Mid- to long-term results of SuPerLap single-port treatment in inguinal hernia. / Resultados a medio-largo plazo del tratamiento monopuerto SuPerLap de la hernia inguinal.

INTRODUCTION: Laparoscopic treatment of inguinal hernia is gaining popularity in many hospitals, but the use of working channel scopes is not as widely extended. We present our long-term experience with the SuPerLap (laparoscopic-assisted percutaneous suture) technique described by Rosell et al.(1) for epigastric hernia repair in the percutaneous, single-port treatment of inguinal hernia using working channel scopes. MATERIALS AND METHODS: A retrospective analysis of a series of male patients with congenital inguinal hernia undergoing surgery from February 2017 to December 2020 was carried out. A 5 mm-0º pleuroscope with a 3.5 mm working channel, a 20 G epidural needle, a 36 cm/3.5 mm laparoscopic Maryland dissector, and 3-0 polypropylene and polyester sutures were used. RESULTS: 384 inguinal hernia repairs using the SuPerLap technique were performed in 295 male patients - 206 unilateral repairs and 89 bilateral repairs. In 24 bilateral cases (26.95%), preoperative diagnosis had been unilateral. Mean age was two years (2 weeks-13 years). Mean operating time was 14 minutes (6-50 min) for unilateral repair, and 27 minutes (14-80 min) for bilateral repair. There were two cases of epigastric vessel damage, and one case of early recurrence in a newborn, who successfully underwent re-intervention using the SuPerLap technique. No late complications were recorded after a mean follow-up of 1-36 months. CONCLUSIONS: Working channel scopes using the SuPerLap technique avoid additional ports in inguinal hernia repair. They allow for excellent functional results, without visible scars, and minimize spermatic cord manipulation. Laparoscopy allows previously undiagnosed defects to be concomitantly treated.

INTRODUCCION: La laparoscopia en el tratamiento de la hernia inguinal está cada vez más presente en muchos hospitales. El uso de ópticas con canal de trabajo no está tan extendido. Se presenta la experiencia a largo plazo en la aplicación de la técnica SuPerLap (sutura percutánea laparoasistida) propuesta por Rosell y cols.(1) para la reparación de hernias epigástricas en el tratamiento monopuerto, percutáneo de las hernias inguinales mediante el uso de ópticas con canal de trabajo. MATERIAL Y METODO: Serie quirúrgica de hernia inguinal congénita en varones (febrero de 2017-diciembre de 2020). Se utilizó: pleuroscopio de 5 mm-0º con canal de trabajo de 3,5 mm; aguja epidural 20 G; suturas de polipropileno y poliéster 3/0; disector Maryland laparoscópico (36 cm-3,5 mm). RESULTADOS: Se realizaron 384 herniorrafias inguinales según técnica SuPerLap en 295 varones (206 unilaterales, 89 bilaterales). En 24 casos bilaterales (26,95%) el diagnóstico preoperatorio fue unilateral. La edad media fue de dos años (2 semanas-13 años). El tiempo medio quirúrgico fue 14 minutos (6-50 min) en unilaterales, 27 (14-80 min) en bilaterales. Hubo dos casos de lesión de vasos epigástricos y una recidiva precoz en un neonato, reintervenido satisfactoriamente mediante técnica SuPerLap. En un seguimiento de 1-36 meses no hubo complicaciones tardías. CONCLUSIONES: El uso de ópticas con canal de trabajo según técnica SuPerLap posibilita prescindir de puertos adicionales en el tratamiento de la hernia inguinal. Permite resultados funcionales comparables y cirugía sin cicatrices visibles. Minimiza la manipulación del cordón espermático. La laparoscopia permite el tratamiento concomitante de defectos no diagnosticados previamente.

Relevance of early diagnosis in polycythemia vera and essential thrombocythemia: A single center's experience.

