Clinical characterization of patients with anal fistula during follow-up of anorectal abscess: a large population-based study.

PURPOSE: Approximately 15-50% of patients with an anorectal abscess will develop an anal fistula, but the true incidence of this entity is currently unknown. The aim of the study was to determine the incidence of anorectal abscess and development of a fistula in a specific population area and to identify potential risk factors associated with demographic, socioeconomic and pre-existing disease (e.g. diabetes and inflammatory bowel disease). METHODS: A longitudinal observational study was designed including a large cohort study in an area with 7,553,650 inhabitants in Spain 1st january 2014 to 31st december 2019. Adults who attended for the first time with an anorectal abscess and had a minimum of 1-year follow-up were included. The diagnosis was made using ICD-10 codes for anorectal abscess and anal fistula. RESULTS: During the study period, we included 27,821 patients with anorectal abscess. There was a predominance of men (70%) and an overall incidence of 596 per million population. The overall incidence of anal fistula developing from abscesses was 20%, with predominance in men, and a lower incidence in the lowest income level. The cumulative incidence of fistula was higher in men and in younger patients (p < 0.0001). On multivariate analysis, patients aged 60-69 years (hazard ratio 2.0) and those with inflammatory bowel disease (hazard ratio 1.8-2.0) had a strong association with fistula development (hazard ratio 2.0). CONCLUSIONS: One in five patients with an anorectal abscess will develop a fistula, with a higher likelihood in men. Fistula formation was strongly associated with inflammatory bowel disease.

Opioid-free anesthesia for open radical cystectomy in morbid obesity.

Opioid-free anaesthesia shows evidence about its efectivity and security, even though its risks and benefits are not well defined. Neither are the patient profile or sort of surgery where it could be superior to the conventional opioid-based anaesthetic technique. Aggressive and/or long-lasting surgeries set out several queries on this technique regarding sudden hemodynamic changes, as it does not produce sympatholysis through µ receptor and there is modest experience in this technique. A morbidly obese patient received open radical cystectomy with Bricker-type urinary diversion using infraumbilical incision under OFA protocol, maintaining an adequate hemodynamic stability and excellent analgesia in postoperatory care without using any intraoperative opioids. Opioid-free anaesthesia technique is developing its evidence. However, it is necessary to keep on researching its clinical applications, different drug combinations and solutions to its expected complications.

Membrane-bound CD40 ligand on T cells from mice injected with lipopolysaccharide accelerates lipopolysaccharide-induced osteoclastogenesis.

BACKGROUND AND OBJECTIVE: T cells infiltrate the inflammatory site of periodontitis and consequently stimulate the loss of periodontal bone. We previously reported that T cells from lipopolysaccharide (LPS)-injected mice (LPS-T cells) accelerated osteoclastogenesis in the presence of LPS. Ηowever, the detailed mechanism of this acceleration is still unclear. In this study, we analyzed the mechanism of osteoclastogenesis accelerated by LPS-T cells. MATERIAL AND METHODS: We examined the mechanism of osteoclastogenesis acceleration. First, to determine the effect of cell-to-cell contact, we co-cultured T cells and bone marrow macrophages, prestimulated with RANKL for 48 h (R-BMMs), in the presence of LPS for 24 h, in a Transwell. Second, to determine the effect of CD40 ligand (CD40L), we co-cultured T cells and R-BMMs in the presence of LPS and anti-CD40L immunoglobulin. Third, we examined the effect of recombinant mouse CD40L (rCD40L) in the presence of LPS in vitro and in vivo. Lastly, we examined the expression of membrane-bound CD40L (mCD40L) by fluorescence-activated cell sorting (FACS). RESULTS: Blocking cell-to-cell contact between LPS-T cells and R-BMMs completely inhibited the acceleration of osteoclastogenesis. Anti-CD40L immunoglobulin also completely inhibited the acceleration of osteoclastogenesis. Moreover, rCD40L accelerated osteoclastogenesis in the presence of LPS in vitro and in vivo. Finally, the expression of mCD40L on LPS-T cells was higher than that on T cells isolated from mice not injected with LPS. CONCLUSION: The results demonstrate that CD40L accelerates osteoclastogenesis in the presence of RANKL and LPS. The results also suggest that mCD40L on LPS-T cells accelerates osteoclastogenesis.

Locally administered interferon-γ accelerates lipopolysaccharide-induced osteoclastogenesis independent of immunohistological RANKL upregulation.

