[Comparison of ropivacaine and bupivacaine for epidural analgesia during labor]. / Estudio comparativo entre ropivacaína y bupivacaína en analgesia epidural del parto.

OBJECTIVES: To compare the analgesic efficacy and level of motor block using two local anesthetics, ropivacaine and bupivacaine, during labor. MATERIAL AND METHODS: Sixty nulliparous women were enrolled during labor after full-term pregnancies. They were randomly assigned to receive epidural analgesia with ropivacaine (group R) or bupivacaine (group B). Group R patients received 10 ml of 0.18% ropivacaine with 5 microgram/ml of fentanyl followed by continuous epidural infusion of 0.1% ropivacaine with 2 microgram/ml of fentanyl at a rate of 10 ml/h. Group B patients received 10 ml of 0.15% bupivacaine with 5 microgram/ml of fentanyl followed by continuous epidural perfusion of 0.0625% bupivacaine with 2 microgram/ml of fentanyl at the same rate. Pain intensity was assessed on a visual analog scale, motor blockade on a Bromage scale, and level of sensory block at different moments. We also recorded total doses of local anesthetic employed during continuous epidural infusion, manner of final delivery, Apgar score, degree of maternal satisfaction and side effects. RESULTS: The demographic and delivery characteristics were similar in both groups. We found no statistically significant differences between the two groups for level of motor blockade, which was nil for 29 patients (96.66%) in group R and 28 patients (93.33%) in group B. No differences in degree of pain or level of sensory block (T8-T10 in both groups) were observed. The total doses of local anesthetic used were similar at 23.7 +/- 11.6 mg in group R and 16.5 +/- 7.3 mg in group B (non-significant difference). Nor did we find differences in manner of delivery, neonatal Apgar scores, degree of maternal satisfaction or side effects. CONCLUSION: Ropivacaine and bupivacaine are equally effective for epidural analgesia during labor at the doses used and they do not cause a relevant level of motor blockade.

Peripheral arterial disease in patients with chronic obstructive pulmonary disease.

AIM: Cardiovascular disease (CV) is the second leading cause of morbidity and mortality in chronic obstructive pulmonary disease (COPD). Peripheral arterial disease (PAD) is associated with cardiovascular disease, and its risk factors are common to other atherosclerotic diseases. The objective is to determine the prevalence of PAD in a population of patients with COPD using the ankle / brachial index (ABI) and to investigate the relationship between PAD and lung disease severity. METHODS: In a prospective cross-sectional study, 246 patients with COPD were recruited. Patients were enrolled consecutively according to their admission to Povisa hospital from September 1, 2008, until March 1, 2010, and were assessed by clinical history, spirometry and ABI. The COPD severity was graded by GOLD criteria in spirometry. RESULTS: Overall, 84 patients (36.8%) had abnormal ABI results and 59 (70.2%) were asymptomatic for PAD. COPD patients with PAD had a higher prevalence of moderate to severe COPD (61.9% vs. 41.7%, P=0.004), lower mean forced expiratory volume in 1 second (FEV1) values (46.7% ± 15 vs. 52.3±14%, P=0.001) and a higher prevalence of hypertension (69% vs. 54.3%, P=0.03) and previous cardiovascular disease (34.5% vs. 21.3%, P=0.03). CONCLUSION: There was a high prevalence of asymptomatic PAD in the COPD patients we examined. Abnormal ABI results were associated with a higher prevalence of cardiovascular risk factors and more severe lung disease. The diagnosis of peripheral arterial disease in COPD is important because this is an entity that limits the patient's physical activity and impairs their quality of life in addition to turn it into a high cardiovascular risk patient that requiring additional therapeutic measures.

[Relationship between arginase activity and the storage time of packed red blood cells]. / Relación entre la actividad arginasa y el tiempo de conservación de los concentrados de hematíes.

