Prevalence of potential drug-drug interactions in outpatients on treatment with parenteral antineoplastic drugs.

Background As live expectancy and cancer incidence growing, polypharmacy in oncology patients is also increasing, raising the risk of developing potential drug-drug interactions.Objective To assess the prevalence of clinically relevant potential drug-drug interactions among cancer patients who receive parenteral treatment at our outpatient clinic. Method Retrospective observational study which included randomly selected patients who had received parenteral treatment from November 1st 2016 to January 31st 2017. Interactions were checked in 3 databases, and classified as clinically relevant or not and in three categories of severity: contraindicated, consider modification or monitor. Results A total of 273 patients were included; of which seventy three (26.7%) had at least one clinically relevant potential drug-drug interaction. Amongst them, 54 (74%) had at least one classified as monitor treatment, 50 (68.5%) as contraindicated and 26 (35.6%) as consider modification. The number of chronic prescriptions was associated with a higher risk of drug interactions. Conclusion Around one in four patients on treatment with parenteral antineoplastic drugs presented a clinically relevant potential drug-drug interaction. A systematic assessment of drug-drug interactions should be implemented to reduce the risk of clinically relevant drug-drug interactions.

Author Correction: Combination of KIR2DS4 and FcγRIIa polymorphisms predicts the response to cetuximab in KRAS mutant metastatic colorectal cancer.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper.

Endoscopic closure of gastrointestinal perforations and fistulas using the Ovesco Over-The-Scope Clip system at a tertiary care hospital center. / Cierre endoscópico de perforaciones y fístulas del tracto digestivo mediante el sistema «Over-the scope clip¼ (Ovesco), en un centro terciario.

INTRODUCTION AND AIM: Enteric perforations and fistulas are difficult to manage due to comorbidities, poor nutritional status, and anatomic challenges related to multiple interventions in those patients. The use of endoscopic methods as a nonsurgical approach is increasing. The aim of the present study was to describe the clinical experience with the use of the Ovesco Over-The-Scope Clip system in the closure of perforations, fistulas, and other indications in the digestive tract at a tertiary care hospital center. MATERIALS AND METHODS: A case series was carried out on patients that underwent lesion closure with the Ovesco clip, within the time frame of January 2015 to December 2017. RESULTS: The Ovesco clip was used for closure in 14 patients ranging in age from 21-90 years, with different indications: iatrogenic perforations; anastomotic leaks and fistulas; tracheoesophageal fistulas; and esophagogastric perforation. Technical success was achieved in 100% of the patients and clinical success in 78.57%. No complications were reported. CONCLUSIONS: The Ovesco Over-The-Scope Clip system is a safe and effective method for managing gastrointestinal acute perforations and fistulas.

Combination of KIR2DS4 and FcγRIIa polymorphisms predicts the response to cetuximab in KRAS mutant metastatic colorectal cancer.

Cetuximab is a standard-of-care treatment for RAS wild-type metastatic colorectal cancer (mCRC) but not for those harbor a KRAS mutation since MAPK pathway is constitutively activated. Nevertheless, cetuximab also exerts its effect by its immunomodulatory activity despite the presence of RAS mutation. The aim of this study was to determine the impact of polymorphism FcγRIIIa V158F and killer immunoglobulin-like receptor (KIR) genes on the outcome of mCRC patients with KRAS mutations treated with cetuximab. This multicenter Phase II clinical trial included 70 mCRC patients with KRAS mutated. We found KIR2DS4 gene was significantly associated with OS (HR 2.27; 95% CI, 1.08-4.77; P = 0.03). In non-functional receptor homozygotes the median OS was 2.6 months longer than in carriers of one copy of full receptor. Multivariate analysis confirmed KIR2DS4 as a favorable prognostic marker for OS (HR 6.71) in mCRC patients with KRAS mutation treated with cetuximab. These data support the potential therapeutic of cetuximab in KRAS mutated mCRC carrying non-functional receptor KIR2DS4 since these patients significantly prolong their OS even after heavily treatment. KIR2DS4 typing could be used as predictive marker for identifying RAS mutated patients that could benefit from combination approaches of anti-EGFR monoclonal antibodies and other immunotherapies to overcome the resistance mediated by mutation in RAS.

'An investigation into the occurrence and removal of pharmaceuticals in Colombian wastewater'.

