Diagnóstico de traqueomalacia con resonancia magnética nuclear / Diagnose of traqueomalacia with nuclear magnetic resonance

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Papel actual de la albúmina en cuidados críticos / Current role of albumin in critical care

Ha sido y es un tema controvertido y en constante evolución el uso de coloides dentro de la fluidoterapia, especialmente cuando nos referimos al paciente crítico. La elección del fluido que debe ser administrado depende de varios factores, muchos de ellos teóricos, aunque sigue siendo objeto de debate. De nuevo resurge el interés en el uso clínico de la albúmina, a raíz de publicaciones recientes en la búsqueda del coloide más adecuado. Es la proteína más abundante en el plasma, siendo la responsable del 80% de la presión oncótica. Regula el equilibrio entre volumen intravascular y extravascular. Estudios multicéntricos recientes ponen en duda la supuesta falta de seguridad que se le asignaba anteriormente. Más aún, estudios in vitro demuestran otras importantes acciones, además de la oncótica, por ejemplo, neutralización de radicales libres y depósito de sustancias exógenas y endógenas (pigmentos biliares, colesterol, etc.). Teniendo en cuenta estas propiedades secundarias de la albúmina y valorando la fisiopatología del paciente crítico, en concreto en la sepsis, el mantener unos niveles de albúmina en plasma dentro de la normalidad podría ser de gran importancia. El propósito de esta revisión es analizar brevemente la fisiopatología de la albúmina, así como discutir sus posibles indicaciones en el paciente crítico, basándonos en los trabajos más actuales (AU)

The use of colloids in fluid therapy has been, and still continues to be a controversial topic, particularly when referring to the critical patient. The choice of the fluid that needs to be administered depends on several factors, many of which are theoretical, and continue being an object of debate. The interest in the clinical use of the albumin has emerged again, immediately after recent publications in the search of the most suitable colloid. It is the most abundant protein in the plasma, being responsible for 80% of the oncotic pressure. It regulates the balance between the intra- and extra-vascular volumes. Recent multicenter studies question the supposed lack of safety that was previously assigned to it. Furthermore, in vitro studies demonstrate other important actions besides oncotic, for example neutralization of free radicals, and exogenous (drugs) and endogenous substances (bile pigments, cholesterol). Being aware of these secondary properties of albumin, and evaluating the pathophysiology of the critical patient (in particular, sepsis), to maintain plasma albumin levels within the normal range, could be of great importance. Based on the most recent publications, the aim of this review is to briefly analyze the pathophysiology of albumin, as well as to discuss its possible indications in the critical patient (AU)

[Current role of albumin in critical care]. / Papel actual de la albúmina en cuidados críticos.

The use of colloids in fluid therapy has been, and still continues to be a controversial topic, particularly when referring to the critical patient. The choice of the fluid that needs to be administered depends on several factors, many of which are theoretical, and continue being an object of debate. The interest in the clinical use of the albumin has emerged again, immediately after recent publications in the search of the most suitable colloid. It is the most abundant protein in the plasma, being responsible for 80% of the oncotic pressure. It regulates the balance between the intra- and extra-vascular volumes. Recent multicenter studies question the supposed lack of safety that was previously assigned to it. Furthermore, in vitro studies demonstrate other important actions besides oncotic, for example neutralization of free radicals, and exogenous (drugs) and endogenous substances (bile pigments, cholesterol). Being aware of these secondary properties of albumin, and evaluating the pathophysiology of the critical patient (in particular, sepsis), to maintain plasma albumin levels within the normal range, could be of great importance. Based on the most recent publications, the aim of this review is to briefly analyze the pathophysiology of albumin, as well as to discuss its possible indications in the critical patient.

[Evaluation of 2 invasive techniques for treating myofascial pain]. / Evaluación de dos técnicas invasivas en el tratamiento del dolor miofascial.