OBJECTIVES: Given the increasing evidence regarding a relationship between packed red blood cells storage time and post-transfusion complications, we decided to determine the relationship between the arginase enzyme levels, biochemical parameters and haemolysis, with the storage time of transfused packed red blood cells. MATERIAL AND METHODS: We designed a prospective study that included 24 units of packed cells that had been consecutively transfused to patients of our hospital. After recording the storage time of each bag, 15 ml of blood was removed to determine arginase activity, biochemical parameters and haemolysis. A univariate analysis was performed on all the recorded parameters, and included those that were significant in the multiple regression model (P<.05). RESULTS: The mean storage time was 18.6±6.1 days (range: 6-31 days), with a haematocrit of 59.8%±0.05%, a haemoglobin of 20.3±1.8 g/dl, a pH of 6.5±0.1, and an arginase activity of 140.1±124.0 mU/ml. A linear relationship was observed in the univariate analysis between the storage time and the pH (P=.001), the actual HCO(3) (P=.001), the haemolysis index (P=.035) and the SpO(2) (P=.01). Once adjusted for the confounding variables of the univariate model, a linear relationship was observed between the arginase activity and the storage time (P=.031). CONCLUSIONS: Our study shows a directly proportional linear relationship between the storage time of packed red blood cells and their arginase activity. We suggest that these findings could be associated with the high incidence of complications after transfusion that may be directly proportional to their storage time.

Relación entre la actividad arginasa y el tiempo de conservación de los concentrados de hematíes / Relationship between arginase activity and the storage time of packed red blood cells

Objetivos. Dada la creciente evidencia a favor de una relación entre el tiempo de conservación de los concentrados de hematíes y las complicaciones postransfusionales, nos planteamos analizar la relación existente entre los niveles de enzima arginasa, parámetros bioquímicos y de hemólisis, con el tiempo de conservación de concentrados de hematíes transfundidos. Material y métodos. Diseñamos un estudio prospectivo que incluyó 24 unidades de concentrado de hematíes, que habían sido transfundidos consecutivamente a pacientes de nuestro hospital. Luego de registrar el tiempo de conservación de cada bolsa, se extrajeron 15ml de sangre para determinar la actividad arginasa, los datos bioquímicos y de hemólisis. Se realizó un análisis univariante de todos los parámetros registrados y se incluyeron aquellos que resultaron significativos en un modelo de regresión múltiple (p<0,05). Resultados. El tiempo promedio de conservación fue de 18,6±6,1 días (rango: 6-31 días), con un hematocrito de 59,8%±0,05%, una hemoglobina 20,3±1,8g/dl, un pH de 6,5±0,1 y una actividad arginasa de 140,1±124,0 mU/ml. Se observó una relación lineal en el análisis univariante entre el tiempo de conservación y el pH (p=0,001), el HCO3act (p=0,001), el índice hemolítico (p=0,035) y la SpO2 (p=0,01). Una vez ajustados las variables de confusión procedentes del modelo univariante, se observó una relación lineal entre la actividad arginasa y el tiempo de conservación (p=0,031). Conclusiones. Nuestro trabajo muestra una relación lineal directamente proporcional entre el tiempo de conservación de los concentrados de hematíes y la actividad arginasa presente en los mismos. Sugerimos que estos hallazgos podrían estar relacionados con la elevada incidencia de complicaciones tras la transfusión que puede ser directamente proporcional a su tiempo de conservación(AU)

Objectives. Given the increasing evidence regarding a relationship between packed red blood cells storage time and post-transfusion complications, we decided to determine the relationship between the arginase enzyme levels, biochemical parameters and haemolysis, with the storage time of transfused packed red blood cells. Material and methods. We designed a prospective study that included 24 units of packed cells that had been consecutively transfused to patients of our hospital. After recording the storage time of each bag, 15ml of blood was removed to determine arginase activity, biochemical parameters and haemolysis. A univariate analysis was performed on all the recorded parameters, and included those that were significant in the multiple regression model (P<.05). Results. The mean storage time was 18.6±6.1 days (range: 6-31 days), with a haematocrit of 59.8%±0.05%, a haemoglobin of 20.3±1.8g/dl, a pH of 6.5±0.1, and an arginase activity of 140.1±124.0mU/ml. A linear relationship was observed in the univariate analysis between the storage time and the pH (P=.001), the actualHCO3 (P=.001), the haemolysis index (P=.035) and the SpO2 (P=.01). Once adjusted for the confounding variables of the univariate model, a linear relationship was observed between the arginase activity and the storage time (P=.031). Conclusions. Our study shows a directly proportional linear relationship between the storage time of packed red blood cells and their arginase activity. We suggest that these findings could be associated with the high incidence of complications after transfusion that may be directly proportional to their storage time(AU)