OBJECTIVES: This work aims to describe the proportion of patients with polycythemia vera (PV) or essential thrombocythemia (ET) and thrombosis prior to the diagnosis who had erythrocytosis or thrombocytosis prior to the thrombosis. PATIENTS AND METHODS: This is a retrospective review of 63 patients with PV and 130 with ET. RESULTS: In regard to PV, we found prior erythrocytosis in 7 (11.1%) of the 17 cases (27%) with thrombosis prior to diagnosis. In ET, we found prior thrombocytosis in 10 (7.7%) of the 25 cases (19.2%) with thrombosis prior to diagnosis. The median time between the laboratory finding and thrombosis was 8.2 months and 11.8 months for PV and TE, respectively. In both entities, patients with thrombosis prior to diagnosis had significantly lower survival. CONCLUSION: A significant proportion of patients with thrombosis prior to the diagnosis of PV and ET present with erythrocytosis or thrombocytosis prior to the episode of thrombosis. This could allow for anticipating diagnosis and treatment.

Resultados y complicaciones de la enfermedad del segmento adyacente tratada mediante artrodesis intersomática lateral mínimamente invasiva / Results and complications of adjacent segment disease treated by minimally invasive lateral intersomatic arthrodesis

Resumen: Introducción: Se ha realizado un estudio clínico comparativo sobre los pacientes intervenidos mediante artrodesis intersomática lateral para tratamiento de la enfermedad del segmento adyacente utilizando dispositivos intersomáticos de titanio y de PEEK. Material y métodos: Se han analizado y comparado los resultados clínicos (EVA y oswestry disability index ODI) y radiológicos (alineamiento y fusión), las complicaciones (mayores y menores) y la calidad de vida (EQ5D) de 32 pacientes intervenidos desde Septiembre de 2015 hasta Septiembre de 2018, con un seguimiento medio de 25 meses (46-18). La edad media en la cirugía fue de 66 años (39-89) y 68% de los pacientes fueron mujeres. El segmento intervenido con más frecuencia fue L3-L4 (62%) abordaje retroperitoneal derecho 86%. La EVA lumbar mejoró de 6.2 ± 2.12 a 4.1 ± 1.71 (p = 0.028). La EVA de la pierna descendió de 5.3 ± 2.26 a 1.9 ± 1.58 (p = 0.02). La escala ODI mejoró de 50.2 ± 18.9 a 33.3 ± 10.2 (p = 0.025) y la EQ5D pasó de 0.52 a 0.73 (p = 0.039) sin diferencias estadísticamente significativas entre los grupos (ODI p = 0.18, EQ5D p = 0.293). Radiológicamente aumentó la altura intervertebral, la lordosis lumbar y segmentaria, disminuyó el ángulo de Cobb y la tasa de fusión global fue de 84.3% (88% Ti/82% PEEK), sin diferencias entre los grupos. Conclusiones: La artrodesis intersomática lumbar lateral Lateral Lumbar Interbody Fusion es un método eficaz para el tratamiento de la enfermedad del segmento adyacente con resultados clínicos-radiológicos y complicaciones similares a la literatura. No se han encontrado diferencias entre los implantes de Ti y de PEEK.

Abstract: Introduction: A comparative clinical study has been conducted on patients involved using lateral intersomatic arthrodesis for the treatment of adjacent segment disease using titanium and PEEK intersomatic devices. Material and methods: Clinical (EVA and oswestry disability index ODI) and radiological (alignment and fusion), complications (major and minor) and quality of life (EQ5D) of 32 patients intervened from September 2015 to September 2018 have been analyzed and compared, with an average follow-up of 25 months (46-18). The average age in surgery was 66 years (39-89) and 68% of patients were women. Results: The most common segment involved was L3-L4 (62%) right retroperitoneal approach 86%. Lumbar EVA improved from 6.2 ± 2.12 to 4.1 ± 1.71 (p = 0.028). The LEG EVA descended from 5.3 ± 2.26 to 1.9 ± 1.58 (p = 0.02). The ODI scales improved from 50.2 ± 18.9 to 33.3 ± 10.2 (p = 0.025) and the EQ5D went from 0.52 to 0.73 (p = 0.039) with no statistically significant differences between the groups (ODI p = 0.18, EQ5D p = 0.293). Radiologically increased intervertebral height, lumbar and segmental lordosis, decreased Cobb's angle and the overall melting rate was 84.3% (88% Ti/82% PEEK), with no differences between the groups. Conclusion: Lateral lumbar interbody fusion is an effective method for treating adjacent segment disease with clinical-radiological results and literature-like complications. No differences have been found between Ti and PEEK implants.

