Transversus abdominis plane block after ambulatory total laparoscopic hysterectomy: randomized controlled trial.

OBJECTIVE: To determine if transversus abdominis plane anesthetic blockage (TAP block) diminishes early postoperative pain scores and facilitates ambulatory management following total laparoscopic hysterectomy. DESIGN: Randomized triple blind trial. SETTING: Gynecological endoscopy unit at a referral center for laparoscopic surgery. POPULATION: A total of 197 patients. METHODS: Comparison of a treatment group receiving TAP block with bupivacaine 0.25% and placebo group with comparably placed bilateral injection of sterile saline solution. MAIN OUTCOME MEASURES: Pain scores at discharge 24, 48 and 72 h after surgery, opioid requirement after procedure. RESULTS: Patients who had TAP block had a significant reduction in their pain score at discharge compared with the placebo group (p = 0.017). There were no significant differences in the pain scores between groups at 24 h (95% CI 1.36-0.133, p = 0.237), 48 h (95% CI 0.689-0.465, p = 0.702) and 72 h (95% CI -0.631 to 0.223, p = 0.347). No differences were found between the groups regarding opioid requirements following the procedure (χ(2)  = 3.62, p = 0.46). CONCLUSION: Although TAP block after a total laparoscopic hysterectomy reduced the pain score at discharge compared with placebo, its role in this setting is debatable due to the possible lack of clinical significance of the small difference found.

Laparoscopic Hysterectomy and Bilateral Salpingectomy in a Patient with Microduplication Syndrome (20p13p12.1) and a Bicornuate Uterus: An Unreported Association.

Trisomy 20p is a chromosomal anomaly resulting from whole or partial duplication of the short arm of chromosome 20. It is a rarely reported syndrome and it is estimated that there are only a few cases of this condition worldwide, which hampers the phenotypic characterization of this entity. Conversely, müllerian anomalies include a group of congenital malformations of the uterus, vagina, cervix, and fallopian tubes resulting from alterations in the embryological development of the müllerian ducts. We report a case of pure trisomy 20p diagnosed using array comparative genomic hybridization (CGH) accompanied by a müllerian anomaly in a female patient with abnormal growth pattern, round face, coarse hair, broad nose, long palpebral fissure, epicanthus, and megaureter.

Pulmonary Arteriography in Pulmonary Vein Stenosis.

A 43-year-old woman underwent radiofrequency pulmonary vein ablation for symptomatic paroxysmal atrial fibrillation. At 3 months, she developed worsening dyspnea and exercise intolerance; tests revealed severe stenosis in her right pulmonary veins at the venoatrial junction and an abnormally small left atrium.

Microbial Processing of Jellyfish Detritus in the Ocean.

When jellyfish blooms decay, sinking jellyfish detrital organic matter (jelly-OM), rich in proteins and characterized by a low C:N ratio, becomes a significant source of OM for marine microorganisms. Yet, the key players and the process of microbial jelly-OM degradation and the consequences for marine ecosystems remain unclear. We simulated the scenario potentially experienced by the coastal pelagic microbiome after the decay of a bloom of the cosmopolitan Aurelia aurita s.l. We show that about half of the jelly-OM is instantly available as dissolved organic matter and thus, exclusively and readily accessible to microbes. During a typical decay of an A. aurita bloom in the northern Adriatic Sea about 100 mg of jelly-OM L-1 becomes available, about 44 µmol L-1 as dissolved organic carbon (DOC), 13 µmol L-1 as total dissolved nitrogen, 11 µmol L-1 of total hydrolyzable dissolved amino acids (THDAA) and 0.6 µmol L-1 PO4 3-. The labile jelly-OM was degraded within 1.5 days (>98% of proteins, ∼70% of THDAA, 97% of dissolved free amino acids and the entire jelly-DOC pool) by a consortium of Pseudoalteromonas, Alteromonas, and Vibrio. These bacteria accounted for >90% of all metabolically active jelly-OM degraders, exhibiting high bacterial growth efficiencies. This implies that a major fraction of the detrital jelly-OM is rapidly incorporated into biomass by opportunistic bacteria. Microbial processing of jelly-OM resulted in the accumulation of tryptophan, dissolved combined amino acids and inorganic nutrients, with possible implications for biogeochemical cycles.

