Anesthetic considerations and postoperative pain management in radical penectomy: Case report / Penectomía radical, consideraciones anestésicas y manejo del dolor postoperatorio: Reporte de un caso

Abstract Radical penectomy (RP) is infrequently performed as it is reserved for specific cases of penile cancer, hence the paucity of reports regarding surgical and anesthetic considerations. Acute postoperative pain, chronic post-surgical pain, concomitant mood disorders as well as a profound impact on the patient's quality of life have been documented. This case is of a patient with diabetes and coronary heart disease, who presented with advanced, over infected penile cancer, depressive disorder and a history of pain of neuropathic characteristics. The patient underwent radical penectomy using a combined spinal-epidural technique for anesthesia. Preoperatively, the patient was treated with pregabalin and magnesium sulphate, and later received a blood transfusion due to intraoperative blood loss. Adequate intra and postoperative analgesia was achieved with L-bupivacaine given through a peridural catheter during one week. Recovery was good, pain was stabilized to preoperative levels and the patient received pharmacological support and follow-up by psychiatry and the pain team.

Resumen La penectomía radical (PR) es una cirugía infrecuente, reservada para casos específicos de cáncer de pene, por lo que hay escasos informes sobre sus consideraciones quirúrgicas y anestésicas. Se ha documentado dolor agudo postoperatorio, dolor crónico posquirúrgico y alteraciones del estado de ánimo concomitantes, así como un profundo impacto en la calidad de vida posterior del paciente. Se presenta el caso de un paciente diabético y cardiópata coronario con cáncer de pene avanzado y sobreinfectado, trastorno depresivo y dolor previo de características neuropáticas, que recibe técnica combinada espinal-peridural para cirugía de penectomía radical. Se le trata también con pregabalina preoperatoria, sulfato de magnesio y transfusión por sangrado quirúrgico. Se otorgó una adecuada analgesia intra y postoperatoria, mediante catéter peridural con L-bupivacaína hasta por una semana. El paciente tuvo una buena recuperación, estabilización del dolor a niveles preoperatorios, controles y apoyo farmacológico por psiquiatría de enlace y equipo del dolor.

Anestesia libre de opioides en hemicolectomía abierta derecha extendida. Reporte de un caso y revisión / Opiod Free Anesthesia (OFA) for Open extended right colectomy. A case report and review

Opioid free anesthesia (OFA) is defined as an anesthesiologic technique where opioids are not used in the intraoperative and postoperative period. Although the mainstay of intra-operative analgesia may be opioids, current challenges are focus on reducing them and preventing the adverse effects of opioids, by rationalizing and even suspending their perioperative use, specifically at risk populations such as Obstructive Sleep Apnea Syndrome (OSAHS), obesity, Chronic Obstructive Pulmonary Disease (COPD) and cancer surgery. We present this case of OFA in a susceptible patient with complications from the use of opioids undergoing an extended right hemicolectomy. Multimodal analgesia was performed with a thoracic peridural and subanesthetic doses of intravenous agents including dexmedetomidine, ketamine and propofol, accompanied by short and long-lasting local periglotic anesthetics. The patient had given an intraand postoperative analgesia without presenting any adverse events, good recovery, early deambulation and extubation.

La anestesia libre de opioides (OFA) es una técnica anestésica donde no hay administración de opioides, tanto en el intraoperatorio como en el postoperatorio. Aunque una de las bases de la analgesia intraoperatoria podrían ser los opioides, los desafíos actuales están enfocados en reducir su uso perioperatorio, previniendo sus efectos adversos, racionalizando y limitando su empleo específicamente en poblaciones de riesgo como síndrome de apnea obstructiva del sueño (SAHOS), obesidad, enfermedad pulmonar obstructiva crónica (EPOC) y cirugía oncológica. Presentamos este caso de OFA en un paciente susceptible de complicaciones por uso de opioides sometido a una hemicolectomía derecha extendida. Se realizó analgesia multimodal con peridural torácica y dosis subanestésicas de agentes endovenosos como dexmedetomidina, ketamina y propofol, acompañado de anestésicos locales periglóticos de corta y larga duración. Se otorgó una adecuada analgesia intra y postoperatoria, el paciente no tuvo eventos adversos, presentando una buena recuperación, deambulación y extubación precoz.

