Revisión Sistemática Sobre el Funcionamiento Familiar en Familias con un Hijo con una Enfermedad Poco Frecuente / Systematic Review on Family Functioning in Families of Children With Rare Diseases

El presente estudio es una revisión sistemática de las investigaciones realizadas sobre el funcionamiento familiar en familias con niños con una enfermedad poco frecuente. La búsqueda se realizó en las bases de datos Pubmed, EBSCO y Google Académico, siguiendo los lineamientos PRISMA. Luego de aplicar los criterios de inclusión y exclusión a los artículos 460 encontrados inicialmente, un total de 55 artículos conformaron la muestra final. A partir del análisis de los resultados se establecieron las siguientes temáticas abordadas en relación al funcionameinto familiar: impacto del diagnóstico; función y responsabilidades del cuidador; funcionamiento familiar; impacto en la esfera emocional; efectos en la vida conyugal y social; estrategias de afrontamiento; familia, cuidados y sistema de salud. Los hallazgos de este estudio pueden proporcionar una justificación para considerar los factores asociados al funcionamiento familiar al momento de dar el diagnóstico de una EPOF y pensar un tratamiento.(AU)

The present study is a systematic review of the research on family functioning in families who have a child with a rare disease. The research was carried out using the databases Pubmed, EBSCO, and Google Scholar, following PRISMA guidelines. After applying the inclusion and exclusion criteria to the 460 articles initially found, a total of 55 articles made up the final sample. The following topics regarding family functioning were identified: impact of diagnosis; caregiver’s role and responsibilities; family functioning; impact on the emotional sphere; effects on marital and social life; coping strategies; family, and care and health system. The results of this study may provide justification for considering factors associated with family functioning when diagnosing a rare disease and deciding on treatment.(AU)

A Rare Presentation of Pseudo-Pneumoperitoneum Secondary to Chilaiditi Sign and Chilaiditi Syndrome in Two Pre-adolescent Females: A Case Series.

Chilaiditi sign is defined as the interposition of the colon or small intestine between the liver and the right diaphragm in the absence of symptoms. Chilaiditi syndrome refers to the condition where the Chilaiditi sign is associated with symptoms including abdominal pain. In this series, we present the cases of two pre-pubescent patients with these rare conditions.  A 10-year-old female with a history of autism, IgA deficiency, and constipation presented for gastrointestinal studies due to weight loss and constipation. An abdominal X-ray revealed bowel gas under the right hemidiaphragm and colonic interposition between the diaphragm and the liver, raising concerns for the Chilaiditi sign. She underwent a bowel cleanout, with studies revealing colonic dysmotility and compartmentalization of the sigmoid colon and rectum with the absence of coloanal reflex. A nine-year-old female with a history of constipation, developmental delay, and hypotonia presented with abdominal pain, vomiting, constipation, and decreased appetite. She also manifested tachypnea, abdominal distension, and abdominal tenderness, with an abdominal X-ray revealing a dilated colon interposed between the liver and diaphragm, confirming Chilaiditi syndrome. Prior gastrointestinal studies showed dilated and redundant sigmoid colon and dyssynergia. The treatment entailed rectal irrigations and catheter decompression, which led to the improvement of symptoms. Conservative treatment is the treatment of choice for patients with Chilaiditi sign or Chilaiditi syndrome. It is important to distinguish Chilaiditi syndrome, a common cause of pseudo-pneumoperitoneum, from true pneumoperitoneum, as this diagnosis warrants immediate surgical intervention. Surgical treatment is indicated when there are signs of bowel obstruction or ischemia and for cases with recurrent Chilaiditi syndrome. Raising awareness about this condition is important to reduce the incidence of misdiagnosed surgical emergencies and resulting exploratory surgeries, as well as to avoid high-risk colonoscopies. Chilaiditi sign and Chilaiditi syndrome are relatively uncommon entities, and their prevalence is very rare in the pediatric population. Hence, we believe this case series will contribute to providing clinical awareness of these major complications and avoiding invasive interventions due to the inaccurate diagnosis of these conditions as pneumoperitoneum.

