Perfusión aislada de extremidad inferior con fuga de quimioterapéutico / Isolated limb perfusion with cytostatic drug leakage

La perfusión aislada de la extremidad es el tratamiento del melanoma en estadio iii, con metástasis en tránsito. Esta técnica permite la administración de citostáticos a concentración y temperatura eficaces, que no podrían ser administrados de manera sistémica debido a su toxicidad. La toxicidad debido al paso a la circulación sistémica de quimioterápico procedente de la extremidad es la complicación más grave a corto plazo, y se manifiesta mediante el síndrome de respuesta inflamatoria sistémica en el postoperatorio inmediato. La detección precoz de esta complicación y su manejo perioperatorio requiere un abordaje multidiscilplicar, en el que el anestesiólogo tiene un papel clave. Presentamos un caso de perfusión aislada de la extremidad inferior en el que el procedimiento tuvo que ser interrumpido por paso de factor de necrosis tumoral a la circulación sistémica, con grave repercusión hemodinámica intraoperatoria (AU)

Isolated limb perfusion is the treatment of stage III melanoma with in-transit metastasis. This technique allows the administration of cytostatics at an effective concentration and temperature, which could not be administered systemically because of their toxicity. The toxicity due to leakage of the chemotherapy agent from the limb into the systemic circulation is the most serious short-term complication, and is manifested by a systemic inflammatory response syndrome in the immediate post-intervention period. Early detection of this complication and its peri-operative management requires a multidisciplinary approach, in which the anaesthesiologist plays a key role. A case of isolated lower limb perfusion is reported in which the procedure had to be interrupted due to the passage of tumour necrosis factor into the systemic circulation, with severe intra-operative haemodynamic repercussions (AU)

Isolated limb perfusion with cytostatic drug leakage. / Perfusión aislada de extremidad inferior con fuga de quimioterapéutico.

Isolated limb perfusion is the treatment of stage III melanoma with in-transit metastasis. This technique allows the administration of cytostatics at an effective concentration and temperature, which could not be administered systemically because of their toxicity. The toxicity due to leakage of the chemotherapy agent from the limb into the systemic circulation is the most serious short-term complication, and is manifested by a systemic inflammatory response syndrome in the immediate post-intervention period. Early detection of this complication and its peri-operative management requires a multidisciplinary approach, in which the anaesthesiologist plays a key role. A case of isolated lower limb perfusion is reported in which the procedure had to be interrupted due to the passage of tumour necrosis factor into the systemic circulation, with severe intra-operative haemodynamic repercussions.

Evaluation of the toxicity and hypoglycemic effect of the aqueous extracts of Cnidoscolus quercifolius Pohl.

Diabetes mellitus is one of the most common chronic degenerative diseases, and it is estimated to increase worldwide to around 415 million and to impact 642 million in 2040. Research shows that some plants are sources of bioactive compounds against diabetes. Thus, the objective of this work was to evaluate the oral toxicity and the hypoglycemic effect of the aqueous extract of the leaves of Cnidoscolus quercifolius Pohl. Diabetes was induced in Swiss mice with streptozotocin and the mice were treated with an aqueous extract of C. quercifolius leaves for a period of 30 days. Phytochemical analysis showed that the extract was rich in flavonoids, catechins and triterpenoid, which did not show any mortality and behavioral alterations in mice treated with 200, 1000, and 2000 mg/kg body weight of the extract for 14 days. Histopathological analysis of organs (kidney, pancreas, liver) from mice treated with the 2000 mg/kg extract revealed no architectural change. In the present study, we found a 29% reduction in glucose levels in animals receiving 200 mg/kg body weight. These results are very promising because they showed that C. quercifolius had a hypoglycemic effect and did not present oral toxicity, thus being a new source of compounds for the control of diabetes.

Recomendaciones GEIPC-SEIMC y GTEI-SEMICYUC para el tratamiento antibiótico de infecciones por cocos grampositivos en el paciente crítico / GEIPC-SEIMC and GTEI-SEMICYUC recommendations for antibiotic treatment of gram positive coccal infections in the critical patient

En los últimos años se ha constatado un incremento en las infecciones causadas por cocos grampositivos tanto en infecciones comunitarias como nosocomiales. En algunos países, se ha observado un rápido desarrollo de resistencias a los antibióticos habitualmente empleados para su tratamiento, y se supone que esa situación puede llegar en el futuro a nuestro país. Se están desarrollando nuevos antimicrobianos específicamente dirigidos para el tratamiento de estas infecciones, pero es necesario profundizar en el conocimiento de las propiedades farmacocinéticas de los antibióticos tanto antiguos como nuevos, para aprovechar al máximo sus cualidades frente a estos patógenos y evitar en lo posible su toxicidad. En el paciente crítico estos problemas son más acuciantes, ya que la inadecuación del tratamiento, tanto en la elección del antibiótico como en la dosis y en la administración, se acompañan frecuentemente de fracasos terapéuticos y por tanto de mal pronóstico. Expertos de dos grupos de trabajo de dos Sociedades científicas, pertenecientes al Grupo de estudio de Infecciones en el Paciente Crítico de la SEIMC (GEIPC-SEIMC) y al Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC (GTEI-SEMICYUC) se han reunido con el objetivo de elaborar un documento de consenso, basado en la evidencia científica, que recoge las recomendaciones para el tratamiento antibiótico de las infecciones graves causadas por cocos grampositivos en el paciente crítico y que ayude en la toma de decisiones asistenciales (AU)

In recent years, an increment of infections caused by gram-positive cocci has been documented in nosocomial and hospital-acquired-infections. In diverse countries, a rapid development of resistance to common antibiotics against gram-positive cocci has been observed. This situation is exceptional in Spain but our country might be affected in the near future. New antimicrobials active against these multi-drug resistant pathogens are nowadays available. It is essential to improve our current knowledge about pharmacokinetic properties of traditional and new antimicrobials to maximize its effectiveness and to minimize toxicity. These issues are even more important in critically ill patients because inadequate empirical therapy is associated with therapeutic failure and a poor outcome. Experts representing two scientific societies (Grupo de estudio de Infecciones en el Paciente Crítico de la SEIMC and Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC) have elaborated a consensus document based on the current scientific evidence to summarize recommendations for the treatment of serious infections caused by gram-positive cocci in critically ill patients (AU)