The feasibility of dexamethasone omission in weekly paclitaxel treatment for breast cancer patients.

OBJECTIVES: Patients with breast cancer who receive weekly paclitaxel therapy may experience deleterious effects associated with prophylactic dexamethasone use for 12 consecutive weeks. Approximately 90% of paclitaxel hypersensitivity reactions (HSRs) occur within the first 10 to 15 min of the first two infusions. We investigated the feasibility of dexamethasone withdrawal between weeks 3 and 12 (W3 and W12) in early stage breast cancer patients treated with weekly paclitaxel at the standard dose (80 mg/m2). METHODS: All patients received intravenous prophylaxis of dexamethasone 20 mg, ranitidine 50 mg, and diphenhydramine 50 mg in the first 2 weeks (W1 and W2) of treatment. Provided that no serious (G3/G4) HSRs events occurred, dexamethasone was omitted between W3 and W12, while ranitidine and diphenhydramine were continued. The primary end point was the incidence of any grade HSRs during the treatment period, and the secondary end points were quality of life and weight changes. RESULTS: Twenty-five patients were included in the study, and 300 infusion cycles of paclitaxel were evaluated for HSRs. The overall incidence of HSRs was 0.6% (2 events), and both of these events occurred in the first week. There were no incidents of serious HSRs or anaphylaxis and no G3 or G4 toxicities. Scores from the EORTC QLQ-C30 questionnaire did not change significantly for the global health status/quality of life scale or for the symptoms scales, although changes in scores differed significantly for the functional scales. There were no clinically relevant weight changes during the treatment period. CONCLUSIONS: Dexamethasone withdrawal from W3 to W12 in early stage breast cancer patients treated with weekly paclitaxel is feasible. The incidence of all grades of HSRs was comparable to that reported in trials with dexamethasone for 12 consecutive weeks, and no serious events (G3/G4) occurred. Studies with larger sample sizes are needed to confirm our results which are important, especially for patients for whom corticosteroids are contraindicated.

Effect of administration rate on propofol requirement in cats.

Objectives The objective of this study was to determine the effect of administration rate on propofol dose for induction of anesthesia and the effect of methadone on this dose. Methods This was a prospective, randomized, blinded clinical study. Forty male cats (mean ± SD age 1.5 ± 0.8 years) were admitted for orchiectomy. Cats were randomly allocated to receive acepromazine (0.05 mg/kg) with either methadone (MET; 0.3 mg/kg) or saline (SAL; 0.03 ml/kg). Each premedication group then received anesthetic induction with propofol at 5 (F) or 1.5 mg/kg/min (S), resulting in the following four groups: MET-F, SAL-F, MET-S and SAL-S. Sedation scores were assigned at 15 and 30 mins after premedication using a simple descriptive scale (SDS) and a visual analog scale (VAS). After assignment of sedation scores, respiratory frequency ( fR) was recorded, and anesthetic induction began and was continued until cats lost their palpebral reflexes and jaw tone, and the eye globe rotated ventromedially. The time for induction and the total amount of propofol needed was recorded, and intubation was then performed. After intubation, fR was also recorded. Results SDS and VAS sedation scores were low at 15 and 30 mins after premedication. There was no significant difference in sedation scores by time or between the groups at any time on any scale. The amount of propofol needed to achieve anesthetic induction was 5.3 ± 1.1 mg/kg in group MET-F, which was statistically lower when compared with the other three groups, which demonstrated no difference among them. Conclusions and relevance Premedication with acepromazine and methadone was not able to produce adequate sedation in healthy cats. The slow induction rate is not adequate for use in cats considering that all of the animals demonstrated excitement during anesthetic induction. The fast administration rate was able to produce adequate induction of anesthesia and reduce the amount of propofol needed to achieve intubation only when using methadone.

Effect of premedication with subcutaneous adrenaline on the pharmacokinetics and immunogenicity of equine whole IgG antivenom in a rabbit model.