BACKGROUND AND OBJECTIVE: Interferon-γ (IFN-γ) potently inhibits RANKL-induced osteoclastogenesis in vitro. In contrast, previous studies have shown that an increase in IFN-γ expression is correlated with an increase in lipopolysaccharide (LPS)-induced bone loss in vivo. However, it is not clear whether local IFN-γ accelerates osteoclastogenesis or not in vivo. Therefore, the aim of this study was to clarify the role of local IFN-γ in LPS-induced osteoclastogenesis. MATERIALS AND METHODS: We induced bone loss in calvaria by injecting LPS. One group of mice received an IFN-γ injection together with LPS injection, while another group received IFN-γ 2 d after LPS injection. Bone resorption was observed histologically. Next, we stimulated murine bone marrow macrophages with macrophage-colony stimulating factor and RANKL in vitro. We added different doses of IFN-γ and/or LPS at 0 or 48 h time points. Cells were stained with tartrate-resistant acid phosphatase at 72 h. RESULTS: Local administration of IFN-γ together with LPS injection did not affect osteoclast formation. However, IFN-γ injected after LPS injection accelerated osteoclast formation. Also, we confirmed that IFN-γ added at 0 h inhibited RANKL-induced osteoclastogenesis in vitro. However, inhibition by IFN-γ added at 48 h was reduced compared with that by IFN-γ added at 0 h. Interestingly, IFN-γ together with a low concentration of LPS accelerated osteoclast formation when both were added at 48 h compared with no addition of IFN-γ. CONCLUSION: The results suggest that local IFN-γ accelerates osteoclastogenesis in certain conditions of LPS-induced inflammatory bone loss.

[Perioperative management of the patient with chronic spinal cord injury using bilateral diaphragmatic pacemaker. Clinical case].

Patients with chronic spinal cord injury suffer from a number of pathophysiological alterations that can lead to important morbidity and mortality in the perioperative period. The diaphragmatic pacemaker is a device that enables pulmonary ventilation in patients with high cervical cord injuries and provides them with a better quality of life when compared to mechanical ventilation. We present here the clinical case of a patient with chronic spinal cord injury who used a diaphragmatic pacemaker, and who was scheduled for percutaneous nephrolithotomy and double-J stent implantation. The anesthesiologist should know the pathophysiological situation of these patients in order to provide a safe perioperatory care.

Narcolepsy and opioid-free anesthesia: a review and case report. / Narcolepsia y anestesia libre de opioides: revisión y caso clínico.

INTRODUCTION: Narcolepsy is the second most common sleep disorder. It is characterised by excessive daytime sleepiness together with other symptoms such as cataplexy, sleep paralysis, and hallucinations. The pathophysiology and treatment of this disease, together with its associated syndromes, can severely interfere with anaesthesia. METHODOLOGY: Due to the lack of quality evidence on which to base a high grade of recommendation for anaesthesia in these patients, we performed a non-systematic, narrative review of the literature in Pubmed. We used the descriptors narcolepsy, anesthesia, surgery, perioperative, opioid, obstructive, apnea and sleep both individually and with AND and OR connectors. CONCLUSION: The recommendation to avoid opioids and the stability of opioid-free anaesthesia (OFA) make this approach an option to consider in these patients. We describe a case in which it was used safely.

Opioid-free anesthesia for open radical cystectomy in morbid obesity. / Anestesia libre de opioides para cistectomía radical laparotómica en obesidad mórbida.

Opioid-free anaesthesia shows evidence about its efectivity and security, even though its risks and benefits are not well defined. Neither are the patient profile or sort of surgery where it could be superior to the conventional opioid-based anaesthetic technique. Aggressive and/or long-lasting surgeries set out several queries on this technique regarding sudden hemodynamic changes, as it does not produce sympatholysis through µ receptor and there is modest experience in this technique. A morbidly obese patient received open radical cystectomy with Bricker-type urinary diversion using infraumbilical incision under OFA protocol, maintaining an adequate hemodynamic stability and excellent analgesia in postoperatory care without using any intraoperative opioids. Opioid-free anaesthesia technique is developing its evidence. However, it is necessary to keep on researching its clinical applications, different drug combinations and solutions to its expected complications.

[Cardiac perforation as a late complication in a man with an implantable cardioverter-defibrillator]. / Perforación cardiaca como complicación tardía en paciente portador de un Desfibrilador Automático Implantable.

