Immune response in breast cancer surgery. A comparative and prospective study of different anesthetic techniques.

INTRODUCTION: The main reason for high mortality in breast cancer is local recurrence and metastasis, despite surgery as the first therapeutic option. The anesthesia used in the operation room can determine the immune response. METHODS: A prospective, comparative and non- randomised study in patients undergoing breast cancer surgery was conducted in our hospital after obtaining approval from the Hospital's Institutional Review Board. Patients were divided in two groups: Group A received general anesthesia with propofol and opioids. Group B, in addition to general anesthesia, three interfascial blocks (Pec I, Pec II and BRILMA) were performed in all patients. Three blood samples were taken 1) previous anesthetic induction; 2) two hours after the end of the surgery and 3) 24-48 h after surgery. Leukocytes, CD3, CD4, CD8 and Natural Killer cells were determined at each time. RESULTS: 103 patients were included. 59 (group A) received general anesthesia and 54 (group B) general anesthesia and interfascial blocks. Regarding baseline characteristics, age was significantly higher in the group that received general anesthesia and mastectomy was more frequent in the group that received interfascial blocks. We observed after surgery an increase in leukocytes level that returns close to baseline levels. On the other hand, a reduction in the immune response was observed that also returns to the previous level 48 h after surgery. Group A and B get similar results and also subgroups of hormonal receptors (HER+, PR and/or ER+). CONCLUSIONS: Interfascial blocks in chest wall added to general anesthesia in breast cancer surgery has not shown a significant difference in the inflammatory response or immunological depression compared to general anesthesia as the only anesthetic technique. It seems to trend less immunological depression in the interfascial block group.

Respuesta inmunológica en cirugía del cáncer de mama. Estudio comparativo y prospectivo de diferentes técnicas anestésicas / Immune response in breast cancer surgery. A comparative and prospective study of different anesthetic techniques

Introducción: El principal motivo de la alta mortalidad en el cáncer de mama es la recurrencia local y las metástasis, siendo la cirugía la primera opción terapéutica. La técnica anestésica utilizada en quirófano puede modificar la respuesta inmunológica del paciente. Métodos: Estudio prospectivo, comparativo y no aleatorizado en pacientes intervenidos de cáncer de mama en el Hospital Universitario de Getafe (Madrid) tras la aprobación del Comité Ético del Hospital.Dividimos a los pacientes en dos grupos: grupo A, que recibió anestesia general con propofol y fármacos opiáceos; grupo B, en el que además de la anestesia general, se realizaron tres bloqueos interfasciales (Pec I, Pec II y BRILMA) en todos los pacientes. Se obtuvieron tres muestras sanguíneas: 1) antes de la inducción anestésica; 2) 2h después de finalizar la cirugía y 3) 24-48h posquirúrgicas. En cada muestra, se analizaron el número de leucocitos, células CD3, CD4 y CD8, así como las células natural killer (NK). Resultados: Se incluyeron en el estudio un total de 103 pacientes; 59 (grupo A) recibieron anestesia general y 54 (grupo B) anestesia general y bloqueos interfasciales. Según las características basales, la edad fue significativamente superior en las pacientes que recibieron anestesia general. La mastectomía se realizó con más frecuencia en el grupo que recibió bloqueos interfasciales. Observamos que después de la cirugía hay un aumento en el número de leucocitos pero regresa a los niveles basales a las 48h, comportamiento que se repite a nivel inmunológico: disminuye después de la cirugía pero vuelve a niveles previos a las 48h de la cirugía. Los grupos A y B presentan resultados similares en el resto de parámetros estudiados, al igual que los subgrupos según los receptores hormonales (HER+, PR y/o ER+).(AU)

