retrospective analysis was conducted on patients subjected to an OLT between January 2002 and December 2009. Patients on pre-transplant haemodialysis, re-transplants, and hepatorenal transplants were excluded. The incidence of acute renal failure, initial dysfunction of the graft, reperfusion syndrome, rejection, and the transaminase peak depending value depending on the hypnotic used, were recorded., Results: About one-third (31.2%) of the patients developed acute renal failure and 11.9% an initial dysfunction, with no differences between the groups. There was a tendency for a lower incidence of initial dysfunction of the graft in the sevoflurane group (8.6% compared to 12.8%), a lower transaminase peak (greater than 2000 U/L, 12.1% versus 15.9%), and a lower incidence of reperfusion syndrome (10.3% compared to 21.6%)., Conclusions: Despite the fact that the renal metabolism sevoflurane is elevated, we did not find any higher incidence of acute renal failure. Sevoflurane in the liver transplant anaesthesia is as least equally as safe propofol as regards renal function and liver function. New prospective studies are needed to clarify the possible effects of the hypnotic in liver transplant., (Copyright © 2011 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.)

Introduction: the abnormalities in liver function tests (LFTs) and liver complications (LC) from parenteral nutrition (PN) are common and usually multifactorial. These factors have not yet been assessed in the adult Mexican population., Objective: To determine whether the dose prescribed > 1 g/kg is a risk factor for the abnormalities in liver function tests (LFTs) from PN., Material and Methods: Cohort study including patients older than 15 years and excluding those managed at the intensive car unit or with abnormalities in liver enzymes before the start of PN. The exposed and non-exposed groups were those receiving > 1 g of lipids per kg of body weight or < 1 g/kg, respectively. LFTs were defined as an increase higher than 50% of the normal range for AST, ALT, AF or total bilirrubin., Results: the incidence of LFTs abnormalities was 20 (47.6%) and 15 (41.6%) in the exposed and non-exposed groups, respectively (RR 1.14 95% IC: 0.69-1.88; p = 0.59). The most frequent liver damage pattern was cholestatic, followed by the mixed pattern and then hepatocellular. The dose of prescribed lipids > 1 g/kg was not associated with the development of LC from LFTs abnormalities. The higher the dose of proteins the lower the frequency of LFTs abnormalities., Conclusion: The dose of lipids prescribed >1 g/kg was not associated with the development of LFTs abnormalities from PN in our sample population. These findings should be confirmed in clinical trials.

Renal cell cancer with tumor thrombus is present in 4-15% of cases. The prognostic significance of this entity has been object of intense debate. Nowadays, it is considered, that the presence of thrombus itself does not have a negative prognostic impact on survival rates if the thrombus could be excised satisfactorily. Complete removal of renal malignant tissue is the only curative strategy for the treatment of this kind of tumors. During the last three decades, there has been steady improvements in surgical technique and preoperative care fields that have favorably modified the surgeons' ability to safely excise these tumors. In this sense, the experience provided by multiorgan, kidney-pancreas and liver procurement and transplantation techniques led the urologists reexamine their approaches to the inferior vena cava and retroperitoneum, thus they could result useful in the always challenging resection of these complex tumors with neoplasic extension into the vena cava.

The liver plays an essential role in the metabolism of most of the nutrients since it is a mainly metabolic organ carrying out a series of physiological and metabolic processes related with protein and energy metabolism. The intestinal tract is considered a key element in the development of Multiorgan Dysfunction (MOD) or failure by loosing its barrier function (impaired permeability) against toxins, bio-products and occasionally intraluminal bacteria secondary to hypoxia, one of the main pathophysiogenic mechanisms being the insufficient blood flow to splacnic organs. Liver dysfunction and/or impairment of liver function test are a common event in critically ill patients. They may be due to previous liver cirrhosis or to more immediate causes of liver failure such as sepsis, drugs, liver transplant or any of the multiple etiologies for hepatitis.

Physical exercise induces effects involving various organ systems in the body. These changes are both immediate and permanent. Such adaptations and changes will be beneficial for most individuals, provided they are included within a physical activity regimen suited to conform to the status and needs of each target subject. This is specially relevant when exercise is prescribed for a person who is suffering from a liver condition, and who in addition is receiving drug therapy.

The repercussions of nutrition on the immunological system are described. The current situation is discussed with regard to the handling of the immuno-inflammatory response to aggression and the improvement of the immune response. The goal pursued by nutritional manipulation of the immune system is to improve the prognosis and reduce the complications in critical patients subjected to surgical or traumatic aggression or sepsis. The following points are reviewed: the importance of preserving the axis from the liver to the digestive tract, the advantages of particularly early enteral nutrition over parenteral nutrition, the substances currently considered as immunonutrients and the available clinical evidence on their use, with a series of conclusions for current decisions and future developments.

We address here the issue concerning the origin of essential long chain polyunsaturated fatty acids (LC-PUFA) needed for early postnatal brain development. Normal newborn rats 1, 5, 10 and 20 day-old were decapitated, immediately after, the livers were processed to obtain the microsomal fraction and its delta 6 fatty acid desaturase activity and fatty acid composition were determined. Samples of plasma, whole homogenized brain hemispheres and milk contained in the gastric cavity of the suckling rats, were analyzed to obtained their fatty acid composition. We fond that the rat neonate has a very low delta 6 desaturase activity in liver microsomes as compared with the adult. In contrast, there is a considerable quantity of DHA an AA in the milk, liver microsomes, plasma lipids and brain. In conclusion, we propose that brain DHA and AA cannot be derived substantially through liver synthesis, but through the availability of these preformed fatty acids in the milk. These fatty acids are concentrated in liver microsomes and then secreted into plasma lipid pool to reach finally to brain structures.