A 55-year-old man with an implantable cardioverter-defibrillator (ICD) placed after diagnosis of Brugada syndrome 4 years earlier was admitted to hospital with dyspnea and a large left pleural effusion. After several episodes of cardiorespiratory arrest and application of advanced cardiac life support measures, an emergency sternotomy was performed. Cardiac and pleural perforation by the ICD lead was observed and the device was removed. Since the ICD was introduced in 1980, it has been effective in the treatment of malignant ventricular arrhythmias and in reducing the incidence of sudden death. Increased use, however, has meant a rise in the number of complications, some of which are potentially fatal. The rare complication we describe should therefore be considered whenever a patient with an ICD develops sudden respiratory failure or massive hemoptysis that cannot be explained by other causes.

In vitro study of the stress response of human skin cells to GSM-1800 mobile phone signals compared to UVB radiation and heat shock.

The evolution of mobile phone technology is toward an increase of the carrier frequency up to 2.45 GHz. Absorption of radiofrequency (RF) radiation becomes more superficial as the frequency increases. This increasingly superficial absorption of RF radiation by the skin, which is the first organ exposed to RF radiation, may lead to stress responses in skin cells. We thus investigated the expression of three heat-shock proteins (HSP70, HSC70, HSP27) using immunohistochemistry and induction of apoptosis by flow cytometry on human primary keratinocytes and fibroblasts. A well-characterized exposure system, SXC 1800, built by the IT'IS foundation was used at 1800 MHz, with a 217 Hz modulation. We tested a 48-h exposure at an SAR of 2 W/kg (ICNIRP local exposure limit). Skin cells were also irradiated with a 600 mJ/cm2 single dose of UVB radiation and subjected to heat shock (45 degrees C, 20 min) as positive controls for apoptosis and HSP expression, respectively. The results showed no effect of a 48-h GSM-1800 exposure at 2 W/kg on either keratinocytes or fibroblasts, in contrast to UVB-radiation or heat-shock treatments, which injured cells. We thus conclude that the GSM-1800 signal does not act as a stress factor on human primary skin cells in vitro.

Cáncer de mama en pacientes octogenarias / Breast cancer treatment in octogenarian patients

IntroducciónEl objetivo del estudio fue analizar el tratamiento quirúrgico recibido en pacientes octogenarias con cáncer de mama en un centro hospitalario de tercer nivel, analizar la calidad de vida de estas pacientes, así como la influencia del tratamiento en la supervivencia global.Material y métodosSe ha diseñado un estudio de cohorte retrospectivo. Se han analizado los resultados del tratamiento recibido, calidad de vida y supervivencia desde 2011 hasta 2015, con seguimiento prospectivo.ResultadosLa primera opción de tratamiento fue la cirugía en el 97% de los casos, a pesar de presentar elevadas comorbilidades según el índice de Charlson ajustado por edad. Más de la mitad de las pacientes respondieron a la pregunta sobre autopercepción de su salud como excelente, muy buena o buena (53%), observándose una tendencia a mayor supervivencia en estas pacientes. La mortalidad a los siete años fue del 46%. Sin embargo, la causa de la muerte estaba relacionada con el cáncer de mama solo en el 31% de los casos.ConclusionesLa mayoría de las pacientes octogenarias de nuestra cohorte se sometieron a cirugía como tratamiento de primera línea y se mostraron satisfechas con los resultados. La calidad de vida y la buena autopercepción del envejecimiento son un objetivo clave en las pacientes de edad avanzada y deben tenerse en cuenta.Es preciso realizar estudios analizando los resultados de la cirugía en pacientes de edad avanzada con cáncer de mama para mejorar la medicina basada en la evidencia y optimizar su tratamiento.

BackgroundThe study objective was to analyse the results of surgical treatment of breast cancer in octogenarian women and to analyse these patients’ quality of life and factors related to treatment and its influence on overall survival over a 7-year follow-up.MethodsA cohort cross-sectional observational study was designed. We analysed the results of treatment of octogenarian women with breast cancer in the Hospital Germans Trias i Pujol from 2011 to 2015 with follow-up until February 2018.ResultsThe first treatment option was surgery in 97% of cases, despite their having a high comorbidity burden according to the age-adjusted Charlson Index. More than half the patients responded to the question on self-perceived health that their health was excellent, very good or good (53%) and survival was higher in patients reporting good self-perceived health. Mortality at 7 years was 46%. However, the cause of death was related to cancer in only 31% of cases.ConclusionsMost of the octogenarian patients in our cohort underwent surgery as the first-line treatment and were satisfied with it. Quality of life and good self-perception of aging are a key aim in older adult patients and should be considered.Additional studies analysing results of surgery for breast cancer in older adult patients are warranted to improve evidence-based medicine and optimize treatment, thus enhancing their quality of life and increasing their survival.

