Assessment of effects of methylene blue on intestinal ischemia and reperfusion in a rabbit model: hemodynamic, histological and immunohistochemical study.

BACKGROUND: Intestinal ischemia-reperfusion (IR) is an important clinical occurrence seen in common diseases, such as gastric dilatation-volvulus in dogs or colic in horses. Limited data is available on the use of methylene blue in veterinary medicine for intestinal ischemia-reperfusion. The present study aimed to compare the hemodynamic, histopathological, and immunohistochemical effects of two doses of methylene blue in two rabbit model groups In one group, 5 mg/kg IV was administered, and in another, 20 mg/kg IV was administered following a constant rate infusion (CRI) of 2 mg/kg/h that lasted 6 h. All the groups, including a control group had intestinal ischemia-reperfusion. Immunohistochemical analysis was performed using caspase-3. RESULTS: During ischemia, hemodynamic depression with reduced perfusion and elevated lactate were observed. During reperfusion, methylene blue (MB) infusion generated an increase in cardiac output due to a positive chronotropic effect, an elevation of preload, and an intense positive inotropic effect. The changes in heart rate and blood pressure were significantly greater in the group in which methylene blue 5 mg/kg IV was administered (MB5) than in the group in which methylene blue 20 mg/kg IV dose was administered (MB20). In addition, lactate and stroke volume variations were significantly reduced, and vascular resistance was significantly elevated in the MB5 group compared with the control group and MB20 group. The MB5 group showed a significant decrease in the intensity of histopathological lesion scores in the intestines and a decrease in caspase-3 areas, in comparison with other groups. CONCLUSIONS: MB infusion produced improvements in hemodynamic parameters in rabbits subjected to intestinal IR, with increased cardiac output and blood pressure. An MB dosage of 5 mg/kg IV administered at a CRI of 2 mg/kg/h exhibited the most protective effect against histopathological damage caused by intestinal ischemia-reperfusion. Further studies with MB in clinical veterinary pathologies are recommended to fully evaluate these findings.

Evaluation of gastric and bladder tonometry as indicators of tissue perfusion in induced hypotension in dogs.

OBJECTIVE: To evaluate the use of gastric (PgCO2 ) and bladder (PbCO2 ) tonometry for assessing tissue hypoperfusion in dogs during sevoflurane-induced hypotension, and to compare these measurements with delivery of oxygen, arterial oxygen content, and plasma lactate concentration. DESIGN: Prospective experimental trial. SETTING: University veterinary teaching hospital. ANIMALS: Fourteen adult Beagle dogs. INTERVENTIONS: Anesthetic induction was performed by mask with sevoflurane and oxygen. Heart rate, direct arterial pressures, respiratory rate, and end-tidal carbon dioxide were recorded; arterial blood samples were taken to measure blood gases, and venous samples were sampled to measure plasma lactate. A tonometric catheter was introduced into the stomach to measure PgCO2 . Samples of saline from the balloon of a Foley catheter placed in the bladder were collected every 10 minutes and used to measure PbCO2 by gas analysis. Tonometry measurements, plasma lactate, and oxygen delivery and consumption were compared at 3 time points: at baseline, during hypotension, and during treatment periods. A hypotensive period (mean arterial pressure (MAP) < 60 mm Hg) of 15 minutes was induced by an overdose of sevoflurane, whereas during the treatment period, a constant-rate infusion of dopamine (10 µg/kg/min) was administered intravenously for 40 minutes. MEASUREMENTS AND MAIN RESULTS: Values for PgCO2 and PbCO2 increased significantly during the hypotensive period, and correlations were found between these values and the delivery of oxygen. Gastric tonometry values had stronger correlations compared with bladder tonometry values. CONCLUSIONS: Gastric and bladder tonometry can be used to detect hypoperfusion. Further studies are warranted to determine the potential use of gastric and bladder tonometry in assessing dogs in clinical situations.

A comparison of cardiopulmonary effects and anaesthetic requirements of two dexmedetomidine continuous rate infusions in alfaxalone-anaesthetized Greyhounds.