Introduction: The main reason for high mortality in breast cancer is local recurrence and metastasis, despite surgery as the first therapeutic option. The anesthesia used in the operation room can determine the immune response. Methods: A prospective, comparative and non-randomized study in patients undergoing breast cancer surgery was conducted in our hospital after obtaining approval from the Hospital's Institutional Review Board. Patients were divided in two groups: Group A received general anesthesia with propofol and opioids. Group B, in addition to general anesthesia, three interfascial blocks (Pec I, Pec II and BRILMA) were performed in all patients. Three blood samples were taken 1) previous anesthetic induction; 2) two hours after the end of the surgery and 3) 24-48hours after surgery. Leukocytes, CD3, CD4, CD8 and Natural Killer cells were determined at each time. Results: 103 patients were included. 59 (group A) received general anesthesia and 54 (group B) general anesthesia and interfascial blocks. Regarding baseline characteristics, age was significantly higher in the group that received general anesthesia and mastectomy was more frequent in the group that received interfascial blocks.We observed after surgery an increase in leukocytes level that returns close to baseline levels. On the other hand, a reduction in the immune response was observed that also returns to the previous level 48hours after surgery. Group A and B get similar results and also subgroups of hormonal receptors (HER+, PR and/or ER+). Conclusions: Interfascial blocks in chest wall added to general anesthesia in breast cancer surgery has not shown a significant difference in the inflammatory response or immunological depression compared to general anesthesia as the only anesthetic technique. It seems to trend less immunological depression in the interfascial block group.(AU)

[Risk prescription associated to treatment at home of the elderly patient when admitted to the hospital]. / Prescripciones de riesgo asociadas al tratamiento domiciliario del paciente anciano al ingreso hospitalario.

OBJECTIVE: To determine the prevalence, the incidence of error, and the potential harm associated to particular prescriptions identified as a risk for medication error in the home treatment of elderly patients admitted to the hospital, as well as factors associated to their occurrence. MATERIAL AND METHODS: Cross-sectional, descriptive study. Patients aged 65 years and older, being admitted to the hospital from the emergency department in the last quarter of 2009. The SPSS software version 15.0 was used for the statistical analysis. RESULTS: 324 patients were included in the study. 1,176 (47%) prescriptions were identified as risk prescriptions in 91% of the patients. The most relevant risk prescription was prescription of high-risk medications (51.5% patients) that accounted for an error incidence of 88/100 patients with high-risk medications, being severe in 68 patients. Factors associated to the occurrence of moderate/high risk error due to risk prescriptions were suffering from a chronic respiratory illness, diabetes or polymedication. CONCLUSIONS: Actions aimed at decreasing the errors due to high risk medications should be prioritized.

Objetivo: Determinar la prevalencia, la incidencia de error y el daño potencial asociado a determinadas prescripciones señaladas como de riesgo de error de medicación en el tratamiento domiciliario de pacientes ancianos que ingresan en el hospital, así como los factores asociados a su aparición. Material y métodos: Estudio transversal descriptivo. Se incluyeron los pacientes de edad igual o mayor a 65 años que ingresaron en el hospital desde el servicio de urgencias durante el último trimestre de 2009.Para el análisis estadístico se utilizó el programa SPSSv15.0. Resultados: Se incluyeron en el estudio 324 pacientes. Se identificaron 1176 (47%) prescripciones de riesgo en el 91% de los pacientes. La prescripción de riesgo más relevante fue la prescripción de medicamentos de alto riesgo (51.5% pacientes) que presentó una incidencia de error de 88/100 pacientes con medicamentos de alto riesgo, de los cuales en 68 pacientes fue grave. Los factores asociados a la presencia de error grave/moderado ocasionado por prescripciones de riesgo fueron tener enfermedad respiratoria crónica o diabetes y la polimedicación. Conclusiones: Se deben priorizar actuaciones dirigidas a disminuir errores por medicamentos de alto riesgo.