In this work, the presence of 20 pharmaceuticals in wastewater from Colombia is investigated. Several widely consumed compounds have been detected in wastewater samples from different origins and geographical areas in Colombia. The studied pharmaceuticals included antibiotics, analgesics and anti-inflammatories, cholesterol lowering statin drugs, lipid regulators, and anti-depressants. The investigated samples were urban wastewater collected during one whole week before (influent) and after treatment (effluent) in the wastewater treatment plants (WWTPs) of Bogotá and Medellin. Raw wastewater from the Hospital of Tumaco and from the city of Florencia were also collected. Analyses performed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) revealed that most of the target analytes were present in all the wastewater samples. The highest concentrations (up to 50 µg/L) corresponded to acetaminophen, but several antibiotics, such as azithromycin, ciprofloxacin and norfloxacin, and antihypertensive drugs, such as losartan and valsartan, were commonly present in influent wastewater (IWW) at levels above 1 µg/L. Moreover, the treatment applied in WWTPs seemed to not efficiently remove the compounds under study, because most pharmaceuticals were also present in effluent wastewater (EWW) at concentrations close to those of the IWW. Special emphasis was made in this work on the quality of data reported, performing a detailed study of quality control (QC) samples. The analytical approach used -direct injection of 5-fold diluted samples without any additional treatment - is simpler and faster than the commonly applied solid phase extraction (SPE). The use of 12 isotope-labelled internal standards ensured the satisfactory correction of matrix effects for the corresponding analytes. For the remaining 8 compounds, no drastic matrix effects were observed, and only four compounds (cloxacillin, doxycycline, losartan, tetracycline) presented QC recoveries near or slightly below 60%, revealing ionization suppression, particularly in the IWW. Data on the occurrence of pharmaceuticals reported in this paper are the basis for current studies that aim to develop efficient systems for the degradation/removal of these compounds from the aquatic environment.

Modernas metodologías diagnosticas para la detección del Virus del Papiloma Humano y prevención del cáncer de cuello uterino / Modern diagnostic methods for detection of Human Papillomavirus and cervical cancer prevention

RESUMEN Los Virus del Papiloma Humano (VPH) presentes en mucosa clasificados como de "alto riesgo" son agentes etiológicos de patologías oncológicas como cáncer de cuello uterino, ano, pene, vulva y cáncer orofaríngeo. Actualmente el principal método de tamizaje utilizado en Colombia para detección de cáncer de cuello uterino es la citología cervical, presentando una moderada cobertura en la población femenina y una sensibilidad cercana al 50%. El objetivo de este trabajo es describir las técnicas modernas utilizadas para la detección del VPH y prevención de los cánceres producidos por estos virus. Se llevó a cabo una revisión de literatura de las ultimas metodologías diagnosticas en la infección viral por VPH y marcadores de malignidad en muestras cervicales. La citología cervical es un recurso altamente específico y de bajo costo, pero poco sensible para la detección y prevención de cáncer de cuello uterino, que puede ser complementado con las tecnologías modernas revisadas con el objetivo de obtener un diagnóstico temprano del VPH como agente etiológico de estas enfermedades malignas.

ABSTRACT Human Papilloma Viruses (HPVs) types present in mucosa and classified as "high risk" are etiologic agents of several oncological diseases as cervical cancer, anus, penis, vulva, and oropharyngeal cancer. Currently the principal method of screening used in Colombia for detecting cervical cancer is cervical cytology, which presents a moderate coverage in the population and sensitivity close to 50%. The objetive of this work is to describe new techniques for detection of Human Papillomavirus and cancer prevention for these viruses. We carried out a literature review of the cutting edge diagnostic methods for HPV viral infection. Cervical cytology is a highly specific resource, low-cost but low sensitivity for preventing cervical cancer, which can be supplemented with the modern technologies checked in order to obtain an early diagnosis of HPV as an etiologic agent of those malignancies.