OBJECTIVE: To assess the efficacy of 2 invasive techniques for treating myofascial pain: trigger point acupuncture and 1% lidocaine infiltration of trigger points. MATERIAL AND METHODS: Patients who met the inclusion criteria were randomized to 2 groups for evaluation at our pain clinic over a period of 7 months. Each patient had 4 treatment sessions. Response was evaluated on a visual analog scale (VAS) and by means of the Lattinen test. RESULTS: Twenty-one patients were enrolled. Eleven underwent acupuncture and 10 received lidocaine infiltrations. When post-treatment pain was assessed, the mean (SD) VAS scores fell from 5.50 (2.08) to 2.45 (2.05) in the acupuncture group and from 4.8 (2.03) to 2.2 (1.91) in the lidocaine group. Lattinen test scores also fell, from 10.63 (2.69) to 8.54 (3.14) in the acupuncture group and from 10.9 (1.59) to 8.60 (2.63) in the lidocaine group. There were no statistically significant differences between the 2 treatment groups. CONCLUSION: Both acupuncture and lidocaine infiltration of trigger points were effective in reducing pain intensity after treatment and in improving quality of life. One method could not be shown to be better than the other for treating myofascial pain.

Evaluación de dos técnicas invasivas en el tratamiento del dolor miofascial / Evaluation of 2 invasive techniques for treating myofascial pain

OBJETIVO: Evaluar la eficacia de dos técnicas invasivasen el tratamiento del dolor miofascial: punción depuntos gatillo con aguja de acupuntura e infiltración delos mismos con lidocaína al 1%.MATERIAL Y MÉTODOS: Se distribuyó a los pacientesaleatoriamente en ambos grupos, de los evaluados duranteun periodo de 7 meses en la Unidad del Dolor y quecumplían los criterios de inclusión. Se practicaron cuatrosesiones por paciente, evaluando la respuesta mediante laEscala Visual Analógica (EVA) y el test de Lattinen.RESULTADOS: Se incluyeron 21 pacientes. Once fueronpinchados con aguja de acupuntura y 10 se infiltraroncon lidocaína. Se objetivó una disminución en la puntuaciónen la EVA al final de ambos tratamientos. Los valoresfueron 5,50 ± 2,08 disminuyendo a 2,45 ± 2,05 en elgrupo acupuntura, y 4,8 ± 2,03 disminuyendo a 2,20 ±1,91 en el grupo lidocaína. También se redujo la puntuaciónen el test de Lattinen de 10,63 ± 2,69 a 8,54 ± 3,14con aguja de acupuntura y de 10,9 ± 1,59 a 8,60 ± 2,63con lidocaína. No hubo diferencias estadísticamente significativaen ambas escalas (visual analógica y test deLattinen) entre ambas técnicas.CONCLUSIÓN: Tanto la punción con aguja de acupunturacomo la infiltración con lidocaína demostraron sereficaces en la disminución de la intensidad del dolor alfinal del tratamiento, así como en su influencia en lacalidad de vida, no pudiendo determinar en este grupode pacientes que un método sea superior a otro en el tratamientodel dolor miofascial(AU)

OBJETIVE: To assess the efficacy of 2 invasivetechniques for treating myofascial pain: trigger pointacupuncture and 1% lidocaine infiltration of triggerpoints.MATERIAL AND METHODS: Patients who met theinclusion criteria were randomized to 2 groups forevaluation at our pain clinic over a period of 7 months.Each patient had 4 treatment sessions. Response wasevaluated on a visual analog scale (VAS) and by meansof the Lattinen test.RESULTS: Twenty-one patients were enrolled. Elevenunderwent acupuncture and 10 received lidocaineinfiltrations. When post-treatment pain was assessed,the mean (SD) VAS scores fell from 5.50 (2.08) to 2.45(2.05) in the acupuncture group and from 4.8 (2.03) to2.2 (1.91) in the lidocaine group. Lattinen test scoresalso fell, from 10.63 (2.69) to 8.54 (3.14) in theacupuncture group and from 10.9 (1.59) to 8.60 (2.63) inthe lidocaine group. There were no statisticallysignificant differences between the 2 treatment groups.CONCLUSION: Both acupuncture and lidocaineinfiltration of trigger points were effective in reducingpain intensity after treatment and in improving qualityof life. One method could not be shown to be better thanthe other for treating myofascial pain(AU)