Prescripciones de riesgo asociadas al tratamiento domiciliario del paciente anciano al ingreso hospitalario / Risk prescriptions associated to treatment at home of the elderly patient when admitted to the hospital

Objetivo: Determinar la prevalencia, la incidencia de error y el daño potencial asociado a determinadas prescripciones señaladas como de riesgo de error de medicación en el tratamiento domiciliario de pacientes ancianos que ingresan en el hospital, así como los factores asociados a su aparición. Material y métodos: Estudio transversal descriptivo. Se incluyeron los pacientes de edad igual o mayor a 65 años que ingresaron en el hospital desde el servicio de urgencias durante el último trimestre de 2009. Para el análisis estadístico se utilizó el programa SPSSv15.0. Resultados: Se incluyeron en el estudio 324 pacientes. Se identificaron 1176 (47%) prescripciones de riesgo en el 91% de los pacientes. La prescripción de riesgo más relevante fue la prescripción de medicamentos de alto riesgo (51.5% pacientes) que presentó una incidencia de error de 88/100 pacientes con medicamentos de alto riesgo, de los cuales en 68 pacientes fue grave. Los factores asociados a la presencia de error grave/moderado ocasionado por prescripciones de riesgo fueron tener enfermedad respiratoria crónica o diabetes y la polimedicación. Conclusiones: Se deben priorizar actuaciones dirigidas a disminuir errores por medicamentos de alto riesgo (AU)

Objective: To determine the prevalence, the incidence of error, and the potential harm associated to particular prescriptions identified as a risk for medication error in the home treatment of elderly patients admitted to the hospital, as well as factors associated to their occurrence. Material and methods: Cross-sectional, descriptive study. Patients aged 65 years and older, being admitted to the hospital from the emergency department in the last quarter of 2009. The SPSS software version 15.0 was used for the statistical analysis. Results: 324 patients were included in the study. 1,176 (47%) prescriptions were identified as risk prescriptions in 91% of the patients. The most relevant risk prescription was prescription of high-risk medications (51.5% patients) that accounted for an error incidence of 88/100 patients with high-risk medications, being severe in 68 patients. Factors associated to the occurrence of moderate/high risk error due to risk prescriptions were suffering from a chronic respiratory illness, diabetes or polymedication. Conclusions: Actions aimed at decreasing the errors due to high risk medications should be prioritized (AU)

[Anesthetic treatment of patients with osteogenesis imperfecta]. / Experiencia en el tratamiento anestésico de los pacientes afectos de osteogénesis imperfecta.

BACKGROUND AND OBJECTIVE: Although the prevalence of osteogenesis imperfecta is low, the effect of this hereditary disease on patients' quality of life is considerable. We report our experience in the perioperative management of patients with this condition in our hospital. PATIENTS AND METHODS: Retrospective study describing the interventions on patients with this disease in our hospital from 1991 to 2009. We analyzed demographic data, disease variants, concomitant disorders, surgical procedures, type of anesthesia, and intraoperative and postoperative complications. RESULTS: From 1991 to 2009, 105 procedures were performed on 29 patients (ages 1 to 25 years) with osteogenesis imperfecta (37.9% women and 62.1% men). The most common type of osteogenesis imperfecta was type III (65.5%). Most patients (93%) had no associated diseases. Two patients were allergic to latex. No complications occurred in 62% of interventions. Reported complications during surgery were 1 case of non-malignant hyperthermia and 1 contralateral femur fracture. CONCLUSIONS: The prevalence of osteogenesis imperfecta is low. Treatment requires a multidisciplinary approach, in which appropriate perioperative management must be based on a proper understanding of the skeletal and extraskeletal abnormalities associated with this disease.

