Inferior vena cava ultrasonography before general anesthesia cannot predict arterial hypotension in patients undergoing vascular surgery.

INTRODUCTION: Intraoperative hypotension (IH) is an independent predictor of mortality. Some experts have suggested that ultrasound measurement of the inferior vena cava (IVC) in spontaneous ventilation can predict IH. OBJECTIVE: To evaluate the capacity of ultrasound measures of IVC in spontaneous ventilation to predict episodes of IH after anaesthesia induction. PATIENTS AND METHODS: We studied 55 high-risk cardiac patients undergoing vascular surgery. The maximum (dIVCmax) and minimum (dIVCmin) diameter of the IVC were measured and the collapsibility index CI = (dIVCmax-dIVCmin)/dIVCmax was calculated prior to anaesthesia induction. Three definitions of IH were used: systolic blood pressure (SBP) less than 100 mmHg, mean arterial pressure (MAP) less than 60 mmHg, and a decrease in MAP greater than or equal to 30% compared to baseline. RESULTS: There were no significant differences in dIVCmax or in CI between patients presenting IH after anaesthesia induction and those who did not. ROC curves for dIVCmax showed an area under the curve of 0.55 (0.39-0.70), 0.69 (0.48-0.90), and 0.57 (0.42-0.73) and ROC curves for the CI were 0.62 (0.47-0.78), 0.60 (0.41-0.78) and 0.62 (0.47-0.78) for the 3 definitions of IH (<100 mmHg, MAP < 60 mmHg, and MAP ≥30% baseline), respectively. CONCLUSIONS: Ultrasound measurements of IVC in spontaneous ventilation are not good predictors of IH after anaesthesia induction in these patients. The optimal cut-off points show low specificity and moderate sensitivity for predicting IH.

Las medidas ecográficas de la vena cava inferior no predicen hipotensión arterial postinducción anestésica en pacientes tratados mediante cirugía vascular / Inferior vena cava ultrasonography before general anesthesia cannot predict arterial hypotension in patients undergoing vascular surgery

Introducción: La hipotensión arterial intraoperatoria (HIO) es un predictor independiente de mortalidad. Las medidas ecográficas de la vena cava inferior (VCI) en ventilación espontánea han sido propuestas como predictores de este evento.ObjetivoEvaluar la capacidad de las medidas ecográficas de la VCI en ventilación espontánea para predecir episodios de HIO postinducción anestésica. Pacientes y métodos: Estudiamos a 55 pacientes de alto riesgo cardíaco tratados mediante cirugía vascular. Previamente a la inducción anestésica se midió el diámetro máximo de la VCI (dVCImáx.), el diámetro mínimo (dVCImín.) y el índice de colapsabilidad (ICVCI=dVCImáx. – dVCImin.)/dVCImáx.). Se utilizaron 3definiciones de HIO: presión arterial sistólica menor de 100mmHg, presión arterial media (PAM) menor de 60mmHg o un descenso de la PAM mayor o igual al 30% respecto a la PAM basal. Resultados: No hubo diferencias significativas en el dVCImáx. ni en el ICVCI entre quienes presentaron HIO postinducción anestésica y quienes no. Las curvas ROC para el dVCImáx. mostraron un área bajo la curva de 0,55 (0,39-0,70); 0,69 (0,48-0,90) y 0,57 (0,42-0,73), mientras que para el ICVCI fueron de 0,62 (0,47-0,78); 0,60 (0,41-0,78) y 0,62 (0,47-0,78), para las definiciones de HIO de<100mmHg, PAM<60mmHg y descenso de la PAM ≥ 30%, respectivamente. Conclusiones: Las medidas ecográficas de la VCI en ventilación espontánea no son buenos predictores de HIO postinducción anestésica en estos pacientes. Los puntos de corte óptimos permiten predecir hipotensión con baja especificidad y moderada sensibilidad.(AU)

