Challenges in implementing a total hip arthroplasty program in a developing country: Our experience at Monkole Hospital in the Democratic Republic of Congo. / Desafíos al implementar un programa de artroplastia total de cadera en un país en vías de desarrollo: nuestra experiencia en el Hospital Monkole de la República Democrática del Congo.

BACKGROUND AND OBJECTIVES: Total hip arthroplasty (THA) is an effective surgery for treating hip osteoarthritis, but access is limited in Sub-Saharan Africa due to multiple challenges. This article describes the implementation of a THA program at Monkole Hospital in the Democratic Republic of Congo, focusing on the technical challenges and surgical complications. The objective is to share our experience to assist other professionals and organizations in similar settings. MATERIALS AND METHODS: Eight THA surgery campaigns were conducted between July 2019 and February 2023. Most patients presented with femoral head necrosis secondary to sickle cell anemia. Demographic and surgical data, technical difficulties, and complications were prospectively collected, and follow-up was conducted by a local orthopedic surgeon. RESULTS: Seventy-three surgeries were performed on 63 patients with a mean age of 34 years and an average follow-up of 24 months. Seventeen intraoperative technical incidents (23.2%) were observed. The postoperative complication rate was 9.5%, and three patients required revision surgery due to complications. CONCLUSIONS: The THA program at Monkole Hospital demonstrates that it is feasible to perform complex surgeries in developing countries and that it is a cost-effective procedure that improves patients' quality of life, provided there are adequate hospital infrastructures, team training, availability of implants, and ensured proper care and follow-up. Training local surgeons and investing in resources are key to the sustainability of the program and the improvement of surgical care.

Anesthesia and surgery in very precarious conditions. Clinical cases.

We performed herniorrhaphy on 21 children (4 of them infants) and 3 adults, in very precarious conditions, in a hospital in a economically depressed area of the Democratic Republic of Congo. Anesthesia technique used in adults was subarachnoid and intravenous and intramuscular ketamine in children. Ketamine is an irreplaceable anesthetic in many parts of the world without resources, where the minimum safety means are not available. Knowing the simple anesthetic techniques, but with less risk, can also be useful in resourceful places, in unexpected situations. Greater solidarity is needed, both from anesthesia societies and from anesthesiologists, to alleviate the great deficiencies in well-trained professionals and means in places without resources.

[Problem/case-based learning compared to lectures for acquiring knowledge of air embolism in continuing medical education]. / Clase magistral versus aprendizaje basado en caso/problema para la enseñanza del embolismo aéreo en formación médica continuada.

OBJECTIVE: The efficacy of continuing medical education in anesthesiology has been examined very little. This study compared the efficacy of a lecture on air embolism to that of a class that used a problem/case-based learning approach. MATERIAL AND METHODS: Prospective, randomized study enrolling 52 experienced anesthesiologists participating in a professional development course. Twenty-six anesthesiologists attended a lecture on air embolism in anesthesia and 25 attended a problem-based class. The objectives were the same for both groups and had been defined previously. The participants' knowledge was evaluated before and after the instruction with tests based on 2 cases dealing with the same knowledge areas: risk factors and symptoms, diagnosis, monitoring, and treatment. RESULTS: No significant between-group differences were found for any of the knowledge areas before or after the classes. After instruction, participants who listened to the lecture improved their scores for knowledge of monitoring (P = .03) and treatment (P = .001). Participants in the problem-based learning group also improved their scores for knowledge of treatment (P = .003). CONCLUSIONS: No between-group differences in participants' knowledge outcomes were detected; improvements were minimal. The study design allowed the knowledge acquired to be evaluated objectively.

[Survey of anesthetic techniques used in Catalonia: results of the analysis of 23,136 anesthesias (2003 ANESCAT study)]. / Encuesta sobre las técnicas anestésicas utilizadas en Cataluña: resultado del análisis de 23.136 anestesias (estudio ANESCAT 2003).

