TC torácica en espiración. Cuándo la hago y cómo la interpreto / Expiratory CT scan: When to do it and how to interpret it

La TC torácica en espiración es una técnica complementaria de la inspiración que aporta valiosa información fisiológica y puede ser más sensible que las pruebas de función respiratoria para detectar atrapamiento aéreo. Tiene múltiples indicaciones, entre las más frecuentes están la enfermedad obstructiva de la vía aérea producida por bronquiolitis obliterante, asma, síndrome de Swyer-James, traqueomalacia, neumonitis por hipersensibilidad o sarcoidosis. En alguna de ellas, como la bronquiolitis obliterante, la TC espiratoria puede ser la única técnica de imagen que detecta alteraciones en las fases iniciales. Si queremos que sea de utilidad diagnóstica, hay que asegurarse de que el estudio tenga calidad suficiente. Para ello se recomienda explicar al paciente en qué consiste la prueba, emplear instrucciones precisas y realizar un breve entrenamiento antes de iniciar la adquisición. En este trabajo sugerimos estrategias para optimizar la técnica y proponemos un algoritmo para interpretar los hallazgos radiológicos en el contexto de la patología obstructiva pulmonar.(AU)

Expiratory CT scan is a complementary technique of inspiratory CT that provide valuable physiological information and may be more sensitive to detect air trapping than pulmonary function tests. It is useful in many obstructive airway diseases, including obliterative bronchiolitis, asthma, Swyer-James syndrome, tracheomalacia, hypersensitivity pneumonitis and sarcoidosis. In obliterative bronchiolitis, expiratory CT scan may be the only imaging technique that shows abnormalities in the early phase of disease. In order to obtain a good quality study, we should explain the procedure to the patient, use precise instructions and do some practice before image acquisition. Here we describe strategies to optimize the technique and propose an algorithm that help in interpretation of imaging findings in patients with obstructive airway disease.(AU)

Expiratory CT scan: When to do it and how to interpret it.

Expiratory CT scan is a complementary technique of inspiratory CT that provide valuable physiological information and may be more sensitive to detect air trapping than pul-monary function tests. It is useful in many obstructive airway diseases, including obliterative bronchiolitis, asthma, Swyer-James syndrome, tracheomalacia, hypersensitivity pneumonitis and sarcoidosis. In obliterative bronchiolitis, expiratory CT scan may be the only imaging technique that shows abnormalities in the early phase of disease. In order to obtain a good quality study, we should explain the procedure to the patient, use precise instructions and do some practice before image acquisition. Here we describe strategies to optimize the techni-que and propose an algorithm that help in interpretation of imaging findings in patients with obstructive airway disease.

Positive psychological characteristics and mental health in skaters during Covid-19 confinement / Características psicológicas positivas y salud mental en patinadores durante confinamiento por Covid-19

The aim of this study was to assess the emotional state, habits and routines (measured through an ad-hoc questionnaire), personality traits (LOT-R, PFRS and COPE-28) and mental health (EBP and GHQ-12) of 71 Spanish high-performance skaters (38 men and 33 women) during COVID-19 confinement. The results indicate a good adaptation of the athletes at the cognitive, emotional and behavioural levels during the confinement. Skaters stand out for optimism, resilience and an active coping style, which may be positive regulators of the behavioural response. Distress is associated with lower resilience and greater avoidance coping. Women presented worse emotional response and greater difficulty to sleep than men. It was concluded that the athletes examined presented a positive profile that makes them cope adequately with confinement, in which potential gender differences need to be considered. (AU)

