[Acute renal failure secondary to hemolytic uremic syndrome in a pregnant woman with pre-eclampsia]. / Fracaso renal agudo secundario a síndrome hemolítico urémico en gestante con preeclampsia.

Acute renal failure is a serious complication of pregnancy associated with a high rate of morbidity and mortality; the incidence is currently 1 per 10,000 pregnancies. The most common causes are gestational hypertension, bleeding, sepsis, and intrinsic renal disease. Other less common pregnancy-related syndromes, such as HELLP syndrome or thrombotic microangiopathy, may also lead to kidney failure. Hemolytic uremic syndrome and thrombotic thrombocytopenic purpura are forms of thrombotic microangiopathy and although neither is specific to pregnancy, the incidence of these entities rises during gestation. The classic symptoms are fever, hemolytic microangiopathic anemia, thrombopenia, neurologic dysfunction, and kidney abnormalities. When renal involvement is the predominant manifestation, the diagnosis is usually hemolytic uremic syndrome.

[General anesthesia in mentally disabled patients undergoing dental surgery]. / Anestesia general en pacientes con discapacidad intelectual sometidos a cirugía dental.

OBJECTIVE: To describe the anesthetic technique used, the evaluation of airway patency, and the perioperative complications in patients with lower than average intelligence (mentally disabled) who are administered general anesthesia for dental surgery. MATERIAL AND METHODS: We carried out a prospective, descriptive, comparative study of mentally disabled ASA 2-3 patients. The patients were distributed in 2 groups: mild to moderate mental disability and severe to very severe mental disability. Induction was via intravenous or inhaled anesthesia depending on availability of venous access. Maintenance was with sevoflurane in oxygen and air at variable concentrations in order to maintain a bispectral index (BIS) between 40 and 60. Statistical comparisons were based on the chi2 test, the log-rank test and the t test. RESULTS: Forty-seven patients were enrolled. The anesthetic technique maintained hemodynamic stability in both groups. No statistically significant differences were found in Mallampati classification, Cormack-Lehane classification, or level of disability. The incidence of complications was higher in the group with more severe disability; the most common complication was difficult tracheal intubation. Bradycardia was the most common complication in the group with mild to moderate mental disability. CONCLUSIONS: The anesthetic technique used in this study proved to be safe and effective in this type of patient. A higher degree of mental disability led to less effective examination of the airway and more difficult direct laryngoscopy. BIS was as effective for monitoring in this population as it is in the general population.

Preoperative assessment.

Although anaesthetic and surgical procedures should be individualised for every patient, in practice many preoperative protocols and routines are used generally. In this article, we aim to emphasise: why preoperative assessment is important; how it should be done, and by whom; what can be expected; and the importance of test selection based on patients' needs and on scientific evidence of effectiveness. We outline the roles of preoperative medical assessment in otherwise healthy patients. Clinical history, preoperative questionnaires, physical examination, routine tests, individual risk-assessment, and fasting policies are investigated by review of published work. Cost of routine preoperative assessment, the anaesthetist's legal responsibility, and patients'views in the preoperative process are also considered. A thorough clinical preoperative assessment of the patient is more important than routine preoperative tests, which should be requested only when justified by clinical indications. Moreover, this practice eliminates unnecessary cost without compromising the safety and quality of care. Education and training of medical doctors should be more scientifically guided, emphasising the relevance of effectiveness, and cost-effectiveness in clinical decision-making and complemented by audit.

Serum and tissue CEA in colorectal cancer: clinical relevance.