OBJECTIVE: To determine the effects of two dexmedetomidine continuous rate infusions on the minimum infusion rate of alfaxalone for total intravenous anaesthesia (TIVA), and subsequent haemodynamic and recovery effects in Greyhounds undergoing laparoscopic ovariohysterectomy. STUDY DESIGN: Prospective, randomized and blinded clinical study. ANIMALS: Twenty-four female Greyhounds. METHODS: Dogs were premedicated with dexmedetomidine 3 µg kg-1 and methadone 0.3 mg kg-1 intramuscularly. Anaesthesia was induced with IV alfaxalone to effect and maintained with a TIVA mixture of alfaxalone in combination with two different doses of dexmedetomidine (0.5 µg kg-1 hour-1 or 1 µg kg-1 hour-1; groups DEX0.5 and DEX1, respectively). The alfaxalone starting dose rate was 0.07 mg kg-1 minute-1 and was adjusted (± 0.02 mg kg-1 minute-1) every 5 minutes to maintain a suitable depth of anaesthesia. A rescue alfaxalone bolus (0.5 mg kg-1 IV) was administered if dogs moved or swallowed. The number of rescue boluses was recorded. Heart rate, arterial blood pressure and arterial blood gas were monitored. Qualities of sedation, induction and recovery were scored. Differences between groups were tested for statistical significance using a Student's t test or Mann-Whitney U test as appropriate. RESULTS: There were no differences between groups in sedation, induction and recovery quality, the median (range) induction dose of alfaxalone [DEX0.5: 2.2 (1.9-2.5) mg kg-1; DEX1: 1.8 (1.2-2.9) mg kg-1], total dose of alfaxalone rescue boluses [DEX0.5: 21.0 (12.5-38.8) mg; DEX1: 22.5 (15.5-30.6) mg] or rate of alfaxalone (DEX0.5: 0.12±0.04 mg kg-1 minute-1; DEX1: 0.12±0.03 mg kg-1 minute-1). CONCLUSIONS AND CLINICAL RELEVANCE: Co-administration of dexmedetomidine 1 µg kg-1 hour-1 failed to reduce the dose rate of alfaxalone compared with dexmedetomidine 0.5 µg kg-1 hour-1 in Greyhounds undergoing laparoscopic ovariohysterectomy. The authors recommend an alfaxalone starting dose rate of 0.1 mg kg-1 minute-1. Recovery quality was good in the majority of dogs.

Unsuspected Lung Pathology in Autopsies of Children with Cancer.

BACKGROUND: Although pulmonary involvement is common in patients with cancer, its frequency and nature is seldom reported in the medical literature. OBJECTIVE: To determine the frequency and type of lung pathological conditions revealed by autopsy in children with cancer. METHODS: All reports from autopsies performed in children with cancer from 1989 to 2012 in a pediatric hospital were reviewed. RESULTS: In the analyzed period, 118 autopsies (10.2% of all autopsies) corresponded to children who died with cancer; 76 had complete information and were included in the analysis. Children were seen in the Hematology (41 cases) or the Oncology (35 cases) services. Their median age at decease was 7 years (range, 15 days to 16.1 years) and 46.1% were females. Main diagnoses were acute lymphoblastic (31 patients) or myeloblastic (10 patients) leukemias and tumors of the central nervous system (12 patients). A pathological respiratory condition was diagnosed antemortem in 31 (40.8%) patients, and at autopsy in 62 (81.6%) cases. Omitted diagnoses occurred in 58 (76.3%) children, being pneumonia (24 cases) and pulmonary hemorrhage (23 cases) the most frequent omissions. Nine patients had clinically unsuspected tumor infiltration or metastases. CONCLUSIONS: In these children with cancer, more than 80% of autopsies revealed some lung pathology, mainly of infectious or hemorrhagic nature. Thus, pulmonary involvement should be investigated in all children with cancer in a timely and intentional manner.

Effect of dexmedetomidine constant rate infusion on the bispectral index during alfaxalone anaesthesia in dogs.

OBJECTIVE: To assess the effect of two rates of infusion of dexmedetomidine on the bispectral index (BIS) in dogs anaesthetized with alfaxalone constant rate infusion (CRI). STUDY DESIGN: Prospective, randomized, 'blinded' experimental study. ANIMALS: Six healthy Beagles (three females and three males). METHODS: Dogs received as premedication saline (group D0), 1 µg kg(-1) (group D1) or 2 µg kg(-1) (group D2) dexmedetomidine, intravenously (IV). Anaesthesia was induced with alfaxalone (6 mg kg(-1) to effect IV) and maintained with alfaxalone at 0.07 mg kg(-1)  minute(-1) and a CRI of saline (D0) or dexmedetomidine 0.5 µg kg(-1)  hour(-1) (D1) or 1 µg kg(-1)  hour(-1) (D2) for 90 minutes. BIS, electromyography (EMG), signal quality index (SQI) and suppression ratio (SR) were measured at 10 minute intervals and the median values were calculated. Nociceptive stimuli were applied every 30 minutes and BIS and cardiorespiratory values were compared before and after stimuli. Cardiorespiratory parameters were recorded throughout the study. RESULTS: BIS and EMG values differed significantly among groups, being lower in D2 (71 ± 8) than in D0 (85 ± 10) and D1 (84 ± 9). SQI was always over 90% and SR was zero throughout all the treatments. There were no significant differences between pre- and post-stimulus values of BIS, EMG and SQI for any treatment, although in D0 and D1, heart rate, respiratory rate and arterial pressures increased significantly after the nociceptive stimulus. CONCLUSIONS AND CLINICAL RELEVANCE: Administration of dexmedetomidine (2 µg kg(-1)  + CRI 1 µg kg(-1)  hour(-1) ) decreases the BIS values and avoids the autonomic responses of a nociceptive stimulus during alfaxalone anaesthesia at 0.07 mg kg(-1)  minute(-1) in dogs. However, further studies are needed to verify whether this combination produces an adequate degree of hypnosis under surgical situations.