[Results and complications of adjacent segment disease treated by minimally invasive lateral intersomatic arthrodesis]. / Resultados y complicaciones de la enfermedad del segmento adyacente tratada mediante artrodesis intersomática lateral mínimamente invasiva.

INTRODUCTION: A comparative clinical study has been conducted on patients involved using lateral intersomatic arthrodesis for the treatment of adjacent segment disease using titanium and PEEK intersomatic devices. MATERIAL AND METHODS: Clinical (EVA and oswestry disability index ODI) and radiological (alignment and fusion), complications (major and minor) and quality of life (EQ5D) of 32 patients intervened from September 2015 to September 2018 have been analyzed and compared, with an average follow-up of 25 months (46-18). The average age in surgery was 66 years (39-89) and 68% of patients were women. RESULTS: The most common segment involved was L3-L4 (62%) right retroperitoneal approach 86%. Lumbar EVA improved from 6.2 ± 2.12 to 4.1 ± 1.71 (p = 0.028). The LEG EVA descended from 5.3 ± 2.26 to 1.9 ± 1.58 (p = 0.02). The ODI scales improved from 50.2 ± 18.9 to 33.3 ± 10.2 (p = 0.025) and the EQ5D went from 0.52 to 0.73 (p = 0.039) with no statistically significant differences between the groups (ODI p = 0.18, EQ5D p = 0.293). Radiologically increased intervertebral height, lumbar and segmental lordosis, decreased Cobb's angle and the overall melting rate was 84.3% (88% Ti/82% PEEK), with no differences between the groups. CONCLUSION: Lateral lumbar interbody fusion is an effective method for treating adjacent segment disease with clinical-radiological results and literature-like complications. No differences have been found between Ti and PEEK implants.

INTRODUCCIÓN: Se ha realizado un estudio clínico comparativo sobre los pacientes intervenidos mediante artrodesis intersomática lateral para tratamiento de la enfermedad del segmento adyacente utilizando dispositivos intersomáticos de titanio y de PEEK. MATERIAL Y MÉTODOS: Se han analizado y comparado los resultados clínicos (EVA y. CONCLUSIONES: oswestry disability index ODI) y radiológicos (alineamiento y fusión), las complicaciones (mayores y menores) y la calidad de vida (EQ5D) de 32 pacientes intervenidos desde Septiembre de 2015 hasta Septiembre de 2018, con un seguimiento medio de 25 meses (46-18). La edad media en la cirugía fue de 66 años (39-89) y 68% de los pacientes fueron mujeres. El segmento intervenido con más frecuencia fue L3-L4 (62%) abordaje retroperitoneal derecho 86%. La EVA lumbar mejoró de 6.2 ± 2.12 a 4.1 ± 1.71 (p = 0.028). La EVA de la pierna descendió de 5.3 ± 2.26 a 1.9 ± 1.58 (p = 0.02). La escala ODI mejoró de 50.2 ± 18.9 a 33.3 ± 10.2 (p = 0.025) y la EQ5D pasó de 0.52 a 0.73 (p = 0.039) sin diferencias estadísticamente significativas entre los grupos (ODI p = 0.18, EQ5D p = 0.293). Radiológicamente aumentó la altura intervertebral, la lordosis lumbar y segmentaria, disminuyó el ángulo de Cobb y la tasa de fusión global fue de 84.3% (88% Ti/82% PEEK), sin diferencias entre los grupos. La artrodesis intersomática lumbar lateral.