Experiencia en el tratamiento anestésico de los pacientes afectos de osteogénesis imperfecta / Anesthetic treatment of patients with osteogenesis imperfecta

Objetivos: La osteogénesis imperfecta es una enfermedad hereditaria con una baja prevalencia, pero gran impacto en la calidad de vida de los pacientes. Se presenta la experiencia en el manejo perioperatorio de estos pacientes en nuestro hospital. Pacientes y métodos: Estudio descriptivo retrospectivo de las intervenciones realizadas en nuestro centro durante los años 1991 a 2009, en los pacientes con esta enfermedad. Se analizan los datos demográficos, variante de la enfermedad, alteraciones asociadas, procedimientos quirúrgicos, tipo de anestesia y complicaciones intraoperatorias y postoperatorias. Resultados: Desde el año 1991 hasta el 2009 se han realizado un total de 105 intervenciones en 29 pacientes con osteogénesis imperfecta (37,9% mujeres, 62,1% varones), con una edad que oscila entre 1 a 25 años. El tipo más frecuente de osteogénesis imperfecta fue el tipo III (65,5%). El 93% de los pacientes no presentaron enfermedades asociadas. Dos pacientes eran alérgicos al látex. El 62% de las intervenciones transcurrieron sin complicaciones. Se registró un caso de hipertermia no maligna y una fractura de fémur contralateral en el quirófano. Conclusiones: La osteogénesis imperfecta es una enfermedad de baja prevalencia que precisa un tratamiento multidisciplinar. Es necesario un adecuado conocimiento de las alteraciones tanto esqueléticas como extraesqueléticas de esta enfermedad para un correcto tratamiento perioperatorio(AU)

Background and objective: Although the prevalence of osteogenesis imperfecta is low, the effect of this hereditary disease on patients’ quality of life is considerable. We report our experience in the perioperative management of patients with this condition in our hospital. Patients and methods: Retrospective study describing the interventions on patients with this disease in our hospital from 1991 to 2009. We analyzed demographic data, disease variants, concomitant disorders, surgical procedures, type of anesthesia, and intraoperative and postoperative complications. Results: From 1991 to 2009, 105 procedures were performed on 29 patients (ages 1 to 25 years) with osteogenesis imperfecta (37.9% women and 62.1% men). The most common type of osteogenesis imperfecta was type III (65.5%). Most patients (93%) had no associated diseases. Two patients were allergic to latex. No complications occurred in 62% of interventions. Reported complications during surgery were 1 case of non-malignant hyperthermia and 1 contralateral femur fracture. Conclusions: The prevalence of osteogenesis imperfecta is low. Treatment requires a multidisciplinary approach, in which appropriate perioperative management must be based on a proper understanding of the skeletal and extraskeletal abnormalities associated with this disease(AU)

Movilidad territorial en la formación de médicos en México / Migration patterns of medical students in Mexico

Objetivo. Conocer la migración de estudiantes de medicina en las entidades federativas del país. Material y métodos. Se estudió el lugar de origen y el de titulación de los médicos que registraron su título entre 1970-1974, 1980-1984, y 1985--1989; los datos se tomaron del Registro de Profesiones de la Secretaría de Educación Pública. Se establecieron focos de atracción, de expulsión, en transición y corrientes migratorias de interés. Resultados. La concentración de la formación médica se ha expresado en la existencia de pocos focos de atracción (Distrito Federal, jalisco, Nuevo León y, en menor grado, Puebla y Michoacán), y en la persistencia de focos de expulsión (Guanajuato, Chiapas, Colima, Campeche, etc.). Dentro de este esquema, hubo cambios a lo largo del periodo de estudio, entre los que destacan la disminución de la migración de estudiantes universitarios: en 1070-1974 prácticamente la mitad de ellos (47 por ciento) se formaba fuera de su lugar de origen; para 1980-1984 bajó a 34 por ciento y en 1985-1989 llegó a 30.6 por ciento. El descenso de la importancia del Distrito Federal como principal centro formador: de 59 por ciento en 1970-1974 baja a 40 por ciento y a 30 por ciento en los siguientes lustros, viéndose aumentada la participación de Jalisco, Michoacán y de manera muy importante Nuevo León. conclusiones. En estas transformaciones de la migración ha jugado un papeñ central el establecimiento de escuelas de medicina en casi todas las entidades, pero del análisis de desprende que hay otras razones por las cuales siguen emigrando los estudiantes, lo que puede estar explicando la persistencia del esquema concentrador de la educación médica en las grandes ciudades del país, Guadalajara y Monterrey