Anaesthetic and cardiorespiratory effects of a constant rate infusion of fentanyl in isoflurane-anaesthetized sheep.

OBJECTIVE: To determine the anaesthetic and cardiorespiratory effects of a constant rate infusion of fentanyl in sheep anaesthetized with isoflurane and undergoing orthopaedic surgery. STUDY DESIGN: Prospective, randomised, 'blinded' controlled study. ANIMALS: Twenty healthy sheep (weight mean 41.1 ± SD 4.5 kg). METHODS: Sheep were sedated with intravenous (IV) dexmedetomidine (4 µg kg(-1) ) and morphine (0.2 mg kg(-1) ). Anaesthesia was induced with propofol (1 mg kg(-1)  minute(-1) to effect IV) and maintained with isoflurane in oxygen and a continuous rate infusion (CRI) of fentanyl 10 µg kg(-1)  hour(-1) (group F) or saline (group P) for 100 minutes. The anaesthetic induction dose of propofol, isoflurane expiratory fraction (Fe'iso) required for maintenance and cardiorespiratory measurements were recorded and blood gases analyzed at predetermined intervals. The quality of recovery was assessed. Results were compared between groups using t-tests or Mann-Whitney as relevant. RESULTS: The propofol induction dose was 4.7 ± 2.4 mg kg(-1) . Fe'iso was significantly lower (by 22.6%) in group F sheep than group P (p = 0). Cardiac index (mean ± SD mL kg(-1)  minute(-1) ) was significantly (p = 0.012) lower in group F (90 ± 15) than group P (102 ± 35). Other measured cardiorespiratory parameters did not differ statistically significantly between groups. Recovery times and recovery quality were statistically similar in both groups. CONCLUSIONS AND CLINICAL RELEVANCE: Fentanyl reduced isoflurane requirements without clinically affecting the cardiorespiratory stability or post-operative recovery in anaesthetized sheep undergoing orthopaedic surgery.

Effectiveness of pre-peritoneal continuous wound infusion with lidocaine for pain control following ovariohysterectomy in dogs.

This study compared the post-operative analgesic efficacy of continuous lidocaine administration with that of intramuscular (IM) methadone in dogs undergoing ovariohysterectomy. Thirty-eight dogs were divided randomly into two groups. Following surgery, the lidocaine group (L) received a continuous lidocaine infusion (2 mg/kg/h) through a wound catheter inserted in the pre-peritoneal space; the control group (C) received methadone (0.2 mg/kg IM). A dynamic and interactive visual analogue scale (DIVAS), the Scale-Form Glasgow Composite Measure Scale (CMPS-SF), mechanical wound thresholds, heart rate, respiratory rate and blood pressure were assessed pre-operatively and 2, 4, 6, 18, and 24 h after surgery. The presence of the wound catheter prevented the evaluator from remaining blinded to group allocations. Plasma lidocaine and cortisol levels were measured 2, 6, 18, and 24 h after surgery. There were no intergroup differences in any pain assessment scale scores at any time point. Stable intravenous lidocaine levels were observed. Four animals in the control group but none in the lidocaine group required rescue analgesia. There were no differences in complication rates between groups. Continuous locoregional lidocaine delivered via a wound catheter between the parietal peritoneum and abdominal muscle offers effective analgesia in dogs during ovariohysterectomy and appears to be a promising analgesic option in veterinary surgery.

Comparison of thermodilution, lithium dilution, and pulse contour analysis for the measurement of cardiac output in 3 different hemodynamic states in dogs.