Subcutaneous administration of a low dose of adrenaline is used to prevent the early adverse reactions (EARs) induced by snake antivenoms. We used a rabbit model to study the effect of premedication with adrenaline on the potential of antivenoms to exert therapeutic effects and to induce late adverse reactions. We found that premedication with adrenaline did not change the heart rate or blood pressure of normal rabbits, but reduced the rise in temperature in rabbits previously sensitized with antivenom. Pharmacokinetic studies suggest that premedication with adrenaline does not affect the ability of the antivenom to exert the initial control of envenomation nor the susceptibility of rabbits to develop recurrence of antigenemia and envenomation. Our results also indicate that it is unlikely that premedication with adrenaline decreases the incidence of late reactions induced by the antivenom administration, although it reduces the extent of early reactions.

When is the Best Time for the Second Antiplatelet Agent in Non-St Elevation Acute Coronary Syndrome?

Dual antiplatelet therapy is a well-established treatment in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), with class I of recommendation (level of evidence A) in current national and international guidelines. Nonetheless, these guidelines are not precise or consensual regarding the best time to start the second antiplatelet agent. The evidences are conflicting, and after more than a decade using clopidogrel in this scenario, benefits from the routine pretreatment, i.e. without knowing the coronary anatomy, with dual antiplatelet therapy remain uncertain. The recommendation for the upfront treatment with clopidogrel in NSTE-ACS is based on the reduction of non-fatal events in studies that used the conservative strategy with eventual invasive stratification, after many days of the acute event. This approach is different from the current management of these patients, considering the established benefits from the early invasive strategy, especially in moderate to high-risk patients. The only randomized study to date that specifically tested the pretreatment in NSTE-ACS in the context of early invasive strategy, used prasugrel, and it did not show any benefit in reducing ischemic events with pretreatment. On the contrary, its administration increased the risk of bleeding events. This study has brought the pretreatment again into discussion, and led to changes in recent guidelines of the American and European cardiology societies. In this paper, the authors review the main evidence of the pretreatment with dual antiplatelet therapy in NSTE-ACS.

When is the Best Time for the Second Antiplatelet Agent in Non-St Elevation Acute Coronary Syndrome? / Qual o Melhor Momento para o Segundo Antiplaquetário na Síndrome Coronariana Aguda sem Elevação do ST?

Abstract Dual antiplatelet therapy is a well-established treatment in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), with class I of recommendation (level of evidence A) in current national and international guidelines. Nonetheless, these guidelines are not precise or consensual regarding the best time to start the second antiplatelet agent. The evidences are conflicting, and after more than a decade using clopidogrel in this scenario, benefits from the routine pretreatment, i.e. without knowing the coronary anatomy, with dual antiplatelet therapy remain uncertain. The recommendation for the upfront treatment with clopidogrel in NSTE-ACS is based on the reduction of non-fatal events in studies that used the conservative strategy with eventual invasive stratification, after many days of the acute event. This approach is different from the current management of these patients, considering the established benefits from the early invasive strategy, especially in moderate to high-risk patients. The only randomized study to date that specifically tested the pretreatment in NSTE-ACS in the context of early invasive strategy, used prasugrel, and it did not show any benefit in reducing ischemic events with pretreatment. On the contrary, its administration increased the risk of bleeding events. This study has brought the pretreatment again into discussion, and led to changes in recent guidelines of the American and European cardiology societies. In this paper, the authors review the main evidence of the pretreatment with dual antiplatelet therapy in NSTE-ACS.

