ABSTRACT
La ecocardiografía transesfofágica es una técnica semiinvasiva que permite una evaluación de la morfología y función cardiaca a tiempo real y que constituye, a día de hoy, un estándar de calidad en las intervenciones de cirugía cardiovascular. Se ha convertido en una herramienta fundamental tanto de monitorización como de diagnóstico en el perioperatorio que permite la correcta planificación quirúrgica y manejo farmacológico dirigido. El objetivo de este documento es dar respuesta de forma consensuada y avalada por la evidencia científica de cuándo y cómo debe hacerse la ecocardiografía transesfofágica intraoperatoria en cirugía cardiovascular, qué aplicaciones tiene en el intraoperatorio, quién debe realizarla y cómo debe transmitirse la información obtenida durante el estudio. Los autores han hecho una revisión sistemática de las guías internacionales, artículos de revisión y ensayos clínicos para dar respuesta a estas preguntas
Transesophageal echocardiography is a semi-invasive technique that allows an evaluation of cardiac morphology and function in real time and it is a quality standard in cardiovascular surgery. It has become a fundamental tool for both monitoring and diagnosis in the intraoperative period that allows decide the correct surgical planning and pharmacological management. The goal of this document is to answer the questions of when and how the perioperative TEE should be performed in cardiovascular surgery, what are their applications in the intraoperative, who should perform it and how the information should be transmitted. The authors made a systematic review of international guidelines, review articles and clinical trials to answer by consensus to these questions
Subject(s)
Humans , Echocardiography, Transesophageal/methods , Cardiovascular Surgical Procedures/methods , Monitoring, Intraoperative/methods , Hemodynamic Monitoring/methods , ConsensusABSTRACT
Transesophageal echocardiography is a semi-invasive technique that allows an evaluation of cardiac morphology and function in real time and it is a quality standard in cardiovascular surgery. It has become a fundamental tool for both monitoring and diagnosis in the intraoperative period that allows decide the correct surgical planning and pharmacological management. The goal of this document is to answer the questions of when and how the perioperative TEE should be performed in cardiovascular surgery, what are their applications in the intraoperative, who should perform it and how the information should be transmitted. The authors made a systematic review of international guidelines, review articles and clinical trials to answer by consensus to these questions.
ABSTRACT
BACKGROUND: Rhizopus microsporus is one of the main causative agents of mucormycosis. These mycoses are mostly described as isolated cases involving uncontrolled diabetes mellitus or immunosuppressed patients. In this work we report a nosocomial outbreak of mucormycosis due to R. microsporum involving three young immunocompetent patients whom underwent arthroscopic anterior cruciate ligament reconstruction surgery in a seven-month time span. PROCEDURES: During the outbreak period, a total of 32 surgeries of this type were performed in the clinic (mucormycosis prevalence of 9.375%). The three patients presented healthcare-associated Mucormycosis comprising the bone surrounding one of the fixation screws (femoral or tibial). In addition to these three strains, another three R. microsporus strains isolated in the medical center during the same period of time were included in the study. One of these fungi was isolated from a skin lesion of a kidney transplant patient while the other two strains were isolated from environmental sources. Classical, mass spectrometry-based (MALDI-TOFF) and molecular identification were performed. Genetic relatedness was established by Rep-PCR (RAPD variant) and by single-linkage cluster analysis mass spectra. Cluster analysis was performed by unweighed pair group method with arithmetic mean (UPGMA). MAIN FINDINGS: All the strains were identified as R. microsporum by the used phenotypic and genetic tools. Clinical strains fell into 2 different clusters separating the renal transplant recipient strain from the three strains isolated post ACLR surgery, which clustered together. CONCLUSIONS: The established genetic/mass spectra relatedness between the three post-surgery isolates suggests that these cases may be considered a healthcare-associated mucormycosis outbreak.
Subject(s)
Anterior Cruciate Ligament Reconstruction/adverse effects , Disease Outbreaks , Mucormycosis/epidemiology , Mucormycosis/microbiology , Rhizopus/classification , Rhizopus/genetics , Adult , Antifungal Agents/pharmacology , Argentina/epidemiology , Cluster Analysis , Cross Infection/epidemiology , Cross Infection/microbiology , DNA, Fungal/chemistry , DNA, Fungal/genetics , DNA, Ribosomal/genetics , Environmental Microbiology , Female , Genotype , Humans , Kidney Transplantation/adverse effects , Male , Microbial Sensitivity Tests , Mucormycosis/diagnosis , Random Amplified Polymorphic DNA Technique/methods , Rhizopus/drug effects , Rhizopus/isolation & purification , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization , Young AdultABSTRACT
This study aimed to compare the sensitivity and accuracy of two methods of quantitative real-time polymerase chain reaction (qrt-PCR), in order to determine haematopoietic chimerism (CH): single nucleotide polymorphisms using TaqMan (TM) probes and insertion/deletion polymorphisms using Hybridization (Hyb) probes. A total of 106 samples from 20 patients who underwent allogenic stem cell transplantation (n = 14) or live-donor liver transplantation (n = 6) were studied. The mean level of chimerism was 8.37% for the TM method and 7.73% in the Hyb method, which was not significantly different (P = 0.69). The Pearson correlation coefficient between the two methods was r = 0.91 (P < 0.001). The estimation of the regression line, using the Passing and Balbock method was Intercept A -0.0381 [95% confidence interval (CI) -0.1265 to 0.0296) and Slope B: 1.04609(95% CI 0.9349-1.161). Bland-Altman data showed that the standard deviations, which differed between the two methods (%Hyb-%TM), were 0.98 and -1.28. The accuracy and sensitivity of qrt-PCR chimerism is independent of the method used if the optimization is adequate and satisfies the criteria for adequate study. Real-time PCR, independent of the method adopted, is a very good tool for study levels of CH.
Subject(s)
Liver Transplantation/immunology , Polymerase Chain Reaction/methods , Transplantation Chimera/immunology , Transplantation, Homologous/immunology , DNA/genetics , Gene Deletion , Genetic Markers/immunology , Hematopoietic Stem Cell Transplantation , Humans , Mutagenesis, Insertional , Polymorphism, Single Nucleotide , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
A total of 62 frozen bone marrow specimens conserved in RNA later (Ambion) were processed using two different extraction methods, the MagNA Pure LC system (MAG; Roche) and the manual RiboPure-Blood RNA method (RIBO; Ambion); Beta glucoronidase RNA (GUS) was amplified by LightCycler PCR to evaluate the quality of both extraction procedures. Less than 1000 GUS copies/ml was detected in 26 of 62 specimens (41.94%) processed by MAG and in five of 62 specimens (8.06%) processed by RIBO. Moreover, RNA recovery from the 62 specimens by MAG is, on average, 2.91 cycle threshold-fold higher than RIBO (P = 0.0008). Furthermore, we compared the extraction times and reagent costs of both methods. In conclusion, RNA extraction using MAG is faster to process 32 samples and less expensive than RIBO but it is not sensitive enough to be employed for research purpose in our laboratory.
