A snapshot of cancer-associated thromboembolic disease in 2018-2019: First data from the TESEO prospective registry.

BACKGROUND: The ever-growing complexity of cancer-associated thrombosis (CAT), with new antineoplastic drugs and anticoagulants, distinctive characteristics, and decisions with low levels of evidence, justifies this registry. METHOD: TESEO is a prospective registry promoted by the Spanish Society of Medical Oncology to which 34 centers contribute cases. It seeks to provide an epidemiological description of CAT in Spain. RESULTS: Participants (N=939) with CAT diagnosed between July 2018 and December 2019 were recruited. Most subjects had advanced colon (21.4%), non-small cell lung (19.2%), and breast (11.1%) cancers, treated with dual-agent chemotherapy (28.4%), monochemotherapy (14.4%), or immune checkpoint inhibitors (3.6%). Half (51%) were unsuspected events, albeit only 57.1% were truly asymptomatic. Pulmonary embolism (PE) was recorded in 571 (58.3%); in 120/571 (21.0%), there was a concurrent deep venous thromboembolism (VTE). Most initially received low molecular weight heparin (89.7%). Suspected and unsuspected VTE had an OS rate of 9.9 (95% CI, 7.3-non-computable) and 14.4 months (95% CI, 12.6-non-computable) (p=0.00038). Six-month survival was 80.9%, 55.9%, and 55.5% for unsuspected PE, unsuspected PE admitted for another reason, and suspected PE, respectively (p<0.0001). The 12-month cumulative incidence of venous rethrombosis was 7.1% (95% CI, 4.7-10.2) in stage IV vs 3.0% (95% CI, 0.9-7.1) in stages I-III. The 12-month cumulative incidence of major/clinically relevant bleeding was 9.6% (95% CI, 6.1-14.0) in the presence of risk factors. CONCLUSION: CAT continues to be a relevant problem in the era of immunotherapy and targeted therapies. The initial TESEO data highlight the evolution of CAT, with new agents and thrombotic risk factors.

Construcción de un instrumento de screening sobre la priorización de la evaluación de trabajo social sanitario en una unidad de cuidados paliativos de agudos / Development of a screening tool for prioritization of health-social work assessment in an acute palliative care unit

OBJETIVO: Construir un instrumento de screening de priorización en base a la complejidad en la intervención del trabajador social (TS) en una unidad de cuidados paliativos de agudos (UCPA). MÉTODO: Se construyó un cuestionario ad hoc de evaluación social con 16 variables (independientes) agrupadas en siete dimensiones. Cada variable se puntuaba con valores de 0, 3, o 5, siendo 0 la situación menos compleja y 5 la situación más compleja. Asimismo, se adjudicó un tiempo promedio a diferentes intervenciones en TS sanitario (variable dependiente). La variable tiempo (invertido por TS) se ha categorizó a partir del valor de su mediana. Se ha realizado una regresión logística multivariante con la variable tiempo y variables explicativas (preguntas del cuestionario), a fin de identificar las variables que incrementaban el riesgo de mayor consumo de tiempo de TS (complejidad) para atender las necesidades de paciente-familia. RESULTADOS: Se evaluaron 200 cuidadores. La mediana de tiempo medio invertido por TS fue de 140 minutos. Las preguntas que definen complejidad en TS son: "En estos momentos se siente apoyado por su entorno (familiar, social)" y "El/los cuidador/es, ¿se ven con ánimos y posibilidad de cuidar al enfermo en casa y con las limitaciones actualmente previsibles?". Cualquier respuesta desfavorable incrementa el riesgo de complejidad 3 veces. CONCLUSIONES: El uso de dos preguntas sencillas de forma proactiva permiten identificar aquellos casos que van a consumir más tiempo de trabajo social sanitario (complejidad) tras ingresar en una UCP