Síndrome de Erasmus / Erasmus syndrome

La neumoconiosis constituye un grupo de enfermedades asociadas con la exposición e inhalación de polvo mineral, de partículas inorgánicas, sílice, berilio, carbón, cobalto, talco, etc. La exposición al polvo de sílice se asocia no sólo con silicosis, sino también con enfermedad pulmonar obstructiva crónica, cáncer de pulmón, insuficiencia renal y riesgo aumentado de tuberculosis pulmonar y enfermedades autoinmunes. Está bien establecida la asociación entre el contacto con el sílice por vía inhalatoria y enfermedades autoinmunes, particularmente en el contexto de una exposición intensa. La exposición al sílice se ha vinculado con un incremento de la síntesis de anticuerpos y complejos inmunes, aún sin la presencia de características clínicas de enfermedad autoinmune. El riesgo de desarrollar esclerosis sistémica, artritis reumatoidea, lupus eritematoso sistémico, dermatomiositis / polimiositis y anticuerpos anticitoplasmáticos del neutrófilo (ANCA) positivos (vasculitis) esta descripto en varios estudios. En paciente que trabajan en canteras con escasas medidas de prevención el desarrollo de silicosis ha llegado ser tan severo que ha requerido trasplante pulmonar; sobre esta base se recomienda seguirlos con un perfil inmunológico como control o estar atentos a otras manifestaciones de autoinmunidad. La esclerosis sistémica es una enfermedad autoinmune definida como un desorden generalizado de la microvasculatura y del tejido conectivo, con engrosamiento y obliteración de los vasos arteriales de piel, pulmón, tracto gastrointestinal, corazón y riñones. Su etiología es desconocida pero probablemente concurren factores endógenos y exógenos. Entre los factores exógenos, la exposición ocupacional juega un rol importante como causa potencial, incluyendo el polvo de sílice, cloruro de vinilo, resina epoxi, bleomicina, hidrocarburos aromáticos, aceites. Excepto el s-lice todos los otros agentes producen cambios reversibles una vez suspendido el contacto con el agente. El polvo de sílice y su inhalación es un factor de riesgo bien reconocido de esclerosis sistémica. Las partículas de cristal de sílice (cuarzo) que miden menos de un micrometro son las más patogénicas ya que al ser inertes pueden permanecer por tiempo indeterminado en el tejido. El antecedente de exposición al polvo de sílice y esclerosis sistémica se conoce como Síndrome de Erasmus.

Immune modulation by the hepatitis C virus core protein.

Hepatitis C virus (HCV) infection is currently the most important cause of chronic viral hepatitis in the world and one of the most frequent indications for liver transplantation. HCV uses different strategies to evade the innate and adaptive immune response, and this evasion plays a key role in determining viral persistence. Several HCV viral proteins have been described as immune modulators. In this review, we will focus on the effect of HCV nucleocapsid core protein in the function of immune cells and its correlation with the findings observed in HCV chronically infected patients. Effects on immune cell function related to both extracellular and intracellular HCV core localization will be considered. This review provides an updated perspective on the mechanisms involved in HCV evasion related to one single HCV protein, which could become a key tool in the development of new antiviral strategies able to control and/or eradicate HCV infection.

Clinical outcomes of melanoma brain metastases treated with stereotactic radiosurgery and anti-PD-1 therapy, anti-CTLA-4 therapy, BRAF/MEK inhibitors, BRAF inhibitor, or conventional chemotherapy.

BACKGROUND: The effect of immunologic and targeted agents on intracranial response rates in patients with melanoma brain metastases (MBMs) is not yet clearly understood. This report analyzes outcomes of intact MBMs treated with single-session stereotactic radiosurgery (SRS) and anti-PD-1 therapy, anti-CTLA-4 therapy, BRAF/MEK inhibitors(i), BRAFi, or conventional chemotherapy. PATIENTS AND METHODS: Patients were included if MBMs were treated with single-session SRS within 3 months of receiving systemic therapy. The primary end point of this study was distant MBM control. Secondary end points were local MBM control defined as a >20% volume increase on follow-up MRI, systemic progression-free survival, overall survival (OS) from both SRS and cranial metastases diagnosis, and neurotoxicity. Images were reviewed alongside two neuro-radiologists at our institution. RESULTS: Ninety-six patients were treated to 314 MBMs over 119 SRS treatment sessions between January 2007 and August 2015. No significant differences were noted in age (P = 0.27), gender (P = 0.85), treated gross tumor volume (P = 0.26), or the diagnosis-specific graded prognostic assessment (P = 0.51) between the treatment cohorts. Twelve-month Kaplan-Meier (KM) distant MBM control rates were 38%, 21%, 20%, 8%, and 5% (P = 0.008) for SRS with anti-PD-1 therapies, anti-CTLA-4 therapy, BRAF/MEKi, BRAFi, and conventional chemotherapy, respectively. No significant differences were noted in the KM local MBM control rates among treatment groups (P = 0.25). Treatment with anti-PD-1 therapy, anti-CTLA-4 therapy, or BRAF/MEKi significantly improved OS on both univariate and multivariate analyses when compared with conventional chemotherapy. CONCLUSION: In our institutional analysis of patients treated with SRS and various systemic immunologic and targeted melanoma agents, significant differences in distant MBM control and OS are noted. Prospective evaluation of the potential synergistic effect between these agents and SRS is warranted.