Resumo A indicação de dupla terapia antiplaquetária para o tratamento da síndrome coronariana aguda sem elevação do ST está bem estabelecida e é recomendação classe I (Nível de Evidência A) nas atuais diretrizes nacionais e internacionais. No entanto, essas mesmas diretrizes não são muito claras e consensuais quanto ao melhor momento para utilização do segundo antiplaquetário. As evidências sobre este tema são conflitantes e, após mais de uma década do uso do clopidogrel neste cenário, ainda há discussão se o pré-tratamento com dupla terapia antiplaquetária teria benefício de maneira rotineira, ou seja, quando aplicada sem conhecer a anatomia coronária. A recomendação de tratamentoupfront com clopidogrel na síndrome coronariana aguda sem elevação do ST se baseia em redução de eventos não fatais identificados em estudos que utilizavam estratégia conservadora, com eventual estratificação invasiva tardia, vários dias após o evento agudo. Essa abordagem é bastante diferente da que é feita atualmente, tendo em vista os benefícios já demonstrados da estratégia invasiva precoce nos pacientes de risco intermediário/alto. O único ensaio clínico randomizado que testou a hipótese do pré-tratamento na síndrome coronariana aguda sem elevação do ST sob a atual estratégia invasiva precoce utilizou o antiplaquetário prasugrel e mostrou que não houve benefício em redução de eventos isquêmicos, tendo, por outro lado, aumentado o risco de eventos hemorrágicos. Este estudo trouxe novamente o pré-tratamento à discussão e modificou recomendações nas atuais diretrizes das sociedades americana e europeia de cardiologia. Neste artigo, os autores apresentam uma revisão sobre as principais evidências do pré-tratamento com dupla terapia antiplaquetária na síndrome coronariana aguda sem elevação do ST.

Premedication with dexmedetomidine in pediatric patients: a systematic review and meta-analysis.

Premedication is important in pediatric anesthesia. This meta-analysis aimed to investigate the role of dexmedetomidine as a premedicant for pediatric patients. A systematic literature search was conducted to identify randomized controlled trials comparing dexmedetomidine premedication with midazolam or ketamine premedication or placebo in children. Two reviewers independently performed the study selection, quality assessment and data extraction. The original data were pooled for the meta-analysis with Review Manager 5. The main parameters investigated included satisfactory separation from parents, satisfactory mask induction, postoperative rescue analgesia, emergence agitation and postoperative nausea and vomiting. Thirteen randomized controlled trials involving 1190 patients were included. When compared with midazolam, premedication with dexmedetomidine resulted in an increase in satisfactory separation from parents (RD = 0.18, 95% CI: 0.06 to 0.30, p = 0.003) and a decrease in the use of postoperative rescue analgesia (RD = -0.19, 95% CI: -0.29 to -0.09, p = 0.0003). Children treated with dexmedetomidine had a lower heart rate before induction. The incidence of satisfactory mask induction, emergence agitation and PONV did not differ between the groups. Dexmedetomidine was superior in providing satisfactory intravenous cannulation compared to placebo. This meta-analysis suggests that dexmedetomidine is superior to midazolam premedication because it resulted in enhanced preoperative sedation and decreased postoperative pain. Additional studies are needed to evaluate the dosing schemes and long-term outcomes of dexmedetomidine premedication in pediatric anesthesia.

Premedication with dexmedetomidine in pediatric patients: a systematic review and meta-analysis

Premedication is important in pediatric anesthesia. This meta-analysis aimed to investigate the role of dexmedetomidine as a premedicant for pediatric patients. A systematic literature search was conducted to identify randomized controlled trials comparing dexmedetomidine premedication with midazolam or ketamine premedication or placebo in children. Two reviewers independently performed the study selection, quality assessment and data extraction. The original data were pooled for the meta-analysis with Review Manager 5. The main parameters investigated included satisfactory separation from parents, satisfactory mask induction, postoperative rescue analgesia, emergence agitation and postoperative nausea and vomiting. Thirteen randomized controlled trials involving 1190 patients were included. When compared with midazolam, premedication with dexmedetomidine resulted in an increase in satisfactory separation from parents (RD = 0.18, 95% CI: 0.06 to 0.30, p = 0.003) and a decrease in the use of postoperative rescue analgesia (RD = -0.19, 95% CI: -0.29 to -0.09, p = 0.0003). Children treated with dexmedetomidine had a lower heart rate before induction. The incidence of satisfactory mask induction, emergence agitation and PONV did not differ between the groups. Dexmedetomidine was superior in providing satisfactory intravenous cannulation compared to placebo. This meta-analysis suggests that dexmedetomidine is superior to midazolam premedication because it resulted in enhanced preoperative sedation and decreased postoperative pain. Additional studies are needed to evaluate the dosing schemes and long-term outcomes of dexmedetomidine premedication in pediatric anesthesia.