Niveles de calidad de vida en niños, adolescentes y adultos con discapacidad y en su sistema familiar, durante la pandemia por COVID-19 en una muestra latinoaméricana / Nivells de qualitat de vida en nens, adolescents i adults amb discapacitat i en el seu sistema familiar, durant la pandèmia per COVID-19 en una mostra llatinoamericana / Quality of life levels in children, adolescents, and adults with disabilities and their family system during the COVID-19 pandemic in a Latin American sample

Este estudio se propuso describir la calidad de vida de niños y adultos con discapacidad, así como la calidad de vida de su sistema familiar en una muestra de Latinoamérica. Se utilizaron los instrumentos WHOQOL-BREF y PedsQL 4.0. Los resultados mostraron una baja calidad de vida de todos los grupos estudiados, principalmente en la dimensión social para adultos y niños, y en las dimensiones de preocupaciones y actividades diarias para su familia. Esta población parecería verse particularmente afectada durante la pandemia por COVID-19.(AU)

This study aimed to describe the quality of life of children and adults with disabilities, as well as the quality of life of their family system in a Latin American sample. The WHOQOL-BREF and PedsQL 4.0 instruments were used. The results showed low quality of life for all groups studied, mainly in the social dimension for adults and children, and in the dimensions of concerns and daily activities for their families. This population seems to be particularly affected during the COVID-19 pandemic.(AU)

Aquest estudi es va proposar descriure la qualitat de vida de nens i adults amb discapacitat, així com la qualitat de vida del seu sistema familiar a Llatinoamèrica. Es van utilitzar els instruments WHOQOL-BREF i PedsQL 4.0. Els resultats van mostrar una baixa qualitat de vida de tots els grups estudiats, principalment en la dimensió social per a adults i nens, i en les dimensions de preocupacions i activitats diàries per a la família. Aquesta població semblaria veure's particularment afectada durant la pandèmia per COVID-19.(AU)

Sedación paliativa con propofol en una unidad de cuidados paliativos de un hospital de tercer nivel / Palliative sedation in a palliative care unit at a tertiary hospital: is emotional or existential suffering frequent?

ANTECEDENTES Y OBJETIVOS: El aumento de pacientes paliativos genera más situaciones de sedación paliativa complicada. Múltiples factores influyen en la dificultad para realizar una sedación: tolerancia farmacológica, interacciones medicamentosas, afrontamiento emocional... En situaciones de resistencia a fármacos sedantes habituales se precisan otros fármacos como el propofol. El objetivo principal es revisar el uso de propofol en cuidados paliativos y describir varios pacientes que precisaron sedación paliativa con propofol en una Unidad de Cuidados Paliativos (UCP). MATERIAL Y MÉTODO: Estudio descriptivo retrospectivo. Se incluyeron, durante 10 meses, los pacientes que precisaron propofol por una sedación complicada y dos pacientes que fallecieron durante la inducción con propofol. Se registraron múltiples variables y comentarios de las historias clínicas para aclarar el motivo de precisar propofol. RESULTADOS: Existe poca literatura acerca del uso de propofol en cuidados paliativos, basada en casos clínicos aislados o series cortas de pacientes. Cuatro pacientes de nuestra revisión precisaron sedación con propofol. Estos casos fueron significativamente más jóvenes (55,5 años; p = 0,01) y la sedación fue más prolongada (7,5 días; p = 0,05). Los principales motivos para la sedación fueron sintomatología física múltiple o sufrimiento emocional. Todos los pacientes habían precisado dosis altas de otros fármacos sedantes y tuvieron mala respuesta a rescates de otros sedantes en las horas previas. Se propone una guía clínica para el uso de propofol en cuidados paliativos. CONCLUSIONES: - El propofol es un fármaco poco usado en cuidados paliativos, en general con buenos resultados. - Los pacientes que precisaron propofol por una sedación complicada fueron más jóvenes y tuvieron una sedación más prolongada. Destaca el intenso sufrimiento emocional. - Existen factores de sedación complicada o resistencia al midazolam que pueden ayudar a iniciar lo antes posible otro fármaco sedante más eficaz. - Se propone un protocolo para el uso de propofol en paliativos, recomendando comenzar con dosis bajas. - Es necesaria una mayor difusión en el empleo del propofol en una sedación complicada. - Son necesarios estudios que aclaren aspectos dudosos en el uso del propofol