El objetivo de este estudio es evaluar el estado emocional, hábitos y rutinas (medido con un cuestionario ad hoc), características de personalidad (LOT-R, PFRS y COPE-28) y salud mental (EBP y GHQ-12) en 71 patinadores españoles de alto rendimiento (38 hombres y 33 mujeres) durante el confinamiento por la COVID-19. Los resultados indican una buena adaptación de los deportistas a nivel cognitivo, emocional y conductual durante el confinamiento. Los patinadores destacan por el optimismo, la resiliencia y un estilo de afrontamiento activo, que pueden ser moduladores positivos de la respuesta comportamental. El distrés se asocia a una menor resiliencia y mayor evitación del afrontamiento. Las mujeres obtienen una peor respuesta emocional y mayor dificultad para dormir que los hombres. Se concluye que los deportistas evaluados poseen un perfil positivo que les hace afrontar el confinamiento adecuadamente, en el que se requiere atender las posibles diferencias de género. (AU)

Inusual endocarditis infecciosa sobre válvula protésica por Pseudomonas monteilii y Acinetobacter nosocomialis con fatal desenlace / Unusual infective prosthetic valve endocarditis due to Pseudomonas monteilii and Acinetobacter nosocomialis with a fatal result

Presentamos el caso de una endocarditis por Pseudomonas monteilii y Acinetobacter nosocomialis con un fatal desenlace. El paciente tenía una historia reciente de reemplazo valvular aórtico. La ecografía transesofágica y la tomografía computarizada confirmaron la presencia de vegetación en la válvula protésica y un seudoaneurisma aórtico con un absceso en la raíz aórtica. El cultivo de la válvula demostró P.monteilii y A.nosocomialis. El paciente fue tratado con cirugía y antibióticos, pero sufrió un deterioro y murió 44días tras la cirugía. En nuestro conocimiento este es el primer caso de endocarditis producida por P.monteilii y A.nosocomialis publicado en la literatura. Estas bacterias han sido descritas como contaminantes ambientales; sin embargo, deben ser consideradas como potenciales patógenos, en especial en pacientes con válvulas protésicas

We report a case of Pseudomonas monteilii and Acinetobacter nosocomialis endocarditis with a fatal outcome in a patient with a recent history of prosthetic aortic valve replacement. Transesophageal echocardiography and computed tomography confirmed the presence of vegetation on the prosthetic valve and aortic pseudoaneurism with an aortic root abscess. Valve cultures yielded P.monteilii and A.nosocomialis. The patient underwent surgery and received antibiotics, but his condition deteriorated and he died 44days after surgery. To our knowledge, this is the first case of P.monteilii and A.nosocomialis endocarditis reported in the literature. These organisms have been described as environmental contaminants; however, they must be considered potential pathogens, particularly in patients with prosthetic valves

Unusual infective prosthetic valve endocarditis due to Pseudomonas monteilii and Acinetobacter nosocomialis with a fatal result. / Inusual endocarditis infecciosa sobre válvula protésica por Pseudomonas monteilii y Acinetobacter nosocomialis con fatal desenlace.

We report a case of Pseudomonas monteilii and Acinetobacter nosocomialis endocarditis with a fatal outcome in a patient with a recent history of prosthetic aortic valve replacement. Transesophageal echocardiography and computed tomography confirmed the presence of vegetation on the prosthetic valve and aortic pseudoaneurism with an aortic root abscess. Valve cultures yielded P.monteilii and A.nosocomialis. The patient underwent surgery and received antibiotics, but his condition deteriorated and he died 44days after surgery. To our knowledge, this is the first case of P.monteilii and A.nosocomialis endocarditis reported in the literature. These organisms have been described as environmental contaminants; however, they must be considered potential pathogens, particularly in patients with prosthetic valves.

Influence of electron acceptors on hexanoic acid production by Clostridium kluyveri.

