Functional mobility and physical fitness are improved through a multicomponent training program in institutionalized older adults.

Physical exercise has demonstrated its effectiveness in the management of the deleterious process of aging. However, it is less studied in institutionalized elderly people. This investigation aims to clarify the benefits of a multicomponent training program in institutionalized older adults. A randomized controlled trial was conducted with institutionalized older adults (≥ 70 years old). Intervention group (IG; N = 18) were submitted to a multicomponent training program based on muscle power training and interval endurance exercise, 2 times/week for 12 weeks. Control group (CG; N = 16) continued their usual mobility exercises. Independence was estimated with the Barthel index, and physical fitness and functional mobility were evaluated by the Short Physical Performance Battery (SPPB), the Timed Up and Go (TUG) test, the 6-min Walking Test (6'WT), the 10-Meter Walking Test (10MWT), hand grip strength dynamometry, and lower limb muscle strength and power. The IG improved, compared with the CG, in TUG scores in -7.43 s (95% IC: 3.28, 11.59; p < 0.001); in 10MWT scores in -5.19 s (95% IC: 1.41, 8.97; p = 0.004) and -4.43 s (95% IC: 1.14, 7.73; p = 0.002), 6'WT scores in + 54.54 m (95% IC: 30.24, 78.84; p < 0.001); and SPPB in + 2.74 points (95% IC: 2.10, 3.37; p < 0.001). Maximum muscle power and maximum strength did not show statistically significant differences. The multicomponent training program based on muscle power and interval endurance exercise was shown to be safe, well tolerated and effective for the improvement of functional mobility and physical fitness, but not for independence in institutionalized older adults.

Is ankle taping effective to limit the ankle dorsiflexion in a single-training session? An observational study in semi-professional basketball players

ABSTRACT BACKGROUND: Ankle taping (AT) is effective in preventing ankle sprain injuries in most common sports and is employed in rehabilitation and prevention sports. OBJECTIVE: This study aimed to investigate the effectiveness of AT to restricting excessive frontal plane ankle movements in semi-professional basketball players throughout the training session. DESIGN AND SETTING: A cross-sectional study was performed at the Universidad Europea de Madrid. METHODS: Forty male and female semi-professional basketball players were divided into two groups. The ankle dorsiflexion range of motion (ROM) and interlimb asymmetries in a weight-bearing lunge position were evaluated at four time points: 1) with no tape, 2) before practice, at 30 min of practice, and 3) immediately after practice. RESULTS: In male basketball players, no differences were observed in the right and left ankles between the baseline and 30 min and between baseline and 90 min of assessment. In female athletes, significant differences were reported between baseline and pre-training assessments for the right ankle and also significant differences between baseline and 90 min in both ankles. CONCLUSIONS: Ankle taping effectively decreased the ankle dorsiflexion ROM in male and female basketball players immediately after application. However, ROM restriction was very low after 30 and 90 min, as assessed in a single basketball practice. Therefore, the classic taping method should be revised to develop new prophylactic approaches, such as the implementation of semi-rigid bracing techniques or the addition of active stripes during training or game pauses.

Is ankle taping effective to limit the ankle dorsiflexion in a single-training session? An observational study in semi-professional basketball players.

BACKGROUND: Ankle taping (AT) is effective in preventing ankle sprain injuries in most common sports and is employed in rehabilitation and prevention sports. OBJECTIVE: This study aimed to investigate the effectiveness of AT to restricting excessive frontal plane ankle movements in semi-professional basketball players throughout the training session. DESIGN AND SETTING: A cross-sectional study was performed at the Universidad Europea de Madrid. METHODS: Forty male and female semi-professional basketball players were divided into two groups. The ankle dorsiflexion range of motion (ROM) and interlimb asymmetries in a weight-bearing lunge position were evaluated at four time points: 1) with no tape, 2) before practice, at 30 min of practice, and 3) immediately after practice. RESULTS: In male basketball players, no differences were observed in the right and left ankles between the baseline and 30 min and between baseline and 90 min of assessment. In female athletes, significant differences were reported between baseline and pre-training assessments for the right ankle and also significant differences between baseline and 90 min in both ankles. CONCLUSIONS: Ankle taping effectively decreased the ankle dorsiflexion ROM in male and female basketball players immediately after application. However, ROM restriction was very low after 30 and 90 min, as assessed in a single basketball practice. Therefore, the classic taping method should be revised to develop new prophylactic approaches, such as the implementation of semi-rigid bracing techniques or the addition of active stripes during training or game pauses.