AIM: To develop a social work (SW) assessment prioritization screening tool base on social complexity in an Acute Palliative Care Unit (APCU). METHOD: We developed an ad hoc questionnaire which assessed 16 variables (independent) grouped into 7 dimensions. Each variable was scored 0,3 or 5, where 0 was the less complex situation and 5 the more complex one. An average time was allocated for each of the SW interventions usually undertaken in the APCU. The variable time (used by the SW) was categorised using its median value. It was used a multivariable logistic regression analysis with the variable time and the explicative variables (questions in the questionnaire) in order to identify those questions that increased the risk of time consumption (complexity). RESULTS: Two hundred main-careers were assessed. The median time used by the SW was 140 minutes. The questions that defined SW complexity were: "Currently, do you feel supported by your social network?", and "Caregivers are looking forward to being able to take care of the patient at home with the currently foreseeable limitations". Any unfavourable answer to any of the questions increases the risk of being a complex case by three. CONCLUSIONS: The use of two easy questions proactively allows identifying those cases that will consume more health SW time at the APCU

3D Nanoporous Anodic Alumina Structures for Sustained Drug Release.

The use of nanoporous anodic alumina (NAA) for the development of drug delivery systems has gained much attention in recent years. The release of drugs loaded inside NAA pores is complex and depends on the morphology of the pores. In this study, NAA, with different three-dimensional (3D) pore structures (cylindrical pores with several pore diameters, multilayered nanofunnels, and multilayered inverted funnels) were fabricated, and their respective drug delivery rates were studied and modeled using doxorubicin as a model drug. The obtained results reveal optimal modeling of all 3D pore structures, differentiating two drug release stages. Thus, an initial short-term and a sustained long-term release were successfully modeled by the Higuchi and the Korsmeyer-Peppas equations, respectively. This study demonstrates the influence of pore geometries on drug release rates, and further presents a sustained long-term drug release that exceeds 60 days without an undesired initial burst.

Eficacia de las alternativas de rehabilitación tras el alta hospitalaria en pacientes intervenidos de prótesis total de rodilla. Revisión sistemática / Efficacy of alternatives for post-discharge rehabilitation in patients undergoing total knee replacement. Systematic review

Objetivo. Comparar la eficacia y la seguridad de las distintas alternativas de rehabilitación tras el alta hospitalaria en prótesis total de rodilla (PTR). Material y métodos. Se realizó una búsqueda bibliográfica sistematizada en las bases de datos Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Embase, Physiotherapy Evidence Database y Pubmed hasta febrero de 2016. Se seleccionaron ensayos clínicos aleatorizados (ECA) que comparaban distintas alternativas de rehabilitación: tratamiento en régimen de ingreso hospitalario, fisioterapia individual en el domicilio del paciente, fisioterapia ambulatoria con supervisión individual o en grupo, tele-rehabilitación y ejercicios realizados en domicilio sin supervisión directa. Las medidas de resultados analizadas fueron: movilidad de rodilla, estado funcional y seguridad. Resultados. Se incluyeron 17 ECA de suficiente calidad metodológica. Se agruparon, según las comparaciones realizadas, en 4 grupos: A)fisioterapia ambulatoria supervisada individual frente a ejercicios realizados en domicilio (9ECA); B)fisioterapia ambulatoria supervisada individual frente a tele-rehabilitación (2ECA); C)fisioterapia domiciliaria frente a otras modalidades (4ECA), y D)fisioterapia ambulatoria supervisada en grupo frente a otras modalidades (4ECA). Dos ECA comparaban más de 2 alternativas. No se encontraron diferencias significativas en la eficacia y la seguridad entre las distintas modalidades. Conclusión. Las diferentes alternativas de rehabilitación tras el alta hospitalaria en PTR tienen una eficacia similar. La selección de la modalidad más adecuada para cada paciente debería realizarse en función de parámetros como comorbilidad, nivel cultural, capacidad de colaboración del paciente en el tratamiento y consumo de recursos (AU)