BACKGROUND AND OBJECTIVES: The more patients cared for in palliative care, the more complicated situations arise - for example, palliative sedation due to a refractory symptom. Many factors may complicate a difficult sedation because of drug tolerance or interactions and psychological assessment. Resistance to usual sedative medications is frequent in these situations, and other pharmaceuticals like propofol, with limited use in a palliative care unit (PCU), are needed. The main objectives of this study were to research the available literature, and to report various PCU cases in a tertiary hospital where palliative sedation with propofol was needed. MATERIAL AND METHODS: A descriptive and retrospective study was performed during 10 months. Sedated patients with propofol were included. Also, two patients who died when induction doses of propofol were administered. Many variables were recorded. The clinical records of patients were also reviewed to elucidate the reason why propofol sedation was needed. RESULTS: Few studies exist examining the use of propofol in palliative care based on case reports or small series of cases. Four patients required sedation with propofol. These patients were younger (average age, 55.5, p = 0.01) and had a longer time between sedation onset and death (average time, 7.5 days, p = 0.05). The main symptoms motivating sedation were multifactorial and emotional suffering. All patients receiving propofol needed high-dose maintenance sedation with other sedative medications, and had responded minimally or not at all to rescue doses in previous hours. Updated guidelines for propofol use in PCUs have been drafted, with recommendations and dosages in case of complicated sedation. CONCLUSIONS: - Propofol use is limited in palliative care, usually with good results. Patients where propofol was needed were younger and sedation was longer. There was high emotional suffering in these patients. - There are factors responsible for complicated sedation or limited response to midazolam. Knowledge of these factors might help in providing earlier, more effective sedation. - Guidelines for propofol use in the PCU setting are proposed, recommending low maintenance doses initially. - A more widespread use of propofol as sedative medication in PCUs is recommended when complicated sedation occurs. - Further studies are needed to clarify many aspects of propofol use

Completeness, accuracy, and readability of Wikipedia as a reference for patient medication information.

OBJECTIVES: This study determined the completeness, accuracy, and reading level of Wikipedia patient drug information compared with the corresponding United States product insert medication guides. METHODS: From the Top 200 Drugs of 2012, the top 33 medications with medication guides were analyzed. Medication guides and Wikipedia pages were downloaded on a single date to ensure continuity of Wikipedia content. To quantify the completeness and accuracy of the Wikipedia medication information, a scoring system was adapted from previously published work and compared with the 7 core domains of medication guides. RESULTS: Wikipedia did not provide patient information that was as complete or accurate as the information within the medication guides: 14.73 out of 42 (SD 5.75). Wikipedia medication pages were written at a significantly higher reading level compared with medication guides (Flesch reading ease score 52.93 vs. 33.24 [P <0.001]; Flesch-Kincaid grade level 10.26 vs. 6.86 [P <0.001]). CONCLUSION: Wikipedia medication pages include incomplete and inaccurate patient information compared with the corresponding product medication guides. Wikipedia patient drug information was also written at reading levels above that of medication guides and substantially above the average United States consumer health literacy level. As the public use of Wikipedia increases, the need for educating patients about the quality of information on Wikipedia and the availability of adequate patient education resources is ever more important to minimize inaccuracies and incomplete information sharing.

Life history linked to immune investment in developing amphibians.

The broad diversity of amphibian developmental strategies has been shaped, in part, by pathogen pressure, yet trade-offs between the rate of larval development and immune investment remain poorly understood. The expression of antimicrobial peptides (AMPs) in skin secretions is a crucial defense against emerging amphibian pathogens and can also indirectly affect host defense by influencing the composition of skin microbiota. We examined the constitutive or induced expression of AMPs in 17 species at multiple life-history stages. We found that AMP defenses in tadpoles of species with short larval periods (fast pace of life) were reduced in comparison with species that overwinter as tadpoles and grow to a large size. A complete set of defensive peptides emerged soon after metamorphosis. These findings support the hypothesis that species with a slow pace of life invest energy in AMP production to resist potential pathogens encountered during the long larval period, whereas species with a fast pace of life trade this investment in defense for more rapid growth and development.

Parental oxytocin responses during skin-to-skin contact in pre-term infants.