Estimating fat-free mass in recreationally resistance-trained young men: Longitudinal and cross-sectional validation of different methods.

Several techniques exist to measure fat-free mass (FFM). Accordingly, this study is based on data from our recent trial comparing the sensitivity of the main field methods available with that of dual-energy X-ray absorptiometry (DXA) as reference and analyzing the cross-sectional accuracy of these field methods in recreationally resistance-trained males. We hypothesized that the use of these techniques would lead to varying estimates of FFM compared with DXA. Participants (N = 23; 21.4 ± 3.3 years) completed a 10-week resistance training plus diet intervention designed to optimize hypertrophy. FFM was determined by bioelectrical impedance analysis (BIA), 23 anthropometric equations, and DXA. After the intervention, FFM increased significantly according to BIA and most anthropometric estimates, but this increase was not detected by 2 anthropometric equations or by DXA. Only 1 of these 2 equations showed significant correlation with DXA and no standardized or significant differences to this reference method, although it did display significant heteroscedasticity. In our cross-sectional analysis, only 1 anthropometric equation gave rise to good accuracy as confirmed by DXA. Our findings indicate that the use of different techniques to assess FFM gains in response to a hypertrophic intervention yields different results. BIA with general embedded equations should not be used to monitor a young male adult's body composition. To monitor FFM over time, we would recommend the Dunne et al. equation (2) as the most sensitive field method, and to assess FFM cross-sectionally, equation (1) of these authors is the most accurate field method.

Validity of the two-minute step test for healthy older adults.

BACKGROUND: In healthy older adults, the two-minute step test (2MST) does not have its concurrent validity tested against the six-minute walk test (6MWT), which is a valid cardiorespiratory fitness test frequently applied in geriatric samples. OBJECTIVE: To derive an equation to predict 6MWT from 2MST and to observe the agreement between observed and estimated 6MWT distances. METHODS: 6MWT and 2MST were measured in 51 older adults (72.9±4.6 years) from community multicomponent exercise programs. Multiple linear regression derives the predictive equation of 6MWT walked distance (dependent outcome) from steps obtained in 2MST, age, sex, and body mass index (independent outcomes). RESULTS: Correlation between 6MWT and 2MST was strong (r=0.696, p<0.001). The regression equation showed good agreement with measured values, when 6MWT was below 600 m. CONCLUSION: The equation stands as a novel approach to obtaining a valid 6MWT estimation from the 2MST. 2MST is easier and faster, representing an alternative approach when time and space are limited.

Dietary Nitrate Ingestion Does Not Improve Neuromuscular Performance in Male Sport Climbers.

Beetroot juice (BJ) is commonly used as an ergogenic aid in endurance and team sports, however, the effect of this supplement on climbing performance is barely studied. The purpose of the current study was to investigate the effect of acute BJ ingestion on neuromuscular and biochemical variables in amateur male sport climbers. Ten physically active sport climbers (28.8 ± 3.7 years) underwent a battery of neuromuscular tests consisting of the half crimp test, the pull-up to failure test, the isometric handgrip strength test, the countermovement jump (CMJ) and the squat jump (SJ). Participants performed the neuromuscular test battery twice in a cross-over design separated by 10 days, 150 min after having consumed either 70-mL of BJ (6.4 mmol NO3-) or a 70-mL placebo (0.0034 mmol NO3-). In addition, nitrate (NO3-) and nitrite (NO2-) saliva concentrations were analysed, and a side effect questionnaire related to ingestion was administrated. No differences were reported in particular neuromuscular variables measured such as the CMJ (p = 0.960; ES = 0.03), the SJ (p = 0.581; ES = -0.25), isometric handgrip strength (dominant/non dominant) (p = 0.459-0.447; ES = 0.34-0.35), the pull-up failure test (p = 0.272; ES = 0.51) or the maximal isometric half crimp test (p = 0.521-0.824; ES = 0.10-0.28). Salivary NO3- and NO2- increased significantly post BJ supplementation compared to the placebo (p < 0.001), while no side effects associated to ingestion were reported (p = 0.330-1.000) between conditions (BJ/placebo ingestion). Acute dietary nitrate supplementation (70-mL) did not produce any statistically significant improvement in neuromuscular performance or side effects in amateur sport climbers.

