[Evaluation of the p53 Arg72Pro polymorphism as a prognostic factor in severe head injury and the inclusion of this indicator in a predictive model]. / Evaluación del polimorfismo Arg72Pro de p53 como factor pronóstico del traumatismo craneoencefálico grave y su participación en la construcción de un modelo predictivo.

BACKGROUND AND OBJECTIVE: Physiologic variables have traditionally been studied as prognostic factors in severe head injury. Until recently it was not thought that genetic factors might play a role. The main objective of this study was to construct a logistic regression model including physiologic variables and the p53 Arg72Pro polymorphism, which can promote neuron death through apoptosis. MATERIAL AND METHODS: We included 90 patients admitted to the postoperative recovery unit with severe head injury. Patients with previous neurologic deficits were excluded. Clinical variables were recorded. The p53 Arg72Pro polymorphism was analyzed using polymerase chain reaction of DNA in blood. Neurologic outcome was assessed on the Glasgow Outcome Scale. A predictive logistic regression model was then constructed based on relevant candidate variables (sex, age, poor Glasgow score, the Acute Physiology and Chronic Health Evaluation II score, pupil size, pupil reactivity, subarachnoid hemorrhage, number of days in the recovery unit, number of days on mechanical ventilation, and the early development of hypotension) in addition to the p53 Arg72Pro polymorphism. RESULTS: The Arg/Arg polymorphism was an independent predictor of poor outcome (odds ratio, 3.55; 95% confidence interval [CI], 1.11-1132; P = .032). The selected model (including the variables age, gene polymorphism, pupil reactivity, and Glasgow score) had adequate discriminatory power (sensitivity 823%, 95% CI 72.8%-91.8%; specificity 78.6%, 95% CI 63.4%-93.8%), classifying 81.1% of the patients correctly. The p53 Arg72Pro polymorphism, along with pupil reactivity, age and Glasgow score, is useful in a predictive model of good or poor outcome on discharge after head injury.

[Incidences of early- and late-onset ventilator-associated pneumonia in a postanesthesia and critical care unit]. / Incidencia de las neumonías nosocomiales precoces y tardías asociadas a ventilación mecánica en una unidad de reanimación- críticos polivalente.

OBJECTIVES: To ascertain the frequency, risk factors, and causes of early- and late-onset ventilator-associated pneumonia (VAP) in a postanesthesia and critical care unit. MATERIAL AND METHODS: A prospective study was carried out between January 1, 1996 and December 31, 2001 of all ventilated patients staying longer than 48 hours in the critical care unit, with follow-up for 48 hours following discharge from the unit. Descriptive statistics were compiled for episodes of early- and late-onset VAP for a period of up to 4 days after intubation; univariate and multiple variable Cox regression analyses were also carried out. RESULTS: A total of 3614 patients were admitted to the unit (study cohort, 652 patients). The mean length of stay in the unit for the study cohort was 13.64 days. The most frequent diagnosis was multiple trauma (50.46%). The incidence density of VAP was 20.31 cases per 1000 patient-days on mechanical ventilation. The pathogens most often isolated in early-onset VAP cases were Staphylococcus aureus and Pseudomonas aeruginosa. In late-onset cases, the pathogens were Pseudomonas species. Early-onset VAP was 2.54 and 2.81 times more frequent in comatose and head-injury patients, respectively. Those rates were significantly different in late-onset cases. CONCLUSIONS: Early-onset VAP was more common in comatose and head-injury patients. The risk of developing late-onset versus early-onset VAP was twice as great for postoperative patients.

[Response to presurgical stress in outpatient surgery: effects on lymphocyte populations of psychological treatment to prevent surgical anxiety]. / Respuesta al estrés prequirúrgico en la cirugía sin ingreso: efectos sobre las poblaciones linfocitarias de un procedimiento de psicoprofilaxis quirúrgica.

OBJECTIVE: To determine the effect of a psychological stress control intervention on lymphocyte populations in patients preparing for outpatient surgery. PATIENTS AND METHODS: A prospective randomized controlled trial enrolling 74 patients scheduled for major outpatient surgery at the Hospital Universitario de Albacete in Spain. The patients were randomized to a control (n = 37) or experimental group (n = 37). Measurements were recorded at baseline (preoperative visit) and before entering the operating room (just before surgery). The experimental group received treatment in a psychological stress control program consisting of an interview, watching a video, provision of informative literature about the operation and techniques for controlling anxiety. Anxiety was measured with the State-Trait Anxiety Inventory. The General Health Questionnaire (Goldberg) was applied, and lymphocyte populations were assessed (total white cell count; CD3, CD4, CD4RA, CD4RO, CD8, CD56, CD19, and CD56 lymphocyte counts). Values were expressed as means (SD). RESULTS: The group that received psychological stress prevention therapy had significantly lower CD19 (B lymphocyte) cell counts than did the control group just before surgery. No differences were found between the groups for any other variables. CONCLUSIONS: Psychological stress control therapy prevents a decrease in B cell populations before outpatient surgery.

[Intravenous perfusion of 2,6-diisopropylphenol (propofol) in the maintenance of emergency anesthesia]. / Perfusión intravenosa de 2,6 diisopropilfenol (propofol) en el mantenimiento de anestesia de urgencias.

In the present study, we describe the use of 2,6 diisopropylphenol (propofol) in emergency surgery. Twenty ASA I and II patients underwent intravenous induction with thiopental (group I) and maintenance with a combination of oxygen/nitrous oxide (30/70%) and in other group of similar characteristics, propofol was used as single induction and maintenance hypnotic (group II). In both groups, atracurium besylate and fentanyl were used according to demand. In group II, there was a significant decrease in systolic blood pressure (16%; p less than 0.01) and diastolic blood pressure (12%; p less than 0.01) during induction as well as a lower incidence of side effects and a more progressive and rapid recovery (eye opening: group II = 16.3 +/- 3.3 minutes; group I = 39.7 +/- 6.3 minutes; p less than 0.01). On the basis of these findings, we believe propofol is a good alternative as single intravenous anesthetic for those patients undergoing emergency surgery and have no marked hemodynamic alterations.