OBJECTIVE: Maternal skin-to-skin contact (M-SSC) has been found to reduce adverse consequences of prematurity, however, its neurobiological mechanisms have been unknown. The purpose of the study was to examine oxytocin mechanism in modulating parental stress and anxiety during M-SSC and P-SSC (paternal SSC) with their pre-term infants. METHODS: Twenty-eight stable pre-term infants and their parents (triads) were recruited in a 2-day cross-over study and 26 mothers and 19 fathers completed the study protocol. Each triad was randomly assigned to one of the two sequences: M-SSC was conducted on day-1 and P-SSC on day-2; and P-SSC on day-1 and M-SSC on day-2. Parents' saliva samples for oxytocin and cortisol assays and visual analog anxiety levels were collected pre-SSC, 30-min during-SSC, and 30-min post-SSC. RESULTS: Both maternal and paternal oxytocin levels were significantly increased during-SSC from baseline. Maternal oxytocin dropped post-M-SSC, but paternal oxytocin continued to be maintained at a higher level during post-P-SSC. Both maternal and paternal cortisol levels significantly decreased during-SSC from baseline. Maternal cortisol continuously dropped post-M-SSC, but paternal cortisol increased post-P-SSC. Both mothers' and fathers' anxiety levels decreased during-SSC from baseline, and then increased post-SSC. Mother-father dyads also showed correlated or synchronized stress and anxiety responses in the NICU. CONCLUSION: M-SSC and P-SSC activated the oxytocin release and reduced stress and anxiety responses in mothers and fathers of pre-term infants. PRACTICE IMPLICATIONS: SSC plays a positive role in early post-partum period and patterns of maternal and paternal bio-behavioral responses to SSC with pre-term infants might be different.

Maternal and Paternal Knowledge and Perceptions Regarding Infant Pain in the NICU.

PURPOSE: To investigate parents' knowledge, self-efficacy, and satisfaction about infant pain in the NICU. DESIGN AND SAMPLE: A survey was conducted, and 80 parents (57 mothers and 23 fathers) participated in the study. MAIN OUTCOME VARIABLE: A researcher-developed questionnaire composed of 3 dimensions: parents' knowledge about infant pain, perception of self-efficacy regarding infant pain, and satisfaction with infant pain management. RESULTS: Most parents had adequate knowledge and moderate to high self-efficacy and were satisfied with infant pain management in the NICU. Mothers and fathers responded differently regarding self-efficacy and satisfaction, and parents' perceptions were correlated with infants' correct age and parents' own age. Most important, most parents wanted to be present and to be given the opportunity to comfort their infant during and after a painful procedure. Parents also preferred to receive formal/written information on infant pain.

Neonatal nurses' perceptions of pain management: survey of the United States and China.

Despite growing knowledge, neonatal pain remains unrecognized, undertreated, and generally challenging. A cross-sectional survey study was conducted to investigate neonatal nurses' perceptions, knowledge, and practice of infant pain in the United States and China, including 343 neonatal nurses (American nurses [n = 237]; Chinese nurses [n = 106]). Nurses' responses regarding neonatal pain reflected adequate knowledge in general pain concepts, but knowledge deficits related to several topics were found (e.g., preterm infants are more sensitive to pain and long-term consequences of pain). Most reported regular use of pain assessment tools, but fewer agreed that the tool used was appropriate and accurate. More American nurses (83%) than Chinese nurses (58%) felt confident in the use of pain medications, while more Chinese nurses (78%) than American nurses (61%) acknowledged the effectiveness of nonpharmacologic interventions. About half reported that pain in their units was well managed (American: 44.3%; Chinese: 55.7%), and less than half felt that pain guidelines/protocols were research-based (American: 42.6%; Chinese: 34.9%). Nurses' perceptions of well-managed pain in their units were significantly correlated with adequate education/training, use of accurate tools, and use of research-based protocols. Barriers to effective pain management included resistance to change, lack of knowledge, lack of time, fear of side effects of pain medication, and lack of trust in the tools. The survey reflects concerns that pain has not been well managed in many neonatal intensive care units in the United States and China. Further actions are needed to solve the issues of inadequate training, lack of clinically feasible pain tools, and absence of evidence-based guidelines/protocols.

Neonatal nurses' perceptions of pain assessment and management in NICUs: a national survey.

PURPOSE: The purpose of this survey was to investigate neonatal nurses' perceptions of knowledge and practice in pain assessment and management. METHODS: A convenience sample consisted of 237 neonatal nurses with a membership in National Association of Neonatal Nurses (NANN) and neonatal nurses in Connecticut who were not NANN members. A researcher-developed questionnaire, including 36 questions with Likert scale and 2 open-ended questions, was used. RESULTS: The nurses were knowledgeable, and about 50% felt that they received adequate training and continuing education on pain. Participants reported the use of pain assessment tools (81%) and felt confident in uses of pharmacologic (83%) and nonpharmacologic interventions (79%). More than half felt that the pain tool used in their unit was appropriate for neonates (65%) and was an accurate measure (60%). Fewer than half reported that pain was well managed (44%) and that their pain protocols were research evidence based (43%). CONCLUSIONS: Nurses' perceptions of well-managed pain were significantly correlated with training, use of appropriate and accurate pain tools, and clear and research-based protocols. Barriers to effective pain management emerged as resistance to change, lack of knowledge, perceived fear of side effects of pain medication and incorrect interpretation of pain signals, lack of time, and lack of trust in the pain assessment tools. Gaps exist in knowledge, evidence, and practice in neonatal assessment and management.