OBJECTIVE: To examine anesthesia practice in Catalonia in 2003 and to describe the specific characteristics and distribution of the anesthesia techniques used and the patient profiles. PATIENTS AND METHODS: We used the data from the ANESCAT epidemiological study that gathered information in questionnaire form on all anesthesias performed in Catalonia on 14 randomly selected days representative of practice in 2003. RESULTS: All 131 hospitals authorized to perform anesthesia participated in the study. We collected 23136 questionnaires, from which we extrapolated to estimate 603189 anesthesias for the year and a rate of 9.0 anesthesias per 100 inhabitants per year. Fifty-eight percent of the patients were women and the mean age was 52 years. The physical status of the patients was as follows: ASA 1 or 2, 73.3%; ASA 3, 213%; ASA 4 or 5, 5.4%. The mean duration of anesthesia was 60 minutes. The most common form of anesthesia was a regional block (41.4%) and spinal block was the one performed most often. General anesthesia was used in 33.5% of the cases, combined anesthesia in 3.5%, and sedation in 21.6%. In descending order, orthopedics/trauma, ophthalmology, general surgery, obstetrics, cataract surgery, vaginal delivery, inguinal hernia repair, and colonoscopy were the procedures for which anesthesia was most commonly administered. CONCLUSIONS: Almost 1 in 10 persons in Catalonia are given anesthesia each year and most of the procedures involve locoregional anesthesia or sedation. These data provide a picture of the current situation of anesthesiology and make it possible to forecast future anesthesia requirements.

Corrigendum to "Tyrosine Kinase Receptor Landscape in Lung Cancer: Therapeutical Implications".

[This corrects the article DOI: 10.1155/2016/9214056.].

Review of difficult airway management in thoracic surgery. / Revisión del manejo de la vía aérea díficil en cirugía torácica.

The management of difficult airway (DA) in thoracic surgery is more difficult due to the need for lung separation or isolation and frequent presence of associated upper and lower airway problems. We performed an article review analysing 818 papers published with clinical evidence indexed in Pubmed that allowed us to develop an algorithm. The best airway management in predicted DA is tracheal intubation and independent bronchial blockers guided by fibroscopy maintaining spontaneous ventilation. For unpredicted DA, the use of videolaryngoscopes is recommended initially, and adequate neuromuscular relaxation (rocuronium/sugammadex), among other maneuvers. In both cases, double lumen tubes should be reserved for when lung separation is absolutely indicated. Finally, extubation should be a time of maximum care and be performed according to the safety measures of the Difficult Arway Society.

[Two cases of early postoperative massive pulmonary thromboembolism after gastric bypass surgery]. / Dos casos de tromboembolismo pulmonar masivo precoz en el postoperatorio de cirugía bariáitrica.

Pulmonary thromboembolism in the early postoperative period is rare. We present 2 cases of massive embolism that occurred soon after gastric bypass surgery. The first patient was a 32-year-old man, a smoker with a body mass index (BMI) of 52 kg/m2, obstructive sleep apnea-hypopnea syndrome and venous insufficiency in the lower extremities. Fatal cardiorespiratory arrest occurred 22 hours after surgery. Autopsy confirmed massive pulmonary thromboembolism. The second patient was a 48-year-old woman with a BMI of 40 kg/m2 who had undergone abdominal hysterectomy 2 months earlier. She survived cardiorespiratory arrest occurring 11 hours after surgery. There were no sequelae. The diagnosis of pulmonary thromboembolism was confirmed by transesophageal echocardiography. These patients undoubtedly had asymptomatic deep vein thrombosis before the operations. Prevention of pulmonary embolism is essential in high risk patients. The prophylactic measures usually applied are administration of low molecular weight heparin to prevent thrombosis, early ambulation, and the use of elastic compression stockings or intermittent pneumatic compression.

Anestesia y cirugía en condiciones muy precarias. Casos clínicos / Anesthesia and surgery in very precarious conditions. Clinical cases

A 21 niños (4 de ellos lactantes) y 3 adultos les fueron realizadas herniorrafias inguinales, en condiciones muy precarias, en un hospital de un área económicamente deprimida de la República Democrática del Congo. Se empleó anestesia subaracnoidea en los adultos y ketamina por vía intravenosa e intramuscular en los niños.La ketamina es un anestésico insustituible en muchos lugares del mundo sin recursos, en los que no se dispone de los mínimos medios de seguridad. Conocer las técnicas anestésicas simples, pero de menor riesgo, puede resultar también útil en sitios con recursos ante situaciones inesperadas. De manera general, hace falta una mayor solidaridad, tanto de las sociedades de anestesia como de los anestesiólogos, para paliar las grandes carencias en medios y profesionales bien formados en lugares sin recursos.(AU)