Clostridium kluyveri was used for chain elongation of C2C4 fatty acids in stirred tank bioreactors. The influence of different electron acceptors (acetic acid, butyric acid and the mixture of both) on C6 fatty acid production was evaluated in presence of ethanol using similar molar alcohol/acid ratios around 3.5. Bottle batch assays without pH regulation and with only acetic acid as electron acceptor yielded a final C6 fatty acid concentration of 6.8 ±â€¯0.6 g L-1. Then, pH-regulated bioreactors were operated at constant pH of 6.8. Under such conditions, the maximum growth rate was 0.039 h-1 obtained using acetic acid and butyric acid as electron acceptors, whereas the lowest growth rate was 0.010 h-1 with only butyric acid as electron acceptor. The maximum growth rate with acetic acid only, was similar, though slightly lower, as with the mixture of C2C4 fatty acids. Besides, the maximum productions of hexanoic acid were 11.8 g L-1, 13.1 g L-1 and 21.2 g L-1 using, respectively, acetic acid, butyric acid and the mixture of both acids as electron acceptors. Thus, the use of a mixture of acetic acid and butyric acid in presence of ethanol for chain elongation, at constant pH, proved to be efficient for hexanoic acid production.

Diferencias en personalidad entre deportista de deportes de riesgo vs otras modalidades deportivas / Diferenças de personalidade de atletas de esportes de risco vs outros esportes / Diferences of personality between athletes of sports of risk vs other modes sports

El objetivo de la presente investigación es estudiar las diferencias en el Estilo de Personalidad entre deportistas y no deportistas y en función del tipo de deporte de práctica. Para ello se aplicó el Inventario Millon de Estilos de Personalidad (MIPS; Millón, 2001) a una muestra de adultos compuesta por 321 deportistas de competición (211 jugadores de fútbol y 110 deportistas de deportes de riesgo) y 88 no deportistas. Los resultados indican que existe un Estilo de Personalidad del deportista, destacándose los deportistas de riesgo por la búsqueda de sensaciones y los futbolistas por aspectos relacionados a la interacción grupal. Se concluye que existen más semejanzas que diferencias entre los grupos de participantes, en el que ciertas características de personalidad se acentúan debido a la influencia ambiental de la actividad física y el deporte sobre la herencia genética de las personas (AU)

The objective of this research is to study the differences in personality style between athletes and non-athletes and depending on the type of sport practice. For this, the Millon Index of Personality Styles applied (MIPS; Millón, 2001) was used. A 321 adult athlete’s sample (211 soccer players and 110 risk sports athletes) and 88 non-athletes. The results indicate that a Sport Personality profile exists, highlighting the risk athletes sensation seeking and footballer’s aspects related to group interaction. It is concluded that there are more similarities than differences between groups of participants, in which certain personality characteristics are accentuated due to environmental influence of physical activity and sport on the genetic heritage of the people (AU)

O objetivo desta pesquisa é o estudar as diferenças no estilo de personalidade entre atletas e não-atletas e dependendo do tipo de prática desportiva. Para isso foi aplicado o Inventário Millon de Estilos de Personalidade (MIPS; Millón, 2001) a uma amostra de adultos constituída por 321 atletas de competição (211 jogadores de futebol e 110 atletas de esportes extremos) e 88 pessoas que não eram atletas nem praticavam nenhum tipo de esporte. Os resultados mostraram que existe um tipo de estilo de personalidade do atleta destacando-se os atletas de esportes extremos pela busca de sensações e os jogadores de futebol por fatores relacionados a interação grupal. Conclui-se que existem mais semelhanças que diferenças entre os grupos de participantes no que certas características de personalidade se acentuam por causa da influência ambiental da atividade física e do esporte sobre a herança genética das pessoas (AU)

Premio Gestión de Calidad en Salud versión 2003 de la Secretaría de Salud del Gobierno de la Ciudad de Buenos Aires / Award in management in health quality 2003of Secreta´´ia de Salud del Gobierno de la Ciudad de Buenos Aires

La siguiente presentación es un trabajo descriptivo que tiene por finalidad dar a conocer de modo detallado los fundamentos y los criterios por los cuales la Secretaría de Salud del GCBA a través de la ComisiÓn Central de Gestión de Calidad ha instituido el Premio a la Gestión de Calidad en Salud.En el desarrollo de este trabajo se describen el marco contextual donde se inserta el premio; los materiales (recursos) y los métodos (acciones planificadas) que se uti lizaron en su diseño, y en su implementación. Finalmente se exponen los resultados Iobtenidos en la denominada versión 2003.

