Effectiveness of acute post-operative pain management by the acute pain service.

BACKGROUND: Analgesia by specialists with formal training in pain management could be more effective, to find out, the results of a team of an acute pain service will be determined. METHODS: Retrospective study (n = 108) of post-operative (POP) analgesia; two evaluations were taken: before starting analgesics in the immediate POP period and the second at 24 h. A multivariate analysis was performed to establish independent risk factors associated with the effectiveness of the treatment. RESULTS: The effectiveness was 81.48% at 24 h. The risk factors associated with poor management effectiveness were: a comorbidity, prevalence ratio (PR) = 1.22; fibromyalgia (PR = 8.47), and cancer (PR = 2.47). The duration of surgery was associated with poor control PR = 1.10 for each hour elapsed. Protective factors for poor pain control: administration of non-steroidal anti-inflammatory drugs during the POP period (PR = 0.11) and use of analgesia controlled by the patient (PR = 0.29). CONCLUSION: POP pain relief is multifactorial; the participation of specialists was very effective. Identification of risk factors led to closer follow-up.

OBJETIVO: La analgesia por especialistas con entrenamiento formal en manejo del dolor podría ser más efectiva, para averiguarlo se determinarán los resultados de un servicio de dolor agudo. MATERIAL Y MÉTODOS: Estudio retrospectivo (n = 108) de analgesia postoperatoria; se tomaron dos evaluaciones: antes de iniciar analgésicos en el postoperatorio inmediato y la segunda a las 24 horas. Se realizó un análisis multivariado para establecer los factores de riesgo independientes asociados con la efectividad del tratamiento. RESULTADOS: La disminución promedio fue 51,75% en el primer día postoperatorio. La efectividad fue del 81,48% a las 24 horas. Los factores de riesgo asociados con la mala efectividad del manejo fueron: una comorbilidad, razón de prevalencia (RP) = 1,22; fibromialgia (RP = 8,47) y cáncer (RP = 2,47). La duración de la cirugía se asoció con un mal control PR = 1,10 por cada hora transcurrida. Factores protectores para el mal control del dolor: administración de antiinflamatorios no esteroideos durante el postoperatorio (RP = 0,11) y uso de analgesia controlada por el paciente (RP = 0,29). CONCLUSIÓN: el alivio del dolor posoperatorio es multifactorial, la participación de especialistas fue muy eficaz. La identificación de los factores de riesgo condujo a un seguimiento más estrecho.

Hysteroscopic myomectomy for submucosal type 2 fibroids with cold enucleation technique and complete fibroid extraction using a double-lumen intracervical cannula.

OBJECTIVE: To introduce a new double-lumen intracervical cannula designed to allow a single-step hysteroscopic myomectomy with nonfragmented complete fibroid extraction after cold enucleation of submucosal type 2 fibroids, avoiding complications related to the use of energy and hypo-osmolar solutions. DESIGN: Video article depicting the use of a new double-lumen intracervical cannula for single-step hysteroscopic cold myomectomy, according to our institutional care guidelines and after obtaining the patient's informed consent. (The publication of this video has been authorized by the Institutional Ethics Committee of CES University in Medellín, Colombia.) SETTING(S): Private infertility clinic. PATIENT(S): A 45-year-old woman with abnormal uterine bleeding consisting of polymenorrhea and hypermenorrhea, nonresponsive to medical treatment, caused by three type 2 (FIGO leiomyoma subclassification system) submucosal fibroids of 17, 15, and 13 mm with more than 80% of intramyometrial component. INTERVENTION(S): Hysteroscopic enucleation of three submucosal fibroids performed by blunt dissection using the 30° Bettocchi hysteroscope's bevel under continuous observation of the avascular subcapsular plane of the fibroids. Once full enucleation was attained, cervical dilatation to 12 mm with Hegar plugs was performed followed by intracervical placement of a newly designed double-lumen intracervical cannula that allows the concomitant introduction of the Bettocchi diagnostic hysteroscope and a 5-mm laparoscopic tenaculum into the uterine cavity for complete nonfragmented fibroid extraction under direct visualization. MAIN OUTCOME MEASURE(S): Complete and unfragmented fibroid extraction in a single intervention, absence of surgical complications, and postoperative course. RESULT(S): Ambulatory hysteroscopic myomectomy of three submucosal type 2 fibroids was successfully performed by blunt enucleation and complete nonfragmented fibroid extraction using the double-lumen intracervical cannula. The total operative time was 32 minutes, and the total amount of distension media (normal saline) used was 800 mL with a liquid balance of 50 mL. No surgical or anesthesia-related complications occurred. In the postsurgical evaluation, the patient classified her pain as minimal, giving it a score of 1 on a pain scale of 1 to 5 (in which 1 is the lowest and 5 the highest pain perception). When asked about the level of satisfaction with the surgical procedure, the patient reported the highest degree of satisfaction with a score of 5 on a satisfaction scale of 1 to 5 (in which 1 is the lowest and 5 the highest satisfaction). The patient reported having postsurgical regular menstrual cycles every 28 days and 3 bleeding days without hypermenorrhea. CONCLUSION(S): An efficient hysteroscopic myomectomy of submucosal type 2 fibroids with deep intramyometrial component can be performed with complete and nonfragmented fibroid extraction in a single intervention by using a newly designed double-lumen intracervical cannula. This technique allows the completion of the surgery without the need of a resectoscope, electrosurgery, or hypo-osmolar uterine distension media, thus avoiding potential complications such as thermal-induced myometrial injury and hyponatremia; a second surgical intervention will not be required because the fibroid enucleation is complete. The procedure can be performed with the use of a diagnostic hysteroscope that is widely available in gynecologic practices. (Acknowledgment: The authors thank Dr. David Olive for the invaluable help and guidance with this surgical technique and video article.).