[Regional Study of Patient Safety Incidents (ERIDA) in the Emergency Services]. / Estudio Regional de Incidentes Derivados de la Atención (ERIDA) en Urgencias.

OBJECTIVE: Evaluate the patient safety incidents that occur in the emergency departments of our region. MATERIAL AND METHOD: Observational study conducted in all the hospital emergency departments in the Regional Health Service of Murcia. After systematic random sampling, data were collected during care and a week later by telephone survey. Health professionals of each service were trained and collected the information, following the methodology of the National Study of Adverse Events Related to Hospitalization -ENEAS- and the Adverse Events Related to Spanish Hospital Emergency Department Care -EVADUR-. RESULTS: A total of 393 samples were collected, proportional to the cases treated in each hospital. In 10 cases (3.1%) the complaint was a previous safety incident. At least one incident was detected in 47 patients (11.95%; 8.7 to 15.1%). In 3 cases there were 2 incidents, bringing the number of incidents to 50. Regarding the impact, the 51% of incidents caused harm to the patients. The effects more frequent in patients were the need for repeat visits (9 cases), and mismanagement of pain (8 cases). In 24 cases (51.1%) health care was not affected, although 3 cases required an additional test, 11 cases required further consultation, and led to hospitalisation in 2 cases. The most frequent causal factors of these incidents were medication (14) and care (12). The incidents were considered preventable in 60% of cases. CONCLUSIONS: A rate of incidents in the emergency departments, representative of the region, has been obtained. The implications of the results for the population means that 12 out of every 100 patients treated in emergency departments have an adverse event, and 7 of these are avoidable.

Consenso colombiano de fibrinólisis selectiva con catéter en enfermedad vascular tromboembólica / Colombian consensus on selective thrombolysis with catheter in thromboembolic vascular disease

Resumen En los pacientes con trombosis arterial o venosa, in situ o por embolia, el uso de fibrinolíticos (como el rtPA) administrados directamente en el trombo a través de un catéter selectivo en el sitio de la oclusión, permite una resolución más rápida de la oclusión trombótica o embólica con menos dosis total del agente fibrinolítico y por ende con menos complicaciones hemorrágicas que con el uso sistémico. Las indicaciones en las cuales se puede considerar la fibrinólisis selectiva con catéter son básicamente la isquemia aguda de una extremidad por oclusión arterial, la tromboembolia pulmonar, la trombosis venosa profunda iliofemoral (proximal), la trombosis venosa profunda proximal axilo-subclavia, la trombosis de los accesos venosos para diálisis y en los pacientes pediátricos en los casos de trombosis o embolia arterial con extremidad isquémica y en casos seleccionados de trombosis venosa profunda proximal de extremidades. En este consenso describirá cada una de las indicaciones a través de un protocolo para el manejo con rtPA en cada situación, cómo monitorizar su uso y cómo tartar las complicaciones hemorrágicas.

Abstract In patients with arterial or venous thrombosis, in situ or due to an embolism, the use of fibrinolytics (such as recombinant tissue-type plasminogen activator, rtPA) administered directly into the clot through a selective catheter into the occlusion site. This can lead to a more rapid resolution of the thrombotic or embolic occlusion with a lower dose of the fibrinolytic agent, and therefore with less problems with haemorrhages than with systemic use. The situations in which selective fibrinolysis with a catheter can be considered are mainly, acute ischaemia of a limb due to a blocked artery, pulmonary thromboembolism, proximal ileo-femoral deep venous thrombosis, proximal axillo-subclavian deep venous thrombosis, and in the thrombosis of the venous access for dialysis It is also indicated in paediatric patients in cases of arterial thrombosis or embolisms with an ischaemic limb, and in selective cases of proximal deep venous thrombosis of the limbs. In this consensus, a description will be given of each one of the indications, with a protocol for the management with rtPA in each one of them, as well as monitoring its use and the management of haemorrhage complications.