Objective. To compare the safety and efficacy of different alternatives for total knee replacement (TKR) rehabilitation after discharge. Material and methods. A systematic review was performed through the following databases: Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Embase, Physiotherapy Evidence Database and Pubmed until February 2016. Only randomized clinical trials (RCT) comparing different treatment options were selected: inpatient hospital care, supervised home physiotherapy, supervised one-to-one or group physiotherapy, tele-rehabilitation and unsupervised home-based exercises. Outcomes assessed were: knee range of motion, functional performance and adverse events. Results. Seventeen RCT of sufficient methodological quality were included and divided into four groups according to the previous comparisons made: (A)supervised one-to-one physiotherapy versus home-based exercises (9RCT); (B)supervised one-to-one physiotherapy versus tele-rehabilitation (2RCT); (C)supervised home physiotherapy versus other modalities (4RCT), and (D)supervised group physiotherapy versus other modalities (4RCT). In 2RCT more than two alternatives were compared. No significant differences in safety and efficacy were found amongst the different therapies. Conclusion. The efficacy of all the post-discharge rehabilitation alternatives analyzed was similar. The choice of the most suitable method for each patient should be made according to criteria such as comorbidity, cultural level, the patient's ability to cooperate in the treatment and resource use (AU)

Optical Monitoring of the Capillary Filling Dynamics Variation in Nanoporous Anodic Alumina toward Sensing Applications.

Fluid imbibition-coupled laser interferometry (FICLI) is a technique in which the kinetics of a fluid infiltrating a nanoporous anodic alumina (NAA) membrane is monitored by the interference of a laser beam at the membrane top and bottom surfaces. Further processing of the measured data results in an estimate of the pore radius. In this work, we study the accuracy of FICLI in the detection of small changes in pore radius, and we evaluate the possibility of using such detection as a sensing paradigm. The accuracy is estimated by measuring samples with increasing pore radius, obtained by successive wet etching steps, and repeatability is evaluated by using different liquids. For decreasing pore radius, samples obtained by the successive deposition of polyelectrolyte double layers are used. With the aim of evaluating the possibility of the FICLI method to sense biological binding events, BSA attachment detection is demonstrated by applying FICLI to samples before and after immobilization of the protein. Results show that the technique permits an accurate estimation of the pore radius, the pore-etching rate (with a radius variation of retch,DI = 1.05 nm/min ± 0.11 nm/min), and the polyelectrolyte double layer thickness (with a radius variation of rPAH/PSS = 3.2 nm ± 0.2 nm per polyelectrolyte double layer). Furthermore, the pore radius reduction measured after BSA immobilization (dBSA = 4.9 nm ± 1.1 nm) is in good agreement with the protein size, as reported in the literature. With these results, we provide a sound basis for the applicability of FICLI as a sensitive technique for the characterization of NAA pore radius modifications.

Sustained, Controlled and Stimuli-Responsive Drug Release Systems Based on Nanoporous Anodic Alumina with Layer-by-Layer Polyelectrolyte.

Controlled drug delivery systems are an encouraging solution to some drug disadvantages such as reduced solubility, deprived biodistribution, tissue damage, fast breakdown of the drug, cytotoxicity, or side effects. Self-ordered nanoporous anodic alumina is an auspicious material for drug delivery due to its biocompatibility, stability, and controllable pore geometry. Its use in drug delivery applications has been explored in several fields, including therapeutic devices for bone and dental tissue engineering, coronary stent implants, and carriers for transplanted cells. In this work, we have created and analyzed a stimuli-responsive drug delivery system based on layer-by-layer pH-responsive polyelectrolyte and nanoporous anodic alumina. The results demonstrate that it is possible to control the drug release using a polyelectrolyte multilayer coating that will act as a gate.

Numb chin syndrome o neuropatía del nervio mentoniano como primera manifestación de progresión tumoral / Numb chin syndrome

La neuropatía mentoniana o síndrome de Roger es una neuropatía sensitiva que en muchas ocasiones se asocia a una neoplasia subyacente. Presentamos el caso de un paciente cuya progresión tumoral se manifestó en forma de neuropatía mentoniana secundaria a metástasis mandibular

Numb chin or Roger syndrome is a sensory neuropathy that is often associated with an underlying malignancy. We report a case of a patient whose tumor progression manifested as mental neuropathy secondary to mandibular metastasis

Cuidados paliativos y derechos humanos / Palliative care and human rights

No disponible

[Primary decompressive craniectomy in patients with aneurysmatic subarachnoid hemorrhage. Results of a pilot study in 11 cases]. / Craniectomía descompresiva primaria en la hemorragia subaracnoidea aneurismática. Resultados deun estudio piloto en 11 casos.