Anestesia libre de opioides para cistectomía radical laparotómica en obesidad mórbida / Opioid-free anesthesia for open radical cystectomy in morbid obesity

El estudio de la técnica anestésica libre de opioides aporta evidencias de su efectividad y seguridad. Sin embargo, aún no están bien definidos todos sus riesgos y beneficios, ni en qué pacientes o intervenciones puede ser superior a la técnica anestésica convencional basada en opioides. Las cirugías intensivas y/o duraderas plantean dudas para la utilización de esta técnica por la respuesta a cambios hemodinámicos bruscos, al no producir la simpaticolisis a través de la actuación sobre el receptor μ y haber poca experiencia de uso. Una paciente con obesidad mórbida fue sometida a cistectomía radical con derivación urinaria tipo Bricker mediante laparotomía infraumbilical, consiguiéndose una adecuada estabilidad hemodinámica y una analgesia óptima en el postoperatorio sin emplear opioides intraoperatorios. La anestesia libre de opioides está en expansión con una evidencia creciente. No obstante, es necesario seguir investigando sobre sus posibilidades de utilización, las distintas combinaciones de fármacos que se puedan emplear y la resolución de complicaciones que puedan ocurrir.(AU)

Opioid-free anaesthesia shows evidence about its efectivity and security, even though its risks and benefits are not well defined. Neither are the patient profile or sort of surgery where it could be superior to the conventional opioid-based anaesthetic technique. Aggressive and/or long-lasting surgeries set out several queries on this technique regarding sudden hemodynamic changes, as it does not produce sympatholysis through μ receptor and there is modest experience in this technique. A morbidly obese patient received open radical cystectomy with Bricker-type urinary diversion using infraumbilical incision under OFA protocol, maintaining an adequate hemodynamic stability and excellent analgesia in postoperatory care without using any intraoperative opioids. Opioid-free anaesthesia technique is developing its evidence. However, it is necessary to keep on researching its clinical applications, different drug combinations and solutions to its expected complications.(AU)

Effect of GSM-900 and -1800 signals on the skin of hairless rats. I: 2-hour acute exposures.

PURPOSE: The acute influence on the skin of non-ionizing electromagnetic fields in the radiofrequency (RF) range used in mobile telephony has not been widely studied to date. The purpose of this work was to determine whether the cells of hairless rat skin are affected by acute local exposure to Global System for Mobile Communication: GSM-900 or -1800 RadioFrequency Radiation (RFR). MATERIALS AND METHODS: Hairless female rats were exposed or sham-exposed for 2 h to GSM-900 or -1800 signals, using a loop-antenna located on the right part of the rats' back. The local Specific Absorption rate (SAR) at skin level was ca. 5 W/kg (5.8+/-0.4 and 4.8+/-0.4 W/kg at 900 and 1800 MHz, respectively). A skin biopsy was done at the end of the experiment not only at the location of exposure, but also on the symmetrical part of the back. RESULTS: Analysis of skin sections using Hematoxylin Eosin Saffron (HES) coloration showed no difference in skin thickness or apparent cell toxicity (with no sign of cellular necrosis) among the animal groups. Histological analysis of the epidermis showed that the ratio between cells expressing the antigen Ki-67 (cellular proliferation marker) and the total number of cells remained within the range of normal proliferation ratio for the exposed side of the animal. No Ki-67 labelling was observed at the dermis level. Results on filaggrin, collagen and elastin levels also showed an insignificant influence of RFR. CONCLUSIONS: These results do not demonstrate any major physical and histological variations at skin level induced by RFR used in mobile telephony.

Effect of GSM-900 and -1800 signals on the skin of hairless rats. II: 12-week chronic exposures.

PURPOSE: The purpose of this work was to determine whether the cellular components of Hairless-rat skin are affected by a chronic local exposure to non-ionizing radiations of Global Mobile Phone System: GSM-900 or -1800 radiations at specific absorption rate (SAR) 2.5 and 5 W/kg. MATERIALS AND METHODS: A selected part of the right back of five-week old female hairless rats was exposed or sham exposed (n = 8) for 2 h per day, 5 days a week, for 12 weeks to GSM-900 or -1800 signals using a loop-antenna. At the end of the experiment, skin biopsies were taken. RESULTS: Analyses of skin sections using hematoxylin eosin saffron (HES) coloration showed no significant difference in skin thickness among the groups. Immunohistochemical analysis of basal lamella cells in radiofrequency radiation (RFR)-exposed epidermis showed that the ratio of the antigen Ki-67 (cellular proliferation marker) positive cells to total lamella cells remained within the range of the normal proliferation ratio. No significant differences in the level of filaggrin, collagen, and elastin were observed among the different groups. CONCLUSIONS: The results of this 12-week chronic study do not demonstrate major histological variations in the skin of hairless rats exposed to RFR used in mobile telephony (GSM-900 or -1800).

