Perioperative care in colorectal surgery: current practice patterns and opinions.

Objective Evidence regarding perioperative care in colorectal surgery has recently increased, leading to changes in classical clinical procedures that make the perioperative period safer and shorter. This survey aimed to evaluate the opinions of Spanish colorectal surgeons on the perioperative management of their patients. Method Emailed surveys submitted to the members of Spanish Coloproctological Associations. Results One hundred and thirty-one (31.7%) of the 413 members participated in the study and responded thus: 21% use clinical pathways and 8% use fast track (FT); 36% use epidural analgesia in colonic surgery and 57% in rectal; 40% use warm air and 23% warm fluids to maintain intraoperative normothermia; 53% prescribe >/= 3000 ml. of iv fluids on the first postoperative day and 6.2%

Dr. Hyacinthe Guilleminot and the first respiratory and cardiac synchronisation systems for obtaining radiological images. / El Dr. Hyacinthe Guilleminot y los primeros sistemas de sincronización respiratoria y cardíaca para obtención de imagen radiológica.

In an era when it was not possible to achieve quality x-rays with short exposure times, the need to obtain chest images without movement led the French doctor Emré Hyacinthe Guilleminot to construct a machine that repeatedly emitted x-rays only when desired during the respiratory cycle. His aim was to create a satisfactory radiograph from multiple short bursts performed at the moment of inhalation or exhalation, based on Charles Bouchard's research on heart disease. He extended his idea to radiography of the heart, creating a system that enabled images to be obtained disassociating the phases of heartbeat. This article seeks to explain the basic functioning of these mechanisms, and to recover previous research papers that led to their creation. We will also retrieve biographical and personal data of the two people involved - one directly, the other indirectly - in these novel inventions.

[Identification of the epidural space: usual practice among Spanish anesthesiologists]. / Identificación del espacio epidural en la práctica habitual de los anestesiólogos españoles.

OBJECTIVE: To determine what methods are habitually used by Spanish anesthesiologists to identify the epidural space. MATERIAL AND METHODS: Spanish anesthesiologists were asked to fill in an Internet questionnaire about the methods they had learned during residency training for identifying the epidural space, the method they currently use most often, and the one they consider best for residents to learn during training. RESULTS: Responses were received from 617 anesthesiologists. The techniques the respondents had learned during training were loss of resistance to air (LOR-A), 58.5%; LOR to saline (LOR-S), 31.9%; LOR and air bubble (LOR-B), 6.1%; and the hanging drop method, 2.4%. Those who had learned the LOR-A technique had changed in 14.2% of the cases, as had 28.4% of those who learned the LOR-S procedure. LOR-A is currently used by 59.2% of the respondents, LOR-S is used by 32.4%, and LOR-B by 6%. The respondents recommended that new residents physicians learn the LOR-A (48.5%) and LOR-S (37.8%) techniques. The LOR-B is recommended by 12.6% a much larger percentage of anesthesiologists than it is habitually used by. Of those who use the LORA technique habitually, 26.4% recommend that new residents use a different procedure. CONCLUSIONS: The procedure used most often by Spanish anesthesiologists to identify the epidural space is the LOR-A technique; however, over a quarter of Spanish users of LOR-A do not recommend it.

[Subdural empyema due to Mycoplasma hominis after a cesarean section under spinal anesthesia]. / Empiema subdural por Mycoplasma hominis tras cesárea bajo anestesia epidural.

The isolation of Mycoplasma hominis in cultured biopsy material from a subdural empyema is a very rare finding. Likewise, subdural empyema complicating epidural anesthesia is an uncommon event after cesarean delivery. We report the case of a 32-year-old patient who presented a throbbing headache when standing 48 hours after undergoing cesarean delivery under spinal anesthesia. On the fifth day after surgery, the headache worsened, fever developed, and an abscess was detected at the abdominal wall; antibiotic treatment was prescribed. When fever and headache persisted and abdominal infection had been ruled out, nuclear magnetic resonance imaging of the head revealed subdural empyema. Emergency surgery to drain pus was carried out twice. Mycoplasma hominis was isolated from a blood-agar culture of the exudate. The patient recovered fully after combined surgical and antibiotic treatment.