Remifentanil versus morphine-midazolam premedication on the quality of endotracheal intubation in neonates: a noninferiority randomized trial.

OBJECTIVE: To compare remifentanil and morphine-midazolam for use in nonurgent endotracheal intubation in neonates. STUDY DESIGN: In this prospective noninferiority randomized trial, newborns of gestational age ≥28 weeks admitted in the neonatal intensive care unit requiring an elective or semielective endotracheal intubation were divided into 2 groups. One group (n = 36) received remifentanil (1 µg/kg), and the other group (n = 35) received morphine (100 µg/kg) and midazolam (50 µg/kg) at a predefined time before intubation (different in each group), to optimize the peak effect of each drug. Both groups also received atropine (20 µg/kg). The primary outcome was to compare the conditions of intubation, and the secondary outcome was to compare the duration of successful intubation, physiological variables, and pain scores between groups for first and second intubation attempts. Adverse events and neurologic test data were reported. RESULTS: Intubation with remifentanil was not inferior to that with morphine-midazolam. At the first attempted intubation, intubation conditions were poor in 25% of the remifentanil group and in 28.6% of the morphine-midazolam group (P = .471). For the second attempt, conditions were poor in 28.6% of the remifentanil group, compared with 10% of the morphine-midazolam group (P = .360). The median time to successful intubation was 33 seconds (IQR, 24-45 seconds) for the remifentanil group versus 36 seconds (IQR, 25-59 seconds) for the morphine-medazolam group (P = .359) at the first attempt and 45 seconds (IQR, 35-64 seconds) versus 56 seconds (IQR, 44-68 seconds), respectively, for the second attempt (P = .302). No significant between-group difference was reported for hypotension, bradycardia, or adverse events. CONCLUSION: In our cohort, remifentanil was at least as effective as the morphine-midazolam regimen for endotracheal intubation. Thus, premedication using this very-short-acting opioid can be considered in urgent intubations and is advantageous in rapid extubation.

The antidiabetic effect of MSCs is not impaired by insulin prophylaxis and is not improved by a second dose of cells.

Type 1 diabetes mellitus (T1D) is due to autoimmune destruction of pancreatic beta-cells. Previously, we have shown that intravenously administered bone marrow-derived multipotent mesenchymal stromal cells (MSCs) allows pancreatic islet recovery, improves insulin secretion and reverts hyperglycemia in low doses streptozotocin (STZ)-induced diabetic mice. Here we evaluate whether insulin prophylaxis and the administration of a second dose of cells affect the antidiabetic therapeutic effect of MSC transplantation. Insulitis and subsequent elimination of pancreatic beta-cells was promoted in C57BL/6 mice by the injection of 40 mg/kg/day STZ for five days. Twenty-four days later, diabetic mice were distributed into experimental groups according to if they received or not insulin and/or one or two doses of healthy donor-derived MSCs. Three and half months later: glycemia, pancreatic islets number, insulinemia, glycated hemoglobin level and glucose tolerance were determined in animals that did not received exogenous insulin for the last 1.5 months. Also, we characterized MSCs isolated from mice healthy or diabetic. The therapeutic effect of MSC transplantation was observed in diabetic mice that received or not insulin prophylaxis. Improvements were similar irrespective if they received one or two doses of cells. Compared to MSCs from healthy mice, MSCs from diabetic mice had the same proliferation and adipogenic potentials, but were less abundant, with altered immunophenotype and no osteogenic potential.Our preclinical results should be taken into account when designing phase II clinical trials aimed to evaluate MSC transplantation in patients with T1D. Cells should be isolated form healthy donor, insulin prophylaxis could be maintained and a second dose, after an elapse of two months, appears unnecessary in the medium-term.

Propofol versus midazolam for intubating preterm neonates: a randomized controlled trial.