Objetive.This work aimed to determine the migration patterns of medical students within Mexico. Materials and methods. We obtained the places of origin of graduates and the states where they registered their medical degrees at the Ministry of Education General Registry of Professions (sEP), between 1970-1974, 1980-1984 and 1885-1989. Data were organized as follows: Attracting foci, sending foci, transition foci, and important migrant flows. Results. The concentration of medical human resource development, is reflected by the existence of a few attracting foci (D.F., Jalisco, Nuevo Leon, and to a less extent, Puebla and Michoacan). Also, we observed the persistence of traditional sending foci (Guanajuato, Chiapas, Colima, Campeche). However, some important changes occurred throughout the study period, namely, a decrease of the migratory mobility of university students. During 1970-1974, almost half of them (47%) obtained their degrees outside their place of origin; during 1980-1984 this figure decreased to 34% and during 1985-1989, it decreased further to 30.6%. Second, the participation of D.F. as a main human resource development center diminished; from 59% to 40% during 1970-1974, it went down, to 30% in the following quinquennia, while it increased in Jalisco, Michoacan and Nuevo Leon. Conclusions. The establishment of medical schools in almost every Mexican state has had a central role in the migration patterns of medical students. Nevertheless, our results show that there are other reasons accounting for the persistence of the concentration of medical human resources development in main cities of the nation such as Guadalajara and Monterrey.

[Territorial mobility in medical education in Mexico]. / Movilidad territorial en la formación de médicos en México.

OBJECTIVE: This work aimed to determine the migration patterns of medical students within Mexico. MATERIALS AND METHODS: We obtained the places of origin of graduates and the states where they registered their medical degrees at the Ministry of Education General Registry of Professions (SEP), between 1970-1974, 1980-1984 and 1985-1989. Data were organized as follows: Attracting foci, sending foci, transition foci, and important migrant flows. RESULTS: The concentration of medical human resource development, is reflected by the existence of a few attracting foci (D.F., Jalisco, Nuevo Leon, and to a less extent, Puebla and Michoacan). Also, we observed the persistence of traditional sending foci (Guanajuato, Chiapas, Colima, Campeche). However, some important changes occurred throughout the study period, namely, a decrease of the migratory mobility of university students. During 1970-1974, almost half of them (47%) obtained their degrees outside their place of origin; during 1980-1984 this figure decreased to 34% and during 1985-1989, it decreased further to 30.6%. Second, the participation of D.F. as a main human resource development center diminished; from 59% to 40% during 1970-1974, it went down, to 30% in the following quinquennium, while it increased in Jalisco, Michoacan and Nuevo Leon. CONCLUSIONS: The establishment of medical schools in almost every Mexican state has had a central role in the migration patterns of medical students. Nevertheless, our results show that there are other reasons accounting for the persistence of the concentration of medical human resources development in main cities of the nation such as Guadalajara and Monterrey.

[Avoidable causes of death and their effects on life expectancy. A socio-demographic interpretation. The case of the northern frontier, 1980-1990]. / Causes de muerte evitables y su contribucion al incremento en la esperanza de vida. Una interpretacion sociodemografica. El caso de la frontera norte, 1980-1990.

"This study forms part of [a] research project on the health-disease-death process along the [Mexican] Northern Frontier--a by-product of the socio-economic structure of a specific social formation that determines disease and death--to support regional and sectorial design of policies and actions for the improvement of health conditions for its population.... An important finding is a 4.1 year increase of life expectancy due, among other causes, to a slight decrease in avoidable death causes, although these still produce about 50% of deaths." (SUMMARY IN ENG)