Transposon impala, a novel tool for gene tagging in the rice blast fungus Magnaporthe grisea.

impala, a Tc1-mariner transposable element from Fusarium oxysporum, was introduced into the rice blast fungus Magnaporthe grisea to develop transposon-based insertional mutagenesis. A construct (pNIL160) containing an autonomous impala copy inserted in the promoter of niaD encoding Aspergillus nidulans nitrate reductase was introduced by transformation into a M. grisea nitrate reductase-deficient mutant. impala excision was monitored by restoration of prototrophy for nitrate. Southern analysis of niaD+ revertants revealed that impala was able to excise and reinsert at new loci in M. grisea. As observed for its host Fusarium oxysporum, impala inserted at a TA site left a typical excision footprint of 5 bp. We have shown that a defective impala copy was inactive in M. grisea, yet it can be activated by a functional impala transposase. A transformant carrying a single copy of pNIL160 was used to generate a collection of 350 revertants. Mutants either altered for their mycelial growth (Rev2) or nonpathogenic (Rev77) were obtained. Complementation of Rev77 with a 3-kb genomic fragment from a wild-type locus was successful, demonstrating the tagging of a pathogenicity gene by impala. This gene, called ORP1, is essential for penetration of host leaves by M. grisea and has no sequence homology to known genes.

Green fluorescent protein (GFP) as gene expression reporter and vital marker for studying development and microbe-plant interaction in the tobacco pathogen Phythphthora parasitica var. nicotianae.

PEG-mediated transformation of protoplasts in the presence of lipofectin was achieved in Phytophthora parasitica var. nicotianae, an oomycete pathogen of tobacco. Using oomycete promoter and terminator sequences, a plant-adapted green fluorescent protein (GFP) was introduced into the microorganism. The data show for the first time that this eukaryotic gene reporter can be used in an oomycete, both as a quantitative reporter of gene induction and as a vital marker allowing the study of development of Phytophthora in vitro and in the host plant.

Comparison of aceclofenac with piroxicam in the treatment of osteoarthritis.

A multicentre, double-blind, randomised, parallel group study was undertaken to investigate the efficacy and safety of aceclofenac (123 patients, 100 mg twice daily) in comparison to piroxicam (117 patients, 20 mg once daily and placebo once daily) in patients with osteoarthritis of the knee. The treatment period of two months was preceded by a washout period of one week duration. On completion of the study, patients in both aceclofenac and piroxicam-treated groups exhibited significant improvement in pain intensity and functional capacity of the affected knee, as represented by the Osteoarthritis Severity Index (OSI) (p < 0.0001 and p < 0.001 respectively). This was further substantiated following the patient's assessment of pain intensity using the Visual Analogue Scale (VAS), in which significant improvements were demonstrated at all time points for each treatment group (p < 0.001). Although both treatment groups showed a significant improvement in all investigator's clinical assessments (functional exploration of the knee, knee flexion and extension (EXT)), there were no significant differences between the groups. There was, however, a more rapid improvement in knee flexion in the aceclofenac group after 15 days of treatment. Both aceclofenac and piroxicam were well tolerated by patients, the most commonly reported adverse events being gastrointestinal, although their incidence was low. Only 24 patients on aceclofenac, as opposed to 33 on piroxicam complained of dyspepsia, epigastralgia and pyrosis. While 7 patients in each group were withdrawn because of adverse events, only one patient with piroxicam was withdrawn because of severe upper gastrointestinal bleeding. Twice as many reports of fecal blood loss were made in the piroxicam group in comparison to the aceclofenac group. In summary, this study confirms the therapeutic efficacy of aceclofenac and suggests that it is a well-tolerated alternative NSAID to piroxicam in the treatment of osteoarthritis.