Avances en el desarrollo de nuevas vacunas profilácticas y terapéuticas contra el Virus del Papiloma Humano / Advances in the development of new prophylactic and therapeutic vaccines against Human Papillomavirus

El uso de vacunas profilácticas contra el Virus del Papiloma Humano (VPH) de alto riesgo ha adquirido gran importancia debido al alto potencial oncogénico, de estos virus, especialmente por su asociación con el cáncer de cuello uterino, uno de los canceres más comunes y de mayor mortalidad en mujeres a nivel mundial. El objetivo de este artículo es describir las vacunas profilácticas y terapéuticas disponibles actualmente contra el VPH, analizando las características, ventajas, desventajas y estudios científicos sobre su uso y seguridad en la población. Se llevó a cabo una revisión de literatura de los últimos avances en el desarrollo de vacunas profilácticas y terapéuticas contra el VPH. La vacunación profiláctica es efectiva y esencial para la prevención del cáncer de cuello uterino causadas por VPH-16 y -18, pero no genera protección cruzada contra otros VPH de alto riesgo, esto ha encaminado a la creación de nuevas vacunas nanovalentes que protegen contra un número mas amplio de VPHs de alto riesgo. Por otra parte, las vacunas terapéuticas han demostrado en sus fases de estudio iniciales ser promisorias en la regresión de lesiones premalignas o malignas in situ.

Prophylactic vaccines against high risk HPV has become important because of the high oncogenic potential of the virus and its association with cervical cancer development, one of the most common and fatal cancers among women worldwide. The objective of this article is describe the state of the art of the current prophylactic and therapeutic HPV vaccines, analyzing their characteristics, advantages, disadvantages and scientific reports on its use and safety in the population. A systematic revision of the latest advances in the development of prophylactic and therapeutic vaccines against HPV was performed. Prophylactic vaccination is effective and essential for the prevention of uterine cervical cancer; new therapeutic vaccines have been shown at the initial phases to be promising contributing in the regression of premalignant or malignant in situ lesions.

Phosphorylated protein phosphatase 2A determines poor outcome in patients with metastatic colorectal cancer.

BACKGROUND: Protein phosphatase 2A (PP2A) is a tumour suppressor frequently inactivated in human cancer and its tyrosine-307 phosphorylation has been reported as a molecular inhibitory mechanism. METHODS: Expression of phosphorylated PP2A (p-PP2A) was evaluated in 250 metastatic colorectal cancer (CRC) patients. Chi-square, Kaplan-Meier and Cox analyses were used to determine correlations with clinical and molecular parameters and impact on clinical outcomes. RESULTS: High p-PP2A levels were found in 17.2% cases and were associated with ECOG performance status (P=0.001) and presence of synchronous metastasis at diagnosis (P=0.035). This subgroup showed substantially worse overall survival (OS) (median OS, 6.0 vs 26.2 months, P<0.001) and progression-free survival (PFS) (median PFS, 3.8 vs 13.3 months, P<0.001). The prognostic impact of p-PP2A was particularly evident in patients aged <70 years (P<0.001). Multivariate analysis revealed that p-PP2A retained its prognostic impact for OS (hazard ratio 2.7; 95% confidence interval, 1.8-4.1; P<0.001) and PFS (hazard ratio 3.0; 95% confidence interval, 1.8-5.0; P<0.001). CONCLUSIONS: Phosphorylated PP2A is an alteration that determines poor outcome in metastatic CRC and represents a novel potential therapeutic target in this disease, thus enabling to define a subgroup of patients who could benefit from future treatments based on PP2A activators.

Active angiogenesis in metastatic renal cell carcinoma predicts clinical benefit to sunitinib-based therapy.

BACKGROUND: Sunitinib represents a widely used therapy for metastatic renal cell carcinoma patients. Even so, there is a group of patients who show toxicity without clinical benefit. In this work, we have analysed pivotal molecular targets involved in angiogenesis (vascular endothelial growth factor (VEGF)-A, VEGF receptor 2 (KDR), phosphorylated (p)KDR and microvascular density (MVD)) to test their potential value as predictive biomarkers of clinical benefit in sunitinib-treated renal cell carcinoma patients. METHODS: Vascular endothelial growth factor-A, KDR and pKDR-Y1775 expression as well as CD31, for MVD visualisation, were determined by immunohistochemistry in 48 renal cell carcinoma patients, including 23 metastatic cases treated with sunitinib. Threshold was defined for each biomarker, and univariate and multivariate analyses for progression-free survival (PFS) and overall survival (OS) were carried out. RESULTS: The HistoScore mean value obtained for VEGF-A was 121.6 (range, 10-300); for KDR 258.5 (range, 150-300); for pKDR-Y1775 10.8 (range, 0-65) and the mean value of CD31-positive structures for MVD visualisation was 49 (range, 10-126). Statistical differences for PFS (P=0.01) and OS (P=0.007) were observed for pKDR-Y1775 in sunitinib-treated patients. Importantly, pKDR-Y1775 expression remained significant after multivariate Cox analysis for PFS (P=0.01; HR: 5.35, 95% CI, 1.49-19.13) and for OS (P=0.02; HR: 5.13, 95% CI, 1.25-21.05). CONCLUSIONS: Our results suggest that the expression of phosphorylated (i.e., activated) KDR in tumour stroma might be used as predictive biomarker for the clinical outcome in renal cell carcinoma first-line sunitinib-treated patients.