Introduction: Intraoperative hypotension (IH) is an independent predictor of mortality. Some experts have suggested that ultrasound measurement of the inferior vena cava (IVC) in spontaneous ventilation can predict IH.ObjectiveTo evaluate the capacity of ultrasound measures of IVC in spontaneous ventilation to predict episodes of IH after anaesthesia induction. Patients and methods: We studied 55 high-risk cardiac patients undergoing vascular surgery. The maximum (dIVCmax) and minimum (dIVCmin) diameter of the IVC were measured and the collapsibility index CI=(dIVCmax-dIVCmin)/dIVCmax was calculated prior to anaesthesia induction. Three definitions of IH were used: systolic blood pressure (SBP) less than 100mmHg, mean arterial pressure (MAP) less than 60mmHg, and a decrease in MAP greater than or equal to 30% compared to baseline. Results: There were no significant differences in dIVCmax or in CI between patients presenting IH after anaesthesia induction and those who did not. ROC curves for dIVCmax showed an area under the curve of 0.55 (0.39-0.70), 0.69 (0.48-0.90), and 0.57 (0.42-0.73) and ROC curves for the CI were 0.62 (0.47-0.78), 0.60 (0.41-0.78) and 0.62 (0.47-0.78) for the 3 definitions of IH (<100mmHg, MAP<60mmHg, and MAP ≥30% baseline), respectively. Conclusions: Ultrasound measurements of IVC in spontaneous ventilation are not good predictors of IH after anaesthesia induction in these patients. The optimal cut-off points show low specificity and moderate sensitivity for predicting IH.(AU)

Uso del Análisis por Componentes Independientes en la extracción de artefactos de la respuesta Mismatch Negativity / Use of Independent Component Analysis in the extraction of Artifacts of the Mismatch Negativity Response

Resumen: El Potencial de disparidad es una respuesta cortical elicitada por la detección automática de estímulos con distintas características, permitiendo la exploración de procesos neuropsicológico. Sin embargo el análisis de esta señal se puede dificultar por una baja relación señal a ruido debida a los artefactos presentes en la adquisición de la misma. Diversas publicaciones proponen el uso de implementaciones de la técnica de Separación Ciega de fuentes, como el Análisis por Componentes Independientes (ACI), para preprocesar las señales y eliminar estos artefactos. Sin em bargo, no se ha estudiado cuál de los algoritmos ACI que se encuentran en la literatura será el óptimo para mejorar la calidad del MMN, por lo que en este estudio se propuso determinar si existen diferencias significativas en las respuestas obtenidas al utilizar los algoritmos de FastICA, Infomax y SOBI para eliminar los artefactos típicamente presentes en este tipo de señales. Adicionalmente se dan algunas características de estos artefactos a manera de sistematizar la identificación y eliminaciones de los mismos, además de comparar las respuestas obtenidas con y sin preprocesamiento, así como la distribución topográfica de este potencial antes y después de la eliminación de artefactos. Mediante el algoritmo Infomax se identifican mejor los Componentes Independientes asociados con artefactos, resultando en un MMN de mayor amplitud y distribución topográfica fronto-central con predominancia izquierda.

Abstract: Mismatch Negativity is a cortical response elicited by the automatic detection of stimuli which have different characteristics, allowing exploration of neuropsychological processes. However, the analysis of this signal can be di fficult by a low SNR due to artifacts present when the signal is recorded. Different publications propose to use the approach given by the Blind Source Separation Technique by means of the Independent Component Analysis (ICA) to preprocess and eliminate these artifacts. Nevertheless, it has not been studied which of the ICA algorithms found in the literature will be optimal for improving the quality of MMN. Therefore the aim of this study is to determine whether there are significant differences in the responses obtained by using FastICA, Infomax and SOBI to remove artifacts typically present in such signals. In addition, some features of the Independent Components related to artifacts are given in order to systematize the identification and elimination of those. In addition, MMN responses obtained with and without data preprocessing, as well as topographic maps before and after the elimination of artifacts were compared. Thus, Infomax is the best ICA algorithm to calculate Independent Components associated with artifacts, resulting in high amplitude MMN and a topographic map with a clear fronto-central distribution with left-hemisphere predominance.

Mycophenolate as induction therapy in lupus nephritis with renal function impairment.