OBJECTIVE: To (1) evaluate lithium dilution (LiDCO) and transpulmonary thermodilution (PiCCOTD ) in relation to traditional thermodilution (PAC-TD) for determining cardiac output (CO) in 3 different hemodynamic states in dogs and to (2) compare the continuous CO values obtained using power analysis (PulseCO) with continuous PiCCO (PiCCOc). DESIGN: Prospective randomized study. SETTING: University research laboratory. ANIMALS: Fourteen healthy Beagles. INTERVENTIONS: CO was measured using PAC-TD, LiDCO, and PiCCOTD in 3 different hemodynamic states induced in random order and defined on the basis of the mean arterial pressure (MAP). Normodynamic state was defined as the baseline MAP and 1 MAC sevoflurane. The hypodynamic state was induced with a deep level of sevoflurane anesthesia. The hyperdynamic state was induced with noradrenaline. After these measurements were obtained in each hemodynamic state, CO was monitored continuously for 30 min using PulseCO and PiCCOc. Agreement was assessed using Bland-Altman analysis and intraclass correlation coefficients, and a trend score was determined for the continuous CO measurements. MEASUREMENTS AND MAIN RESULTS: There was good agreement among the 3 modalities of CO measurement in each hemodynamic state. The mean CIPAC-TD /CIPICCOTD bias was -0.04 ± 1.19 L/min/m(2) (limits of agreement, -2.37/1.93 L/min/m(2) ), and the mean CIPAC-TD /CILiDCO bias was -0.11 ± 1.55 L/min/m(2) (limits of agreement, -3.04/2.93 L/min/m(2) ). The mean CIPulseCO -CIPiCCOc bias was -0.04 ± 1.91 L/min/m(2) (limits of agreement, -1.95/1.87 L/min/m(2) ), which suggested good agreement. The CIPulseCO -CIPiCCOc trend score, calculated from 252 paired comparisons, was 93.3% positive after zone exclusion (∆CI < 15%). CONCLUSIONS: Both LiDCO and PiCCOTD agreed well with PAC-TD for the measurement of CO under different hemodynamic conditions. Moreover, PiCCOc appears to be an accurate method for monitoring continuous CO in dogs as its performance for measurement was similar to that of PulseCO.

[Clinical course and prognosis of patients with urolithiasis in a pediatric hospital]. / Curso clínico y pronóstico de pacientes con urolitiasis en un hospital pediátrico.

BACKGROUND: Nephrolithiasis is considered rare in pediatrics. Information available is not sufficient to establish its prognosis with certainty. The purpose of this research was to describe the signs, symptoms, complications and recurrence shown by pediatric patients with urolithiasis. METHODS: Medical records of pediatric patients with urolithiasis were identified for the period from 2003 to 2009. RESULTS: Sixty patients were included, out of which 26.2 % had some comorbidity and 31 % had a family history of lithiasis. The cardinal symptom was abdominal pain (65 %) and the most important sign was gross hematuria (46.6%). 72.9 % had some metabolic abnormality (predominantly hypercalciuria), 97.9 % received medical and 70 % surgical treatment. Diet modification was the most widely used medical treatment (95.7%). In 52 % initial treatment was surgical. During the follow-up, 18.7% recurred and 12 % had renal failure. CONCLUSIONS: The most common clinical conditions were abdominal pain, gross hematuria and dysuria. The most common metabolic cause was hypercalciuria, whereas the most common structural cause was ureteropielic stenosis. About 15 % recurred and 12 % were at risk of progression to kidney failure.

INTRODUCCIÓN: la litiasis renal se considera poco frecuente en pediatría. La información disponible no es suficiente para determinar con certeza su pronóstico. El objetivo de esta investigación fue describir los signos, síntomas, complicaciones y recurrencia que presentaron los pacientes pediátricos con urolitiasis. MÉTODOS: se identificaron los expedientes de pacientes pediátricos con urolitiasis atendidos en el Hospital de Pediatría del Centro Médico Nacional Siglo XXI, en el periodo de 2003 a 2009. RESULTADOS: se incluyeron 60 pacientes, de los cuales 26.2 % presentó alguna enfermedad concomitante y 31 % tenía antecedentes familiares de litiasis. El síntoma cardinal fue el dolor abdominal (65 %) y el signo principal fue la hematuria macroscópica (46.6 %). El 72.9 % tenía alguna alteración metabólica (predominó la hipercalciuria), 97.9 % recibió tratamiento médico y 70 %, tratamiento quirúrgico. La modificación en la dieta fue el tratamiento médico más empleado (95.7 %). En 52 % el tratamiento inicial fue quirúrgico. Durante el seguimiento, 18.7 % presentó recurrencia y 12 % falla renal. CONCLUSIONES: el cuadro clínico con mayor frecuencia fue el dolor abdominal, la hematuria macroscópica y la disuria. La causa metabólica más frecuente fue la hipercalciuria y la causa estructural, la estenosis ureteropiélica. Aproximadamente 15 % presentó recurrencia y 12 %, riesgo de progresión a insuficiencia renal.