Calidad percibida de la atención de enfermería por usuarios hospitalizados, Tunja, 2011 / Perceived quality of nursing care hospital by users, Tunja 2011

Objetivo: evaluar la calidad percibida de los usuarios en servicios de hospitalización respecto a la atención de enfermería recibida. Metodología: estudio cuantitativo, descriptivo de corte transversal. Análisis univariado y bivariado. La muestra n=183 fue recolectada en un Hospital de Tunja en los servicios de Medicina Interna y Quirúrgicas, a través del instrumento servqhos-e. Resultados: la medición de la calidad objetiva, subjetiva y el nivel de satisfacción de los usuarios de los servicios del hospital, reportó puntuaciones con medias de 4,08 para amabilidad y 3,98 para preparación del personal de enfermería y un nivel de satisfacción global del 92,9%. Discusión: la medición de la calidad percibida por los usuarios mediante el instrumento servqhos-e, permite evaluar desde la percepción de los usuarios, la calidad de la atención brindada por profesionales de enfermería en aspectos objetivos y subjetivos, los cuales son predictores de la satisfacción; los aspectos mejor evaluados corresponden a variables subjetivas, sin embargo, las expectativas de los usuarios no se superan...

Objective: to evaluate the usersÆ perception regarding the quality of the nursing care received. Methodology: a quantitative, cross-sectional descriptive study with univariate and bivariate analyses. The sample (n = 183) was collected from the Internal Medicine and Surgery units of the Tunja Hospital using the servqhos-e instrument. Results: the measurement of the objective and subjective quality, as well as the measurement of the usersÆ satisfaction level regarding hospital services had scores with a mean of 4.08 for kindness, and 3.98 for nursing staff training. In addition, the overall satisfaction level was 92.9%. Discussion: using the instrument servqhos-e to measure the quality perceived by the users made it possible to assess the quality of the care provided by nursing professionals. This measurement was conducted from the userÆs own point of view and focused on the objective and subjective aspects, which are predictors of satisfaction. Additionally, the highest scores belonged to subjective variables, but the usersÆ expectations were not met...

Análisis molecular de Sonic hedgehog (Shh) en la etiología de la fisura labiopalatina no sindrómica en tríos caso-progenitores chilenos / Molecular analysis of Sonic hedgehog (Shh) in the etiology of nonsyndromic cleft lip and palate in Chilean case-parent trios

introducción: la fisura labio palatina no sindrómica, NSCLP (del inglés Nonsyndromic cleft lip and palate) es una de las malformaciones congénitas más frecuentes tanto en Chile como en el resto del mundo. Presenta un modo de herencia multifactorial, en la que interactúan varios genes y el medio ambiente. Evidencias experimentales han demostrado la participación de Sonic hedgedhog (Shh) en la migración de las células de la cresta neural, en la transformación epitelio-mesénquima y en la formación de las estructurasmedias craneofaciales durante el desarrollo embrionario, es probable una asociación entre variantes de Shh y la NSCLP. Métodos: el objetivo de este trabajo fue evaluar las regiones exónicas e intrónicas adyacentes de Shh, en una muestra de 150 tríos caso-progenitores para hallar la asociación con NSCLP. Se utilizó el método PCR-RFLP para determinar la presencia de heterodúplex. Luego, se utilizó la técnica de Conformation Sensitive Gel Electrophoresis (CSGE) para ver la distorsión del ADN en los heterodúplex. Como método alternativo, se hizo un análisis de polimorfismos de un solo nucleótido (del inglés single-nucleotide polymorphism SNP) para determinar asociación entre NSCLP y Shh, para lo cual se utilizaron los SNP: rs1233555 y rs1233556, ubicados en el primer intrón de Shh. Resultados:no se observaron heterodúplex en ninguno de los segmentos de Shh analizados en 150 tríos, el análisis de SNP tampoco mostró asociación con Shh y FLPNS. conclusión: la no asociación puede deberse a que la frecuencia de distribución de los SNP en la población chilena es diferente a la de las poblaciones referidas, o a que el número de SNP analizados fue insuficiente, o la no inclusión para el análisis de otras regiones de Shh.

