Effects of preoperative dexamethasone on postoperative pain, nausea, vomiting and respiratory function in women undergoing conservative breast surgery for cancer: Results of a controlled clinical trial.

The objective was to evaluate whether preoperative administration of dexamethasone improved postoperative nausea and vomiting (PONV), pain and respiratory function tests in women undergoing conservative surgery for breast cancer. This was a controlled clinical trial conducted between June 2013 and October 2014. Eighty patients were evaluated. Patients received a preoperative dose of 8 mg of dexamethasone (n = 40) or placebo (n = 40). The data on PONV and pain intensity was obtained and forced spirometry tests were performed, 1 hr before and at 1, 6, 12 and 24 hr after surgery. Any use of additional analgesic/antiemetic drugs was recorded. Patients were followed until 30 days after surgery for any surgical or medical complications. The pain intensity was lower in the treatment group for all periods; PONV was lower at 6, 12 and 24 hr; Additional analgesics/antiemetics were required less frequently (all p < .05). Both groups exhibited a restrictive ventilatory pattern immediately after surgery, which was reversed in the following hours. However, spirometric values were higher in the dexamethasone group. There were no pulmonary or metabolic complications after surgery. Our conclusions were that dexamethasone significantly reduced the incidences of PONV, pain and improved respiratory parameters, and reduced the need for additional postoperative analgesic and antiemetic drugs.

Body weight changes after adjuvant chemotherapy of patients with breast cancer: results of a Mexican cohort study.

Weight gain is observed in breast cancer patients receiving chemotherapy and is a well-known complication. Several factors that contributing to weight gain have been identified. However, there is a lack of information about factors associated with weight changes following adjuvant chemotherapy. A retrospective cohort of 200 pre- and post-menopausal Mexican patients treated for breast cancer was made. Anthropometric variables were measured before/after treatment. Biomarkers, cellular differentiation and chemotherapy were similar between groups. Weight gain occurred in 85.6% of pre-menopausal and 72.6% of post-menopausal women (p = .03). At the end of chemotherapy, weight and body mass index (BMI) did not differ significantly between pre-menopausal (69.3 ± 12.6 kg; 26.6 ± 4.8 kg/m2 ) and post-menopausal women (69.5 ± 10.9 kg; 27.3 ± 4.4 kg/m2 ) (p = .91 and 0.34). Dexamethasone doses were higher in pre-menopausal (85.7 ± 39.1 g) than post-menopausal patients (79.2 ± 22.5 g; p = .13). Weight loss was observed in 9.2% of pre-menopausal and 20.2% of post-menopausal patients (p = .04). A multivariate analysis revealed that age (OR = 2.7; 95% CI = 1.26-5.79; p = .01), menopausal status (OR = 2.29; 95% CI = 1.09-4.80; p = .03), dexamethasone dosage (OR = 2.1; 95% CI = 1.04-4.23; p = .03) and daily caloric intake (OR = 2.3; 95% CI = 1.12-5.10; p = .02) were independent variables that inducted weight gain. Pre- and post-menopausal women gained weight, but more pre-menopausal patients showed gain. An effort should be made to administer lower steroid doses to reduce weight gain.

Valvular dysfunction due to the obstruction of the ventricular catheter caused by cysticercus cyst.

Five patients were studied with the diagnosis of secondary hydrocephaly to neurocysticercosis. Valvular dysfunction was observed due to the obstruction of the ventricular catheter caused by cysticercus cysts. The Biomed System was used in four cases and the Hakim System in one. Valvular dysfunction was observed in patients within a period of 18 to 24 months after derivation, they also had a history of several valvular dysfunctions. The diagnosis was made upon extraction of the catheter where the cyst was found to be attached to the ventricular brush. Subsequent evolution has not been satisfactory. The reasons for this complication are of a hydrodynamic and pharmacological nature and are also due to the growth of the cyst. This complication is not often suspected, therefore we recommend that in cases of frequent valvular dysfunction and asymmetrical hydrocephaly, studies like iodine-tomography or magnetic resonance be carried out in order to rule out this factor.

Obstruction of the ventricular catheter of a CSF shunt system due to the own cyst of Taenia solium

Se estudiaron cinco pacientes con el disgnóstico de hidrocefalia secundaria a neurocisticercosis, que presentaron disfunción valvular por obstrucción del catéter ventricular debido a quistes de cisticercos. En cuatro casos se utilizaron sistemas Biomed (Mex) y en un caso sistema tipo Hakim. Los pacientes presentaron la disfunción valvular entre 18 y 24 meses posterior a la derivación, ellos tenían historia de múltiples disfunciones valvulares. El diagnóstico se realizó al momento de la extracción del catéter en que se encontró el quiste adherido al cepillo ventricular. La evolución clínica posterior ha sido poco satisfactoria. Las causas de esta complicación parecen relacionarse con factores relacionados a la hidrodinámica (a pesar de haberse cambiado el sistema derivativo), al tratamiento farmacológico y al crecimiento propio del quiste. Esta complicación por su rareza, es poco sospechosa por lo que recomendamos que en casos de pacientes cisticercosos con disfunción valvular con hidrocefalia asimétrica se realicen estudios (yodotomografía o resonancia magnética nuclear) para descartar esta posibilidad

Obstruction of the ventricular catheter of a CSF shunt system due to the own cyst of Taenia solium.

Five patients were studied who suffered secondary hydrocephalus due to neurocysticercosis. Shunt dysfunction was due to the obstruction of the ventricular catheter caused by the own cysticercus cysts. The Biomed system was used in four cases and the Hakim system in one. Valvular dysfunction was observed in patients within a period of 18 to 24 months after surgery, they had a history of several valvular dysfunctions. The diagnosis was made upon of extracting the catheter where the cyst was found to be attached to the ventricular brush. Subsequent evolution has not been satisfactory. The reasons for this complication are of a hydrodynamic and pharmacological nature and are also due to the growth of the cyst. This complication is not often suspected, therefore we recommend that in case of frequent valvular dysfunctions and asymmetrical hydrocephalus, studies like iodinetomography or magnetic resonance imaging be carried out in order to discard this possibility.

Intraventricular cysticercosis.

The authors review their experience with 21 cases of intraventricular cysticercosis, which corresponded to 28% of all cases of neurocysticercosis in their department during an 18-month period. The surgical approach depends on the cyst's location; one uses the transcortical microsurgical approach to reach the lateral ventricles, the transcortical or transcallosal approach to reach the 3rd ventricle, and direct exploration to reach the 4th ventricle. Cysticercus cysts should be removed because they may produce acute or chronic hydrocephalus and, if the parasite dies within the ventricles, it will generate an inflammatory reaction with local and generalized ventriculitis, which produces irreversible neurological damage.

Tuberculoma intramedular cervical (informe de un caso). / Cervical intramedullary tuberculoma (report of a case)

Se informa del caso numero 24 en la literatura mundial de tuberculoma intramedular tratado quirurgicamente con exito.Se hacen consideraciones clinicas y revision de la literatura

Transorbital ventricular puncture for emergency ventricular decompression. Technical note.

A transorbital technique for emergency ventricular drainage has been used successfully in comatose hydrocephalic patients. The technique is described.

[Lipoma of the corpus callosum]. / Lipoma del cuerpo calloso.

A case of-lipoma of the corpus callosum is presented. This is a rare intracranial lesion, perhaps congenital and often asymptomatic. Review of the literature disclosed 85 cases including our case, which is the first in Latin America.