Abstract: There is a large population in Mexico with cirrhosis, which is among the first causes of death in our country. Patients with liver disease can be classified as compensated or decompensated, but there is a small portion of patients with liver disease to whom an insult added to their disease will lead them to a state of multiple organ failure, regardless of the reason for cirrhosis or its stage. This evolution that differs from those already known, is known as acute on chronic liver failure and is a newly described pathology. The importance of knowing this pathology is the prognosis and the management for the correct evolution of this type of patient. Materials and methods: A search was conducted on PubMed, Scholar Google, and the journal of Internal Medicine of Mexico, between 1995-2020. The main search terms were “cirrosis”, OR “descompensación hepática”, OR “insuficiencia hepática aguda sobre crónica”, OR “síndrome hepatorrenal”, OR “decompensated cirrhosis”, OR “acute on chronic liver failure”, OR “hepatorenal syndrome”. Additional items were identified by internet research.

Resumen: Existe una gran población en México con cirrosis, la cual forma parte de las primeras causas de muerte en nuestro país. A los pacientes con hepatopatía se les puede clasificar como compensados o descompensados, además existe una pequeña porción de hepatópatas donde un insulto sobre su cirrosis los llevará a un estado de falla orgánica múltiple, sin importar la razón de la cirrosis o de su estadio. Esta evolución que difiere a las ya conocidas se le conoce como insuficiencia hepática aguda sobre crónica. La importancia de conocer esta patología es el pronóstico y los medios necesarios para la correcta evolución de este tipo de pacientes. Material y métodos: Se realizó una búsqueda en PubMed, Scholar Google y en archivos de la revista de Medicina Interna de México, entre 1995-2020. Los principales términos de búsqueda fueron “cirrosis”, OR “descompensación hepática”, OR “insuficiencia hepática aguda sobre crónica”, OR “síndrome hepatorrenal”, OR “decompensated cirrhosis”, OR “acute on chronic liver failure”, OR “hepatorenal syndrome”. Artículos adicionales fueron identificados mediante su búsqueda en Internet.

A review of the management of blood supply and its administration during disasters was conducted based on the experience of several events that occurred primarily from 2000-2010, particularly the earthquake that measured 8.8 on the Richter scale that struck central and southern Chile on 27 February 2010. The objective was to provide information that could be useful in improving response plans and strategies during potential future disasters. The descriptive information on response procedures was obtained from interviews, internal reports, and the computer database from the Maule regional blood production center. The results lead to the conclusion that to respond efficiently and effectively to the need for blood in the immediate wake of a disaster it is essential to have both a centralized management system that facilitates the supply and administration of blood and volunteers with competence in health that are willing to swiftly arrive during these events. A change in the profile of blood donors during such emergencies was also observed. In Chile, for example, during the two weeks after the earthquake, the ratio of male/female donors was reversed. There was 61.1% participation by women, whereas in the week before the event women accounted for only 37%.

Se realizó una revisión de la gestión del abastecimiento y suministro de sangre durante desastres a partir de las experiencias de diversos eventos ocurridos principalmente en la primera década de este siglo, y en particular el terremoto grado 8,8 en la escala de Richter que afectó la zona centro sur de Chile el 27 de febrero de 2010. El objetivo fue proporcionar información que pueda ser útil para mejorar las estrategias y planes de respuesta durante potenciales desastres futuros. La información descriptiva sobre los procedimientos de respuesta se obtuvo mediante entre-vistas, reportes internos y la base de datos del sistema informático del Centro Productivo Regional de Sangre del Maule. Los resultados permiten concluir que para responder de manera eficiente y efectiva a las necesidades de sangre inmediatamente después de un desastre es de importancia clave tener un sistema centralizado de gestión que facilite el abastecimiento y el suministro de sangre y con-tar con personal voluntario competente en salud que esté dispuesto a acudir con celeridad durante estos eventos. Asimismo, se ha observado que durante dichas emergencias se produce un cambio en el perfil de quienes donan sangre. En Chile, por ejemplo, durante las dos semanas siguientes al terremoto la razón hombre/mujer en los donantes se invirtió, con 61,1% de participación por parte de las mujeres, quienes en la semana previa al evento representaban a solo 37%.

Laparoscopic adrenalectomy, if done by skilled surgeons, is now the first choice for treating most adrenal tumors, including bilateral pheochromocytoma. We report two women, aged 35 and 34 years old, with bilateral adrenal pheochromocytoma successfully excised by laparoscopic surgery. Both had severe hypertension, high urinary catecholamine values (epinephrine + norepinephrine: 528 and 1083 ug/24h) and bilateral adrenal tumors at CT scan. After 4 weeks of doxazosin treatment, a laparoscopic transperitoneal adrenalectomy was done (Gugner’s technique), with surgical times of 7 and 5 hours respectively. Both patients received hydrocortisone and only the second one required one unit of packed cells. Postoperative evolution was uneventful and both patients were discharged at the fifth postoperative day. At two months of follow up, both patients are asymptomatic and normotensive (Rev Méd Chile 2001; 129: 91-94)