introduction: nonsyndromic cleft lip and palate (NSCLP) is one of the most common congenital malformations not only in Chile but also worldwide. It has a multifactorial inheritance pattern with interaction of several genes and the environment. Several experimental studies have proven the participation of Sonic hedgedhog (Shh) in the migration process of cells from the neural crest,in the epithelium-mesenchyme transformation, and in the formation of middle craniofacial structures during embryo development; an association between Shh variants and NSCLP is probable. Methods: the goal of this study was to evaluate both exonic and intronic regions adjacent to Shh, in a sample of 150 case-parent trios in order to find possible associations with NSCLP. The PCR-RFLP method was used to determine the presence of heteroduplex. Afterwards, the Conformation Sensitive Gel Electrophoresis (CSGE) technique wasused to visualize DNA distortion at the heteroduplexes. As an alternative method, a single-nucleotide polymorphism (SNP) analysis wasperformed in order to determine NSCLP-Shh associations, by means of these SNPs: rs1233555 and rs1233556, located at the first Shhintron. Results: no heteroduplexes were found in any of the analyzed Shh segments in 150 trios; SNP analysis did not show associations between Shh and NSCLP either. conclusions: this lack of association may be due to the fact that SNP distribution frequency among Chilean population is different to that of reference populations, or because the number of SNPs analyzed was not sufficient, or even because this study did not include other Shh regions.

[Spanish Society of Anaesthesia (SEDAR) guidelines for pre-anaesthesia checking procedures]. / Directrices de procedimientos de comprobación y validación («chequeo¼) previos a la anestesia de la Sociedad Española de Anestesiología.

We present this document as a guide to preparing a specific institutional pre-anaesthesia checklist, as recommended in the Helsinki declaration on patient safety in anaesthesiology. Also, the recently recommended WHO "safe surgery check-list" includes a check-list for anaesthesia. A working group was established in accordance with the charter of the Spanish Society of Anaesthesiology and Resuscitation (Sociedad Española de Anestesiología y Reanimación [SEDAR]). The new patient safety culture introduced into medicine, and the recommendations of European anaesthesia societies has led us to design and update protocols in order to improve results in this important part of our speciality. We have prepared these recommendations or guidelines using, as examples, updates of pre-anaesthesia check-lists by other American (ASA), British, or Canadian societies of anaesthesia. With that aim, we enlisted the help of anaesthesia ventilator experts and the participation and advice of experienced anaesthesiologists from all parts of Spain. After various corrections and modifications, the document was available at www.sedar.es, so that any anaesthesiologist could propose any correction, or give their opinion. Finally, these guidelines have been approved by the SEDAR Board of Directors, before it was sent for publication in this journal. The aims of this document are to provide: a guideline applicable to all anaesthesia machines, a descriptive pre-anaesthesia check-list that include everything necessary for the anaesthesia procedure, and a resumed check-list to be available in all the anaesthesia machines or other equivalent, but prepared for each institution, which should include anaesthetic equipment and drugs. So, in order to ensure the aims and requirements of the European Board of Anaesthesiology, the European Society of Anaesthesiology, and the WHO are met, each institution should have a protocol for checking equipment and drugs. These guidelines are applicable to any anaesthesia equipment, enabling every institution to develop their own checking protocols, adapted to their anaesthesia machines and their procedures. With the consent of the SEDAR, this group will collaborate with anaesthesia machines providers in order to develop specific checklists for each of their models that will be available at www.sedar.es.