[Health-care workload and instructional capacity of Spanish hospitals accredited to train residents in anesthesiology]. / Actividad asistencial y capacidad docente de los hospitales españoles acreditados para la formación de residentes de anestesiología.

OBJECTIVES: To describe the health-care workload and instructional capacity of Spanish hospitals accredited to train anesthesiology residents. METHODS: Survey of supervisors of anesthesiology residents in 2008 to determine caseloads in surgery and obstetrics as well as in pain clinics and critical care units. The results are presented for different Spanish autonomous communities. The maximum theoretical capacity for instruction in accordance with European guidelines is calculated. RESULTS: The 100 hospitals surveyed train 325 residents per year and could theoretically increase the training opportunities they offer, within certain limits. Given optimal distribution of resources, the system could train 397 residents per year in pediatric surgery in 3-month rotations, 442 residents in neurosurgery in 2-month rotations, and 479 residents in thoracic surgery in 1-month rotations. Some Spanish communities presently have problems giving training in the settings of pediatric, thoracic, and major outpatient surgery. Furthermore, even though anesthesiologists are presently responsible for 41.6% of available critical care beds, 46 hospitals do not have a sufficient number of beds to give training in this setting. This shortage may have negative repercussions on the accreditation of training programs. CONCLUSIONS: Although certain limitations were found, the survey showed that the training capacity of the system is greater than accreditation suggests. It would therefore be possible to increase the number of residents.

[In-hospital mortality in surgical patients. Predictive factors]. / Mortalidad intrahospitalaria en cirugía con ingreso. Análisis de factores predictores.

OBJECTIVE: To analyze the value of patient and surgical variables as predictors of the survival until discharge of hospitalized surgical patients in a tertiary care hospital over the course of 1 year. MATERIAL AND METHODS: The hospital records for patients admitted for surgery between January 1 and December 31, 2007, were consulted to extract age, sex, ASA physical status classification of the patient, type of admission and surgery (scheduled or emergency), surgical department assigned, and date of discharge or exitus. The data were subjected to multivariate survival analysis using the Cox regression model. RESULTS: A total of 4184 patients underwent surgery in 2007; the median (25th-75th percentile) patient age was 56 (39-71) years. In 77.5% of the cases (3244 patients) surgery was scheduled; 23.1% of those patients had been admitted by the emergency department. The ASA classification was 1 for 21.8%, 2 for 44.2%, 3 for 28%, and 4 for 6%. Of patients classified as ASA 1-3, a total of 33.2% were aged 65 years or older; in contrast, 78.7% of ASA 4 patients were in that age bracket. Eighty-nine (2.1%) surgical patients died. Cox regression survival analysis showed that variables related to a lower likelihood of survival to discharge were a physical status classification of ASA 4, age 65 years or older, and emergency surgery (P < .0005 for all comparisons). CONCLUSIONS: Patients over the age of 65 years, in an ASA 4 anesthetic risk category, admitted on an emergency basis for emergency surgery were at higher risk of death. Greater vigilance in the perioperative care of patients with these risk factors is advisable in the interest of reducing mortality.