Romifidine and low doses of tiletamine-zolazepam in dogs.

OBJECTIVE: To evaluate clinical effects of romifidine and low doses of tiletamine-zolazepam (TZ) in dogs. STUDY DESIGN: Randomized "blinded" cross-over study. ANIMALS: Six healthy beagle dogs (two males, four females). METHODS: In separate preliminary experiments dogs received intravenous (IV) tiletamine-zolazepam (TZ) at 1 and 2 mg kg(-1). For the main trial, dogs received romifidine (R) followed 5 minutes later by IV at six dose regimens: R40TZ1, R60TZ1, R80TZ1 (Romifidine at 40, 60, 80 µg kg(-1) and TZ at 1 mg kg(-1)), R40TZ2, R60TZ2 and R80TZ2 (Romifidine at 40, 60, 80 µg kg(-1) and TZ at 2 mg kg(-1)). Dogs underwent endotracheal intubation, but breathed room air. Cardiorespiratory variables were measured and arterial blood analyzed. Quality of sedation, duration of anaesthesia and time to recovery (TR) were recorded. Data were analysed by anova or Friedman test as relevant. RESULTS: Endotracheal intubation was possible with all romifidine/TZ combinations but not with TZ alone. Mean times (minutes) from TZ injection to return of pedal reflex were 1-3 minutes for TZ alone, and 9-17 minutes for romifidine combinations. In the main trial (romifidine combinations) mean time (minutes) to standing increased with increasing dosage (R40TZ1 13; R80TZ2 32). Five minutes after TZ administration, when compared with baseline arterial blood pressures and arterial carbon dioxide had increased, and respiratory rate, pH and arterial oxygen tensions decreased, these changes becoming statistically significant with the higher dose rates. One dog in R60TZ2 and three dogs in R80TZ2 became hypoxaemic. CONCLUSIONS AND CLINICAL RELEVANCE: Romifidine improves the quality and lengthens the duration of anaesthesia induced by TZ. The combination provides a suitable protocol for induction of or short-term anaesthesia in healthy dogs. However, the higher doses cause cardiovascular stimulation and respiratory depression, and precautions should be taken accordingly.

Histological study of the influence of plasma rich in growth factors (PRGF) on the healing of divided Achilles tendons in sheep.

BACKGROUND: The use of plasma rich in growth factors (PRGF) has been proposed to improve the healing of Achilles tendon injuries, but there is debate about the effectiveness of this therapy. The objective of the present study was to evaluate the histological effects of PRGF, which is a type of leukocyte-poor platelet-rich plasma, on tendon healing. METHODS: The Achilles tendons of twenty-eight sheep were divided surgically. The animals were randomly divided into four groups of seven animals each. The repaired tendons in two groups received an infiltration of PRGF intraoperatively and every week for the following three weeks under ultrasound guidance. The tendons in the other two groups received injections with saline solution. The animals in one PRGF group and one saline solution group were killed at four weeks, and the animals in the remaining two groups were killed at eight weeks. The Achilles tendons were examined histologically, and the morphometry of fibroblast nuclei was calculated. RESULTS: The fibroblast nuclei of the PRGF-treated tendons were more elongated and more parallel to the tendon axis than the fibroblast nuclei of the tendons in the saline solution group at eight weeks. PRGF-treated tendons showed more packed and better oriented collagen bundles at both four and eight weeks. In addition to increased maturation of the collagen structure, fibroblast density was significantly lower in PRGF-infiltrated tendons. PRGF-treated tendons exhibited faster vascular regression than tendons in the control groups, as demonstrated by a lower vascular density at eight weeks. CONCLUSIONS: PRGF was associated with histological changes consistent with an accelerated early healing process in repaired Achilles tendons in sheep after experimental surgical disruption. PRGF-treated tendons showed improvements in the morphometric features of fibroblast nuclei, suggesting a more advanced stage of healing. At eight weeks, histological examination revealed more mature organization of collagen bundles, lower vascular densities, and decreased fibroblast densities in PRGF-treated tendons than in tendons infiltrated with saline solution. These findings were consistent with a more advanced stage of the healing process. CLINICAL IMPLICATIONS: Based on the findings in this animal model, PRGF infiltration may improve the early healing process of surgically repaired Achilles tendons.

