Antisepsia cutánea antes de la cirugía / Preoperative skin antisepsis

La infección de la herida quirúrgica es una de las principales complicaciones del paciente intervenido con cirugía y tiene graves consecuencias clínicas y económicas, sobre todo cuando afecta a implantes prostéticos o si está causada por bacterias multirresistentes. Dentro de las medidas preventivas, la preparación cutánea es uno de los elementos fundamentales. Las principales guías de práctica clínica recomiendan no retirar el pelo de la zona de la cirugía a no ser que interfiera con la intervención y, en caso de ser necesario, hacerlo con cortadora de uso único, lo más cercano en el tiempo a la cirugía. En cuanto a la ducha previa a la cirugía, la recomendación actual es hacerlo con un jabón (antimicrobiano o no) o con un producto antiséptico al menos la noche anterior. Para la preparación de la zona de incisión y el área de alrededor, se recomienda en general el empleo de antisépticos de base alcohólica, preferiblemente clorhexidina alcohólica por su alta actividad antibacteriana y su efecto residual prolongado, respetando de manera conveniente el tiempo de secado por evaporación

Surgical wound infection is one of the main complications of patients undergoing surgery and has significant clinical and economical consequences, especially when it affects prosthetic implants or is caused by multidrug resistant bacteria. Cutaneous preparation is one of the main preventive measures. Clinical practice guidelines recommend not to remove the hair from the surgery site unless it interferes with the operation, and that if removal proves necessary, it should be done with a single-use cutter, as close as possible to the time of surgery. With regard to preoperative showering, the current recommendation is to perform it with a soap (whether antimicrobial or otherwise) or an antiseptic product, at least the night before surgery. Regarding preparation of the incision area and surrounding zone, the use of an alcohol-based antiseptic is generally advised, preferably alcoholic chlorhexidine, due to its high antibacterial activity and prolonged residual effect, respecting the evaporation drying time

Preoperative skin antisepsis. / Antisepsia cutánea antes de la cirugía.

Surgical wound infection is one of the main complications of patients undergoing surgery and has significant clinical and economical consequences, especially when it affects prosthetic implants or is caused by multidrug resistant bacteria. Cutaneous preparation is one of the main preventive measures. Clinical practice guidelines recommend not to remove the hair from the surgery site unless it interferes with the operation, and that if removal proves necessary, it should be done with a single-use cutter, as close as possible to the time of surgery. With regard to preoperative showering, the current recommendation is to perform it with a soap (whether antimicrobial or otherwise) or an antiseptic product, at least the night before surgery. Regarding preparation of the incision area and surrounding zone, the use of an alcohol-based antiseptic is generally advised, preferably alcoholic chlorhexidine, due to its high antibacterial activity and prolonged residual effect, respecting the evaporation drying time. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.

12 Years of Repair of Amalgam and Composite Resins: A Clinical Study.

OBJECTIVE: The objective of this study was to clinically evaluate repaired posterior amalgam and composite restorations over a 12 year period, investigate the influence of repair in the survival of restorations, and compare their behavior with respect to controls. METHODS: Thirty-four patients, 18 to 80 years of age with 167 restorations, 67 composite resin (RC), and 100 amalgam (AM) restorations, participated. Restorations with localized, marginal, anatomical deficiencies and/or secondary caries, and "clinically judged" suitable for repair or replacement according to US Public Health Service (USPHS) criteria, were randomly assigned to four groups: repair (n=35, 20 AM, 15 RC), replacement (n=43, 21 AM, 22 RC), positive control (n=71, 49 AM, 22 RC), or negative control (n=18, 10 AM, 8 RC). The quality of the restorations was blind scored according to the modified USPHS criteria. Two examiners scored them at initial status (κ=0.74) and after one to five, 10, and 12 years (κ=0.88). Wilcoxon and Mann-Whitney tests provided for comparisons within the same group and between years, respectively. RESULTS: After 12 years, all groups behaved similarly in marginal adaptation, marginal stain, teeth sensitivity, anatomic form, and luster ( p≥0.05). Better behavior in roughness was observed in replaced RC ( p=0.049). CONCLUSIONS: Given that most clinical parameters investigated were similar between all groups during the follow-up, the repair of RC and AM restorations is a good clinical option because it is minimally invasive and can consistently increase the longevity of restorations.

Heart rate as a predictor of energy expenditure in undisturbed fasting and incubating penguins.

Heart rate (f(H)) measurement offers the possibility to monitor energy expenditure (EE) in wild animals if the EE/f(H) relationship for the species, physiological stages and activities of interest is known. This relationship has been extensively studied using oxygen consumption rate ( ) measurement in captive, repeatedly handled king penguins (Aptenodytes patagonicus). Unfortunately, the potential effects of stress on the observed relationships resulting from handling and confinement were not considered. This study is the first involving undisturbed animals, and determines the EE/f(H) relationship in naturally fasting and freely incubating or captivity-acclimatized male and female king penguins. EE determination was based on (1) the measurement of body mass loss during periods of phase II fasting, and (2) the calculation of its energy equivalent from changes in body composition, i.e. 23.9 kJ g(-1). f(H) levels in freely incubating and captivity-acclimatized birds were found to be 50-70% lower than those previously reported for resting king penguins during measurements. Significant EE/f(H) relationships were found in freely incubating and captive males and females (R(2)=0.59 to 0.84), with no difference observed between genders. The best overall relationship was obtained by including fasting duration (t, days) in the model: EE=818+43.7xf(H)+36.3t-1.4txf(H) (R(2)=0.91). This equation yielded EE estimates approximately 26% higher than the previously reported 'best' predictive equation in king penguins, and even more so when f(H) was low. This result suggests that stress induces a disproportionate increase of f(H) vs O(2) consumption, and that the use of EE/f(H) relationships obtained in stressed birds could lead to underestimated EE values.

Terminating ventricular fibrillation by chest thump.

A 41-year-old man with a surgically closed atrial septal defect presented with anginalike symptoms of 5 years duration. While undergoing coronary arteriorgraphy, the patient sustained ventricular fibrillation which was converted successfully to sinus rhythm by a chest thump. This is the first reported case of such conversion. The mechanism of mechanical conversion from ventricular tachycardia, or fibrillation, to sinus rhythm may be that the mechanical stimulus interrupts a re-entry pathway or depresses ectopic impulses to allow the normal sinoatrial rhythm to emerge.