INTRODUCTION: Despite the scientific and technical advances of recent years, aneurysmal subarachnoid hemorrhage (aSAH) continues to present a high morbidity and mortality. This fact, together with the impressive results of the primary decompressive craniotomy (PDC) in the malignant infarction of the middle cerebral artery suggests a possible beneficial effect of decompressive technique in aSAH. We present our experience of a pilot study that PDC was used in patients with poorgrade aSAH with associated intracerebral hematoma. PATIENTS AND METHODS: Between March 1st, 2002 and 31st April, 2008, 342 patients with aneurysmatic subarachnoid hemorrhage (aSAH) were treated at our hospital. Of these, 64 had a poor neurological grade (scores of 4 or 5 of the World Federation of Neurosurgical Societies) at the time of admission. The present study examines 11 of those patients who underwent PDC, which is performed in the same clipping and / or evacuation of an associated hematoma. RESULTS: In three patients PDC was performed after endovascular aneurysm treatment because of the need to evacuate an associated hematoma. In the eight remaining patients, PDC was performed in the same clipping and evacuation of the associated hematoma. Outcome evaluation of these eleven patients was conducted 1 year after the operation assessed by the Glasgow Outcome Scale. Six patients survived, and four of them with good results. The PDC was effective in controlling intracranial pressure in all six surviving patients. However, two of these six patients had unfavorable outcomes. Of the five who didn't survive, one patient died from a delayed epidural-subgaleal hematoma as a complication of the decompressive technique, and the other four patients died because of refractory intracranial hypertension. CONCLUSIONS: Primary DC may be beneficial in selected subgroups of patients with poor-grade aSAH. However, there is a lack of definitive evidence to support a clear recommendation for its use.

Craniectomía descompresiva primaria en la hemorragia subaracnoidea aneurismática. Resultados de un estudio piloto en 11 casos / Primary decompressive craniectomy in patients with aneurysmatic subarachnoid hemorrhage. Results of a pilot study in 11 cases

A pesar de los avances científicos y técnicos de los últimos años, la hemorragia subaracnoidea aneurismática (HSAa) sigue presentando una alta morbilidad y mortalidad. Este hecho, junto con los impresionantes resultados de la craneotomía descompresiva primaria (CDP) en el infarto maligno de la arteria cerebral media sugiere la posibilidad que la CDP sea una alternativa terapéutica a considerar en algunos pacientes con una HSAa. Presentamos nuestra experiencia de un estudio piloto en el que se utilizó la CDP en pacientes con HSAa en mal grado neurológico y hematoma intracerebral asociado. Pacientes y métodos. Entre el 1 de marzo de 2002y el 31 de abril de 2008, se trataron 342 pacientes con HSA a en nuestro hospital. De estos, 64 tenían una puntuación de 4 ó 5 de la escala de la WFNS (World Federation of Neurosurgical Societies). En el presente estudio prospectivo se analizan 11 pacientes en los que se realizó una CDP durante la misma cirugía de clipajeo/y evacuación del hematoma asociado. Resultados. En tres pacientes la CDP se realizó después del tratamiento endovascular del aneurisma debido a la necesidad de evacuar el hematoma asociado. En los ocho pacientes restantes, la CDP se realizó durante el clipaje y la evacuación del hematoma asociado. La evaluación de los resultados de estos once pacientes se llevó a cabo al año de la cirugía mediante la escala de resultados de Glasgow. La CDP fue eficaz en el control de presión intracraneal en los pacientes que sobrevivieron. Seis pacientes sobrevivieron, cuatro de (..) (AU)

Introduction. Despite the scientific and technical advances of recent years, aneurysmal subarachnoid hemorrhage (aSAH) continues to present a high morbidity and mortality. This fact, together with the impressive results of the primary decompressive craniotomy(PDC) in the malignant infarction of the middle cerebralartery suggests a possible beneficial effect of decompressive technique in aSAH. We present our experience of a pilot study that PDC was used in patients with poor grade aSAH with associated intracerebral hematoma. Patients and methods. Between March 1st, 2002 and31st April, 2008, 342 patients with aneurysmatic subarachnoid hemorrhage (aSAH) were treated at our hospital. Of these, 64 had a poor neurological grade (scores of4 or 5 of the World Federation of Neurosurgical Societies)at the time of admission. The present study (..) (AU)

Small bowel evisceration after laparoscopic cholecystectomy: report of an unusual case.