Bloqueo aurículo-ventricular completo secundario a un colirio de Timolol: importancia de una consulta preanestésica / Complete atrial ventricular block secondary to application of timolol eyedrops: importance of the preanesthetic interview

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Estudio comparativo entre ropivacaína y bupivacaína en analgesia epidural del parto / Comparison of ropivacaine and bupivacaine for epidural analgesia during labor

OBJETIVOS. Valorar la eficacia analgésica y el grado de bloqueo motor alcanzado cuando se comparan dos anestésicos locales, ropivacaína y bupivacaína, en analgesia epidural del parto. MATERIAL Y MÉTODOS. Se incluyó a 60 parturientas en dinámica de parto y con embarazo a término y único. Fueron distribuidas aleatoriamente en dos grupos según recibieran la analgesia epidural con ropivacaína (grupo R) o con bupivacaína (grupo B). Las pacientes del grupo R recibieron 10 ml de ropivacaína al 0,18 por ciento con 5 µg/ml de fentanilo y posteriormente una infusión continua epidural de ropivacaína al 0,1 por ciento con 2 µg/ml de fentanilo a un ritmo de 10 ml/h. Las pacientes del grupo B recibieron 10 ml de bupivacaína al 0,15 por ciento con 5 µg/ml de fentanilo y después una perfusión continua epidural de bupivacaína al 0,0625 por ciento con 2 µg/ml de fentanilo al mismo ritmo. Se valoró la intensidad del dolor según la escala visual analógica (EVA), el grado de bloqueo motor según la escala modificada de Bromage y el nivel sensitivo analgésico en diferentes períodos de tiempo.Asimismo, se anotaron las dosis totales de anestésico local empleado en la perfusión continua epidural, el modo de finalizar el parto, el Apgar del recién nacido, el grado de satisfacción materna y los efectos secundarios.RESULTADOS. Las características demográficas y de paridad fueron comparables en ambos grupos. No se encontraron diferencias estadísticamente significativas entre los grupos en cuanto al grado de bloqueo motor, y éste fue nulo en 29 pacientes (96,66 por ciento) del grupo R y en 28 pacientes (93,33 por ciento) del grupo B. No hubo diferencias respecto al grado de dolor ni en el nivel sensitivo analgésico alcanzado, T8-T10, en ambos grupos. Las dosis totales de anestésico local empleado fueron de 23,7 ñ 11,6 mg en el grupo R y de 16,5 ñ 7,3 mg en el grupo B sin que las diferencias fueran significativas. Tampoco hubo diferencias con respecto al modo de finalizar el parto, Apgar del neonato, grado de satisfacción materna o efectos secundarios. CONCLUSIÓN. Ropivacaína y bupivacaína, a las dosis empleadas, son igualmente eficaces en analgesia epidural del parto sin provocar un bloqueo motor relevante (AU)

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Tratamiento del osteoma osteoide del cuello femoral mediante termocoagulación del nidus / Treatment of osteoid osteoma of the femoral neck by nidus thermocoagulation

Se presenta una paciente afecta de un osteoma osteoide localizado en el cuello femoral tratado mediante termocoagulación del nidus con ondas de radiofrecuencia. La estancia hospitalaria postoperatoria fue de un día, la carga del miembro intervenido fue inmediata y el alta médica fue dada al tercer mes con un resultado excelente. Trece meses después del tratamiento, la paciente continúa asintomática (AU)