Directrices de procedimientos de comprobación y validación («chequeo») previos a la anestesia de la Sociedad Española de Anestesiología / Spanish Society of Anaesthesia (SEDAR) guidelines for pre-anaesthesia checking procedures

Este documento que presentamos pretende servir de guía para la elaboración por cada centro de una lista de chequeo previo a la anestesia o pre-anestesia, tal y como recomienda la reciente declaración de Helsinki sobre seguridad del paciente en anestesia. Además, la reciente implantación del «check-list quirúrgico de la OMS» (safe surgery check-list) incluye un epígrafe de chequeo de anestesia. El grupo de trabajo se constituyó con este fin según los estatutos de la Sociedad Española de Anestesiología, Reanimación y Tratamiento del Dolor (SEDAR). La nueva cultura de seguridad del paciente que se está implantando en la práctica médica y las recomendaciones de las sociedades europeas de anestesia nos obligan a actualizar y realizar protocolos que mejoren los resultados en este aspecto fundamental de nuestra especialidad. Tomando como ejemplo las actualizaciones de las listas de comprobación de diferentes asociaciones de anestesiólogos como la americana, británica o canadiense, hemos elaborado esta propuesta. Para ello hemos contado con la ayuda de expertos en respiradores y la colaboración y consejos de anestesiólogos expertos de todas las comunidades autónomas. Después de sucesivas correcciones, fue publicada en la página web de la SEDAR para que cualquier anestesiólogo pudiera aportar sus correcciones o su opinión. Finamente el documento ha sido aprobado por la junta directiva de la SEDAR, antes de ser enviado para su publicación en esta revista. Los objetivos de este documento son: proporcionar unas directrices o recomendaciones de comprobación aplicables a todos los sistemas de anestesia, realizar un listado descriptivo de comprobación que incluya todos los elementos necesarios para el procedimiento anestésico y aportar un listado con los elementos del chequeo en forma de esquema para disponer de él en cada equipo de anestesia o de otro similar realizado por cada centro, que incluya respirador, monitores, material auxiliar y fármacos. Por tanto, para cumplir con las recomendaciones de seguridad del paciente del European Board of Anaesthesiology (EBA), European Society of Anaesthesiology (ESA) y de la OMS, cada centro debe elaborar una lista de comprobación y verificación (en adelante «chequeo») previo a la anestesia. Este documento proporciona unas directrices aplicables a todos los sistemas de anestesia de tal manera que cada departamento pueda desarrollar sus propios protocolos de comprobación, adaptados a sus equipos de anestesia y a sus procedimientos de trabajo. De acuerdo con la directiva de la SEDAR, este grupo de trabajo colaborará con los fabricantes de equipos de anestesia para desarrollar listas de comprobación específicas de cada uno de sus modelos para que estén disponibles en www.sedar.es(AU)

We present this document as a guide to preparing a specific institutional pre-anaesthesia checklist, as recommended in the Helsinki declaration on patient safety in anaesthesiology. Also, the recently recommended WHO "safe surgery check-list" includes a check-list for anaesthesia. A working group was established in accordance with the charter of the Spanish Society of Anaesthesiology and Resuscitation (Sociedad Española de Anestesiología y Reanimación [SEDAR]). The new patient safety culture introduced into medicine, and the recommendations of European anaesthesia societies has led us to design and update protocols in order to improve results in this important part of our speciality. We have prepared these recommendations or guidelines using, as examples, updates of pre-anaesthesia check-lists by other American (ASA), British, or Canadian societies of anaesthesia. With that aim, we enlisted the help of anaesthesia ventilator experts and the participation and advice of experienced anaesthesiologists from all parts of Spain. After various corrections and modifications, the document was available at www.sedar.es, so that any anaesthesiologist could propose any correction, or give their opinion. Finally, these guidelines have been approved by the SEDAR Board of Directors, before it was sent for publication in this journal. The aims of this document are to provide: a guideline applicable to all anaesthesia machines, a descriptive pre-anaesthesia check-list that include everything necessary for the anaesthesia procedure, and a resumed check-list to be available in all the anaesthesia machines or other equivalent, but prepared for each institution, which should include anaesthetic equipment and drugs. So, in order to ensure the aims and requirements of the European Board of Anaesthesiology, the European Society of Anaesthesiology, and the WHO are met, each institution should have a protocol for checking equipment and drugs. These guidelines are applicable to any anaesthesia equipment, enabling every institution to develop their own checking protocols, adapted to their anaesthesia machines and their procedures. With the consent of the SEDAR, this group will collaborate with anaesthesia machines providers in order to develop specific checklists for each of their models that will be available at www.sedar.es(AU)

[Chronic postoperative pain after general anesthesia with or without a single-dose preincisional paravertebral nerve block in radical breast cancer surgery]. / Comparación entre anestesia general con o sin bloqueo paravertebral preincisional con dosis única y dolor crónico postquirúrgico, en cirugía radical de cáncer de mama.