Aportes de la terapia ocupacional al contexto educacional inclusivo: interrelación entre el enfoque psicosocial, la teoría de integración sensorial y acciones de atención temprana / Contributions of the occupational therapy to the inclusive educational context: interrelation of the psychosocial approaches, the theory of sensory integration and early attention actions

En contextos sociales vulnerados se observan condiciones que interfieren el desarrollo de habilidades y destrezas académicas, relacionales y emocionales. Esto, ligado a una respuesta inadecuada a los estímulos ambientales o necesidades individuales, puede convertir el proceso de adaptación del niño al contexto escolar en una tarea que requiere coordinación y gestión en red. Esta sistematización tiene como objetivo presentar un tipo de intervención que facilita los procesos de autonomía de niños en situación de vulnerabilidad escolar en escuelas municipales de la comuna de Huechuraba, entre los años 2006 y 2009. La estrategia central consiste en fomentar las interacciones de todos los sistemas a través de intervenciones ya sea individuales y/o grupales a niños, familiares, profesores, comunidad educativa, centros de salud y especialistas de salud y educación. Con ello se promueve el respeto por los derechos del niño y por las particularidades individuales del desarrollo, incorporando acciones relevantes en la convivencia diaria. Esto permite reconstruir y resignificar relaciones y símbolos vinculares desde la cotidianeidad, abarcando los contextos ocupacionales y el campo relacional del niño, permitiendo así el surgimiento de la autonomía del niño.

In social harmed contexts, it’s common to observe conditions that interfere with the development of social, emotional and academic skills. This, bound to an inadequate answer to the environmental stimuli and individual necessities, can turn the process of adaptation to the school context a complex task, that requires preventive actions, coordination and management in network. The present document has as objective to present a type of intervention that facilitates the processes of autonomy and participation of children in situation of vulnerability in municipal schools of district Huechuraba, between years 2006 and 2009. The central strategy is to foment the interactions of all the systems, it is used individual and group interventions to children, relatives, professors and educative community, specialists of education and health. With it, the respect for the child’s rights as well as the individual particularitities of development are promoted, incorporating complementary methodologies and educative practices in the daily coexistence. This makes it possible to reconstruct and to resignificate relations and symbols from the daily activities, promoting with it the upcoming of child`s autonomy.

[Dermoscopic features of eccrine poroma]. / Características dermatoscópicas del poroma ecrino.

Eccrine poroma is a benign adnexal neoplasm that clinically may mimic malignant skin tumors such as squamous cell carcinoma and amelanotic melanoma. The dermoscopic features of pigmented and nonpigmented eccrine poroma have recently been described. We present 2 cases of eccrine poroma, with their dermoscopic features. The lesions were characterized by multiple red lacunes and a polymorphous vascular pattern in both cases. Dermoscopy can improve the clinical diagnosis of this benign adnexal skin tumor.

[Retrospective analysis of 6 cases of elastofibroma dorsi]. / Elastofibroma dorsi: estudio retrospectivo de seis casos.

Elastofibroma dorsi is a benign lesion of fibroelastic tissue. It often presents bilaterally, is frequently localized to the subscapular region, and is more common in middle-aged and elderly women. The pathogenesis is still unclear but it has been suggested to involve reactive, degenerative, or neoplastic processes. We present a retrospective study of the findings from 6 patients with elastofibroma dorsi. Elastofibroma should be included in the differential diagnosis of subcutaneous scapular tumors, as it is a benign lesion that only requires surgery when associated with symptoms or the lesion is extensive. Noninvasive techniques such as ultrasonography, computed tomography, and, above all, magnetic resonance imaging, may be sufficient to guide diagnosis. The results of histology and imaging are closely correlated, so the need for unnecessary biopsy and surgery may be avoided.

Rosácea ocular: un diagnóstico a menudo no considerado en rosácea / Ocular rosacea: a diagnostic frequently non-considered in rosacea

La rosácea es una enfermedad crónica que puede asociarse e incluso debutar con un compromiso ocular (rosácea ocular), siendo ésta principalmente de predominio palpebral (blefaritis), conjuntiva y/o corneal, es decir, fundamentalmente del polo anterior del ojo. Se presume multifactorial, siendo la alteración de la composición del componente lipídico de la lágrima, motivada por lipasas estafilocócicas aumentadas y meibomitis, los eventos precursores más ampliamente aceptados. Actualmente el tratamiento se basa en fotoprotección ocular, uso de lágrimas artificiales y antibioticoterapia oral y tópica. Otras alternativas de segunda línea son el metronidazol, isotretinoína tópica y sistémica, cirugía y oclusión del punto lacrimal.