PURPOSE: This article is an analysis of the information derived from the determination of tumor-tissue concentration of CEA in patients with colorectal cancer. To ascertain the relationship between tumor marker content with the histologic aspects and serologic levels of CEA of this neoplam. MATERIALS AND METHODS: 136 patients with colorectal adenocarcinoma and 41 with colorectal benign processes are analyzed and followed during an average time of 27 months. The CEA of the serum were obtained preoperatively and postoperatively and measured by radioimmunoassay (RIA). Tissular CEA levels were determined with RIA. The histological characteristics are analyzed (Dukes classification, grade of differentiation, index of atypia, microscopic vascular and lymphatic involvement. RESULTS: 1) The cut off point of the tissular CEA with the best sensitivity and specificity for the diagnosis of normal mucosa is 386 ng/mg and for tumoral tissue is 1160 ng/mg. 2) There is no correlation between tissue and serologic CEA value. 3) The tissular level of CEA have a significant statistical correlation with Dukes stage (p < 0.003); other histological characteristics were no significative. 4) There are significant statistical correlations between serologic CEA and relapse but no with survival rates. CONCLUSIONS: 1) Serologic CEA levels depend on numerous factors. 2) There aren't correlations between preoperative serologic levels and tissular CEA levels. 3) Tissular CEA do not predict what patients will have an elevated serologic CEA level in relapse.

[Indications for thoracic radiography in the preoperative evaluation for elective surgery]. / Indicaciones de la radiografía de tórax para la valoración preoperatoria en cirugía programada.

OBJECTIVES: To establish a protocol for ordering chest x-ray films for screening before elective surgery. To study the prevalence of anomalies detected in routinely-ordered chest x-rays, their influence on management of anesthesia and surgery and on the prevention of perioperative complications. MATERIAL AND METHODS: A prospective study of 413 patients undergoing elective surgery over a period of two years. Anomalies detected in chest films were classified as significant or not significant and then as expected or unexpected in function of agreement between the patient's medical history and the image. RESULTS: A preoperative chest x-ray was obtained for 99.5% of the patients and anomalies were detected in 28.1%, of which 49.1% were significant. The prevalence of anomalies was higher among men over 60 years of age, smokers, those with cardiac or respiratory disease, and those who were classified ASA III-IV. In 6.9% of the cases, the anomalous findings were unexpected based on the patient's history. Findings led to preoperative changes in management in 0.5% of the cases; no delays or cancellations occurred. The frequencies of intraoperative and postoperative complications were 7.9% and 24.6%, respectively. CONCLUSIONS: A preoperative chest x-ray should be ordered only for patients over 60 years of age, smokers of 10 cigarettes/day or more, those with heart or respiratory disease, those who have had contact with tuberculosis and who have not had any other chest x-ray taken within the past year.

[Indications for electrocardiogram in the preoperative assessment for programmed surgery]. / Indicaciones del electrocardiograma para la valoración preoperatoria en cirugía programada.

OBJECTIVES: To establish indications for ordering a screening electrocardiogram (ECG) before scheduled surgery. To study the prevalence of abnormalities found in routine ECGs and the impact of routine ECGs on anesthetic and surgical management and on preventing perioperative complications. MATERIAL AND METHODS: A prospective study of 413 patients undergoing scheduled non-cardiac surgery over a two-year period. ECG anomalies were defined as major or minor in function of their association with perioperative morbimortality. ECG results were considered expected or unexpected in function of agreement with a patient's history. RESULTS: An ECG was done for all patients before surgery. Anomalies were observed in 41.9% of the ECGs, 28.6% of which were considered major. The prevalence of anomalies was greater among men over 40 years of age, with heart or respiratory disease and these classified as ASA III-V. The anomalies were unexpected in 8.9% and did not cause postponement or cancellation of scheduled procedures. Anomalies found led to changes in preoperative approach in 0.5% of the cases. Intraoperative complications were seen in 7.9% and postoperative complications in 24.6%. CONCLUSIONS: Preoperative ECGs should be obtained only in patients over 40 years of age who present cardiac or respiratory signs or symptoms and who are diagnosed of some heart or respiratory disease.

[Anal condylomata acuminata in children]. / Condilomas acuminados anales en niños.

Perianal condyloma acuminatum is a lesion rarely seen in children or babies. We report three new cases of this disease in children less than 3 years of age. There was no evidence of the mechanism of transmission in these cases. All patients underwent radical surgical excision. In one case, surgical treatment was needed on two different occasions due to the extension of the warts. None of the patients showed any recurrence of condyloma over a follow-up period of six years.