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Hepatic surgery requires, under diverse circumstances, periods of ischemia and reperfusion (I-R) such as those present in liver resection, hepatic injury, and liver transplantation. The objective of the present work was to conduct an experimental study to evaluate the effect of hepatic preconditioning (HPC) on modulation of the I-R injury.Male Wistar rats were distributed into the following three study groups: group 1, simulated or sham; group 2, submitted to a 30-min period of total warm ischemia and a reperfusion phase, and group 3, in which we carried out 10-min preconditioning of warm ischemia and 10 min of reperfusion prior to the total ischemia period for a total of 60 min and the reperfusion phase. We obtained liver biopsies for thiobarbituric acid reactive substances (TBARS) (MDA, thiobarbituric acid adducts) and for blood sample determinations in serum of liver-cell enzymes such as alanine aminotransferase and aspartate aminotransferase during a 24-h time course.We observed a decrease in the variables studied in group 3 (HPC) as well as of serum liver enzymes and TBARS levels such as indirect oxidative stress indicators upon comparison with group 2 animals submitted to total hepatic I-R.HPC is an efficient surgical strategy for decreasing the elevation of hepatic enzymes and indirect lipoperoxidation indicators in an I-R model. Controlled clinical studies should be performed to determine its functional properties and clinical applicability.

The present study was aimed to assess the effect of protein carbonylation (PC) in hepatic cells and effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on indicators of tissue damage induced by liver ischemia-reperfusion injury (LIRI). Warm ischemia was performed by partial vascular occlusion during 90 min in Wistar rats. In serum, we determined the catalytic activity of Alanine Aminotransferase, Aspartate Aminotransferase, Lacticate Dehydrogenase, and Ornithine Carbamoyltransferase. In liver samples, we studied cellular alterations by means of histologic studies, lipid peroxidation, PC by immunohistochemistry, apoptosis and reactive oxygen species in bile by electron paramagnetic resonance. Based on PC data, sinusoidal endothelial cells (SEC) and Kupffer cells (KC) were the first to exhibit LIRI-associated oxidative damage and prior to parenchymal cells. Administration of piroxicam or meloxicam during the pre-ischemic period produced a highly significant decrease in all studied injury indicators. No significant differences were revealed between the protective action of the two drugs. The data shown here suggest the potential use of NSAIDs such as piroxicam or meloxicam in minimizing ischemic event-caused damage in liver. We also propose that PC may be employed as an adequate tool to assess tissue damage after oxidative stress.

"Introducción: La cirugía hepática requiere en diversas circunstancias de periodos de isquemia y reperfusión, como los que se presentan en las resecciones de hígado, trauma y trasplante hepático. Objetivo: realizar un estudio experimental para evaluar el efecto del preacondicionamiento hepático en la modulación del fenómeno de isquemia-reperfusión. Material y métodos: Se emplearon ratas Wistar macho, distribuidas en tres grupos de estudio: grupo 1, simulado; grupo 2, sometido a periodo de isquemia caliente total por 30 minutos y fase de reperfusión; grupo 3, preacondicionamiento por 10 minutos de isquemia caliente y 10 minutos de reperfusión, previo al periodo de isquemia hepática total por 60 minutos y la fase de reperfusión. Se realizaron tomas de biopsias hepáticas para análisis espectrofotométrico del aducto de malondialdehído ácido tiobarbitúrico y, por muestras sanguíneas, determinaciones de enzimas hepáticas en suero como deshidrogenasa láctica y transaminasas (ALT y AST) en un curso temporal de 24 horas. Resultados: En el grupo 3 se observó disminución de las enzimas hepáticas en suero y de los niveles de especies reactivas al ácido tiobarbitúrico como marcadores indirectos de estrés oxidativo al compararlos con el grupo 2 sometido a isquemia-reperfusión hepática total. Conclusiones: El preacondicionamiento hepático es una estrategia quirúrgica eficaz para disminuir la elevación de las enzimas hepáticas y los indicadores indirectos de lipoperoxidación en un modelo de isquemia y reperfusión, y deben realizarse estudios clínicos controlados para determinar su aplicación clínica."

Gastroesophageal reflux (GER) is a common disease in children less one year old. It is present around 10% of unselected infant population. 40-50% have abnormal 24 h pH monitoring. An early diagnosis and treatment should be done in order to avoid complications.To establish the consensus for the diagnosis and treatment of children with GER, to rule out similar diseases avoid the use of unnecessary drugs and the secondary side effects as well as unnecessary surgery.The consensus was done with the participation of general pediatricians, pediatrics gastroenterologist, pediatric surgeons, radiologist and endoscopist. An initial paper was done by pediatric surgeon and pediatric gastroenterologist who submitted to the rest of participants. Second stage: the paper was review through E-mail for all participants who send their suggestions and modifications. A new paper was done and discussed by medical and surgery area. During the Congress of Pediatric Surgery, in an open session was discuss again with the participation of the main authors and all the audience present. Finally, a paper was done and review for the main authors.