[Lymphomas associated with human immunodeficiency virus infection: retrospective review of medical records]. / Linfomas asociados a infección por Virus de Inmunodeficiencia Humana: experiencia de un centro hospitalario de la V región, Chile.

BACKGROUND: The incidence of lymphoma increases enormously in patients infected with the human immunodeficiency virus (HIV). AIM: To describe the incidence, clinical and histological characteristics, treatments and survival of lymphomas associated with HTV infection. MATERIAL AND METHODS: Retrospective review of medical records of patients with HIV and lymphoma, treated in a public hospital, between January 2001 and June 2009. RESULTS: Twenty-two male patients were included but 14 had immunohistochemical confirmation of the lymphoma. The accumulated incidence for this period was 2.8%. The median age at lymphoma diagnosis was 39.5 years. Twelve patients (86%) had non-Hodgkin lymphoma (NHI) and two (14%) Hodgkin lymphoma. The main pathological type of non-Hodgkin lymphomas was diffuse large B cell in seven cases (50%). The mean CD4 cell count and viral load were 83 cell/mm³ (33.5-113.5) and 26.000 RNA copies/ml (1210-196500), respectively Twelve patients (86%) had B type symptoms of lymphoma at the moment of diagnosis. Eleven patients (29%) received chemotherapy with or without radiotherapy, one patient (7%) received radiotherapy alone and two patients (14%) received palliative symptomatic treatment. Six cases (43%) received highly active antiretroviral therapy simultaneously with chemotherapy. Global mortality in this series was 57% (8 patients) with a median survival time of 5.8 months (2.6-26.2). CONCLUSIONS: In this series of patients infected with HIV, a predominance of aggressive histological subtypes of lymphomas and low complete remission rates, were observed.

Linfomas asociados a infección por Virus de Inmunodeficiencia Humana: Experiencia de un centro hospitalario de la V región, Chile / Lymphomas associated with human immunodeficiency virus infection: Retrospective review of medical records

Background: The incidence oflymphoma increases enormously inpatients infecten with the human immunodeficiency virus (HIV). Aim: To describe the incidence, clinical and histológica! characteristics, treatments and survival of lymphomas associated with HTV infection. Material and Methods: Retrospective review of medical records ofpatients with HIV and lymphoma, treated in a public hospital, between January 2001 and June 2009. Results: Twenty-two mole patients were included but 14 had immunohistochemical confirmation ofthe lymphoma. The accumulated incidence for thisperiod was 2.8 percent. The median age at lymphoma diagnosis was 39.5 years. Twelvepatients (86 percent) had non-Hodgkin lymphoma (NHI) and two (14 percent) Hodgkin lymphoma. The main pathological type of non-Hodgkin lymphomas was diffuse large B cell in seven cases (50 percent). The mean CD4 cell count and viral load were 83 cell/mm³ (33.5-113.5) and 26.000 RNA copies/ml (1210-196500), respectively Twelve patients (86 percent) had B type symptoms of lymphoma at the moment of diagnosis. Eleven patients (29 percent) received chemotherapy with or without radiotherapy, onepatient (7 percent) received radiotherapy alone and two patients (14 percent) received palliative symptomatic treatment. Six cases (43 percent) received highly active antiretroviral therapy simultaneously with chemotherapy. Global mortality in this series was 57 percent (8patients) with a median survival time of 5.8 months (2.6-26.2). Conclusions: In this series ofpatients infected with HIV, a predominance of aggressive histológica! subtypes of lymphomas and low complete remission rates, were observed.