Antioxidant vitamin supplementation on muscle adaptations to resistance training: A double-blind, randomized controlled trial.

OBJECTIVES: The aim of this study was to examine whether antioxidant vitamin supplementation with vitamin C (VitC) and vitamin E (VitE) affects the hypertrophic and functional adaptations to resistance training in trained men. METHODS: This was a double-blind, randomized controlled trial in which participants were supplemented daily with VitC and VitE ( n = 12) or placebo ( n = 11) while completing a 10-wk resistance training program accompanied by a dietary intervention (300 kcal surplus and adequate protein intake) designed to optimize hypertrophy. Body composition (dual-energy x-ray absorptiometry), handgrip strength, and one-repetition maximum (1-RM), maximal force (F0), velocity (V0), and power (Pmax) were measured in bench press (BP) and squat (SQ) tests conducted before and after the intervention. To detect between-group differences, multiple-mixed analysis of variance, standardized differences, and qualitative differences were estimated. Relative changes within each group were assessed using a paired Student's t test. RESULTS: In both groups, similar improvements were produced in BP 1-RM , SQ 1-RM SQ, and BP F0 (P < 0.05) after the resistance training program. A small effect size was observed for BP 1-RM (d = 0.53), BP F0 (d = 0.48), and SQ 1-RM (d = -0.39), but not for SQ F0 (d = 0.03). Dominant handgrip strength was significantly increased only in the placebo group (P < 0.05). According to body composition data, a significant increase was produced in upper body fat-free mass soft tissue (FFMST; P < 0.05) in the placebo group, whereas neither total nor segmental FFMST was increased in the vitamin group. Small intervention effect sizes were observed for upper body FFSMT (d = 0.32), non-dominant and dominant leg FFMST (d = -0.39; d = -0.42). Although a significant increase in total body fat was observed in both groups (P < 0.05) only the placebo group showed an increase in visceral adipose tissue (P < 0.05), showing a substantial intervention effect (d = 0.85). CONCLUSIONS: The data indicated that, although VitC/VitE supplementation seemed to blunt upper body strength and hypertrophy adaptations to resistance training, it could also mitigate gains in visceral adipose tissue elicited by an energy surplus.

Functional flexibility in institutionalized sedentary older adults / A flexibilidade funcional em idosos sedentários institucionalizados

Abstract The aging process leads to deterioration in physiological functions, decreasing functional capacity. Since physical exercise reduces deleterious effects, measuring physical condition is necessary in older adults. The aim of this study was to verify the evolution of the range of motion in institutionalized sedentary older adults. The sample consisted of 19 volunteers aged 65-95 years who completed the Chair Sit-and-Reach test (CSR) and the Back-Scratch test (BS) to measure flexibility of the lower and upper limbs, respectively, before and after a period of 12 weeks without intervention. The results showed significant decrease during the control period (BS, p=0.004; CSR, p=0.001). These findings confirm that physical inactivity could lead to important loss of flexibility of institutionalized individuals, indicating decline of the elastic properties of musculoskeletal tissues and of connective tissues of joints. Therefore, the participation of institutionalized older adults in properly prescribed and guided physical exercises should be continuous and regular.