Ergonomic procedure for heel sticks and shots in Kangaroo Care (skin-to-skin) position.

Kangaroo Care (KC) has been recommended as a pain-reducing strategy in neonates; however, KC has not been widely used to minimize procedural pain caused in part by nurses'/phlebotomists' discomfort when positioning themselves and the infant for blood drawing and injections. Therefore, an ergonomically designed setup incorporating the use of KC was introduced into clinical practice to facilitate blood draws and injections. The step-by-step procedure used for heel sticks and injections is presented in this manuscript. After implementing the ergonomic step-by-step protocol, complaints of discomfort by nurses and phlebotomists ceased, and an additional benefit was that infant pain responses were significantly reduced.

A novel system for individually housing bullfrogs.

A researcher at the authors' institution needed to house adult bullfrogs (Rana catesbeiana) individually. The authors responded to this need by modifying 5-gallon plastic buckets to use for individual housing of bullfrogs. These buckets provided a simple, inexpensive housing system that successfully maintained healthy and behaviorally normal frogs. The authors describe the housing and husbandry of the bullfrogs in this individual housing situation and recommend it for use by others.

Widespread occurrence of the amphibian chytrid fungus Batrachochytrium dendrobatidis in the southeastern USA.

From 1999 to 2006, we sampled > 1200 amphibians for the fungal pathogen Batrachochytrium dendrobatidis (Bd) at 30 sites in the southeastern USA. Using histological techniques or PCR assays, we detected chytrid infection in 10 species of aquatic-breeding amphibians in 6 states. The prevalence of chytrid infection was 17.8% for samples of postmetamorphic amphibians examined using skin swab-PCR assays (n = 202 samples from 12 species at 4 sites). In this subset of samples, anurans had a much higher prevalence of infection than caudates (39.2% vs. 5.5%, respectively). Mean prevalence in ranid frogs was 40.7%. The only infected salamanders were Notophthalmus viridescens at 3 sites. We found infected amphibians from late winter through late spring and in 1 autumn sample. Although we encountered moribund or dead amphibians at 9 sites, most mortality events were not attributed to Bd. Chytridiomycosis was established as the probable cause of illness or death in fewer than 10 individuals. Our observations suggest a pattern of widespread and subclinical infections. However, because most of the sites in our study were visited only once, we cannot dismiss the possibility that chytridiomycosis is adversely affecting some populations. Furthermore, although there is no evidence of chytrid-associated declines in our region, the presence of this pathogen is cause for concern given global climate change and other stressors. Although presence-absence surveys may still be needed for some taxa, such as bufonids, we recommend that future researchers focus on potential population-level effects at sites where Bd is now known to occur.

Piriformis syndrome: a simple technique for US-guided infiltration of the perisciatic nerve. Preliminary results.

The piriformis syndrome is an uncommon cause of sciatica, buttock or thigh pain. Because of the deep location of the muscle and sciatic nerve, infiltration has traditionally been guided by electromyography, fluoroscopy, computed tomography or magnetic resonance imaging. The aim of the present study is to describe a simple technique for ultrasound (US)-guided perisciatic infiltration of corticosteroids and anaesthetic using the inferior gluteal artery as a landmark. This technique was used satisfactorily in ten patients. Although the series in the study is limited, the procedure for US-guided infiltration of the perisciatic nerve is a quick, simple, economical and effective technique and can be considered an alternative in the percutaneous treatment of the piriformis syndrome.

Geographical distribution of HCV genotypes in Mexico.