Premio Gestión de Calidad en Salud versión 2003 de la Secretaría de Salud del Gobierno de la Ciudad de Buenos Aires / Award in management in health quality 2003of Secreta´´ia de Salud del Gobierno de la Ciudad de Buenos Aires

La siguiente presentación es un trabajo descriptivo que tiene por finalidad dar a conocer de modo detallado los fundamentos y los criterios por los cuales la Secretaría de Salud del GCBA a través de la ComisiOn Central de Gestión de Calidad ha instituido el Premio a la Gestión de Calidad en Salud.En el desarrollo de este trabajo se describen el marco contextual donde se inserta el premio; los materiales (recursos) y los métodos (acciones planificadas) que se uti lizaron en su diseño, y en su implementación. Finalmente se exponen los resultados Iobtenidos en la denominada versión 2003.(AU)

Premio Gestión de Calidad en Salud versión 2003 de la Secretaría de Salud del Gobierno de la Ciudad de Buenos Aires / Award in management in health quality 2003 of Secretaria de Salud del Gobierno de la Ciudad de Buenos Aires

La siguiente presentación es un trabajo descriptivo que tiene por finalidad dar a conocer de modo detallado los fundamentos y los criterios por los cuales la Secretaría de Salud del GCBA a través de la ComisiOn Central de Gestión de Calidad ha instituido el Premio a la Gestión de Calidad en Salud.En el desarrollo de este trabajo se describen el marco contextual donde se inserta el premio; los materiales (recursos) y los métodos (acciones planificadas) que se uti lizaron en su diseño, y en su implementación. Finalmente se exponen los resultados Iobtenidos en la denominada versión 2003.(AU)

Application of tracheal gas insufflation to acute unilateral lung injury in an experimental model.

In unilateral lung injury, application of global positive end-expiratory pressure (PEEP) may cause overdistension of normal alveoli and redistribution of blood flow to diseased lung areas, thereby worsening oxygenation. We hypothesized that selective application of tracheal gas insufflation (TGI) will recruit the injured lung without causing overdistension of the normal lung. In eight anesthetized dogs, left lung saline lavage was performed until Pa(O(2))/FI(O(2)) fell below 100 mm Hg. Then, the dogs were reintubated with a Univent single lumen endotracheal tube that incorporates an internal catheter to provide TGI. After injury, increasing PEEP from 3 to 10 cm H(2)O did not change gas exchange, hemodynamics, or lung compliance. Selective TGI, while keeping end-expiratory lung volume (EELV) constant, improved Pa(O(2))/FI(O(2)) from 212 +/- 43 to 301 +/- 38 mm Hg (p < 0.01) while Pa(CO(2)) and airway pressures decreased (p < 0.01). During selective TGI, reducing tidal volume to 5.2 ml/kg while keeping EELV constant, normalized Pa(CO(2)), did not affect Pa(O(2))/FI(O(2)), and decreased end-inspiratory plateau pressure from 16.6 +/- 1.0 to 11.9 +/- 0.5 cm H(2)O (p < 0.01). In unilateral lung injury, we conclude that selective TGI (1) improves oxygenation at a lower pressure cost as compared with conventional mechanical ventilation, (2) allows reduction in tidal volume without a change in alveolar ventilation, and (3) may be a useful adjunct to limit ventilator-associated lung injury.

Relative roles of vascular and airspace pressures in ventilator-induced lung injury.