OBJECTIVE: The ideal combination of premedication for neonatal tracheal intubation has not been established. The aim of this preliminary study was to compare the intubation conditions between propofol and midazolam as premedication for tracheal intubation in neonates. STUDY DESIGN: A double-blinded, randomized, controlled trial was performed, and 20 preterm neonates (28 to 34 week) underwent tracheal intubation following the use of remifentanil associated to either propofol (n = 10) or midazolam (n = 10). Intubation conditions were scored according to a four-point scale. RESULT: According to the main outcome measured (identification of a 50% difference in the intubation conditions), there were no differences regarding the number of attempts and the overall intubation conditions among the groups (P = 1.00). CONCLUSION: Both combinations of premedications have no differences regarding the quality of intubation, which could be of clinical interest. Besides midazolam, propofol could be a valid alternative as hypnotic for premedication for endotracheal intubation in neonates.

Riesgos de la preparación colónica con fosfato sódico / Risks of sodium phosphate colonic cleansing

Introducción. La difusión de la colonoscopía incrementó el uso del fosfato sódico oral (NaP). Se han notificado complicaciones como deshidratación, hipotensión, insuficiencia renal aguda e insuficiencia renal crónica con nefrocalcinosis, y hasta casos fatales de hiperfosfatemia severa. Basado en la evidencia científica actual, en el presente trabajo se presentan los riesgos y contraindicaciones de la utilización de laxantes de fosfato sódico y cómo evitarlos. Material y métodos. Se realizó un análisis bibliográfico sobre el tema en PubMed y Google Advanced Search, de publicaciones en español e inglés, en el que se incluyen ensayos clínicos, revisiones bibliográficas, cartas, editoriales, guías prácticas, meta análisis y revisiones Cochrane. Resultados. Las complicaciones por NaP se relacionan con patologías que incrementan la absorción del fosfato, con hiperparatiroidismo y con disfunción renal. También se asocian con dosis mayores a 60 g y con intervalos entre las tomas menores a 5 h, y son facilitadas por la deshidratación. Se reportaron algunos casos en los que no se respetaron estas condiciones. La insuficiencia renal por nefrocalcinosis es irreversible. Conclusión. Se debe realizar una selección adecuada de los pacientes para evitar el uso de NaP en aquellos que presenten riesgo de desarrollar hiperfosfatemia o insuficiencia renal; además, es necesario efectuar una correcta hidratación oral, no administrar más de 60 g de NaP y evitar que los intervalos entre las dosis sean menores a 5 h.

Introduction. The spread of colonoscopy has increased the use of oral sodium phosphate (OSP). Complications such as dehydration, hypotension, acute renal failure and chronic kidney disease with nephrocalcinosis and even fatal cases of severe hyperphosphatemia have been reported. The risk and contraindications of OSP use and the ways to avoid them are shown in this paper according to the scientific evidence. Material and methods. Bibliographic analysis on this subject is carried in PubMed and Google Advanced Search, publications in Spanish and English, including clinical trials, bibliographic revisions, letters, editorials, practical guidelines, meta analyses and Cochrane reviews. Results. OSP complications are related to pathologies that increase its absorption, with hyperparathyroidism and with kidney impairment. They are also associated with OSP doses >60 g and with dose intervals <5 h and are facilitated by dehydration. Some cases have been reported in patients without those conditions. Nephrocalcinosis kidney disease is irreversible. Conclusion. Adequate patient selection is mandatory to avoid OSP in patients with risk of developing hyperphosphatemia or renal impairment; proper oral hydration is also essential as is not administering more than 60 g OSP, and avoiding dose intervals <5 h.