With the rapid development of laparoscopic surgery particularly in cholecystectomy, despite its own advantages, an ever increasing number of reports describe the appearance of new pathologies, due to laparoscopic approach. Evisceration is a rare complication previously described in gynecological obstetric procedures and only once in laparoscopic cholecystectomy. The case of a small bowel evisceration after laparoscopic cholecystectomy in a patient with a multifactorial etiology is presented: weakness area in the umbilical region, intractable cough in the first postoperative day and disruptive tear of the fascia to remove 2 large-size stones. The conclusion is drawn that, according to the literature, holes greater than 5 mm in diameter should be closed at fascial level and we believe that the removal of the gallbladder from epigastric holes is important, in order to avoid an enlargement and rupture of the umbilical port.

Hialuronidasa en el manejo de la obstrucción de las sondas vesicales en pacientes con cáncer / No disponible

La retención aguda de orina, secundaria a obstrucción de la sonda vesical por detritus celulares, en pacientes con invasión vesical tumoral por patología oncológica avanzada en fase terminal, plantea serias dificultades de manejo, gran deterioro de la calidad de vida y un importante sufrimiento para el paciente, la familia y el equipo asistencial cuando las medidas paliativas convencionales fracasan y otros tratamientos más «agresivos» o «invasivos» no están indicados dentro del contexto global del enfermo. En teoría, un tratamiento que «disolviera» estos detritus celulares, resolvería el problema mecánico obstructivo y por tanto los episodios de retención urinaria. El ácido hialurónico es un componente importante de la matriz intercelular y su hidrolización por la enzima hialuronidasa, produce una disminución de la viscosidad y de la acción de barrera de esta. Bajo la hipótesis de que la hialuronidasa contribuyera a «disolver» estos detritus celulares, presentamos en esta nota clínica nuestra experiencia con dos casos clínicos de retención aguda de orina refractarios, que al ser tratados con hialuronidasa intravesical presentaron una excelente respuesta en el control de los síntomas obstructivos urinarios previos (AU)

Acute urinary retention secondary to the obstruction of urinary in dwelling catheters by cellular debris in patients with neoplastic bladder invasion entails serious management difficulties in end-stage malignancies.This situation greatly deteriorates quality of life, and has a significant impact on the suffering of patients, their families, and the multidisciplinary team, becoming a problem when standard palliative care treatment shave failed and more aggressive or invasive measures are not indicated because of the patient's overall status.Theoretically, a treatment that «dissolves» this cellular debris may be a satisfactory palliative solution to this obstructive mechanical problem, and there fore to the acute urinary retention episodes. Hyaluronic acid is an important component of the extracellular matrix. It is hydrolyzed by hyaluronidase, an enzyme that may reduce the viscosity and barrier action of this matrix. Under the hypothesis that, by using hyaluronidase, we may «dissolve» cellular debris, we present in this paper our experience with two cases of previously refractory acute urinary retention that finally achieved excellent symptom control after using intravesical hylauronidase infusions (AU)

Sedación en cuidados paliativos: reflexiones éticas / Sedation in palliative medicine: ethical principles

Se describe el marco en que los cuidados paliativos deben manejar los diferentes problemas que los pacientes y las familias pueden tener al final de la vida. La sedación es una maniobra terapéutica utilizada con cierta frecuencia en cuidados paliativos, que sin embargo presentan el riesgo de conculcar algunos principios éticos. Desde nuestro punto de vista, los principios de beneficencia y autonomía son posiblemente los principios éticos mayormente afectados cuando se considera la sedación. Se discuten algunos de los aspectos para prevenir la conculcación de los principios éticos, asimismo se proporcionan algunas sugerencias para ayudar en la toma de decisiones.

[Intraventricular hemorrhage due to the rupture of atherosclerotic dissecting aneurysm of the middle cerebral artery]. / Hemorragia intraventricular por rotura de aneurisma disecante ateroscleroso de la arteria cerebral media.