Fibrosarcoma / Fibrosarcoma

Este caso clínico hace referencia a un tumor del tejido blando, el fibrosarcoma. Si bien este tipo de tumor no es muy frecuente en la población, el fibrosarcoma es uno de los más comunes dentro de este grupo. Debido a esto hemos querido complementarlo con una revisión bibliográfica que incluye sus características generales, los hallazgos histopatológicos, el diagnóstico y tratamiento propuesto en la literatura.

[Lead poisoning: clinical picture, diagnosis and related environmental factors]. / Intoxicación por plomo: clínica, diagnóstico y factores ambientales condicionantes.

BACKGROUND: The predisposing environmental factors and clinical picture of lead poisoning, are not well known. AIM: To describe the clinical picture, diagnosis and treatment of lead poisoning in individuals under industry exposure. SUBJECTS AND METHODS: Twenty of 38 workers of a printing press were studied. Their medical and labor histories were recorded. Lead in air in the working area and the dose received by the workers was measured. RESULTS: The environmental lead in the linotype room was 25% over the accepted values. Twelve of the 20 workers were poisoned and three were highly exposed. Poisoned workers were working in areas with high environmental lead concentrations, were in direct contact with the metal, had plasma lead concentrations over 70 micrograms/dl and an average exposure time of over 17 years. Their clinical picture was not specific and related to plasma and environmental lead concentrations, length of exposure and type of contact. CONCLUSIONS: Lead poisoning must be suspected among workers exposed to high environmental concentrations and its treatment consists in withdrawing poisoned subjects from polluted areas.

Intoxicación por plomo: clínica, diagnóstico y factores ambientales condicionantes / Lead poisoning: clinics, diagnosis and environmental related factors

The environmental lead in the linotype room was 25 percent over the accepted values. Twelve of the 20 workers were poisoned and 3 were highly exposed. Poisoned workers were working in areas with high environmental lead concentrations, were in direct contact with the metal, had plasma lead concentrations over 70 ug/dl and an average exposure time over 17 years. Their clinical picture was not specific and related to plasma and environmental lead concentrations, length of exposure and type of contact. Lead poisoning must be suspected among workers exposed to high environmental concentrations and its treatment consists in withdrawing poisoned subjects from polluted areas.

Enfoque terapéutico del glaucoma neovascular terminal (GNVT) / Therapeutic approach of terminal neovascular glaucoma

El estadio final del glaucoma neovascular se caracteriza en la mayoría de los casos por la presencia de un severo e intratable dolor. Se utilizó un procedimiento filtrante en 24 ojos con glaucoma neovascular terminal obteniéndose la remisión completa del dolor en todos los casos, con un seguimiento promedio de 19 meses (6-48 meses). El descenso de la presión intraocular medio fue de 25.6 mmHg. y las complicaciones intra y postoperatorias fueron el Hipema, la fuga vítrea, la atalamia y la ptisis bulbi. Se analizaron también los resultados obtenidos con la utilización de sustancias viscoelásticas. Se compararon además los resultados obtenidos con otros procedimientos

Enfoque terapéutico del glaucoma neovascular terminal (GNVT) / Therapeutic approach of terminal neovascular glaucoma

El estadio final del glaucoma neovascular se caracteriza en la mayoría de los casos por la presencia de un severo e intratable dolor. Se utilizó un procedimiento filtrante en 24 ojos con glaucoma neovascular terminal obteniéndose la remisión completa del dolor en todos los casos, con un seguimiento promedio de 19 meses (6-48 meses). El descenso de la presión intraocular medio fue de 25.6 mmHg. y las complicaciones intra y postoperatorias fueron el Hipema, la fuga vítrea, la atalamia y la ptisis bulbi. Se analizaron también los resultados obtenidos con la utilización de sustancias viscoelásticas. Se compararon además los resultados obtenidos con otros procedimientos (AU)