Uso de antibióticos en cirugía de implantes: una revisión sistemática / Antibiotics use in implantology surgery: a sistematic review

La infección del sitio quirúrgico previo, durante o después de la cirugía implantológica puede ser la causa del fracaso de un implante dental, por lo que el uso de antibióticos en implantología se ha convertido en un protocolo establecido para evitar la infección postoperatoria. Sin embargo, aún no existe consenso sobre el protocolo de administración más adecuado y la importancia desde el punto de vista clínico de la indicación de estos fármacos. El objetivo fue realizar una revisión sistemática actualizada en relación con el uso de antibióticos en la cirugía de implantes y encontrar qué tipo de antibiterapia, dosis y duración es la más efectiva. Se realizó una revisión electrónica en MEDLINE-PubMed, SciELO, Cochrane Central y Web of Science desde el 1 de Enero 2002, complementada con búsqueda manual, para identificar ensayos clínicos controlados aleatorios (ECCA) con un seguimiento entre 3-5 meses comparando la administración de varios regímenes antibióticos versus placebos en pacientes sometidos a la colocación del implantes. Fueron comparados los fracasos prótesicos, implantológicos, infecciones y complicaciones postoperatorias. Luego de seleccionar los estudios, se evaluó la calidad metodológica y se extrajeron los datos. Cinco ECCA fueron identificados: 3 artículos compararon 2 g de amoxicilina preoperatoria con placebo (771 pacientes), 1 artículo comparó 2 g de amoxicilina preoperatoria más 500 mg 4 veces al día durante 2 días versus placebo (80 pacientes), y 1 artículo que comparó 3 esquemas antibióticos diferentes: 2 g de amoxicilina preoperatoria. 2 g de amoxicilina preoperatorio más 500 mg postoperatorio y 625 mg amoxicilina/ácido clavulánico postoperatorio, ambos 3 veces al día durante 5 días (240 pacientes). El éxito de los implantes fue del 94% en los pacientes con antibióticos, y un mayor número de pacientes experimentaron fracasos en los grupos que no recibieron antibióticos. La evidencia sugiere que la utilización de 2 g de amoxicilina...

The surgical site infection before, during or after the implant surgery may be the cause of dental implant failure. It is for this reason that the use of antibiotics in implant dentistry has become a protocol established to avoid the postoperative infection. However, there is still no consensus on the most appropriate management protocol. The aim was to conduct a systematic review to date in relation to the use of antibiotics in implant surgery and find which type, dosage and duration is the most effective. An electronic MEDLINE-Pubmed, SciELO, Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science were searched since January 1, 2002. The search complemented by manual searching was conducted to identify randomized controlled clinical trials (RCTs) with a follow up between 3-5 months comparing the administration of various antibiotic regimens versus no antibiotics to patients undergoing dental implant placement. Outcome measures were prosthesis failures, implant failures, postoperative infections and complications. Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted. Five RCTs were identified: 3 comparing 2 g of preoperative amoxicillin versus placebo (771 patients), one comparing 2 g of preoperative amoxicillin plus 500 mg 4 times a day for 2 days versus no antibiotics (80 patients), and one comparing 2 g of preoperative amoxicillin versus 2 g of preoperative amoxicillin plus 500 mg and Amoxicillin/Clavulanate 625mg, both 3 times a day for 5 days (240 patients). The implant success was 94% in patients with antibiotics, with a higher number of patients experiencing implant failures in the groups not receiving antibiotics...