OBJECTIVE: To determine whether elevations in pulmonary vascular pressure induced by mechanical ventilation are more injurious than elevations of pulmonary vascular pressure of similar magnitude occurring in the absence of mechanical ventilation. DESIGN: Prospective comparative laboratory investigation. SETTING: University research laboratory. SUBJECTS: Male New Zealand white rabbits. INTERVENTIONS: Three groups of isolated, perfused rabbit lungs were exposed to cyclic elevation of pulmonary artery pressures arising from either intermittent positive pressure mechanical ventilation or from pulsatile perfusion of lungs held motionless by continuous positive airway pressure. Peak, mean, and nadir pulmonary artery pressures and mean airway pressure were matched between groups (35, 27.4 +/- 0.74, and 20.8 +/- 1.5 mm Hg, and 17.7 +/- 0.22 cm H2O, respectively). MEASUREMENTS AND MAIN RESULTS: Lungs exposed to elevated pulmonary artery pressures attributable to intermittent positive pressure mechanical ventilation formed more edema (6.8 +/- 1.3 vs. 1.1 +/- 0.9 g/g of lung), displayed more perivascular (61 +/- 26 vs. 15 +/- 13 vessels) and alveolar hemorrhage (76 +/- 11% vs. 26 +/- 18% of alveoli), and underwent larger fractional declines in static compliance (88 +/- 4.4% vs. 48 +/- 25.1% decline) than lungs exposed to similar peak and mean pulmonary artery pressures in the absence of tidal positive pressure ventilation. CONCLUSIONS: Isolated phasic elevations of pulmonary artery pressure may cause less damage than those occurring during intermittent positive pressure mechanical ventilation, suggesting that cyclic changes in perivascular pressure surrounding extra-alveolar vessels may be important in the genesis of ventilator-induced lung injury.

Epidural washout with high volumes of saline to accelerate recovery from epidural anaesthesia.

BACKGROUND: Prolonged postoperative blockade can follow neuraxial blocks for short surgical procedures. We investigated whether washout with a high volume of saline through an epidural catheter could provide a faster recovery after epidural anaesthesia. METHODS: Thirty patients were randomly assigned to a control group (no washout), to group 2x (epidural washout with twice the volume of 2% mepivacaine) and group 4x (epidural washout with four times that volume). RESULTS: Recovery times from sensory blockade at L2 were 151+/-24, 122+/-29 and 116+/-24 min for control, 2x and 4x groups respectively. Significant differences were found in both saline groups when compared with control group, but not between group 2x and group 4x. No differences were found concerning motor blockade. One patient in group 4x demonstrated signs of intracranial hypertension. Mepivacaine plasma concentrations were increased by saline washout in group 4x. CONCLUSIONS: Epidural washout with a high volume of saline can not be recommended since no clinically significant reduction in the recovery time can be achieved without risk.

Selective tracheal gas insufflation during partial liquid ventilation improves lung function in an animal model of unilateral acute lung injury.