BACKGROUND AND OBJECTIVE: Over 50% of patients still experience pain a year after mastectomy with or without lymphadenectomy. We aimed to determine the association between anesthetic technique, acute postoperative pain intensity, and the development of chronic postoperative pain. PATIENTS AND METHODS: Forty patients were randomly assigned to receive general anesthesia with or without a paravertebral nerve block for modified radical mastectomy. Postoperative pain was assessed on a visual analog scale at 60 minutes and 24 hours; the patients were also asked to respond to a telephone questionnaire on chronic pain 4 to 5 months later. RESULTS: No significant differences in acute pain were observed. Twenty-nine responded to the telephone questionnaire. Only 1 patient in the paravertebral block group reported chronic neuropathic pain and none had phantom breast pain. Only 1 patient (6.7%) in the paravertebral block group reported chronic neuropathic pain and none had phantom breast pain. In the group that received general anesthesia alone, 1 patient reported phantom breast pain and 6 patients had neuropathic pain, associated with phantom breast pain in 2 cases (incidence of chronic pain 50%; P = .01, Fischer exact test; relative risk, 7.5, 95% confidence interval, 1.0-53.5). The incidences of myofascial pain (neck muscle tightness) were similar in the 2 groups. CONCLUSIONS: Four to 5 months after mastectomy, fewer cases of chronic pain developed in the group operated under general anesthesia with a preincisional paravertebral block than in the group that received only general anesthesia, with postoperative morphine chloride for analgesia.

Comparación entre anestesia general con o sin bloqueo paravertebral preincisional con dosis única y dolor crónico postquirúrgico, en cirugía radical de cáncer de mama / Chronic postoperative pain after general anesthesia with or without a singledose preincisional paravertebral nerve block in radical breast cancer surgery

Objetivo: En la cirugía del cáncer de mama, en más del 50% de las pacientes con mastectomía y/o linfadenectomía persiste el dolor en el primer año. Nuestro objetivo fue determinar la asociación entre la técnica anestésica, la intensidad del dolor agudo postquirúrgico y el desarrollo del dolor crónico postquirúrgico. Pacientes y métodos: Cuarenta pacientes fueron asignadas aleatoriamente a recibir anestesia general o anestesia general con bloqueo paravertebral para mastectomía radical modificada. Se midió el dolor mediante escala visual analógica a los 60 minutos, a las 24 horas y a los 4-5 meses se realizó encuesta de dolor crónico postquirúrgico. Resultados: No hubo diferencias significativas respecto al dolor agudo. Veintinueve pacientes contestaron a la encuesta telefónica. En el grupo del bloqueo paravertebral sólo hubo un caso de dolor neuropático y ninguno de miembro fantasma mientras que en el grupo de anestesia general hubo 7 casos de dolor neuropático asociados a 3 casos de miembro fantasma [6,7% frente a 50%; test exacto de Fischer, p = 0,01, con un RR de 7,5 (IC95% 1,0-53,5)]. Hubo dolor miofascial (contracturas en cuello) en ambos grupos sin diferencias significativas. Conclusiones: A los 4-5 meses de la cirugía la anestesia general con bloqueo paravertebral preincisional presenta menos casos de dolor crónico que sí se utiliza anestesia general y analgesia con cloruro mórfico(AU)

Background and objective: Over 50% of patients still experience pain a year after mastectomy with or without lymphadenectomy. We aimed to determine the association between anesthetic technique, acute postoperative pain intensity, and the development of chronic postoperative pain. Patients and methods: Forty patients were randomly assigned to receive general anesthesia with or without a paravertebral nerve block for modified radical mastectomy. Postoperative pain was assessed on a visual analog scale at 60 minutes and 24 hours; the patients were also asked to respond to a telephone questionnaire on chronic pain 4 to 5 months later. Results: No significant differences in acute pain were observed. Twenty-nine responded to the telephone questionnaire. Only 1 patient in the paravertebral block group reported chronic neuropathic pain and none had phantom breast pain. Only 1 patient (6.7%) in the paravertebral block group reported chronic neuropathic pain and none had phantom breast pain. In the group that received general anesthesia alone, 1 patient reported phantom breast pain and 6 patients had neuropathic pain, associated with phantom breast pain in 2 cases (incidence of chronic pain 50%; P = .01, Fischer exact test; relative risk, 7.5, 95% confidence interval, 1.0-53.5). The incidences of myofascial pain (neck muscle tightness) were similar in the 2 groups. Conclusions: Four to 5 months after mastectomy, fewer cases of chronic pain developed in the group operated under general anesthesia with a preincisional paravertebral block than in the group that received only general anesthesia, with postoperative morphine chloride for analgesia(AU)