INTRODUCTION: We present a case of fusiform intracranial aneurysm where, apart from the unusual site, we draw attention to the form of clinical presentation, namely intraventricular haemorrhage. Clinical case. A 68 year-old-man with a history of smoking, hyperuricemia with seizures of gout treated with colchicine and allopurinol, and hypertension treated with captopril. Nine years previously he had a right capsulothalamic haematoma and presented (as a sequela of this) a left sensomotor deficit, with a good functional level. In December 1998 he was admitted for sudden onset of headache and deterioration of consciousness. He had right limb movements which were typical of decerebration and made intubation and mechanical ventilation necessary. Cerebral CT, with angiographic sequences, showed blood in the lateral ventricles and III ventricle, with ventricular dilation and a fusiform aneurysm of the left middle cerebral artery. In view of the neurological state of the patient, treatment of the aneurysm was postponed. After initial improvement, which permitted extubation, tetraparesia (predominantly right) and a pseudobulbar syndrome were seen. The patient had repeated respiratory infections and died from sepsis caused by Pseudomona aeruginosa (of respiratory origin) three months after admission. CONCLUSIONS: Fusiform intracranial aneurysms form 9% of all aneurysms. Localization to the middle cerebral artery is infrequent, the basilar trunk and internal carotid artery are commoner sites. In our case angio-CT was a useful non-invasive neuro-radiological technique.

Fluvastatin and low-density lipoprotein oxidation in hypercholesterolemic renal transplant patients.

BACKGROUND: Hyperlipidemia contributes to the development and progression of vascular disease in organ transplant patients. Oxidative modification of low-density lipoproteins (LDLs) has been suggested as a key event in early atherogenesis. METHODS: We conducted a pilot study in renal transplanted patients with persistent hypercholesterolemia above 6.5 mmol/liter. We studied the LDL oxidation before and after one year of fluvastatin treatment. Twenty patients (12 males and 8 females, 46 +/- 10 years old) who received a kidney transplant 24 +/- 18 months before the study were treated with fluvastatin (20 mg/day for 12 weeks). Patients with a total cholesterol under 6.3 mmol/liter continued to receive 20 mg/day for another 40 weeks (group I, N = 10). Nine patients with a total cholesterol above 6.3 mmol/liter received 40 mg/day for a further 40 weeks (group II). RESULTS: Cyclosporine levels did not experience a significant variation. Total and LDL cholesterol decreased significantly in both groups (21.7 and 27.9% in group I, 18.3 and 27.2% in group II, respectively). The lag-phase time, which was significantly enlarged before fluvastatin treatment in the patients with respect to the controls (N = 18, 82 +/- 45 vs. 50 +/- 8 min) was shortened after one year of fluvastatin treatment (64 +/- 24 vs. 50 +/- 8 min, P = 0.04). Fluvastatin was stopped in only one patient because of nausea and vomiting. Transaminases and creatin-phospho-kinase were not altered. All of the patients maintained a functioning graft during the study period. CONCLUSIONS: Fluvastatin significantly reduced total and LDL cholesterol, without interferences with cyclosporine A through levels. Fluvastatin has not demonstrated an antioxidant effect in our renal hypercholesterolemic transplant patients.

Fatty acid composition of platelet membrane lipids after administration of two different fat emulsions in critically ill patients.

OBJECTIVE: To determine the effects on platelet membrane fatty acid composition following administration of two different fat emulsions. DESIGN: Prospective, randomized, double-blind study. SETTING: Intensive care unit in a university-affiliated hospital. PATIENTS: 12 adult critically ill patients in need of total parenteral nutrition. INTERVENTIONS: Patients were treated with total parenteral nutrition (TPN) for 7 days, receiving for fat intake either a long-chain triglyceride (20% LCT) emulsion (group 1, n=6) or a medium-chain triglyceride-LCT (20% MCT/LCT) emulsion (group 2, n=6). MEASUREMENTS AND RESULTS: High-performance liquid chromatography of membrane fatty acids was carried out before and after 7 days of TPN. In the LCT group, an increase in C18:2n-6 and a decrease in caprylic acid and docosahexaenoic acid, which resulted in a decreased ratio of n-3/n-6 fatty acid content, was observed. In the MCT/LCT group, a reduced percentage of palmitoleic acid and arachidonic acid was shown. CONCLUSIONS: The observed changes in fatty acid composition are in agreement with the lipid composition of the fat emulsions used. Because the C18:2n-6/C18:3n-3 ratio in both emulsions is close (approximately 9.0), the observed changes in the fatty acid composition of platelets may not be relevant for platelet function.