Manejo perioperatorio del paciente con lesión medular crónica portador de marcapasos frénico bilateral. Descripción de un caso / Perioperative management of the patient with chronic spinal cord injury using bilateral diaphragmatic pacemaker. Clinical case

Los pacientes con lesión medular crónica tienenunas alteraciones fisiopatológicas que determinan unaimportante morbilidad y mortalidad en el periodo perioperatorio. El marcapasos diafragmático es un dispositivo que permite la ventilación pulmonar en pacientescon lesiones cervicales altas y mejora la calidad de vidafrente al uso de ventilación mecánica. Presentamos el caso de una paciente con lesiónmedular crónica y portadora de un marcapasos diafragmático que fue programada para realización de nefrolitotomía percutánea y colocación de catéter doble Jderecho. El anestesista debe conocer la situación fisiopatológica de estos pacientes para asegurar la seguridad en el proceso perioperatorio.(AU)

Patients with chronic spinal cord injury suffer froma number of pathophysiological alterations that canlead to important morbidity and mortality in the perioperative period. The diaphragmatic pacemaker is adevice that enables pulmonary ventilation in patientswith high cervical cord injuries and provides them witha better quality of life when compared to mechanicalventilation. We present here the clinical case of a patient withchronic spinal cord injury who used a diaphragmaticpacemaker, and who was scheduled for percutaneousnephrolithotomy and double-J stent implantation. Theanesthesiologist should know the pathophysiologicalsituation of these patients in order to provide a safeperioperatory care.(AU)

Effect of exposure to the edge signal on oxidative stress in brain cell models.

In this study we investigated the effect of the Enhanced Data rate for GSM Evolution (EDGE) signal on cells of three human brain cell lines, SH-SY5Y, U87 and CHME5, used as models of neurons, astrocytes and microglia, respectively, as well as on primary cortical neuron cultures. SXC-1800 waveguides (IT'IS-Foundation, Zürich, Switzerland) were modified for in vitro exposure to the EDGE signal radiofrequency (RF) radiation at 1800 MHz. Four exposure conditions were tested: 2 and 10 W/kg for 1 and 24 h. The production of reactive oxygen species (ROS) was measured by flow cytometry using the dichlorofluorescein diacetate (DCFH-DA) probe at the end of the 24-h exposure or 24 h after the 1-h exposure. Rotenone treatment was used as a positive control. All cells tested responded to rotenone treatment by increasing ROS production. These findings indicate that exposure to the EDGE signal does not induce oxidative stress under these test conditions, including 10 W/kg. Our results are in agreement with earlier findings that RF radiation alone does not increase ROS production.

Narcolepsia y anestesia libre de opioides: revisión y caso clínico / Narcolepsy and opioid-free anesthesia: a review and case report

Introducción: La narcolepsia es el segundo trastorno del sueño en frecuencia y se caracteriza por somnolencia excesiva durante el día junto con otros síntomas como cataplejía, parálisis del sueño y alucinaciones. Su fisiopatología y tratamiento, así como los síndromes que asocia, pueden interferir de forma severa con el acto anestésico. Metodología: Debido al déficit de evidencia de calidad que aporte un grado de recomendación alto en la anestesia de estos pacientes, se realizó una revisión narrativa de la literatura no sistemática en Pubmed. Como descriptores se usaron narcolepsy, anesthesia, surgery, perioperative, opioid, obstructive, apnea y sleep y se emplearon de forma individual y cruzándolos con conectores AND y OR. Conclusión: La recomendación de evitar opioides y la estabilidad de la anestesia libre de opioides (OFA), hace de esta última una opción para estos pacientes. Se describe un caso en el que se empleó de forma segura.(AU)

Introduction: Narcolepsy is the second most common sleep disorder. It is characterised by excessive daytime sleepiness together with other symptoms such as cataplexy, sleep paralysis, and hallucinations. The pathophysiology and treatment of this disease, together with its associated syndromes, can severely interfere with anaesthesia. Methodology: Due to the lack of quality evidence on which to base a high grade of recommendation for anaesthesia in these patients, we performed a non-systematic, narrative review of the literature in Pubmed. We used the descriptors narcolepsy, anesthesia, surgery, perioperative, opioid, obstructive, apnea and sleep both individually and with AND and OR connectors. Conclusion: The recommendation to avoid opioids and the stability of opioid-free anaesthesia (OFA) make this approach an option to consider in these patients. We describe a case in which it was used safely.(AU)