Cefalea postpunción dural tras anestesia subaracnoidea en un programa de cirugía mayor ambulatoria / No disponible

Objetivo: Evaluar la incidencia de cefalea postpunción dural en pacientes sometidos a cirugía mayor ambulatoria bajo anestesia espinal intradural. Material y métodos: Estudio retrospectivo y descriptivo de9.992 pacientes intervenidos en un periodo de 9 años. Se cuantifican la relación de CPPD-tipo de aguja empleada, así como el consumo de agujas espinales por año de estudio. Se valoró por las consultas e ingresos al Servicio de Urgencias de los casos de CPPD según criterios de Jones. El método estadístico empleado fue la t de Student para las variables cuantitativas y la (..) (AU)

Objective: To evaluate the ratio of headaches after dural puncture (PDPH) in patients undergoing intradural spinal anaesthesia for ambulatory surgery. Material and methods: We undertook a retrospective and descriptive study of 9,992 patients over a period of 9 years. The relationship between PDPH and the type of needle used, as well as the consumption of spinal needles per year of study, were quantified. We evaluated the number of cases of PDPH through the consultations and admissions to the Emergency Service according to the Jones’ criteria. The statistical methods used were: Student’s t test for the quantitative variables and chi-squared test of frequencies for the qualitative variables. Results: The incidence of PDPH was 0.60%. The average age of PDPH appearance was 43.12 ± 15.62 years, with a predominance of the feminine sex (63,3%). The incidence of PDPH when using a 22-G Quincke type needle was superior, with statistically significant differences, with respect to the rest of needles. The PDPH was severe in 58% of the cases. The evolution of the migraine in most of the cases (91%) was benign with medical treatment. Conclusions: The progressive reduction in the number of days of hospitalization, accentuated, in the last years, with the new organizational models for surgical assistance has lead to the appearance, in primary medicine, of clinical problems usually found only in hospitalized patients. The PDPH is characterized bya front occipital headache that gets worse when in the upright position in surgical patients undergoing spinal anaesthesia, and is benign and self-limited when treated with conventional medication (AU)

[Specialized training in anesthesiology: the opinions of supervising tutors]. / La formación especializada en Anestesiología desde la perspectiva de los tutores.

OBJECTIVE: To evaluate the common curriculum for teaching theoretical knowledge in anesthesiology in Catalonia, Spain; to assess differences between hospital teaching programs, evaluation systems, and the situation for tutors. MATERIAL AND METHODS: A 35-item questionnaire was sent to 49 accredited tutors during the 2005-2006 academic year. The questionnaire covered 1) the curriculum and training rotations, 2) teaching and research, and 3) assessment and tutorial interventions. An additional question asked the respondent's view on how to improve instruction. RESULTS: Eighty-five percent of the tutors responded. Seventy-eight percent of the residents (168/216) follow some form of external rotation, most often in pediatric anesthesia (79%). The common courses are considered useful by 96% of the tutors. Ninety-two percent are satisfied with the current annual examination and 79% would extend the residency training period to 5 years. Eighty-two percent of the teaching centers have weekly instructional sessions. Eighty-one percent of the tutors consider the resident's logbook, filled in by 77% of residents, to be useful for assessment. Eighty-five percent take teacher training courses, 65% feel that their work is being recognized, and 92% do not allot a specific period of time for teaching. CONCLUSIONS: The survey has helped shed light on the current training situation in Catalonia. The common courses are of great help. The number of external rotations is high, overloading certain areas. Improvements could be made by unifying external rotations, updating the curriculum and extending the training period to 5 years, recognizing the role of the tutor, and establishing a specific time for teaching activity.