UNLABELLED: Chronic hepatitis C (CHC) is the second cause of endstage liver disease in our country and one of the main indications of liver transplantation. Hepatitis C virus (HCV) genotype is the principal prognostic factor and the determinant of the therapeutic scheme. In our country few data exist regarding the prevalence of HCV infection and genotype distribution in the Mexican Republic has not been determined. The aim of this study was to characterize the prevalence of the different HCV genotypes and to explore their geographical distribution. METHODS: Mexican patients with hepatitis C infection, detected throughout the country between 2003 and 2006, were included. All samples were analyzed by a central laboratory and Hepatitis C genotype was identified by Line Immuno Probe Assay in PCR positive samples (Versant Line Probe Assay Quest Diagnostics Nichols Institute, San Juan Capistrano CA). Data were analyzed according to the four geographical areas in Mexico. RESULTS: One thousand three hundred and ninety CHC patients were included. The most frequent genotype detected was genotype 1 (69%) followed by genotype 2 (21.4%) and genotype 3 (9.2%). Genotype 4 and 5 were infrequent. There was no subject infected with genotype 6. Genotype 1 and 2 exhibit very similar distribution in all geographical areas. Genotype 3 infected patients were more frequent in the North region (52%) compared with other areas:center-western (30%), center (17%), South-South east (1%) (p < 0.001). CONCLUSIONS: The most prevalent HCV genotype in Mexico is genotype 1. Geographical distribution of HCV genotypes in the four geographical areas in Mexico is not homogenous with a greater frequency of genotype3 in the north region. This difference could be related to the global changes of risk factors for HCV infection.

Determinación de las necesidades en atención farmacéutica de los inmigrantes del Campo de Gibraltar / Assessing the necessities in pharmaceutical care of immigrants in Campo de Gibraltar

Existen barreras específicas que condicionan la normal integración del colectivo inmigrante al sistema sanitario público y que están incrementadas en los inmigrantes en situación administrativa irregular. Los farmacéuticos pueden contribuir en la mejora de la atención sanitaria y farmacéutica de estos pacientes. Objetivo: Analizar la atención farmacéutica recibida y la accesibilidad a los medicamentos o prestación farmacéutica de los inmigrantes en situación administrativa irregular de la zona del Campo de Gibraltar. Método: Realizamos entrevistas estructuradas e individuales a inmigrantes personalmente. Se usaron cuestionarios en español o traducidos (a tres idiomas: árabe, inglés y francés), y validados (traducción y re-traducción). Dos traductores intérpretes realizaron las preguntas a los inmigrantes en una de las lenguas traducidas elegida por los entrevistados. Resultados: Los inmigrantes presentan resultados clínicos negativos de la medicación y dificultades económicas para adquirir los medicamentos. Para mejorar la atención farmacéutica que reciben demandan mayor información sobre enfermedades, el uso de los medicamentos y facilidades de acceso a los mismos. Conclusiones: Los inmigrantes no muestran preocupación por los problemas en la atención sanitaria o farmacéutica, por tener otras preocupaciones derivadas de su situación administrativa, sin embargo, constituyen un colectivo con mayor riesgo de presentar resultados clínicos negativos de la medicación . La aportación económica de los medicamentos constituye una barrera en el proceso de su asistencia sanitaria, subsanado por las ONG (AU)

Some specific barriers impede the normal integration of the immigrant in the healthcare system, and those barriers are augmented in non legal immigrants. Pharmacists can contribute in improving immigrants’ healthcare and pharmaceutical care. Objective: To analyze pharmaceutical care received and drug accessibility of non-legal immigrants in the area of Campo de Gibraltar. Methods: We carried out personal interviews to immigrants. Questionnaires translated into three languages (Arabian English and French) we revalidated (translation retro-translation) and used. Two translators interviewed the immigrants in one of those languages, the one chosen by the interviewed patient. Results: Immigrants present negative clinical outcomes associated with their medication and economic difficulties to acquire their medicines. To improve pharmaceutical care they are receiving, they demand more information on their illnesses, the use of their medicines, and bigger accessibility to them. Conclusions: Immigrants were not worried about health care or pharmaceutical care, because they have other major worries produced by their legal status. Nevertheless, they constitute a group with higher risk of presenting negative clinical outcomes of medication. Medicines’ expenditure constitutes a barrier to the healthcare process, reduced by NGOs (AU)

Human thrombin for treatment of pseudoaneurysms: comparison of bovine and human thrombin sonogram-guided injection.

OBJECTIVE: The purpose of this research was to review our experience and determine the success rate of percutaneous sonogram-guided human thrombin injection to treat iatrogenic femoral pseudoaneurysms and compare this with the results obtained with bovine thrombin injection. CONCLUSION: In our experience, the use of human thrombin for the treatment of iatrogenic femoral pseudoaneurysms is highly efficient (100%), the administered dose is significantly less than with bovine thrombin, and the risk for allergy is potentially lower. At our hospital, human thrombin has replaced bovine thrombin and is the first line of treatment for an iatrogenic pseudoaneurysm.