BACKGROUND: Mycophenolate (MF) is effective as induction therapy for lupus nephritis (LN) in patients with normal renal function; however, little is known about its role in patients with impaired renal failure. The purpose of this study was to evaluate the response to MF in LN and its association with baseline renal function. METHODS: Data were obtained for 90 patients from 12 Spanish renal units who were receiving MF as induction therapy for LN. Patients were classified into 2 groups: group 1 (estimated glomerular filtration rate [eGFR] ≥60 ml/min/1.73 m(2)) and group 2 (eGFR <60 ml/min/ 1.73 m(2)). The primary outcome measure was the percentage of patients who achieved any response and its relationship with initial eGFR. The secondary outcome measures were the percentage of patients who achieved a complete response (CR) or partial response (PR) and the appearance of relapses during treatment and side effects. RESULTS: At initiation of MF treatment, there were no differences in the main parameters between group 1 (n = 63; eGFR 87 ± 23 ml/min/ 1.73 m(2)) and group 2 (n = 27; eGFR 44 ± 12 ml/min/1.73 m(2)). Exposure to prednisone and MF was similar. The percentages of patients who achieved a response in groups 1 and 2 were, respectively, 69.2 and 43.8% at 6 months and 81.3 and 73.7% at 12 months. CR was more frequent in group 1, whereas PR was similar in both groups. Four patients relapsed and side effects were unremarkable. CONCLUSIONS: MF is effective and safe as induction therapy for LN, and response is even achieved in patients with baseline renal impairment.

Sampling, sampling errors and specimen preparation.

To obtain an adequate cervical smear for making a correct cytologic diagnosis, smear taking, laboratory handling and interpretation must be optimal. Many people are involved, and only by a combined effort of all links can this target be seriously approached: the smear takers will have to be open minded about technical improvements and read the morphologic descriptions cautiously; in the laboratory, cytotechnicians and physicians will have to challenge themselves and each other. It is mandatory to discard specimens that do not meet general standards of adequacy. At present a host of new techniques are being implemented. It is not feasible for all laboratories to be engaged in testing these new methods, but we are all requested to follow the development the best we can and switch to new ways when justified. Our working conditions are very different; therefore, it is our professional responsibility and plight to respond at the right time. So far the conclusion is that the conventional Pap smear is the international standard of care for the diagnosis of cervical cancer precursers in cancer screening programs. Certainly, this may change within a very short time. Liquid-based techniques, and in particular HPV technologies, are just around the corner.

Resultados obtenidos en el seguimiento de embarazadas hipertensas. / Results of the following plan of pregnant hypertensive women

Se realiza una breve introduccion considerando los actuales conceptos etiopatologicos de la hipertension arterial inducida por el embarazo. Se efectua una revision de los casos de preeclampsia-eclampsia atendidos en el Servicio de Obstetricia del Hospital de Clinicas "Jose de San Martin", desde el 1 de enero de 1981 al 30 de junio de 1982. Sobre un total de 3.278 partos se analizaron 217 embarazadas hipertensas, significando una incidencia del 6,61%. La frecuencia de cesareas fue del 40%.Hubo un porcentaje de recien nacidos de bajo peso de 25%. La mortalidad perinatal especifica fue del 18,4 por mil. No hubo morbimortalidad materna. El manejo clinico de la embarazada hipertensa fue normatizada en base a reposo, dieta, hipotensores e interrupcion del embarazo en los casos graves que no cedieron al tratamiento

Resultados obtenidos en el seguimiento de embarazadas hipertensas. / Results of the following plan of pregnant hypertensive women

Se realiza una breve introduccion considerando los actuales conceptos etiopatologicos de la hipertension arterial inducida por el embarazo. Se efectua una revision de los casos de preeclampsia-eclampsia atendidos en el Servicio de Obstetricia del Hospital de Clinicas "Jose de San Martin", desde el 1 de enero de 1981 al 30 de junio de 1982. Sobre un total de 3.278 partos se analizaron 217 embarazadas hipertensas, significando una incidencia del 6,61%. La frecuencia de cesareas fue del 40%.Hubo un porcentaje de recien nacidos de bajo peso de 25%. La mortalidad perinatal especifica fue del 18,4 por mil. No hubo morbimortalidad materna. El manejo clinico de la embarazada hipertensa fue normatizada en base a reposo, dieta, hipotensores e interrupcion del embarazo en los casos graves que no cedieron al tratamiento