Hematoma intrapleural e hiperinsuflación del pulmón nativo en paciente con trasplante pulmonar / Intrapleural hematoma and hyperinsuflation of the native lung in lung transplant recipients

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Hematoma subdural de repetición / Recurrent subdural hematoma

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Results After Implementing a Program of Intensive Care to Facilitate Organ Donation.

A program of intensive care to facilitate organ donation (ICOD) represents one of the ways to increase donation rate following brain death (BD). OBJECTIVES: To analyze the impact and cost-effectiveness of setting up an ICOD strategy. METHOD: Retrospective cases of BD donors from the Spanish region La Rioja were included, after implementation of an ICOD program (2011-2016). This was activated in cases of devastating neurologic injury where treatment had been rejected following therapeutic futility criteria. Follow-up of kidney and liver transplant patients with the obtained grafts was carried out. RESULTS: A total of 134 potential donors were admitted to intensive care unit (ICU), of whom 106 were selected under the ICOD strategy. BD was diagnosed in 108 cases (25 conventional donors, 83 ICOD donors). A total of 21.6% of potential ICOD donors did not evolve to BD, subsequently dying in the ICU. ICOD cases accounted for more than 50% of donors each year. This cohort had an average stay of 2.4 days in the ICU and accounted for a small proportion of total ICU admissions. A total of 68 (81.9%) ICOD donors were finally effective and 146 grafts were extracted, the majority being abdominal organs (liver and kidney). Probability of survival 1 year after liver transplant (ICOD donor) was 90.9%, with 1 case of primary graft failure. Survival 1 year after kidney transplant (ICOD donor) was 92.7%. No differences were detected in survival rates of kidney and liver transplant patients regarding donor type (ICOD vs conventional). CONCLUSIONS: Implementation of an ICOD program allows an increase in the pool of valid and quality grafts for transplant as well as implying a minimum consumption of intensive medicine resources. The results in transplant patients support this strategy.

Edema pulmonar ex vacuo tras drenaje de neumotórax / Pulmonary edema ex vacuo after drainage of pneumothorax

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Inter- and intra-patient variability in breakthrough pain episodes of opioid-treated patients with underlying chronic pain. An observational, prospective and multicenter study / Variabilidad inter- e intra-individual en pacientes con dolor irruptor tratados con opioides. Estudio observacional, prospectivo y multicéntrico

Objective: Since, to date, there are few epidemiological data assessing the diversity in the characteristics of breakthrough pain episodes, the present study was performed to assess the intra-individual variability in the episodes of breakthrough pain in patients with underlying chronic pain controlled with opioids. Methods: An observational, prospective and multicenter study (CADI study) was conducted in the context of the routine clinical practice of Spanish pain specialists recruiting opioidtreated patients with underlying chronic pain. Data were recorded in three visits (baseline, at 7 and 28 days post-inclusion) and by the patient on a patient´s diary card, specifically designed to characterise the first 8 breakthrough pain episodes (type, intensity –using 100 mm Visual Analog Scale– and duration of pain), to assess the intra-individual and inter-individual variability in the intensity, duration and typology of episodes of breakthrough pain. Results: 50 opioid-treated patients were recruited (23 with oncologic pain and 27 with non oncologic pain, mean age of 61.1 years, 62 % females). For all three parameters, inter-patient variability was higher than intra-patient variability throughout the episodes. Nevertheless, we found intra-patient variability in maximum pain intensity, pain intensity at the end of the episode, pain relief and duration of the episode. Conclusions: This is the first study to quantify the intrapatient variability of breakthrough pain. The results show a great variability in terms of intensity and duration of the episode and its typology. Although inter-patient variability is higher, the intra-patient variability is important enough to be taken into account in optimizing the approach and treatment selection (AU)