Resumo O envelhecimento implica uma deterioração das funções fisiológicas, podendo diminuir a capacidade funcional. O exercício físico poderia minimizar esses efeitos deletérios, por isso é necessário conhecer a condição física dos idosos. O objetivo deste estudo é verificar a evolução da amplitude de movimento em idosos institucionalizados e sedentários. A amostra foi composta por 19 voluntários, com idades entre 65 e 95 anos, que concluíram os testes Chair Sit and Reach (CSR) e Back Scratch (BS) para medir a flexibilidade dos membros inferiores e superiores, respectivamente; antes e depois de um período de 12 semanas sem intervenção. Os resultados mostraram uma diminuição significativa durante o período de controle (BS, p=0.004; RSE, p=0.001). Esses achados confirmam que a inatividade física pode implicar uma perda significativa de flexibilidade dos idosos institucionalizados, indicando uma diminuição nas propriedades elásticas do tecido musculoesquelético e dos tecidos conjuntivos nas articulações. Portanto, a participação de idosos institucionalizados no exercício físico orientado e adequadamente prescrito deve ser contínua e regular.

Efectos analgésicos del ejercicio físico en pacientes con dolor crónico musculoesquelético durante el confinamiento por la pandemia COVID-19 / Analgesic effects of physical exercise in patients with chronic musculoskeletal pain during confinement by the COVID -19 pandemic

INTRODUCCIÓN: El confinamiento vivido durante la pandemia del COVID-19 en España durante más de dos meses, podría afectar severamente a la condición y calidad de vida de los pacientes que sufren dolor crónico musculoesquelético. Teniendo en cuenta los efectos analgésicos que el ejercicio físico puede generar, gran parte de la población ha realizado ejercicio físico en sus domicilios como mecanismo del control del dolor, durante este periodo. OBJETIVO: El objetivo de este estudio fue conocer el tipo y la dosis de ejercicio físico realizado, así como la percepción de los pacientes en la reducción del dolor, durante el periodo de confinamiento por el COVID-19. MATERIAL Y MÉTODO: Se realizó una encuesta ad hoc a través de Google Forms a 86 pacientes para conocer su estado, el tipo de ejercicio que realizaron y la cantidad de ejercicio, así como si habían percibido una reducción de su dolor durante el periodo de confinamiento. RESULTADOS: La intensidad de dolor disminuyó de forma significativa (p = 0,001) cuando se hizo algún tipo de ejercicio físico. El ejercicio de fuerza fue elegido por el 51% de la población de forma exclusiva, y las frecuencias y el tiempo de sesión no fueron diferentes de forma significativa entre los sujetos que sintieron una reducción del dolor y los que no. CONCLUSIÓN: Una programación de ejercicio físico de 4 días a la semana, durante al menos 50 minutos y con intensidades del 77% de FCmax de ejercicio aeróbico o de fuerza sería recomendable en un paciente con dolor crónico, como estrategia para la reducción del dolor. Los resultados de nuestro estudio no aconsejan, para pacientes con dolor crónico, sesiones de terapia combinada, independientemente de la localización primaria del dolor

INTRODUCTION: The confinement experienced during the COVID-19 pandemic in Spain for more than two months, could severely affect the condition and quality of life of patients suffering from chronic musculoskeletal pain. Taking into account the analgesic effects that physical exercise can generate, a large part of the population has carried out some kind of physical exercise at home as a mechanism for pain control, during this period. OBJECTIVE: The objective of this study was to know the type and dosage of the exercise performed, as well as the perception of the patient ́s pain during the confinament period. MATERIAL AND METHOD: An ad hoc survey by a Google Form was conducted in 86 patients to find out the health status of the patients, the type of exercise they performed and the dossage of the exercise, as well as whether they had perceived a reduction in their pain during the period of confinement. RESULTS: The pain intensity was reduced significantly (p = 0.001) when some kind of exercise was done. Strength exercise exclusively was chosen by 51% of the population, and the frequencies and session time were not significantly different bet-ween the subjects who felt a reduction in pain and those who did not. CONCLUSION: A schedule of physical exercise 4 days a week, for at least 50 minutes and with intensities around 77% of HR-máx of aerobic or strength training would be recommended in patients with chronic pain, as a strategy for pain reduction. The results of our study do not advise, for patients with chronic pain, combined therapy sessions, regardless of the primary location of the pain