Introdução. A difusão da colonoscopia aumentou o uso de fosfato de sódio oral (NaP). Têm sido relatadas complicações como desidratação, hipotensão, insuficiência renal aguda e insuficiência renal crônica com nefrocalcinose, e até casos fatais de hiperfosfatemia severa. Com base na evidência científica atual, são apresentados os riscos e contraindicações da utilização de laxantes de fosfato de sódio e a forma de evitá-los. Material e métodos. Foi feita uma análise bibliográfica sobre o tema (publicações em espanhol e inglês) em PubMed e Google Advanced Search que abrange ensaios clínicos, revisões bibliográficas, cartas, editoriais, guias práticos, meta-análise e revisões Cochrane. Resultados. As complicações por NaP se associam a patologias que aumentam a absorção de fosfato, a hiperparatiroidismo e a disfunção renal. Também se associam a doses maiores que 60 g e intervalos entre as tomadas menores que 5 h, e são facilitadas pela desidratação. São relatados casos em estas condições não foram respeitadas. A insuficiência renal por nefrocalcinose é irreversível. Conclusão. Deve ser feita uma seleção adequada dos pacientes para evitar o uso de NaP naqueles com risco de desenvolver hiperfosfatemia ou insuficiência renal; além disso, é necessário realizar uma correta hidratação oral, não administrar mais do que 60 g de NaP e evitar intervalos entre as doses menores que 5 h.

Pretreatment with Cry1Ac protoxin modulates the immune response, and increases the survival of Plasmodium-infected CBA/Ca mice.

Malaria is a major global health problem that kills 1-2 million people each year. Despite exhaustive research, naturally acquired immunity is poorly understood. Cry1A proteins are potent immunogens with adjuvant properties and are able to induce strong cellular and humoral responses. In fact, it has been shown that administration of Cry1Ac protoxin alone or with amoebic lysates induces protection against the lethal infection caused by the protozoa Naegleria fowleri. In this work, we studied whether Cry1Ac is able to activate the innate immune response to induce protection against Plasmodium berghei ANKA (lethal) and P. chabaudi AS (nonlethal) parasites in CBA/Ca mice. Treatment with Cry1Ac induced protection against both Plasmodium species in terms of reduced parasitaemia, longer survival time, modulation of pro- and anti-inflammatory cytokines, and increased levels of specific antibodies against Plasmodium. Understanding how to boost innate immunity to Plasmodium infection should lead to immunologically based intervention strategies.

Anestesia general en odontología / General anesthesia in dentistry

En el presente la aplicación de anestesia general en odontología existe sobre una base incierta y muy confusa. La causa primaria de estas líneas es por el gran número de especialistas odontológicos que están involucrados en su desarrollo. Es imperativo que el Odontólogo que realice un tratamiento bajo anestesia general, tenga en cuenta que este procedimiento debe ser considerado como una disciplina distinta para asegurar en el paciente un cuidado consistente, predecible y de alta calidad. Este mensaje está escrito para presentar la anestesia general en odontología en términos fisiológicos racionales e indicaciones clínicas y fines terapéuticos de manera que puedan ser utilizados universalmente por las diferentes espcecialidades de la odontología, siendo un procedimiento de manejo multidisciplinario porque se ofrece al paciente un tratamiento integral odontológico bajo anestesia general en forma completa, es decir en la mayoría de las veces en una sola sesión. El éxito de esta terapia requiere procedimientos estandarizados para brindar un cuidado integral en el paciente y a la vez delinear esquemas, parámetros, métodos y metas en bejeficio de los mismos. Así como la Anestesia General en Odontología requiere pasos y pautas bien definidas, también debe considerarse una evaluación y premedicación adecuadas, es así como en este artículo se darán algunos parámetros al respecto

Xilazina como pré-medicação para anestesia com tiopental sódico em cães / Xylazine as a premedication for thiopental sodium anaesthesia in the dogs

A xilazina produz um bom efeito sedativo-analgésico quando associado à drogas anestésicas. O tiopental sódico é um barbitúrico de curta duração que produz sonolência, sedação e hipnose. O objetivo deste trabalho é verificar a eficiência da associação da xilazina como pré-medicação e do tiopental sódico na manutenção da anestesia, em cães. Foram usados 32 cães sem raça definida, adultos, machos e com peso entre 8 e 10 kg, que foram submetidos à procedimento operatório no esôfago cervical. A dose média de xilazina administrada foi de 3,8 mg/kg e de tiopental sódico foi de 7,7 mg/kg. Não houve necessidade de intubação endotraqueal e não ocorreu óbito relacionado com as medicações anestésicas. Concluindo, o procedimento anestésico descrito é de fácil execução, é seguro e diminui o estresse do animal.