We performed herniorrhaphy on 21 children (4 of them infants) and 3 adults, in very precarious conditions, in a hospital in a economically depressed area of the Democratic Republic of Congo. Anesthesia technique used in adults was subarachnoid and intravenous and intramuscular ketamine in children.Ketamine is an irreplaceable anesthetic in many parts of the world without resources, where the minimum safety means are not available. Knowing the simple anesthetic techniques, but with less risk, can also be useful in resourceful places, in unexpected situations. Greater solidarity is needed, both from anesthesia societies and from anesthesiologists, to alleviate the great deficiencies in well-trained professionals and means in places without resources.(AU)

[Anesthesia with sevoflurane for tonsillectomy in a boy with Duchenne muscular dystrophy]. / Anestesia con sevoflurano para amigdalectomía a un niño con enfermedad de Duchenne.

A 6-year-old boy with Duchenne muscular dystrophy (DMD) and foreseen difficult tracheal intubation underwent tonsillectomy under general inhaled anesthesia with sevoflurane. No neuromuscular blockers were administered and no perioperative complications emerged. In spite of advances in genetic diagnosis there continue to be patients with DMD because of spontaneous mutation of the dystrophin gene. Late detection leaves them vulnerable to administration of drugs like succinylcholine that can trigger fatal reactions involving hyperpotassemia, rhabdomyolysis, and malignant hyperthermia. Total intravenous anesthesia seems the best way to provide general anesthesia for a patient with DMD. Inhaled anesthesia is an alternative. Although halogenated agents can lead to rhabdomyolysis and malignant hyperthermia, the frequency seems low if we bear in mind that the use of sevoflurane is widespread in pediatrics. In this case sevoflurane induction facilitated safe tracheal intubation.

Tyrosine Kinase Receptor Landscape in Lung Cancer: Therapeutical Implications.

Lung cancer is a heterogeneous disease responsible for the most cases of cancer-related deaths. The majority of patients are clinically diagnosed at advanced stages, with a poor survival rate. For this reason, the identification of oncodrivers and novel biomarkers is decisive for the future clinical management of this pathology. The rise of high throughput technologies popularly referred to as "omics" has accelerated the discovery of new biomarkers and drivers for this pathology. Within them, tyrosine kinase receptors (TKRs) have proven to be of importance as diagnostic, prognostic, and predictive tools and, due to their molecular nature, as therapeutic targets. Along this review, the role of TKRs in the different lung cancer histologies, research on improvement of anti-TKR therapy, and the current approaches to manage anti-TKR resistance will be discussed.

Carbon dioxide embolism during laparoscopy and hysteroscopy.

Venous carbon dioxide embolism is a rare but potentially lethal complication of laparoscopy. The risk is increased when it is associated with hysteroscopy. A case is presented of a young women undergoing laparoscopy and hysteroscopy for infertility. Cardiovascular collapse and cardiac arrest, associated with a mill-wheel murmur, occurred during hysteroscopy at the time of a change of position. The patient had irreversible brain damage and died a week later. Early diagnosis and prevention of this serious complication are discussed.

[Transient block of the brachial plexus after catheterization of the subclavian vein]. / Bloc transitoire du plexus brachial après cathétérisme de la veine sous-clavière.

Two cases are reported of brachial plexus anaesthesia and palsy after catheterization of the subclavian vein. This very rare complication occurred after several unsuccessful attempts to catheterize one or both subclavian veins. This was due to inexperience, with insufficient knowledge of clinical anatomy, infiltration with unnecessarily high doses of local anaesthetic, and accidental puncture of the brachial plexus by an infraclavicular approach. One of the patients also had iatrogenic pneumothorax.

[Expected versus real impact factors of publications from Spanish departments of anesthesiology (1991-1996)]. / Factor de impacto esperado y factor de impacto real de las publicaciones de los servicios de anestesiología españoles (1991-1996).