Cálculo del volumen hepático mediante TC espiral: utilidad en la planificación de la resección hepática mayor en pacientes no cirróticos / Utility of spiral computed tomography calculation of hepatic volume in the planning of major liver resection in noncirrhotic patients

Introducción. Mediante tomografía computarizada (TC) espiral es posible estimar la extensión de la resección hepática preoperatoriamente y seleccionar a los pacientes que presentan mayor riesgo de insuficiencia hepática posquirúrgica. El objetivo de este estudio es determinar de forma prospectiva la utilidad de la estimación del volumen hepático residual (VHR) mediante TC espiral en la planificación de la resección hepática mayor (RHM) en pacientes no cirróticos. Pacientes y método. Entre septiembre de 2000 y marzo de 2003 se calculó el volumen hepático total (VHT) y el VHR en 31 pacientes como parte de la planificación preoperatoria de una RHM. En los pacientes con un porcentaje de VHR/VHT menor del 25 por ciento se realizó una oclusión portal derecha preoperatoria. Resultados. En 7 pacientes, el porcentaje de VHR/VHT fue menor del 25 por ciento. En 2 posibles donantes vivos la resección estaba contraindicada. En los 5 restantes, tras la oclusión portal se consiguió suficiente hipertrofia del hígado izquierdo para indicar la RHM. Conclusión. La medida del VHR afectó a la decisión quirúrgica, al seleccionar los pacientes en los que es posible realizar una resección segura. En caso de quedar escaso hígado residual, las técnicas de embolización preoperatoria o ligadura intraoperatoria de vena porta han resultado ser un buen procedimiento para incrementarlo (AU)

Treatment of a radial artery pseudoaneurysm with ultrasound-guided percutaneous thrombin injection in a patient with Behçet's syndrome.

A 57-year-old man with Behçet's syndrome and recurrent deep vein thrombosis of the lower limbs presented with a painful, pulsating mass on the volar aspect of the radial edge of his left wrist. One month before this visit, he had had venous blood drawn from the same site. Using color Doppler sonography, we diagnosed an iatrogenic pseudoaneurysm of the left radial artery, which was then treated with an ultrasound-guided percutaneous injection of thrombin. A follow-up examination 6 months after the treatment revealed complete resolution of the pseudoaneurysm. To our knowledge, this is the first case report to demonstrate the use of this technique for thrombosis of a pseudoaneurysm in a patient with Behçet's syndrome. We believe that the safety, efficiency, speed, and minimal invasiveness of this procedure make it feasible for use as a treatment for peripheral pseudoaneurysms in such patients.

[Usefulness of sonographically guided thrombin injection of iatrogenic femoral pseudoaneurysms]. / Utilidad de la inyección de trombina dirigida por ecografía en los seudoaneurismas femorales iatrogénicos después del fracaso de la compresión.

BACKGROUND AND OBJECTIVE: In december 2000, we began to treat iatrogenic femoral pseudoaneurysms with direct thrombin injection under sonographic guidance after failed sonographically guided compression repair. Our purpose was to determine the success and complications rate of this technique. PATIENTS AND METHOD: We treated 50 patients who had iatrogenic femoral pseudoanerysms using direct thrombin injection. A 22-gauge spinal needle was placed into the psudoaneurysm lumen with sonographic guidance, and bovine thrombin (mean dose, 1200 units; range 200-7000 units) was injected under continous color Doppler sonographic visualization. Patient demographics clinical variables, and pseudoaneurysms characteristics were collected. RESULTS: The overall success rate was 98% (49/50). 30 patiens only required one thrombin injection, with mean thrombosis time of 4 s. When more than one injection was required the mean thrombosis time increased to 9,5 s. There was correlation between thrombosis time and the pseudoaneurysm size (p < 0.005); and between pseudoaneurysm size and the dose of thrombin used. No mayor sedation was needed and no recurrent pseudoaneurysms were observed. With the exception of a mild local eritema in one patient no complications were found. CONCLUSION: The thrombin injection under sonographic guidance is a quick, effective and secure method of therapy for the treatment of iatrogenic femoral pseudoaneurysms. Failures and complications are infrequents. At our hospital sonographically guided thrombin injection had replaced compression repair.