Hepatocyte growth factor (HGF), originally described as an hepatocyte specific mitogen, has been shown to be a potent stimulator of DNA synthesis in a wide variety of cell types. In addition to its mitogenic effect, HGF has the unique ability to transmit information that determines the spatial organization of epithelial cells in tissues as well as induce cell migration and invasion of extracellular matrix in a variety of epithelial cells. HGF is involved in physiological processes like embryogenesis and development, and also in pathophysiological process as regeneration and carcinogenesis. Although the role that HGF plays in liver cancer is not clear, the findings strongly suggest that it influences the malignant cells. The present paper shows a review on the advances in the knowledge of HGF in physiological processes and in those related to liver diseases.

Identification of so called endothelium derived relaxing factor, EDRF, as nitric oxide, ON, produced in situ in digestive tract, as well as in many other organs, offers the possibility of pharmacologic control blocking or stimulating its production in situ. Theoretically, conditions like achalasia, cell injury by endotoxins, altered visceral arterial flow, hyperdynamic circulatory state in decompensated cirrhosis, protein synthesis and glomerular filtration in ascites, will be amenable of better treatment. This gas is considered as labile humoral-like messenger, mediator or a regulator of cell function in a number of physiological are promising. By now most of the information available comes from animal studies.

Objectives: To compare the postoperative effects of three anesthetic agents, fentanyl, halothane and isoflurane, on recovery from anesthesia, changes in arterial blood gases, and tests of liver and kidney function in morbidly obese patients recovering from vertical ring gastroplasty., Material and Methods: Thirty-three patients were studied, randomly distributed into three groups of 11. Induction for all was with atracurium (5 mg), 2.5% thiopentone sodium (5-6 mg.kg-1), succinylcholine (1.5 mg.kg-1) and orotracheal intubation. Anesthesia was maintained with intermittent doses of fentanyl (group F), 2% halothane (group H) or 2.5% isoflurane (group I). All patients received a 50% O2/N2O mixture at a minute volume calculated on ideal weight. Muscle relaxation was achieved by continuous perfusion of atracurium. Postoperative analgesia was by morphine chloride through a lumbar epidural catheter. Time of eye opening and time of extubation were recorded. Arterial blood gas measurements were taken and the results of liver and kidney function tests were recorded until the 7th day after surgery., Results: Eye opening after awakening was earlier in the fentanyl group (6 +/- 5 min), but no differences were found for time of extubation. Blood gas measurements for the 33 patients revealed a significant decrease in PaO2 (58 +/- 14 mmHg), a slight increase of PaCO2 (40 +/- 6 mmHg) and a lower pH (7.32 +/- 0.04) immediately after surgery. On day seven, PaO2 had not yet reached preoperative levels (p < 0.01). These results were independent of anesthetic agent used. Kidney function tests showed significant rises in SGOT (81 +/- 36 U/l), SGPT (150 +/- 110 U/l) and bilirubin (Bil: 15 +/- 5 mmol/l) and decreases in prothrombin activity (PT: 73 +/- 11%) 24 hours after surgery, with later normalization. Urea fell significantly throughout the seven-day period (3.2 +/- 1.3 mmol/l). These results were also independent of the anesthetic agent used., Conclusions: Morbidly obese patients undergoing gastroplasty recover from anesthesia in the same way regardless of the agent used. The early postoperative period is characterized by severe hypoxemia and transitory changes in kidney function tests. Neither of these findings is dependent on the agent used.

The cytokines are proteins synthetized by lymphoid and monocyte/macrophage system cells in response to a wide variety of infectious stimulus, featuring bacterial endotoxins. These proteins have immunoregulatory effects and have been implicated in inflammation and fibrosis. In this review we refer to the interleukin-1, interleukin-6 and tumor necrosis factor because of their elevated basal levels in acute and chronic hepatopaties and in response to lipopolisacharide mainly in alcoholic liver disease.

Enzyme determinations and hepatic histological studies were carried out in normal rats and in rats intoxicated with the organophosphorus pesticide parathion. No significative evidence of hepatocellular damage was seen in parathion -- intoxicated rats as responsible of the impaired bile flow and sulfobromophthalein biliary excretion that were previously reported. On the contrary, the isolated perfused rat liver from normal and intoxicated rats showed a similar behavior when the perfusate flow through the liver was maintained at a similar rate. We conclude that altered hepatic blood flow may be a factor determinant of an impairment of bile flow and of biliary excretion of several organic anions like sulphobromopthalein that were observed in parathion -- intoxicated rats.

We present an experimental study of the anatomopathologic repercussions of segmental liver resection. Sixty rats were used, distributed into 3 groups of 18 animals each one with 6, group I, as follows: 1) anesthesia and laparotomy; 2) 30% liver resection; 3) 50% liver resection, and 4) 80% liver resection. The three resection groups were distributed into three subgroups according to parameters studied at 24 hours, 72 hours and 10 days, respectively. The data studied were: 1. Inflammation: activation of Kupffer cells, state of the lobule and portal spaces. 2. Degeneration: steatosis, necrotic foci, infarction and eosinophilic degeneration. 3. Regeneration: hepatocytic hypertrophy, mitosis, binucleation and trabeculation. The results confirm that the resected liver undergoes regenerative processes that condition the adaptation of the animal after hepatic exeresis.