OBJECTIVE: During unilateral lung injury, we hypothesized that we can improve global lung function by applying selective tracheal gas insufflation (TGI) and partial liquid ventilation (PLV) to the injured lung. DESIGN: Prospective, interventional animal study. SETTING: Animal laboratory in a university hospital. SUBJECTS: Adult mixed-breed dogs. INTERVENTIONS: In six anesthetized dogs, left saline lung lavage was performed until PaO(2)/FiO(2) fell below 100 torr (13.3 kPa). The dogs were then reintubated with a Univent single-lumen endotracheal tube, which incorporates an internal catheter to provide TGI. In a consecutive manner, we studied 1) the application of 10 cm H(2)O of positive end-expiratory pressure (PEEP); 2) instillation of 10 mL/kg of perflubron (Liquivent) to the left lung at a PEEP level of 10 cm H(2)O (PLV+PEEP 10 initial); 3) application of selective TGI (PLV+TGI) while maintaining end-expiratory lung volume (EELV) constant; 4) PLV+TGI at reduced tidal volume (VT); and 5) PLV+PEEP 10 final. MEASUREMENTS AND MAIN RESULTS: Application of PLV+PEEP 10 initial did not change gas exchange, lung mechanics, or hemodynamics. PLV+TGI improved PaO(2)/FiO(2) from 189 +/- 13 torr (25.2 +/- 1.7 kPa) to 383 +/- 44 torr (51.1 +/- 5.9 kPa) (p <.01) and decreased PaCO(2) from 55 +/- 5 torr (7.3 +/- 0.7 kPa) to 30 +/- 2 torr (4.0 +/- 0.3 kPa) (p <.01). During ventilation with PLV+TGI, reducing VT from 15 mL/kg to 3.5 mL/kg while keeping EELV constant decreased PaO(2)/FiO(2) to 288 +/- 49 torr (38.4 +/- 6.5 kPa) (not significant) and normalized PaCO(2). At this stage, end-inspiratory plateau pressure decreased from 19.2 +/- 0.7 cm H(2)O to 13.6 +/- 0.7 cm H(2)O (p <.01). At PLV+PEEP 10 final, measurements returned to those observed at previous baseline stage (PLV+PEEP 10 initial). CONCLUSIONS: During unilateral lung injury, PLV with a moderate PEEP did not improve oxygenation, TGI superimposed on PLV improved gas exchange, and combination of TGI and PLV allowed a 77% reduction in VT without any adverse effect on PaCO(2).

[Continuous renal replacement therapy: management of acute renal insufficiency in critical care units]. / Terapias continuas de sustitución renal: tratamiento de la insuficiencia renal aguda en las unidades de cuidados críticos.

Acute renal insufficiency is characterized by a sudden decrease in renal function. Various causes are implicated and the physiopathological mechanisms are quite complex. When kidney failure is associated with other organ or system failure, the patient is usually treated in an intensive care unit. Such "critical status" patients are characterized by severe cardiovascular, respiratory and metabolic unstability that may make conventional methods of dialysis (intermittent hemodialysis and peritoneal dialysis) impossible or inadvisable. Continuous methods of renal replacement include 24-hour extracorporeal blood filtration for an indefinite period of time. Such aspects of renal function as electrolyte regulation of nitrogenated products, inflammatory mediators and so forth are replaced or supplemented by various continuous modes available. In this review we discuss the functions and indications for the continuous renal replacement techniques available. The components of each technique are studied exhaustively with a view to obtaining benefit.

[Obstetric anesthesia/analgesia in Spain. Study notes on its historical evolution during the 1st half of this century]. / La anestesia-analgesia obstétrica en España. Apuntes para el estudio de su evolución histórica durante la primera mitad de este siglo.

This historical review of obstetric analgesia-anesthesia in Spain covers the first half of the twentieth century. Following usual practice for researching medical history, we have performed an exhaustive review of Spanish medical literature published during the study period, followed by classification, study and critical analysis. We found that the first half of the century saw considerable change in the application of analgesic-anesthetic techniques for childbirth and obstetric procedures, indicating that practitioners were far from apathetic as had been obstetricians of the second half of the nineteenth century, who generally rejected any type of analgesia for use during labor and birth. The numerous techniques in vogue during that period under study are described, although analgesia-anesthesia by inhaled ether and chloroform was undoubtedly the most widely used by obstetricians until well into the 1950's.

[Perforation and entrapment of an intra-aortic balloon: a complication related to the duration of implantation]. / Perforación y atrapamiento de un balón intraaórtico: una complicación relacionada con el tiempo de inserción.

A 69-year-old man was admitted to the Intensive Care Recovery Unit after heart surgery, carrying an intra balloon counterpulsation (IABCP) device inserted percutaneously days before surgery to provide hemodynamic support and which was still required after surgery. Fifteen days after insertion, blood was observed in the safety chamber. Surgical removal of the catheter was required when attempts to remove it manually failed. The balloon was seen to be perforated and clotted blood was found inside. We believe that long-term maintenance of IABCP carries high risk of perforation and entry of blood, which will clot, as well as of catheter entrapment unless removal is prompt.