Bloqueo del nervio femoral en postoperatorio de artroplastia total de rodilla: comparación de bupivacaína 0, 25% con mezcla de bupivacaína 0,25% y mepivacaína 2% / Femoral nerve block further to total knee replacement: a comparison between bupivacaine 0.25% and bupivacaine-mepivacaine 2% mixture

Objetivos: Valorar la eficacia del bloqueo del femoral (punción única guiada por neuroestimulación) como técnica analgésica en el postoperatorio de artroplastia total de rodilla (ATR) y comparar si hay diferencias si se utilizan como anestésico local bupivacaína 0,25% sola (30ml) o mezcla de bupivacaína 0,25% (15ml) con mepivacaína 2% (15ml), en cuanto al inicio de acción o duración del efecto analgésico. Material y método: Estudio prospectivo, observacional, aleatorizado, de un grupo de 40 pacientes, intervenidos de ATR, mediante la utilización del bloqueo del femoral como técnica analgésica en postoperatorio. Resultados: Se han encontrado diferencias estadísticamente significativas en tiempo de inicio de analgesia usando mezcla de anestésicos (X¯: 2,90min; desviación típica [DT]: 1,36) frente al uso de bupivacaína sola (X¯: 3,85min; DT: 1,21) (p = 0,027). Se obtuvo una mayor duración analgésica con la bupivacaína (X¯: 22h; DT: 10,47) frente a la utilización de la mezcla (X¯: 15,2h; DT: 9,2) (p=0,036). Conclusiones: Para la realización del bloqueo, la adición de mepivacaína a la bupivacaína no aporta ningún beneficio clínico en cuanto a acortamiento en la latencia de inicio de acción, y puede ser contraproducente el uso de la mezcla por la pérdida en horas de analgesia. El bloqueo femoral es una técnica segura, con escasas complicaciones y muy bien aceptada por los pacientes (AU)

Purpose: To assess the efficacy of femoral nerve block (single neurostimulation-guided puncture) as an analgesic technique in postoperative total knee replacement (TKR) in an attempt to identify any potential differences between the use of bupivacaine 0.25% (30ml) or a bupivacaine 0.25% (15ml) + mepivacaine 2% (15ml) mixture as local anesthetics, as regards the inception of their activity and/or the duration of their analgesic effect. Material and methods: Prospective randomized observational study of a group of 40 patients subjected to TKR, with femoral nerve block being used as postoperative analgesic technique. Results: Statistically significant differences were found in terms of the onset of analgesic effect using an anesthetics-mixture (X¯: 2.90min; SD: 1`36) as compared with bupivacaine on its own (X¯: 3.85min; SD: 1.21); (p=0.027). The analgesic effect lasted longer with bupivacaine (X¯: 22h; SD: 10.47) as compared with the mixture (X¯: 15.2h; SD: 9.2) (p=0,036). Conclusions: Addition of mepivacaine to bupivacaine does not contribute any clinical benefit to the nerve block as far as reducing the latency of onset. The use of the mixture could even be counterproductive given the shortening in the effect of analgesia. Femoral block is a safe technique with few complications, which is well accepted by patients (AU)

Prevención secundaria farmacológica tras cirugía de revascularización coronaria / Pharmacological secondary prevention after coronary artery bypass grafting surgery

La cardiopatía isquémica es una enfermedad crónica en la que se debe mantener la prevención secundaria de forma indefinida. Para un subgrupo de pacientes con cardiopatía isquémica, la revascularización coronaria constituye una opción terapéutica en la que se ha demostrado que una prevención secundaria farmacológica adecuada disminuye la morbilidad y la mortalidad a largo plazo. El objetivo de este estudio es analizar el cumplimiento de las guías clínicas de prevención secundaria farmacológica en una muestra de pacientes operados de revascularización coronaria. Se realizó un estudio prospectivo observacional sobre un grupo de 35 pacientes varones intervenidos de revascularización coronaria en el Hospital Meixoeiro (Vigo), analizando las prescripciones farmacológicas al ingreso para cirugía, al alta y tras un seguimiento medio de 2 años. Se comprobó un adecuado cumplimiento de la prevención secundaria farmacológica con antiagregantes y betabloqueadores, acompañado, sin embargo, de un descenso en la prescripción de inhibidores de la enzima conversora de la angiotensina (IECA) tras la cirugía. El dato más relevante fue una disminución no justificada en la prescripción de hipolipemiantes al alta del paciente, que se corrigió durante el seguimiento. Nuestros resultados apoyan la implantación de un programa específico de atención farmacéutica para estos pacientes (AU)