[Influence of resting the digestive duct in gastric emptying. Comparison of 2 nutritional modalities: glucidic enteral and total parenteral nutrition]. / Influencia del reposo del tubo digestivo en el vaciado gástrico. Comparación de dos modalidades nutricionales: enteral y parenteral total glucídica.

Gastrointestinal motility is altered in several clinical situations in which Total Parenteral Nutrition (TPN) is indicated. Nevertheless, the effects of TPN on motility are not well known. In this study, Wistar rats (250-280 g) were divided into two groups were defined according to the route of administration of the nutrients: Group A (with TPN: 100% of the total non-protein calories administered as glucose), and Group B (solid enteral nutrition, but with the infusion of normal saline under the same conditions as in the previous group). Each group was subjected to three different infusion times: 24 hours, 3 days, and 5 days post-intervention, after which the gastric emptying was measured by means of the phenol red test. TPN delayed emptying in all the times with respect to group B, although significant differences were only found after 3 days of infusion.

[Iatrogenic bilateral hydrothorax following the placement of a central catheter]. / Hidrotórax bilateral yatrógeno tras colocación de vía central.

We present a case of bilateral hydrothorax after internal jugular vein catheterization. 60 hours after placing the catheter, the patient showed an abrupt picture of jugular ingurgitation, abolished vesicular breath sounds, and displaced cardiac tones. It was necessary to immediately drain one hemithorax to guarantee ventilation of the patient. The present article examines iatrogenicity derived from the placement of central catheters, and special attention is given to the need for post-insertion x-ray control.

[Analysis of bibliographic citations received by Spanish anesthesiologists for work indexed by Science Citation Index, 1988-2002]. / Análisis de las citas bibliográficas recibidas por las publicaciones de los anestesiólogos españoles (incluidas en el Science Citation Index) en el período 1988-2002.

OBJECTIVE: To analyze the international impact of articles published by authors in Spanish anesthesiology departments. METHOD: Citable articles indexed by Science Citation Index between 1988 and 2002 and authored by members of Spanish departments of anesthesiology were considered. Citations were counted 2 years and 5 years after publication. Authors and institutions were ranked according to number of citations received. We also determined the journals Spanish anesthesiologists most often chose for publishing their work. RESULTS: Of the 322 citable articles identified, 61.8% were cited in the 2 years following publication (total 587 citations), and 79.5% were cited within 5 years (total 1472 citations). The most frequently cited articles received 17 citations in 2 years and 45 in 5 years after publication. Articles from the Department of Anesthesiology of Hospital Clinic i Provincial of Barcelona received the largest number of citations (333 citations in 5 years). The author with the highest rate of citations received 11.57 per article. The author with the largest number of citations received 86. Anesthesia & Analgesia was the journal publishing the largest number of articles by Spanish anesthesiologists (35 articles). CONCLUSION: This citation analysis shows the international impact of publications by Spanish anesthesiologists.

WT1 exon 1 deletion/insertion mutations in Wilms tumor patients, associated with di- and trinucleotide repeats and deletion hotspot consensus sequences.

The WT1 gene is known to play a role in at least some cases of Wilms tumor (WT). The first exon of the gene is highly GC rich and contains many short tandem di- and trinucleotide repeats, interrupted direct repeats, and CCTG (CAGG) motifs that have been identified as hotspots for DNA deletions. We have analyzed 80 WT patient samples for mutations in the first exon of WT1, either by SSCP analysis of the first 131 bp of the coding portion of WT1 exon 1 or by size analysis of a PCR product encompassing the coding region of exon 1 in addition to flanking noncoding regions. We report here the occurrence of somatic and germ-line deletion and insertion mutations in this portion of the gene in four WT patients. The mutations are flanked by short direct repeats, and the breakpoints are within 5 nt of a CCTG (CAGG) sequence. These data suggest that a distinctive mutational mechanism, previously unrecognized for this gene, is important for the generation of DNA mutations at the WT1 locus.