OBJECTIVE: To identify publications by Spanish anesthesiologists in journals indexed by Journal Citation Report from 1991 through 1996; to count the number of citations received and compare the results with the impact factor (IF) of the journals in which they were published. MATERIAL AND METHODS: Articles for which the first author was a member of a Spanish anesthesiology department were searched for in MEDLINE, Science Citation Index and EMBASE. Only publications for which the IF was known were included for analysis. We then counted the number of citations each article received over the two years following publication, recording the source journal in which the citation appeared and country of origin of each citing author. We then calculated the real IF (RIF) of each article, the RIF of all the Spanish articles, and the mean RIF. Also calculated for each article was the expected IF (EIF), based on the IF of the source journal, the overall EIF and the mean EIF. RESULTS: One hundred seventy-two articles were published; 49 of them were letters to the editors. Specialist anesthesiology journals published 72.7%. A total of 186 citations were received. American authors cited the articles more often than did other Spanish authors. Thirty-seven citations (19.9%) were self-citations. Ninety-two articles (53.5%) were never cited. With letters to the editor excluded, the RIF was 85.48 and the global EIF was 213.28; the mean EIF was 1.734 and the RIF was 0.695. Therefore, the rate of citation of the Spanish authors in the period studied was only 40% of the citation rate of the entire population of authors from all countries. The authors of the published articles worked mainly in hospitals in Barcelona, Madrid, La Coruña, Valencia, Cantabria and Murcia. Hospital Germans Trias i Pujol (Badalona, Barcelona) had the largest number of publications and the highest EIF (39.41). Hospital del Mar (Barcelona) had the highest mean RIF and the highest global RIF.A gradual increase in the annual productivity of Spanish scientists can be discerned in a progressive increase in the number of publications as well as their EIF and RIF. CONCLUSIONS: Research by Spanish anesthesiologists is concentrated in only a few hospitals. Although the number of publications is increasing, their international repercussion has still not reached the desired level.

[Impact factor of the Revista Española de Anestesiología y Reanimación for 1997 and 1998]. / Factor de impacto de la Revista Española de Anestesiología y Reanimación de los años 1997 y 1998.

OBJECTIVES: Revista Española de Anestesiología y Reanimación (REDAR) is not listed in the Journal Citation Reports (JCR) of the Institute for Scientific Information (ISI) and therefore REDAR's impact factor (IF) is unknown. This study aimed to calculate REDAR's IF and immediacy index for the years 1997 and 1998 as well as the IF that the journal would have had if it were considered an ISI source journal. The study also aimed to analyze self-citations and how they would affect the IF if REDAR were considered a source journal. MATERIAL AND METHODS: We calculated the IF and immediacy indexes using ISI methodology, by manually counting the references to REDAR articles published in 1997 and 1998 and singling out self-citations. RESULTS: The IF was 0.014 for 1997 and 0.054 for 1998. If REDAR had been considered a source journal in 1997 the IFs would have been 0.437 for 1997 and 0.419 for 1998. The immediacy indexes were 0.37 for 1997 and 0.30 for 1998. The mean number of references per article for the two-year period under study was 19.04 with differences depending mainly on type of article. The highest numbers of self-citations and the highest proportions of the same were found in letters to the editor and authors' replies. The 30 author-plus-journal self citations accounted for 9.3% of all self-citations (n = 322). CONCLUSION: The IF of REDAR is far lower than those of other European journals. If REDAR were accepted as a source journal, it would benefit from its self-citations. Improving REDAR's if would result in greater international recognition of our scientific level.

[Anuria in the third trimester of pregnancy in a patient with renal transplant]. / Anuria en el tercer trimestre del embarazo en una paciente sometida a trasplante renal.

We present a pregnant patient with a transplanted kidney experiencing chronic rejection, with chronic kidney failure and arterial hypertension. During the third trimester the patient's kidney function deteriorated somewhat and hypertension worsened. In the thirty-second week of pregnancy uterine activity increased, fetal movement decreased and oliguria progressed rapidly to anuria, leading to an emergency cesarean section. Surgery was performed under epidural anesthesia; after removal of the fetus diuresis immediately began and was maintained. Both mother and infant recovered, but after three months the patient entered a hemodialysis program due to terminal kidney failure. The risk of acute kidney failure is greater in the parturient who has been the recipient of a transplanted kidney because of the functional overload that pregnancy involves, the possible exacerbation of acute or chronic rejection, and the higher incidence of pyelonephritis and preeclampsia. The extraperitoneal location of the transplanted organ in the iliac fossa may cause obstructive anuria. Our patient's recovery of diuresis immediately after removal of the fetus suggests that the excretory channel coming from the kidney was compressed by the uterus.

[Effect of the peridural methadone concentration in postoperative analgesia]. / Influencia de la concentración de metadona peridural en la analgesia postoperatoria.