Objetivos: Debido a los pocos datos epidemiológicos existentes que evalúen la diversidad de las características de los episodios de dolor irruptivo, se realizó el presente estudio, cuyo principal objetivo fue evaluar la variabilidad intraindividual de las crisis de dolor irruptivo en pacientes con dolor crónico controlado con opioides. Métodos: Este estudio observacional, prospectivo y multicéntrico (estudio CADI) se llevó a cabo en el contexto de la práctica clínica habitual, en Unidades del Dolor de España, con la participación de pacientes tratados con opioides para el dolor crónico. Los datos fueron registrados en tres visitas (basal, a los 7 y 28 días después de la inclusión) y por el propio paciente, en un Diario del Paciente, específicamente diseñado para caracterizar los primeros 8 episodios de dolor irruptivo (tipo, intensidad −utilizando la Escala Analógica Visual (EVA)− y duración del dolor) con el objetivo de evaluar la variabilidad intraindividual e interindividual en la intensidad, duración y tipología de los episodios de dolor irruptivo. Resultados: Se reclutaron 50 pacientes, 23 con dolor oncológico y 27 con el dolor no oncológico (edad media de 61,1 años; 62 % de mujeres). Aunque para los tres parámetros medidos, la variabilidad entre pacientes fue mayor que la variabilidad intrapaciente, la variabilidad intraindividual fue significativa en la evaluación de la máxima intensidad del dolor, la intensidad del dolor al final del episodio, el alivio del dolor y la duración del episodio de dolor irruptivo. Conclusiones: Este es el primer estudio que cuantifica la variabilidad intraindividual del dolor irruptivo. Los resultados muestran una gran variabilidad en cuanto a la intensidad y la duración del episodio y su tipología. Aunque la variabilidad entre pacientes es mayor, la variabilidad intrapaciente es lo suficientemente importante como para ser tenida en cuenta para la mejor aproximación y selección del tratamiento (AU)

Diagnosis and risk stratification in patients with anti-RNP autoimmunity.

INTRODUCTION: Anti-RNP autoantibodies occur either in mixed connective tissue disease (MCTD) (with a frequently favorable prognosis), or in systemic lupus erythematosus (SLE) cases with aggressive major organ disease. It is uncertain how to assess for the risk of severe disease in anti-RNP + patients. METHODS: Following institutional review board-approved protocols, clinical data and blood were collected from patients with known or suspected anti-RNP autoimmunity and normal controls in a cohort study. Samples were screened for parameters of immune activation. Groups were compared based on clinical diagnoses, disease classification criteria, disease activity and specific end-organ clinical manifestations. RESULTS: Ninety-seven per cent of patients satisfying Alarcon-Segovia MCTD criteria also met Systemic Lupus International Collaborating Clinic (SLICC) SLE criteria, while 47% of the anti-RNP + SLE patients also met MCTD criteria. Among SLICC SLE patients, MCTD criteria were associated with reduced rates of renal disease (odds ratio (OR) 4.3, 95% confidence interval (CI) 1.3-14.0), increased rates of Raynaud's phenomenon (OR 3.5, 95% CI 1.3-9.5) and increased serum B-cell maturation antigen, transmembrane activator and CAML interactor and TNFα levels. Circulating immune markers and markers of type I interferon activation were not effective at distinguishing clinical subgroups. CONCLUSIONS: Among anti-RNP patients, the question of MCTD versus SLE is not either/or: most MCTD patients also have lupus. MCTD classification criteria (but not a broad set of immune markers) distinguish a subset of SLE patients at reduced risk for renal disease.

Neuropatía óptica isquémica en el postoperatorio de cirugía de raquis lumbar / Ischemic optic neuropathy after lumbar spine surgery

La causa más frecuente de complicaciones visuales enel postoperatorio de cirugía no oftalmológica es la neuropatía óptica isquémica. La incidencia es variabledependiendo de las series publicadas, en la mayoría deellas, la cirugía de raquis realizada en decúbito pronoaparece implicada.Exponemos el caso de una mujer de 47 años que trasuna artrodesis lumbar, con unas pérdidas hemáticas deunos 900 mL, desarrolló una ceguera prácticamentetotal en el ojo izquierdo. En el examen oftalmológicorealizado, fondo de ojo, angiofluoresceingrafía, campimetría y potenciales evocados visuales se diagnosticó una neuropatía óptica retrolaminar, que evolucionó desfavorablemente

Ischemic optic neuropathy is the most common cause ofvisual complications after non-ophthalmic surgery. Theincidence has varied in different case series, but prone-position spine surgery appears to be involved in most of the reports.We present the case of a 47-year-old woman whodeveloped near total blindness in the left eye followinglumbar spine fusion surgery involving the loss of 900 mLof blood. An ophthalmic examination including inspectionof the ocular fundus, fluorescein angiography, and visualevoked potentials returned a diagnosis of retrolaminaroptic neuropathy. Outcome was poor (AU)

[Ischemic optic neuropathy after lumbar spine surgery]. / Neuropatía optica isquémica en el postoperatorio de cirugía de raquis lumbar.