Tension pneumomediastinum and diffuse subcutaneous emphysema with severe acute respiratory syndrome coronavirus 2 infection requiring operative management for impending airway collapse: A case report.

Tension pneumomediastinum is a rare complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that has increased in incidence with the novel coronavirus disease 2019 pandemic. Although traditionally managed with conservative measures, we present the indications and methods for the first operative management of tension pneumomediastinum with concomitant SARS-CoV-2 infection.

Avances en el tratamiento del glioblastoma multiforme: [revisión] / Advances in the treatment of glioblastoma multiforme: [review]

El glioblastoma multiforme es el tumor primario del sistema nervioso central más frecuente en hombres. Su incidencia en Europa oscila entre 3 y 4 casos por 100.000 habitantes, y representa el 25% de todos los tumores de sistema nervioso central y el 50% de los tumores primarios. Menos del 3% de todos los pacientes con diagnóstico de glioblastoma sobreviven más de cuatro años y la supervivencia promedio es de seis meses. En la actualidad, se están adelantando estudios que tienen como objetivo lograr una mayor supervivencia y aumentar los periodos asintomáticos. Esta revisión tiene como objetivo principal hacer un breve recuento de los avances en el tratamiento del glioblastoma multiforme, haciendo énfasis en la terapia génica. En la literatura revisada se encontró que, en la actualidad, sólo hay dos tipos de mutaciones capaces de definir el pronóstico de la enfermedad; la presencia de la metilguanina-ADN metiltransferasa (MGMT) y la deleción 1p/19q, en las cuales se hará hincapié en el transcurso del documento.

Glioblastoma multiforme is the most common central nervous system (CNS) primary tumor in men. Its incidence in Europe lies between 3 to 4 cases per 100,000 inhabitants and it represents 25% of all the CNS tumors and 50% of the primary tumors. Less than 3% of all patients diagnosed with glioblastoma multiforme survive more than 4 years and the average survival is of 6 months. Studies aiming to increase the survival rate, as well as to achieve longer asymptomatic periods are being carried out at present. The main goal of this review is to offer a brief recount on the progress in the treatment of glioblastoma multiforme, focusing on genetic therapy. The consulted literature showed, that there are only two types of mutations capable of defining the prognosis of this disease at this point; one is the presence of O6-methylguanine-DNA methyltransferase protein expression (MGMT) and the 1p/ 19q deletion on which we will emphasize in the course of this document.

Determinación d la dependencia micorrizal del lulo / Determination Of Mycorrhizal Dependency Of Lulo

Se realizó un experimento de invernadero para determinar la dependencia micorrizal del lulo (Solanum quitoense Lam.) híbrido “La selva”. Se utilizó un diseño experimental completamente al azar, los tratamientos tuvieron un arreglo factorial 3x2 con tres repeticiones; estos consistieron en la combinación de tres niveles de fósforo (P) en la solución del suelo (0,002, 0,02 y 0,2 mg L-1) con dos niveles de inoculación del hongo micorrizal Glomus aggregatum (inoculado y no inoculado). Se emplearon como variables respuesta el contenido de P foliar en función del tiempo, la masa seca aérea y de raíces, la colonización micorrizal, la dependencia micorrizal y la morfología del sistema de raíces al momento de la cosecha. Los resultados indican que esta especie puede ser clasificada como moderadamente dependiente de la asociación micorrizal. La dependencia micorrizal fue mayor a 0,002 mg L-1. Todas las plantas inoculadas con G. aggregatum exhibieron colonización micorrizal, mientras que ninguna de las plantas no inoculadas desarrollaron la asociación micorrizal. La inoculación modificó significativamente la longitud y área superficial del sistema de raíces en las plantas de lulo en los niveles 0,002 y 0,02 mg L-1.

A greenhouse experiment was carried out to determine the mycorrhizal dependency of lulo (Solanum quitoense Lam.). An experimental design completely randomized was used, treatments were arranged in factorial combination 3x2, which consisted of the combination of three soil solution phosphorus (P) concentration (0.002, 0.02 and 0.2 mg L-1) and two levels of inoculation with the mycorrhizal fungus Glomus aggregatum (inoculated and uninoculated). Foliar P content was monitored as a function of time. At harvest, shoot and root dry weight, shoot P content, mycorrhizal colonization, mycorrhizal dependency, and root morphology were determined. The results indicated that lulo can be classified as moderately dependent on the mycorrhizal association. However, increases in soil solution P concentration decreased the mycorrhizal dependency of all plants. All inoculated plants showed mycorrhizal colonization. None of the control plants (uninoculated) exhibited mycorrhizal colonization. Increases in soil solution P significantly decreased mycorrhizal colonization. Mycorhizal inoculation significantly modified the root morphology. At 0.002 and 0.02 mg L-1 root length and surface area significantly increased with the inoculation.