Grado de predicción de la motivación hacia las actividades físicodeportivas a través de la orientación de metas, la percepción del éxito y el grado de satisfacción. Un análisis transcultural / Prediction Level of Motivation through Physical and Sport Activities according to Goal Orientation, Success Perceived and Satisfaction Rate. A Cross-Cultural Analysis

Resumen El objetivo de este estudio fue conocer en qué medida se puede predecir el tipo de motivación hacia la práctica de actividad físicodeportiva en función de la orientación de metas, la percepción del éxito y el grado de satisfacción, mediante un análisis transcultural en tres países latinos: España, México y Costa Rica. Se evaluaron 2 168 escolares de edades entre 11 y 16 años, utilizando cuatro instrumentos: Sport Motivation Scale (SMS), Task and Ego Orientation Sport Questionnaire (TEOSQ), Satisfaction Instrument (SSI) y Beliefs about the Causes of Sport Success Questionnaire (BACS). Los resultados mostraron que valores altos en orientación a la tarea, diversión y esfuerzo pueden predecir significativamente la manifestación de motivación intrínseca en los sujetos de los tres países.

Abstract The objective of this study was to analyse at which level it is possible to predict motivation type through physical and sport activities according to goal orientation, success perceived and satisfaction rate, in a transcultural analysis through three Latin countries: Spain, Mexico and Costa Rica. 2168 students (between 11-16 years-old) completed 4 evaluation instruments: Sport Motivation Scale (SMS), Task and Ego Orientation Sport Questionnaire (TEOSQ), Satisfaction Instrument (SSI) y Beliefs About the Causes of Sport Success Questionnaire (BACS). Results showed that high values in task orientation, fun, and effort could significantly predict intrinsic motivation in the three countries of our research.

Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax using a single-incision laparoscopic surgery port: a feasible and safe procedure.

BACKGROUND: Recent authors have pioneered the use of single-incision laparoscopic surgery (SILS) for umbilical cholecystectomy. The SILS approach has the potential of reducing the trauma of the surgical access and postoperative pain. Video-assisted thoracic surgery (VATS) greatly reduces patient postoperative pain compared with traditional thoracotomy incisions. The current trend is to use fewer working ports to reduce even more postoperative pain, chest wall paresthesia, and hospital stay. No reports have described using a SILS port in VATS. METHODS: From September 2009 to March 2010, 13 patients had surgery for primary spontaneous pneumothorax. The patients underwent single-lung ventilation. A 2.5-cm-long incision was made at the sixth intercostal space in the median axillary line. The pleural space was entered by blunt dissection for placement of a single flexible port. A 5-mm 0° videothoracoscope, a roticulating grasper, and an endoGIA stapler were introduced through port channels. Apical lung blebs were stapled, and pleurodesis by pleural abrasion with Marlex mesh was performed. RESULTS: The study enrolled nine men (69.2%) and four women with a median age of 26.3 years. No complications were recorded. The postoperative pain was mild for 10 patients (76.9%) and moderate for 3 patients. Mild chest wall paresthesia (numbness) was observed in three patients (23.07%). The postoperative hospital stay was 2.15 days. CONCLUSIONS: Although the SILS port is for laparoscopic use, it allowed an adequate lineup of the instruments along the intercostal space and adequate instrument maneuverability for stapling and resecting of apical lung bullae or blebs. The procedure was accomplished successfully for 92.3% of the patients. This is the first report on the use of a SILS port in VATS. Further work and development of a proper thoracic single port are needed to define the uses and advantages of this uniportal technique.