Successful treatment of disseminated Aspergillosis in a leukemic child

The incidence of severe fungal infections in the immunocompromised patient with malignancies has increased in recent years. This appears to be associated to the profound periods of immunosuppression and the extended use of broad spectrum antibiotics. Aspergillosis is the second most common fungal infection reported in the immunocompromised cancer patients. In patients with advanced immunosupression, the mortality due to invasive aspergillosis approaches 100despite treatment with antifungal agents. Reports of complete or partial response to echinocandins are well demonstrated in adults, but very limited in the pediatric population. This report describes the case of a child with relapsed acute lymphoblastic leukemia (ALL) who developed cutaneous aspergillosis and subsequent multiorgan dissemination during therapeutic induction and was treated successfuly with caspofungin acetate.

Consenso argentino de ventilación no invasiva / Argentine consensus of non-invasive ventilation

Non-invasive ventilation (NIV) is nowadays increasingly used. The significant decrease in tracheal intubation related complications makes it particularly attractive in patients with moderately acute respiratory failure (ARF) who still have some degree of respiratory autonomy. It has also been used to support patients with chronic respiratory failure. However, final outcomes are variable according to the conditions which determined its application. This Consensus was performed in order to review the evidence supporting the use of positive pressure NIV. The patho-physiological background of NIV and the equipment required technology are described. Available evidence clearly suggests benefits of NIV in acute exacerbation of chronic obstructive pulmonary disease (COPD) and in cardiogenic pulmonary edema (Recommendation A). When considering ARF in the setting of acute respiratory distress syndrome results are uncertain, unless dealing with immunosupressed patients (Recommendation B). Positive results are also shown in weaning of mechanical ventilation (MV), particularly regarding acute exacerbation of COPD patients (Recommendation A). An improved quality of life in chronic respiratory failure and a longer survival in restrictive disorders has also been shown (Recommendation B) while its benefit in stable COPD patients is still controversial (Recommendation C). NIV should be performed according to pre-established standards. A revision of NIV related complications is performed and the cost-benefit comparison with invasive MV is also considered.

La ventilación no invasiva (VNI) ha alcanzado notable difusión en los últimos años. El ahorro delas complicaciones causadas por la intubación traqueal la hace especialmente atractiva en pacientesque presentan insuficiencia respiratoria aguda (IRA) no muy grave y que conservan cierta autonomía respiratoria.También se han descripto efectos terapéuticos en pacientes con insuficiencia respiratoria crónica de etiologías diversas. No obstante, los resultados obtenidos son variables según las circunstancias que motivan su aplicación. A fin de revisar la evidencia a favor de su uso se elaboró este Consenso referido particularmente a la VNI a presión positiva. Se describen su fundamento fisiopatológico, esencial para su correcta aplicación, y elequipamiento necesario para implementarla. La evidencia existente en la literatura establece definida utilidad de la VNI en la exacerbación de la EPOC y en el edema agudo de pulmón cardiogénico (Recomendación A).Su beneficio es aún incierto en pacientes con IRA secundaria a síndrome de dificultad respiratoria aguda, salvoen el subgrupo de pacientes inmunosuprimidos (Recomendación B). Los resultados son también favorablesen la desvinculación de la asistencia respiratoria mecánica (ARM), especialmente en pacientes ventilados por exacerbación de EPOC (Recomendación A). En la insuficiencia respiratoria crónica se ha hallado mejoría en la calidad de vida y mayor sobrevida en pacientes con enfermedades restrictivas (Recomendación B), mientrasque existe aún controversia sobre su utilidad en pacientes con EPOC estable (Recomendación C). La VNI debeser aplicada con estándares de cuidados que son establecidos. Se revisan las eventuales complicaciones derivadasde su uso y el beneficio costo-efectividad ahorrando recursos de mayor complejidad y disminuyendolos riesgos que implica la ARM invasiva.