Ischemic optic neuropathy is the most common cause of visual complications after non-ophthalmic surgery. The incidence has varied in different case series, but prone-position spine surgery appears to be involved in most of the reports. We present the case of a 47-year-old woman who developed near total blindness in the left eye following lumbar spine fusion surgery involving the loss of 900 mL of blood. An ophthalmic examination including inspection of the ocular fundus, fluorescein angiography, and visual evoked potentials returned a diagnosis of retrolaminar optic neuropathy. Outcome was poor.

[Incidence of influenza and influenza vaccine effectiveness in the 2004-2005 season]. / Incidencia de la gripe y efectividad de la vacuna antigripal en la temporada 2004-2005.

BACKGROUND: To quantify the incidence of flu in different groups of the population of Navarra in the 2004-2005 season, and to evaluate the effectiveness of anti-flu vaccination. METHODS: The analysis of influenza cases in the system of compulsory notificable diseases was complemented by the individualised notifications in the network of sentinel doctors that covers a population of 22,339 inhabitants. The coverage and effectiveness of the vaccine was studied. RESULTS: Vaccine coverage in (3)65 year olds reached 62%. The incidence of influenza was 42.6 cases per 1,000 inhabitants. It reached a maximum in mid-January, exceeding 750 weekly cases per 100,000 inhabitants and 1,900 cases per 100,000 children. The highest rate of influenza was observed in under-15 year olds (49.4 cases per 1,000 inhabitants) and the lowest in non-institutionalised (3)65 year olds (2.6 per 1,000 inhabitants), although it was higher in geriatric residences (62.1 per 1,000; p<0.0001). Seventy-nine percent of the cases from 5 to 64 years resulted in absenteeism from school or work. The flu virus was identified in 42/65 (65%) nasopharyngeal smears, 90% being influenza virus A(H3). The incidence of influenza was 3.08% in the unvaccinated and 0.45% in the vaccinated (p<0.001). The global effectiveness of the anti-flu vaccine was 65%, and in (3)65 years old it was 73%. CONCLUSION: Although its effectiveness is not total, the vaccine is the main measure for preventing influenza. The network of sentinel doctors provide useful information for the coordination of care and public health activities against flu.

Incidencia de la gripe y efectividad de la vacuna antigripal en la temporada 2004-2005 / Incidence of influenza and influenza vaccine effectiveness in the 2004-2005 season

Fundamento. Cuantificar la incidencia de gripe en distintos grupos de la población de Navarra en la temporada 2004-2005 y evaluar la efectividad de la vacunación antigripal.Métodos. El análisis de los casos de gripe del sistema de enfermedades de declaración obligatoria se ha complementado con las notificaciones individualizadas de la red de médicos centinela que atiende a una población de 22.339 habitantes. Se estudió la cobertura y efectividad de la vacuna. Resultados. La cobertura vacunal en Ž65 años alcanzó el 62%. La incidencia de gripe fue de 42,6 casos por 1.000 habitantes. Alcanzó el máximo a mediados de enero, superando 750 casos semanales por 100.000 habitantes y 1.900 casos por 100.000 niños. La mayor tasa de gripe se observó en menores de 15 años (49,4 casos por 1.000 habitantes) y la menor en Ž65 años no institucionalizados (2,6 por 1.000 habitantes), aunque fue mayor en residencias geriátricas (62,1 por 1.000; p<0,0001). El 79% de los casos de 5 a 64 años causó absentismo escolar o laboral. Se identificó el virus de la gripe en 42/65 (65%) frotis nasofaríngeos, siendo el 90% virus gripal A(H3). La incidencia de gripe fue del 3,08% en los no vacunados y del 0,45% en vacunados (p<0,001). La efectividad global de la vacuna antigripal fue del 65%, y en Ž65 años del 73%.Conclusión. Aunque su efectividad no es total, la vacuna es la principal medida para la prevención de la gripe. La red de médicos centinela aporta información útil para la coordinación de actividades asistenciales y de salud pública frente a la gripe