Cardiotrophin-1 reduces ischemia/reperfusion injury during liver transplant.

BACKGROUND: Orthotopic liver transplantation (OLT) is currently the elective treatment for advanced liver cirrhosis and acute liver failure. Ischemia/reperfusion damage may jeopardize graft function during the postoperative period. Cardiotrophin-1 (CT-1) has demonstrated cytoprotective properties in different experimental models of liver injury. There is no evidence to demonstrate its potential use in the prevention of the ischemia/reperfusion injury that occurs during OLT. The present study is the first report to show that the administration of CT-1 to donors would benefit the outcome of OLT. MATERIALS AND METHODS: We tested the cytoprotective effect of CT-1 administered to the donor prior to OLT in an experimental pig model. Hemodynamic changes, hepatic histology, cell death parameters, activation of cell signaling pathways, oxidative and nitrosative stress, and animal survival were analyzed. RESULTS: Our data showed that CT-1 administration to donors increased animal survival, improved cardiac and respiratory functions, and reduced hepatocellular injury as well as oxidative and nitrosative stress. These beneficial effects, related to the activation of AKT, ERK, and STAT3, reduced caspase-3 activity and diminished IL-1ß and TNF-α expression together with IL-6 upregulation in liver tissue. CONCLUSIONS: The administration of CT-1 to donors reduced ischemia/reperfusion injury and improved survival in an experimental pig model of OLT.

Experiencia de 15 años en ginecología pediátrica y de la adolescente en un hospital pediátrico de tercer nivel / Pediatric and adolescent gynecology in a tertiary level pediatric hospital: 15-years of experience

Introducción. La atención de los aspectos ginecológicos de las niñas y adolescentes se encuentra en fase de desarrollo en todo el mundo. Desde 1994, en el Hospital de Pediatría, Centro Médico Nacional Siglo XXI, se empieza a brindar atención ginecológica a la población pediátrica por un equipo multidisciplinario que conforma la Clínica de Ginecología Pediátrica. Se describen los motivos de consulta ginecológica de pacientes atendidas entre 1996-2011. Métodos. Se realizó una revisión de los registros de la consulta de la Clínica de Ginecología Pediátrica para identificar la edad de las pacientes al momento de la atención y los diagnósticos registrados en el periodo de estudio. Resultados. En el periodo de 15 años se otorgaron 3,200 consultas, es decir, en promedio de 226 por año. El 90% fueron para pacientes con enfermedad crónica; el resto fueron pacientes derivadas de segundo nivel de atención sin enfermedad de base. El motivo principal de consulta fue por alteraciones menstruales (58%), seguido por patologías vulvo-vaginales (16.1%), malformaciones uterinas y tumores de ovario y de útero. Conclusiones. La clínica de Ginecología ha permitido mejorar la calidad de atención de las niñas y adolescentes, en particular las que tienen una enfermedad de fondo. Es importante la detección de pacientes con problemas ginecológicos desde el primer nivel de atención.

Background. Pediatric and adolescent gynecology is undergoing a developmental phase worldwide. Since 1994, the Hospital of Pediatrics of the Centro Medico Nacional Siglo XXI (National Medical Center XXI Century) has been providing gynecological care for the pediatric population by a multidisciplinary team at the Pediatric Clinic of Gynecology. The objective of this study is to describe the reasons for gynecological consultation between 1996 and 2011. Methods. We reviewed the consultation records of the Pediatric Clinic of Gynecology to identify patients' ages at the time of care and diagnoses recorded during the study period. Results. During the 15-year period, 3,200 consultations were given, averaging 226 consultations per year: 90% of these consultations were for patients with chronic disease and 10% for patients referred from secondary medical care institutions but without underlying disease. The primary complaint was menstrual disorders (58%) followed by vulvovaginal pathology (16.1%), uterine malformations and tumors of the ovary and uterus. Conclusions. The Pediatric Clinic of Gynecology has improved the quality of care for young girls and adolescents, particularly those with an underlying disease. It is important to detect patients with gynecologic problems from a primary care setting.

A comparison of the effect of convection against diffusion in hemodynamics and cytokines clearance in an experimental model of septic shock.