Déficit congénito de antitrombina III: reporte de un caso clínico de una paciente sometida a cirugía oral / Congenital deficiency of antithrombine III: report of a patient submitted to oral surgery

El déficit congénico de antitrombina III (AT III) es una patología de escasa prevalencia que se manifiesta clínicamente por fenómenos tromboembólicos que ocurren principalmente en territorio venoso, especialmente de las extremidades inferiores. En estos pacientes la incidencia de trombosis venosa aumenta con la edad, al igual que al someter a los pacientes a factores disponibles como son cirugía, parto, trauma, reposo prolongado, etc. Por esta razón la terapia profiláctica-anticoagulante en estos enfermos es necesaria cuando debe someterse a una cirugía. La administración de AT III exógenal, sola o junto a heparina, aparece como el tratamiento profiláctico más efectivo en prevenir los eventos trombólicos. En el presente trabajo se describe la evolución y manejo terapéutico de una paciente portadora de un déficit congénito de AT III, en relación a su segundo parto y cirugía de terceros molares

Efectividad analgésica entre Ketorolaco y Alfentanil durante la sedación con Midazolam para colonoscopia / Comparing analgesic effects during colonoscopy of Ketorolac versus Alfentanil in patients sedated with Midazolam

Se realizó un ensayo clínico controlado con muestreo aleatorio simple con 65 pacientes divididos en 2 grupos para valorar los efectos analgésicos del ketorolaco y del alfentanil durante la colonoscopia. Todos ellos premedicados con butilhioscina y sedados con midazolam. Se empleo una escala ordinal para la medición del dolor, la Escala de Lawrence para la sedación, se midio la saturación de Oxígeno en los diversos segmentos del colon y los efectos secundarios de los medicamentos. Se concluye que el ketorolaco provee de una adecuada analgesia para la realización de la colonoscopia en algunos pacientes, sin embargo el alfentanil demostró proveer mejor analgesia y mayor grado de sedación

[Results of preoperative preparation with mannitol in colorectal surgery. January-December 1995]. / Resultados de la preparación preoperatoria con manitol en cirugía colorrectal. Enero-diciembre, 1995.

A study on the results obtained in 20 patients selected by the simple randomized method, who were preoperatively prepared for colorectal surgery with the oral administration of manitol and complementary antimicrobial therapeutics at the ASaturnino Lora@ Provincial Teaching Hospital, in Santiago de Cuba, from January to December, 1995, was conducted aimed at evaluating the results attained with the use of manitol in the preoperative preparation for colorectal surgery, determining its complications, analyzing its advantages, and assessing the patient, nurse and surgeon's opinion about the new procedure. The following variables were taken into account: age, preoperative diagnosis and previous operations. The percentage statistical method was used. Most of the patients were elderly, who were able to undergo surgery. There were no complications in connection with the preoperative preparation, which has the following advantages: it is simpler and more efficient that the traditional use of enemas, it is easy to apply, it saves time and resources on reducing the preoperative stay, it is considered as more comfortable for patients and nurses, and it is much more economic and effective, which was proved by surgeons during the operation.

Absceso hepático de origen hidatídico: resultado de la cirugía de urgencia / Liver abscess of hydatidic origin: results of the emergency surgery

La hidatidosis constituye una zoonosis de importancia en Chile, su frecuencia es mayor en aquellas regiones donde es importante la actividad agrícola y ganadera. La localización hepática de la enfermedad es la más común y se relaciona con una incidencia significativa de complicaciones y mortalidad. Se efectúa el análisis de una serie prospectiva de pacientes portadores de hidatidosis hepática complicada como absceso hepático (AHH), tratados con carácter de urgencia en la Unidad de Emergencia del Hospital Regional de Temuco entre mayo de 1994 y abril de 1996. En ellos se efectuó un tratamiento agresivo de su patología, que consistió en terapia antimiocrobiana y cirugía de urgencia (quistectomía subtotal con o sin drenaje de la via biliar dependiendo de las condiciones de cada paciente en particular). Se realizó un seguimiento clínico, de laboratorio y ecotomográfico para constatar la evolución postoperatoria de los pacientes