Background. To quantify the incidence of flu in different groups of the population of Navarra in the 2004-2005 season, and to evaluate the effectiveness of anti-flu vaccination. Methods. The analysis of influenza cases in the system of compulsory notificable diseases was complemented by the individualised notifications in the network of sentinel doctors that covers a population of 22,339 inhabitants. The coverage and effectiveness of the vaccine was studied. Results. Vaccine coverage in Ž65 year olds reached 62%. The incidence of influenza was 42.6 cases per 1,000 inhabitants. It reached a maximum in mid-January, exceeding 750 weekly cases per 100,000 inhabitants and 1,900 cases per 100,000 children. The highest rate of influenza was observed in under-15 year olds (49.4 cases per 1,000 inhabitants) and the lowest in non-institutionalised Ž65 year olds (2.6 per 1,000 inhabitants), although it was higher in geriatric residences (62.1 per 1,000; p<0.0001). Seventy-nine percent of the cases from 5 to 64 years resulted in absenteeism from school or work. The flu virus was identified in 42/65 (65%) nasopharyngeal smears, 90% being influenza virus A(H3). The incidence of influenza was 3.08% in the unvaccinated and 0.45% in the vaccinated (p<0.001). The global effectiveness of the anti-flu vaccine was 65%, and in Ž65 years old it was 73%. Conclusion. Although its effectiveness is not total, the vaccine is the main measure for preventing influenza. The network of sentinel doctors provide useful information for the coordination of care and public health activities against flu

Brotes de gripe en población vacunada de residencias geriátricas en la temporada 2004-2005 / Influenza outbreaks in highly-vaccinated older institutionalised people in the 2004-2005 season

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Anafilaxia y rocuronio. Réplica / Reply to "Anaphylactic reactions to rocuronium: myth or reality?": Anaphylaxis and rocuronium

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Hematoma epidural secundario a anestesia espinal. Tratamiento conservador / Epidural hematoma secondary to spinal anesthesia. Conservative treatment

Introducción: El hematoma epidural secundario a una anestesia neuroaxial es una complicación poco frecuente, pero de gran trascendencia tanto por sus implicaciones clínicas como por las médico legales; según algunos autores su incidencia puede oscilar entre 1/190.000-1/200.000 para las punciones peridurales y 1/320.000 en el caso de las espinales. El aspecto prioritario en su manejo terapéutico es el del diagnóstico y tratamiento precoz, antes de las 6-12 primeras horas. No obstante, en determinados pacientes como en el caso que presentamos puede no ser precisa la cirugía, resolviéndose el cuadro con tratamiento conservador. Caso clínico: Varón de 73 años, ASA IV, con antecedentes de cirrosis con hipertensión portal, hiperesplenismo, EPOC, obesidad, cardiopatía hipertensiva e insuficiencia tricuspídea. Se programa para alcoholización prostática al haber sido desechada la cirugía. En la analítica preoperatoria destacaba una actividad de protrombina del 80 por ciento y 90.000 plaquetas. Se realizaron varios intentos fallidos de punción espinal, finalmente fue precisa una anestesia general con ventilación espontánea mediante mascarilla laríngea, propofol, fentanilo y sevoflurano. A las 36 horas, comienza la clínica en forma de dolor intenso lumbar, sin irradiación y arreflexia cutáneo plantar, confirmándose en la RMN la presencia de un hematoma epidural de L1 a L4. Ante la ausencia de paraparesia flácida, afectación esfinteriana u otros signos sensitivo-motores y tras consulta con la Unidad de Raquis y con el Servicio de Neurología se decide tratamiento conservador y actitud expectante en forma de analgesia y monitorización neurológica estricta, clínica y radiológica. Evolucionando favorablemente en los siguientes días. Discusión: Determinadas condiciones clínicas pueden influir en la aparición de un hematoma tras la realización de un bloqueo regional central: heparinas de bajo peso molecular, punciones dificultosas, cirugía vertebral previa, hepatopatías, fármacos, etc. El tratamiento quirúrgico en forma de laminectomía descompresiva realizada de forma precoz suele ser necesario y es el tratamiento de elección en muchas ocasiones, pero en determinadas condiciones como la que nos ocupa, sin síntomas compresivos, sin un carácter progresivo o bien que estos disminuyan rápidamente, puede optarse por un tratamiento conservador en forma de analgesia y corticoterapia, siempre bajo un estricto control que permita actuar de forma rápida ante cualquier eventualidad negativa en su evolución (AU)

Camelostrongylus mentulatus in domestic goats from the Iberian Peninsula.

Two male worms of Camelostrongylus mentulatus were found in one of 84 murciano-granadina goats in Murcia, south-eastern Spain. This is the first report of C. mentulatus in goats in the Iberian peninsula and the possible origin and transmission of this nematode in Spain are discussed.