BACKGROUND: Replacement therapies based on the use of convection have value for the removal of inflammatory mediators. Such therapies have been proposed for the management of septic shock, but diffusion has not proved useful in this scenario, unless high-flow membranes are used. The exact role of diffusion in these cases remains to be clarified because continuous replacement therapies are usually delivered with low-flow membranes and mixed convection-diffusion modalities. However, studies specifically addressing this problem have not been performed. Our aim was to define the efficacy of hemofiltration (convection) and hemodialysis (diffusion) in cytokine clearance and hemodynamic improvement in an experimental model of septic shock. METHODS: Shock was induced in 15 beagle dogs (weight 10-15 kg) by infusion of 1 mg/kg of ultrapure Escherichia coli lipopolysaccharide diluted in 20 mL saline for 10 minutes. Five animals were followed without interventions (controls), five animals were treated with convection (100 mL kg h) for 6 hours, and five animals were treated with diffusion (100 mL kg h) for 6 hours. RESULTS: All subjects in the control group died during the study, whereas all treated subjects survived. Mean arterial pressure, cardiac output, systolic variability volume, systemic vascular resistances, dPMax, and pulmonary compliance improved in treated subjects. However, the differences in mean arterial pressure and cardiac output were significant only in the convection group and not in the diffusion-treated group.Tumor necrosis factor α rose equally in all groups and decreased only in treated subjects. Interleukin 6 rose in the three groups but decreased only in the convection group and remained unchanged in the control and diffusion groups. CONCLUSION: Convection and diffusion improved survival and hemodynamic parameters in a septic shock model. Improvement was more pronounced with convection, a difference that may be explained by convective clearance of cytokines.

Bladder mucosal CO2 compared with gastric mucosal CO2 as a marker for low perfusion states in septic shock.

Recent reports indicate the possible role of bladder CO(2) as a marker of low perfusion states. To test this hypothesis, shock was induced in six beagle dogs with 1 mg/kg of E. coli lipopolysaccharide, gastric CO(2) (CO(2)-G) was measured with a continuous monitor, and a pulmonary catheter was inserted in the bladder to measure CO(2) (CO(2)-B). Levels of CO(2)-B were found to be lower than those of CO(2)-G, with a mean difference of 36.8 mmHg (P < 0.001), and correlation between both measurements was poor (r(2) = 0.16). Even when the correlation between CO(2)-G and ΔCO(2)-G was narrow (r(2) = 0.86), this was not the case for the relationship between CO(2)-B and ΔCO(2)-B (r(2) = 0.29). Finally, the correlation between CO(2)-G and base deficit was good (r(2) = 0.45), which was not the case with the CO(2)-B correlation (r(2) = 0.03). In our experience, bladder CO(2) does not correlate to hemodynamic parameters and does not substitute gastric CO(2) for detection of low perfusion states.

Alteraciones menstruales en adolescentes / Menstrual disorders in adolescents

Las alteraciones menstruales constituyen una causa de consulta ginecológica frecuente en adolescentes. Por esta razón, recientemente se ha propuesto que los ciclos menstruales sean considerados como un signo vital. Con el propósito de mejorar la calidad de atención de las adolescentes, en este artículo se describen los principales trastornos menstruales y la forma de abordarlos desde la perspectiva de los médicos de primer contacto. El sangrado uterino disfuncional, la dismenorrea, así como la amenorrea u oligomenorrea son las principales alteraciones en las adolescentes. La anamnesis y la exploración física constituyen la base para la evaluación de estas adolescentes; sin embargo, en ciertas pacientes, los estudios de laboratorio y radiológicos ayudan a complementar el diagnóstico. El sangrado uterino disfuncional es la causa más frecuente de los trastornos menstruales en la adolescencia; en general, esta condición se sospecha cuando la duración de la menstruación es mayor a 7 días y presenta una periodicidad menor a 21 días. Debido a que, primordialmente, se presenta por la inmadurez del eje hipotálamo-hipófisis, es habitual que ocurra en los primeros ciclos menstruales. El tratamiento médico está enfocado a disminuir la morbilidad y será suficiente en la mayoría de los casos. Por otra parte, la amenorrea es la condición donde hay ausencia de menstruación. Su tratamiento dependerá de la etiología, por lo que es necesario conocer si la amenorrea es primaria o secundaria. El síndrome de Turner es la causa más frecuente de amenorrea primaria en adolescentes sin desarrollo de caracteres sexuales secundarios. En la amenorrea secundaria, los estudios hormonales ayudan a orientar para descartar problemas de tiroides, hipófisis, trastornos de la alimentación o enfermedades crónicas que la ocasionen. Otro trastorno es la dismenorrea, que se clasifica en primaria y secundaria (o adquirida); la primaria ocurre en más de 80% de los casos y, a diferencia de la secundaria, no está asociada a alguna alteración, como la endometriosis. El tratamiento de elección para la dismenorrea primaria es el uso de antiinflamatorios no esteroideos mientras que para la secundaria éste dependerá de la etiología.