The analgesic characteristics of 3 to 6 mg epidural methadone administered in two different concentrations for postoperative analgesia have been compared in two homogeneous groups of patients submitted to surgical procedures on trunk or legs. Methadone was given at a concentration of 0.1% in group I (70 patients) and diluted in 10 ml saline in group II (35 patients). Methadone doses were calculated on the basis of age and weight of the patient and the performed surgical procedure. Mean latency for analgesia was 25 +/- 11 min in group I and 28 +/- 13 min in group II. The duration of the analgesia was significantly longer (p less than 0.01) in group I (9.7 +/- 5.6 h) than in group II (5.7 +/- 2.4 h). Side effects were not frequent and without clinical significance in both groups. Epidural methadone is an effective method for postoperative pain relief. Drug concentration modifies the duration of the analgesia and concentration of 0.1% gives better results than more diluted preparations.

[Effectiveness of isobaric 0.5% bupivacaine and 5% lidocaine in continuous subarachnoid anesthesia with microcatheters]. / Eficacia de la bupivacaína al 0,5% y lidocaína al 5% isobaras en anestesia subaracnoidea continua con microcatéteres.

OBJECTIVES: To study the clinical effect of two isobaric local anesthetics infused through microcatheters for continuous subarachnoid anesthesia. MATERIAL AND METHODS: Patients undergoing surgery under continuous subarachnoid anesthesia were enrolled prospectively over 12 months. Twenty-seven-gage catheters were inserted through 22 G Sprotte (Intralong) needles. The two isobaric anesthetics (0.5% bupivacaine and 5% lidocaine) were studied in two successive six-month periods. One milliliter of local anesthetic was administered, followed by incremental doses of 0.5 ml until the required anesthetic level was reached. Hemodynamic variables were recorded, as were levels of anesthetic and motor blockade and complications developing during the surgical and postoperative periods. RESULTS: Thirty-one patients were anesthetized with isobaric 0.5% bupivacaine and 40 with isobaric 5% lidocaine. A high blockade was observed in three patients in the bupivacaine group and in 15 in the bupivacaine group (p < 0.05). The highest anesthetic level reached was T4. Hypotension occurred in one patient in the bupivacaine group and in 10 in the lidocaine group (p < 0.05). Blockade was difficult to increase to the appropriate level in 11 lidocaine patients and in one bupivacaine patient, whereas blockade of distal roots was difficult in 13 bupivacaine patients and in 7 lidocaine patients (p < 0.005). The total doses infused were 11.0 +/- 3.0 mg of 0.5% bupivacaine and 95.6 +/- 24.6 mg of 5% lidocaine. CONCLUSIONS: Isobaric 0.5% bupivacaine provides a more predictable anesthetic blockade with greater hemodynamic stability and a lower rate of difficulty in raising the level of blockade than does 5% lidocaine when administered through microcatheters for continuous subarachnoid anesthesia.

[Spanish doctoral dissertations on anesthesiology and the scientific publications of their authors]. / Tesis doctorales españolas sobre Anestesiología y publicaciones científicas de sus autores.

OBJECTIVES: To determine whether obtaining a doctorate is a factor that promotes the research careers of the authors. To analyze the dissemination of Spanish doctoral theses in anesthesiology by looking at the publications they generate. MATERIAL AND METHODS: The TESEO data base was searched for theses on anesthesiology written between 1976 and June 2001. The Medline database was then searched for publications related to each author's thesis. The search identified papers related to each thesis as well as those in which the thesis director was a coauthor. RESULTS: Two hundred twenty-eight theses (9.12 theses/year) were found. Twenty-four authors were not anesthesiologists. The universities of Barcelona (28), Valencia (24), Navarra (23), Autónoma de Barcelona (21), Complutense de Madrid (18) and Cádiz (18) accounted for most of the theses read. The doctoral degree recipients also co-authored 1,833 publications, as the first authors of 649 articles, of which 216 (33.3%) were published before the corresponding thesis was read. Only 127 articles were related to theses. Ninety-seven authors (42.5%) published no article as first author and 22 (9.6%) accomplished no publication as co-author. The thesis director was listed in 154 of the 228 theses in the TESEO database. In this subgroup, 39 doctoral thesis authors published 58 related articles, with the director included among the co-authors in 41 of them. CONCLUSION: Spain produces few doctoral theses on anesthesiology. Most writers of doctoral theses do not publish the results in journals with international readerships. These findings call into question the efficacy of the doctoral thesis as a factor that promotes research.