Secondary prevention recommendations must be maintained indefinitely in patients with coronary artery disease. Pharmacological secondary prevention demonstrated a long-term benefit in morbidity and mortality after coronary artery bypass grafting surgery. In this paper we analyze the observance of clinical guidelines of pharmacological secondary prevention in patients submitted to coronary surgery. We performed a prospective observational study on 35 male patients submitted to elective coronary artery bypass grafting in Hospital Meixoeiro (Vigo). We recorded prescriptions on admission before surgery, on hospital discharge, and after a two years follow-up. There was a correct observance of pharmacological secondary prevention guidelines regarding antiplatelet drugs and beta-blockers, but with a decrease in prescription of angiotensinconverting enzyme inhibitors after surgery. The most important finding was an unjustified decrease in prescription of lipid-lowering agents on discharge, which was corrected on follow-up. Our results support the implementation of a pharmaceutical care program for these patients (AU)

Multicentered study of viral acute lower respiratory infections in children from four cities of Argentina, 1993-1994.

This study describes the first multicentered study of acute lower respiratory infection viral etiology in young children from four different geographical areas of Argentina. A total of 1,278 children under 5 years of age, hospitalized in primary care centers from Buenos Aires, Córdoba, Santa Fé and Mar del Plata cities during a 2-year period were studied (1993-1994). Nasopharyngeal aspirates were investigated for respiratory syncytial virus (RSV), adenovirus, parainfluenza, and influenza A and B viruses by indirect immunofluorescence. Out of the patients studied, 946 (74%) were under 1 year of age. Viruses were detected in 399 patients (32%). RSV was observed in 25.3% of the samples, representing 78.2% of all viral positive cases. Adenoviruses were detected in 2.5% of the cases, parainfluenza in 2.2%, influenza A in 2.1%, and influenza B in 0.2%. Compared with other viruses, the higher RSV frequency was statistically significant (P < 0.000). Most RSV cases were detected between May and September with a significant peak in July (P < 0.000). Pneumonia was observed in 46% of the patients, bronchiolitis in 41% and other entities in 13%. The case fatality rate observed during the 2 year study was 0.73%. Most of the above respiratory viruses were detected in the four cities, however, the frequency of RSV and influenza were different in the southern city.

Respiratory syncytial virus: changes in prevalence of subgroups A and B among Argentinian children, 1990-1996.

The frequency of respiratory syncytial virus (RSV) and the distribution of subgroups A and B strains during 7 consecutive years (1990-1996) were examined in two cities of Argentina. Nasopharyngeal aspirates from 1,304 children less than 2 years of age hospitalized with acute lower respiratory infection were studied by indirect immunofluorescence. RSV was detected in 352 cases (26.9%), and the peak activity was observed in midwinter. Subgroup characterization was performed with two monoclonal antibodies against the F protein on nasopharyngeal aspirate smears. Of 195 samples, 174 (89.2%) were identified as subgroup A strains and 21 (10.8%) as subgroup B. Both strains cocirculated during 5 of 7 years studied with subgroup A predominating. Subgroup A occurred at least 8 times as often in all years except for 1994-1995. Children infected by subgroup A were younger than those infected by subgroup B (P < 0.05). The association of subgroup A infection with bronchiolitis and subgroup B with pneumonia was statistically significant (P < 0.03).

Relevancia clínica de los diferentes métodos diagnósticos para citomegalovirus / Clinical relevance of different idagnostic methods in citomegalovirus diagnosis

This review article details the clinical relevance of different diagnostic methods in citomegalovirus diagnosis

Relevancia clínica de los diferentes métodos diagnósticos para citomegalovirus / Clinical relevance of different idagnostic methods in citomegalovirus diagnosis

This review article details the clinical relevance of different diagnostic methods in citomegalovirus diagnosis