Uso de diferentes protocolos antibióticos en cirugía implantológica en las ciudades de Antofagasta, Concepción y Temuco / Use of different antibiotics protocols in implantologic surgery in the cities of Antofagasta, Concepción and Temuco

El uso masivo de antibióticos en implantología, sin un respaldo científico adecuado y que justifique su uso, ha sido y es en la actualidad, un tema que debe ser analizado y discutido, así como la resistencia bacteriana asociada. Es por este motivo que se realiza una encuesta diagnóstica, dirigida a cirujano dentistas con formación en cirugía de implantes, pertenecientes a las ciudades de Antofagasta, Concepción y Temuco, con el objetivo de conocer la realidad local en relación a los prototocolos antibióticos utilizados en cirugía de implantes dentales.

The massive use of antibiotics in implant dentistry, without adequate scientific support that justify their use, has been and is currently, an issue that must be analyzed and discussed, and the associated bacterial resistance. For this reason it makes a diagnostic survey, aimed at dentists trained in implant surgery, belonging to the cities of Antofagasta, Concepción and Temuco, in order to know the local situation with regard to the antibiotics used in surgery protocols of dental implants.

El caso de infecciosas: absceso por Candida albicans / The infections case: abscess due to Candida albicans

Se presenta el caso de una paciente diabética, de 75 años, quien presentó absceso en brazo por C. albicans, luego de una invección intramuscular. El agente causal fue observado microscópicamente en el pus y aislado en cultivo puro en dos oportunidades. La paciente recibió tratamiento con Ketoconazol por un mes, mostrando remisión completa de su sintomatología

Enferemedad Mitral reumatica: caracteristicas hemodinamicas antes y despues de valvuloplastia mitral percutanea. Estudio comparativo utilizando tecnicas de medicina nuclear

Objetivos: evaluar cambios enla función sistodiastolica ventricular izquierda (VI) por ventriculografia de radiolucidos antes y despues de valvuloplastia mitral percutanea (VMP) con balon de Inoue, en pacientes con estenosis mitral (EM) reumatica aislada sintomaticos. Metodos: estudio prospectivo de una serie de 8 pacientes referidos al centro cardiovascular Colombiano, Clinica Santa Maria, para VMP. Antes y despues de cada procedimeinto se realizaron ecocardiografias transtoracica y transesofagica, y medicion de parametros hemodinamicos por tecnicas de cateterismo cardiaco y medicina nuclear. Resultados: 18 pacientes, 16 (89 porciento) mujeres y dos (11 porciento) hombres, edad 34ñ 9 años. El area del orificio valvular mitral (gorlin) seguida de valvuloplastia, aumento de 1,07ñ0.3 a 2.7 ñ0.4 cm²(p<0.0001) y al mes 17 pacientes (94 porciento) estaban en clase funcional I y uno (6 porciento) en clase funcional II. No se observaron alteraciones significativas en los indices de volumen diastolico final, (IDVF) de volumen sistolico final (IVSF) de volumen latido (IVL), fraccion de expulsion (FE) o indice cardiaco del VI inmediatamente a al mes de VMP. La tasa de llenado pico (TLLP) derivada de la curva de tiempo-actividad incremento de 1,8ñ0.3 a 2.09ñ0.4 y 2.14ñ0.4 VDF /seg (p<0.01). Despues de VMP, los sujetos con FEVI disminuida (< o igual 0.5 n=7) comparados con los de fraccion normal (> 0.5. n=11) mostraron IVSF mayores (43ñ12 vs 28ñ11 ml/m², p<0.02), menores TLLP (1.6ñ0.2 vs 1.9ñ0.3 VDF/seg, p<0.04) y fueron mas jovenes (28ñ5 vs 38ñ8 años, p< 0.007). Al mes de VMP estos apcientes mejoraron el IVL y la FE (36ñ13 a 48ñ9 ml/m², p<0.05 y de 0.44(0.05 a 0.52)(0.05, p<0.002)), sin cambios significativos en el IVDF y en la frecuencia cardiaca. Conclusiones: La FEVI es anormal en muchos pacientes con EM reumatica severa y no puede ser explicada por la disminucion en la precarga, la cual no se halló alterada. La VMP mejora el estado clinico, la funcion diastolica de VI y el deterioro en la FEVI