Evaluación de la analgesia post-toracotomía por bloqueo intercostal con bupivacaína / Evaluation of analgesia post-thoracotomies by intercostal block with bupivacaine

Con el objeto de evaluar la eficiencia de la analgesia postoperatoria del Bloqueo Intercostal luego de cirugía Torácica, se estudian prospectivamente 40 pacientes sometidos a Toracotomías posterolaterales. A 20 de ellos se les colocó un carácter intercostal para administrar Bupivacaína al 0.5 por ciento cada 4 horas (Grupo Bupivacaína) y además recibirían drogas opiáceas si fuera necesario. Los otros 20 pacientes (Grupo Meperidina) fueron tratados exclusivamente con medicación opiácea. Se determinó que el grado de analgesia en los pacientes bloqueados (Grupo Bupivacaína) fue mucho mejor que el de los pacientes tratados exclusivamente con Meperidina, mostrando diferencias significativas (p<0.01) en los registros de dolor postoperatorio de las 4,24, 48 y 72 horas. Así mismo los pacientes del Grupo Bupivacaína, solicitaron un número significativamente menor (p<0.01) de dosis de opiáceos que los otros pacientes (Grupo Meperidina) durante los tres primeros días del postoperatorio (31 Vs 178 dosis), esto es una reducción del 82,5 por ciento de los analgésicos solicitados. Más aún 8 de los 20 pacientes bloqueados (40 por ciento) no necesitaron de ninguna dosis de Merperidina. Aunque se observaron menos complicaciones respiratorias en los pacientes con bloqueo intercostal (3 Vs 5) ésta diferencia no fue significativa estadísticamente (p>0.05). Sin embargo la reducción en la estancia hospitalaria en éstos pacientes bloqueados (4,4 ñ 1,18 Vs 6,2 ñ 1,96 días), sí mostró diferencias significativas (p<0.01). En conclusión el bloqueo intercostal utilizando Bupivacaína en bolo, posterior a Cirugía Torácica, es un método de analgesia postoperatoria efectivo, sencillo y seguro, que permite un mejor control de dolor en el paciente y una reducción tanto del número de analgésicos opiáceos requeridos, como de la estancia hospitalaria

Hemotórax por fístula arteriovenosa pulmonar durante el embarazo: reporte de un caso / Hemothorax due to lung arteriovenous fistula in pregnancy: case report

Una embarazada de 42 años de edad y 29 semanas de gestación, arribó al Servicio de Emergencias del Hospital Central Universitario "Antonio María Pineda" (HCUAMP), con disnea y signos de hipovolemia, diagnósticandose hemotórax derecho no traumático. Ameritó toracotomia cerrada y drenaje inicialmente, y luego se le realizó cesárea y neumonectomía parcial derecha debido a la presencia de una fístula arteriovenosa pulmonar. Estas son malformaciones vasculares pulmonares infrecuentes y existe una fuerte asociación entre estas y la enfermedad de Rendu-Osler-Weber. El Embarazo ha sido implicado en el deterioro súbito de estos pacientes, mas aún el mecanismo parece incierto. Discutimos el diagnostico y tratamiento de esta enfermedad

La identificación del ganglio centinela axilar con azul patente en el carcinoma mamario / The identification of the sentinel node axillary with blue pantent v in the mammary carcinoma

El estado de los Ganglios Axilares es el indicador pronóstico más importante en la sobrevida de las pacientes con cáncer mamario. La linfadenectomía de los niveles axilares I y II no es un procedimiento excento de morbiblidad y permite determinar metástasis en sólo el 25 al 35 por ciento de las pacientes. La finalidad de este estudio es determinar, sí la identificación del Ganglio Centinela coloreado con Azul Pantene No.5 mediante inyección mamaria peritumoral, pudiera ser un método de evaluación del estado ganglionar axilar, tan confiable como la linfadenectomía estándar. Se estudiaron prospectivamente 65 pacientes con diagnóstico histológico de carcinoma mamario entre Enero de 1997 y Enero del 2000. Se identificaron un total de 97 ganglios centinelas en 56 de la pacientes (1,7 ganglios por paciente). La capacidad de método de identificar los ganglios centinelas fue 86,15 por ciento 18 pacientes presentaron ganglios centinelas metastasicos (32,14 por ciento). Observamos 3 pacientes con faltos negativos (5,35 por ciento), de ellas 1 (1,78 por ciento) con metástasis discontinuan (skip). La precisión del método en reflejar el estado ganglionar axilar fue 94,64 por ciento (53/56), lo que permite recomendarlo como una alternativa a la linfadenectomía axilar clásica en las pacientes con carcinoma mamario