[Subcutaneous panniculitis at a third level hospital retrospective study of 113 cases]. / Paniculitis subcutáneas en un hospital de tercer nivel: estudio retrospectivo de 113 casos.

INTRODUCTION: The panniculitides or hypodermitis are a wide and heterogeneous group of diseases characterized by the presence of subcutaneous inflammatory nodules located generally in low limbs. OBJECTIVES: Show the clinicopathologic characteristics of the cases diagnosed as panniculitis for a 5 years period; their epidemiology, etiopathogenic factors, evolution and treatment. MATERIAL AND METHODS: A retrospective study of 113 patients diagnosed as panniculitis by histopathologic report of cutaneous biopsy since 1997 to 2001 were performed. RESULTS: The sex proportion was of 4.65 women to every man. The mean age of these patients was 49 +/- 20 years old. 100% had legs affectation, 7.1% in arms, 5.9% in trunk and 0.9% in face. 9.7% presented fever and arthromyialgias, especially in young people (p < 0.05). The etiopathogenic factors implied were tuberculosis, streptococcic pharyngoamygdalitis, sarcoidosis and different drugs. The most frequent histological pattern was septal panniculitis without vasculitis. 24.8% did not realize any treatment; 32.5% took nonsteroideal anti-inflammatory drugs; 31.6% potassium iodide; 16% systemic corticosteroids and 7.1% tuberculostatic drugs. Evolution of the patients was good and independently from the treatment performed. CONCLUSIONS: Panniculitides are a group of diseases with similar clinic, but very heterogeneous in their etiology and histopathologic findings. They are more frequent in women and with more expressive clinic in young people. Up to in the 59.3% of the studied cases a causal etiologic agent was identified. These factors are compatible with the published ones in other previous panniculitis series. When a paniculitis is suspected, the most efficient tool is the clinical diagnosis. Histological confirmation by cutaneous biopsy it must be done when it is possible.

Gingivostomatitis after eating fish parasitized by Anisakis simplex: a case report.

Anisakis simplex (AS) is a nematode that may be encountered as a parasite in various kinds of seafood. Human beings may accidentally acquire AS larvae by eating raw or undercooked seafood. In addition to human parasitization (anisakiasis), this nematode can induce allergic reactions. AS-related diseases are frequent, especially in those countries with a high level of fish consumption and with traditions of eating raw or undercooked seafood. To our knowledge, this is the first report of gingivostomatitis secondary to the ingestion of fish with AS parasites.

Functional outcome and subset identification in RA patients from meridional Europe: analysis of a Spanish cohort.

The aim of this study was to study the short-term functional and anatomical prognosis of rheumatoid arthritis (RA) in a series of Spanish patients and to identify different subsets of patients as well as possible baseline factors associated with specific outcomes. All patients seen in our division who met the ACR criteria for RA and with disease duration between 2 and 7 years were eligible for the study. Available patients were further evaluated at the clinic for disease activity using biological tests and joint indices as joint counts and Thompson's index, functional capacity using the ACR functional classification (ACR-FC) and the modified Health Assessment Questionnaire (M-HAQ) and radiologic damage by the Sharp's radiologic scoring method. Cluster analysis was used to identify different clinical subsets of patients. One hundred and sixty-three patients were eligible for the study, 13 could not be located or refused to participate and 12 had died. Mean (+/-SD) age at disease onset and mean disease duration were, respectively, 56(+/-14) years and (55+/-20) months. Median (interquartile range) of M-HAQ was 0.4 (0.1-1.1) and 41% of patients were in III or IV ACR-FC. The majority of patients (93%) showed radiologic lesions and 65% had erosions. Cluster analysis identified three subsets: cluster I (70% of patients) was characterised by a good prognosis, cluster II (13%) by a high level of disease activity, and cluster III (17%) by a greater anatomic damage and longer disease duration. No baseline predictive markers were found for these different outcomes. We concluded that RA portends an overall poor short-term prognosis in a relative large percentage of our patients with significant anatomic and functional sequelae. Aggressive management is specially indicated in this subgroup of patients, although definitive prognostic markers for its early identification are still lacking.