Menstrual disorders are one of the most common concerns in adolescent gynecology. Therefore, it has recently been proposed that the menstrual cycle should be considered as a vital sign. The main menstrual disorders are disfunctional uterine bleeding (DUB), dysmenorrhea and amenorrhea or oligomenorrhea. Clinical history and physical examination are the basis for the evaluation of these adolescents. In some patients, radiological and laboratory studies will complement the diagnosis. DUB is considered when the menstrual cycle lasts longer than 7 days and occurs more frequently than each 21 days. In adolescence, the immaturity of the hypothalamic-pituitary axis is the main cause. Normally, AUB is seen more often during the first menstrual cycles. Treatment aims to decrease morbidity and medical treatment is sufficient in most cases. Amenorrhea is defined as an absence of menstruation. Treatment depends on the etiology; therefore, it is initially necessary to determine whether it is primary or secondary amenorrhea. In adolescents without pubertal development, Turner's syndrome is the most common cause of primary amenorrhea. Hormonal studies will help determine the cause of secondary amenorrhea such as thyroid or pituitary disease or if it is related to eating disorders or a chronic disease. Dysmenorrhea is classified according to primary and secondary dysmenorrhea (or acquired). Primary dysmenorrhea occurs in >80% of all cases and, unlike secondary dysmenorrhea, is not associated with any abnormality such as endometriosis. The use of anti-inflammatory drugs is the treatment of choice for primary dysmenorrhea, whereas for secondary dysmenorrhea, treatment depends on the etiology.

Sedative effects of three doses of romifidine in comparison with medetomidine in cats.

OBJECTIVE: To compare the sedative effects of three doses of romifidine with one dose of medetomidine. STUDY DESIGN: Prospective blinded experimental cross-over. ANIMALS: Five adult Domestic Short Hair cats. METHODS: Cats were administered romifidine at 80, 120 and 160 µg kg(-1) or medetomidine at 20 µg kg(-1) (M20) intramuscularly (IM). Sedative effects were assessed for 3 hours by summing the scores given to posture, auditory response, resistance to positioning, muscular relaxation, and response to noxious stimuli, giving a total sedation score (TS). The area under the curve (AUC) of TS ≥7 (the score considered as clinically useful sedation) was calculated. Times to stages of sedation were determined. Some physiological parameters were measured. Data to compare treatments were analysed by anova or Kruskal-Wallis test as relevant. RESULTS: All treatments gave a TS considered clinically useful. There were no significant differences between treatments for times to onset of sedation, maximum TS reached, or AUC. Differences between romifidine treatments for other sedation parameters were not significant but the time to maximum TS and to recovery was shortest in M20. Heart rate (HR) fell significantly with all treatments and, although with M20 it recovered at 65 minutes, it remained significantly depressed for 3 hours after all romifidine treatments. Most cats vomited, and/or hypersalivated after all treatments. CONCLUSIONS: Doses of 80, 120 and 160 µg kg(-1) romifidine IM produce sedation in cats which is similar to that following medetomidine 20 µg kg(-1) . Recovery from sedation and of physiological parameters was quickest after M20. CLINICAL RELEVANCE: Doses of romifidine considerably lower than those investigated by previous authors give a clinically useful level of sedation, and their use might result in less side effects and a quicker recovery.

Evaluation of spectral entropy to measure anaesthetic depth and antinociception in sevoflurane-anaesthetised Beagle dogs.

The use of spectral entropy to determine anaesthetic depth and antinociception was evaluated in sevoflurane-anaesthetised Beagle dogs. Dogs were anaesthetised at each of five multiples of their individual minimum alveolar concentrations (MAC; 0.75, 1, 1.25, 1.5 and 1.75 MAC), and response entropy (RE), state entropy (SE), RE-SE difference, burst suppression rate (BSR) and cardiorespiratory parameters were recorded before and after a painful stimulus. RE, SE and RE-SE difference did not change significantly after the stimuli. The correlation between MAC-entropy parameters was weak, but these values increased when 1.75 MAC results were excluded from the analysis. BSR was different to zero at 1.5 and 1.75 MAC. It was concluded that RE and RE-SE differences were not adequate indicators of antinociception and SE and RE were unable to detect deep planes of anaesthesia in dogs, although they both distinguished the awake and unconscious states.