Valor diagnóstico de la laparoscopia en el trauma abdominal cerrado / Diagnóstic value of the laparoscopy in the closed abdominal trauma

Con el objeto de evaluar la efectividad de la laparoscopia como método diagnóstico de lesiones intraabdominales en los casos de traumatismo abdominal cerrado, estudiamos 18 pacientes que acudieron al Servicio de Emergencia del Hospital Universitario "Dr. Antonio María Pineda", entre marzo de 1993 y septiembre de 1994, y en los cuales el diagnóstico de abdomen agudo quirúrgico fue dudoso basado en procedimientos clínicos y paraclínicos. En 11 de los pacientes encontramos hallazgos laparoscópicos positivos que se correspondieron con lesiones intraabdominaels confirmadas en todos los casos por laparotomía exploradora. Evitamos 6 laparotomía innecesarias (33,33 por ciento) basándonos en hallazgos laparoscópicos negativos. Recomendamos el uso rutinario de la laparoscopia diagnóstica con anestesia local en vista de su fácil realización, baja morbilidad y excelentes resultados

Analgesia con Bupivacaína en cirugía abdominal / Analgesia with Bupivacaine in abdominal surgery

En este trabajo estudiamos los efectos postoperatorios de la infiltración músculo aponeurótica con bupivacaína al 0,5 por ciento en 25 pacientes sometidos a laparostomías (10 biliares y 15 ginecológicas). Al compararlos con controles que fueron infiltrados con solución fisiológica encontramos, un efecto analgésico postoperatorio significativo durante las primeras 24 horas siendo más evidente durante las primeras 6 horas (p<0,01) y disminuyendo progresivamente hasta no ser significativo durante el segundo día de postoperatorio (p>0,05). Igualmente el número de dosis de analgésicos (ketoprofeno) utilizada por los pacientes del grupo de trabajo fue significativamente menor (18 dosis) que el del grupo control (83 dosis) durante el primer día (p<0,01) sin embargo la diferencia de dosis en el segundo día (30 vs 41) no fue significativa (p>0,05). El número de complicaciones respiratorias fue menor en el grupo de pacientes infiltrados bupivacaína que en los controles (4 vs 7) así como el promedio de días de estancia hospitalaria (26 vs 3,29) sin embargo ambas diferencias no fueron significativas estadísticamente

Herniorrafia según técnica de Lichtenstein / Hernioraphy according toas technique Lichtenstein

Intervenimos 23 pacientes con 28 hernias inguinales, (5 bilaterales y 8 recidivadas) según la técnica de Lichtenstein, con anestesia local (bupivacaína 0,5 por ciento) y en forma ambulatoria, desde noviembre 1990 hasta abril 1992. Se presentaron 8 complicaciones menores que se resolvieron satisfactoriamente. La reincorporación a sus actividades fue precoz, las 2/3 partes de nuestros pacientes lo hicieron durante la primera semana de post-operatorio. Ninguna recidiva en el grupo a pesar de que las 3/4 partes de los pacientes tenían más de 1 año de operados. Recomendamos el procedimiento por la facilidad técnica, escaso dolor y excelentes resultados

Cirugía ambulatoria experiencia 6 años / Ambulatory surgery: experience of 6 years

Se presenta la experiencia de 6 años del Servicio de Cirugía Ambulatoria del Hospital AMP de Barquisimeto con un número de 5450 intervenciones de diferentes tipos, de las cuales 3816 (70 por ciento) corresponden a los niveles II y III de Velez (que normalmente se hospitalizaban) ahorrándole al Hospital 45792 días/cama y Bs. 61.300.224, para ser utilizados en procedimientos más complejos. Además de un ahorro de 165 días de espera por paciente, con un total de 629.440 días para los 3816 pacientes. Tuvimos un índice de complicaciones del 1,72 por ciento, ninguna grave. Recomendamos la creación de centros de Cirugía Ambulatoria intrahospitalarios independientes administrativamente de los Departamentos quirúrgicos