Systemic Treatment of Moderate to Severe Psoriasis in Pediatric Patients in Galicia, Spain: A Descriptive Study. / Tratamiento sistémico de la psoriasis moderada-grave en edad pediátrica en Galicia: estudio descriptivo.

BACKGROUND AND OBJECTIVE: Studies on the use of systemic therapy for psoriasis in pediatric patients are scarce. The main aim of this study was to describe the systemic treatments used for moderate to severe psoriasis in pediatric clinical settings. The second aim was to describe the effectiveness and safety of these treatments. MATERIAL AND METHODS: Descriptive, cross-sectional, multicenter study of patients under 18 years of age with moderate to severe psoriasis who were being treated or had been treated with a systemic drug (conventional or biologic) or phototherapy. We recorded demographic and clinical information, treatments received, tolerance, adverse effects, and response to treatment. RESULTS: Data were collected for 40 patients (60% female; mean age, 13 years) who had received 63 treatments in total. The most common first treatment (n=40) was phototherapy (administered to 68% of patients), followed by acitretin (15%). The most common treatments overall (n=63) were phototherapy (57%) and methotrexate (16%). At week 12 (evaluation of systemic treatment and phototherapy), 66% of the patients were classified as good responders and 22% as partial responders. The respective rates for week 24 (evaluation of systemic treatment only) were 36% and 32%. The treatments were well tolerated (97%) and adverse effects were reported in just 11% of cases. There were no treatment discontinuations because of adverse effects. CONCLUSIONS: Phototherapy, followed by methotrexate, was the most common treatment for moderate to severe psoriasis in this series of patients under 18 years. The treatments showed a favorable safety profile and were associated with a good response rate of 66% at week 12 (systemic treatment and phototherapy) and 36% at week 24 (systemic treatment only).

Sevoflurane anaesthesia for nasal surgery in a patient with multiple chemical sensitivity. / Anestesia con sevoflurano para cirugía de senos paranasales en un paciente con sensibilidad química múltiple.

Multiple chemical sensitivity syndrome is a group of complex disorders that include psychiatric disorders, chronic fatigue and/or respiratory problems. This syndrome could be triggered by specific allergens and toxins that cause neurophysiological sensitization and the appearance of the clinical symptomatology. Anaesthesia for these patients always poses a challenge for the anaesthetist, because they need to find and use drugs that do not trigger or aggravate the symptoms of the disease. Therefore, sevoflurane in these circumstances might be "the ideal anaesthetic". Performing general anaesthesia with sevoflurane as the sole anaesthetic agent, together with a series of environmental measures formed the basis for successful anaesthesia and surgery in our patient with a multiple chemical sensitivity syndrome.

Histological differences in the adherence of connective tissue to laser-treated abutments and standard abutments for dental implants. An experimental pilot study in humans.

BACKGROUND: The goal of the current study is to assess the difference in connective tissue adherence to laser microtextured versus machined titanium abutments. MATERIAL AND METHODS: Six patients were selected and each of them received 2 implants, one combined with a laser treated abutment and one with a machined abutment. After three months, the abutments were retrieved together with their surrounding gingival tissue for histological analysis. Qualitative and quantitative evaluation of microscopical images was performed to assess the presence or absence of adherence between the soft tissues and the abutment, and the percentage of soft tissue adhered to the two different surfaces. RESULTS: Intimate adherence between connective tissue and the laser treated abutments, while on machined abutments no adherence was detected. A significant difference was found in the percentage of surface in contact with soft tissue between both implant abutments p=0.03. CONCLUSIONS: Within the limitation of the current study, it can be concluded that connective tissues show enhanced adherence to microtextured abutments compared to machined abutments.

[Treatment of a patient with refractory cardiac arrhythmias using stellate ganglion block. Access by the classical and ultrasound-guided approach]. / Tratamiento de las arritmias cardíacas refractarias mediante bloqueo del ganglio estrellado en un paciente. Acceso por técnica clásica y ecodirigida.

Stellate ganglion block is a technique that is often used by anesthesiologists for the treatment of complex regional pain syndromes of the upper extremity. This technique interrupts cardiac sympathetic innervation and has been proposed as treatment for refractory arrhythmias. We present the case of a patient with arrhythmias that were refractory to pharmacological treatment, and were finally treated by continuous stellate ganglion block. Left stellate ganglion is a lynchpin of cardiac arrhythmias due to being a structure where the majority of postganglion sympathetic fibers responsible for preferentially innervating the atriventricular node, bundle of His and ventricular mass are originated, fundamentals in the origin and maintenance of ventricular arrhythmias.

[Thermal effects of epidural anesthetic block]. / Efectos térmicos del bloqueo anestésico epidural.

In a sample of 20 healthy men (ASA I) we studied the thermal effects induced after epidural anesthetic blockade with bupivacaine (0.625%) and their relationship with the level of sensitive blockade to puncture or to cold. After 30 min of epidural injection of bupivacaine the level of cephalic analgesia was D IX (D IX +/- 2 segments) and that of cold discrimination D VII (D VII +/- 2 segments) being the thermo-algesic differential blockade of 2 to 3 segments. During epidural anesthesia there was a significant increase in foot skin temperature (4.1 +/- 1 centigrade degrees, p less than 0.001) without any appreciable skin temperature change at the thorax, abdomen, thigh, and calves. It is concluded that epidural anesthesia with bupivacaine (0.625%) at a sensitive analgesic level D IX produces significant increases in skin temperature only at the foot. This indicates that the extension level of sympathetic blockade is lower that of the analgesia.

[Rheological and expander effect of hydroxyethyl-starch in intradural anesthesia]. / Efecto reológico y expansor del hidroxietilalmidón en anestesia intradural.

We have evaluated the effect of the infusion of hydroxyethylstarch (HES) on blood viscosity and its usefulness to prevent hypotension associated with intradural anesthetic blockade. The sample consisted of 20 healthy patients scheduled for elective surgery with intradural anesthesia (0.5% hyperbaric bupivacaine), in whom 500 ml of HES were infused in 20 minutes. Blood samples were taken before lumbar puncture and 20 minutes after it and once HES infusion had been finished. Blood viscosity, the erythrocyte and leukocyte mass parameters and biochemical values (total protein, BUN, creatinine, glucose) were measured. Blood pressure (systolic, diastolic, mean) and heart rate were monitored every 5 minutes. During the study time, systolic blood pressure did not show significant changes. Mean and diastolic blood pressure in the minutes 15 and 20 were reduced in less than 10 mmHg (p less than 0.01). Packed red cell volume diminished in 5.7% and the blood viscosity in 0.5-2.3 mPas. It was concluded that HES is a good option for intradural anesthesia because of its plasma volume expanding effect and the hemodilution it induces.

[Anesthetic management of a hydatid cyst adhering to the inferior vena cava]. / Tratamiento anestésico de un quiste hidatídico adosado a la vena cava inferior.

A patient with a hepatic hydatid cyst with fistula formation to inferior vena cava is reported. To carry out the resection, the cyst was isolated from systemic circulation by means of cardiopulmonary bypass. Inferior vena cava was cannulated through the right atrium until the implantation area of the cyst (above the hepatic veins) was surpassed. Bypass was carried out in 25 minutes by means of cannulation of the ascending aorta, without clamping the aorta, myocardial protection or hypothermia. Postoperative analgesia was achieved with a lumbar epidural catheter. Measures to prevent anaphylactic shock are recommended, an anesthetic technique based on the prevention of hypersensitivity reactions and a careful surgical technique to prevent hydatid dissemination.