Severe acute pancreatitis: treatment with somatostatin.

OBJECTIVE: To investigate the efficacy of somatostatin for the treatment of severe acute pancreatitis. DESIGN: Prospective, randomized and unblinded study. SETTING: A general intensive care unit (ICU) in a university hospital. PATIENTS: 50 patients with severe acute pancreatitis. INTERVENTIONS: All patients received the conventional treatment for this clinical condition. The study group received, in addition, somatostatin over a 10-day period. MEASUREMENTS AND RESULTS: We evaluated age, gender, etiology of the pancreatitis, severity of the illness, complications, length of hospitalization, and mortality in the ICU. The patients were classified as severe (Acute Physiology and Chronic Health Evaluation II score, Ranson's criteria, and computed tomography Balthazar classification). Biliary lithiasis was the most common etiologic factor (63.6% in the control group, 37.5% in study group; NS). The study group required fewer overall surgical interventions than the control group (45.8 vs 86.4%; p = 0.005). Late surgical procedures related to the evolution of pancreatic necrosis were more common in the controls (63.6 vs 37.5%; p = 0.07). No differences in length of stay in hospital or mortality in the ICU were observed. CONCLUSION: The only advantage of somatostatin administration in the patients studied was a slight reduction in the need for surgery due to local complications.

Eicosanoids and fat emulsions in acute respiratory distress syndrome patients.

Lipid emulsions have been associated with changes in pulmonary function. Although these changes were related to the physical effects of the infusion-induced lipemia on gas exchange, several animal and human studies suggest that the impairment in pulmonary function observed with lipid infusions was mediated by prostaglandins. Prostaglandins are synthesized enzymatically from essential fatty acids. We studied the effects of two lipid emulsions, with different amounts of essential fatty acids (20% long-chain triacylglycerols [LCT] with 55% of linoleic acid and 7% of alpha linolenic acid in 100 g of emulsion, and a physical mixture of 20% medium-chain triacyglycerols [MCT] and LCT with 26% of linoleic acid and 4% of alpha linolenic acid in 100 g of emulsion), on plasma levels of eicosanoids in patients with acute respiratory distress syndrome (ARDS). Although in patients with ARDS, plasma levels of prostanoids were higher than the reference values, neither lipid emulsion, administered at the rate of 2 mg.kg-1.min-1 induced significant changes in the eicosanoids except for a decrease in systemic-pulmonary arterial 6-keto prostaglandin F1 alpha difference.

Effect of two lipid emulsions on platelet function.

OBJECTIVE: To examine the effect of two lipid emulsions administered with total parenteral nutrition (TPN) on platelet aggregation and activation and the production of eicosanoids in nonseptic critically ill patients. DESIGN: Prospective, randomized, unblinded, non-crossover study. SETTING: ICU of a general teaching hospital. PATIENTS: 23 adult, critically ill, nonseptic patients, who were in need of TPN for at least 7 days. INTERVENTIONS: The patients were randomly distributed into 2 groups each of which received TPN with a different essential fatty acid content. The 2 lipid emulsions, Intralipid 20% (long-chain triglycerides) and Lipofundin MCT/LCT 20% (10% each of long- and medium-chain triglycerides) provided 43% of the nonprotein caloric requirements calculated for each patient. Parameters demonstrating platelet function (plasma beta-thromboglobulin, platelet factor 4, platelet aggregation, 6-keto-PGF1 alpha) were assessed before starting TPN and after 4 and 7 days of initiation. RESULTS: Before beginning lipid perfusion, platelet activation evaluated by beta TG and PF4 levels was notable, 6-keto-PGF1 alpha production was elevated and no hyperaggregation of platelets was observed in patients. The studies of platelet function at 4 and 7 days of TPN did not show significant changes with respect to the basal data or between the 2 groups. CONCLUSIONS: Our results indicate that platelet function was not affected by either of the 2 lipid emulsions administered to patients during the study period.