sábado, 3 de noviembre de 2012

Novedades en anestésicos locales

Bupivacaína liposomal: revisión de una nueva formulación de bupivacaína


Liposomal bupivacaine: a review of a new bupivacaine formulation.
Chahar P, Cummings KC 3rd.
Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
J Pain Res. 2012;5:257-64. doi: 10.2147/JPR.S27894. Epub 2012 Aug 14.
Abstract
Many attempts have been made to increase the duration of local anesthetic action. One avenue of investigation has focused on encapsulating local anesthetics within carrier molecules to increase their residence time at the site of action. This article aims to review the literature surrounding the recently approved formulation of bupivacaine, which consists of bupivacaine loaded in multivesicular liposomes. This preparation increases the duration of local anesthetic action by slow release from the liposome and delays the peak plasma concentration when compared to plain bupivacaine administration. Liposomal bupivacaine has been approved by the US Food and Drug Administration for local infiltration for pain relief after bunionectomy and hemorrhoidectomy. Studies have shown it to be an effective tool for postoperative pain relief with opioid sparing effects and it has also been found to have an acceptable adverse effect profile. Its kinetics are favorable even in patients with moderate hepatic impairment, and it has been found not to delay wound healing after orthopedic surgery. More studies are needed to establish its safety and efficacy for use via intrathecal, epidural, or perineural routes. In conclusion, liposomal bupivacaine is effective for treating postoperative pain when used via local infiltration when compared to placebo with a prolonged duration of action, predictable kinetics, and an acceptable side effect profile. However, more adequately powered trials are needed to establish its superiority over plain bupivacaine.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3442744/pdf/jpr-5-257.pdf


Bupivacaína liposomal; inovativo analgésico local no opioide para el manejo del dolor postoperatorio
Liposomal bupivacaine: an innovative nonopioid local analgesic for the management of postsurgical pain.
Candiotti K.
University of Miami Miller School of Medicine, Miami, Florida.
Pharmacotherapy. 2012 Sep;32(9 Pt 2):19S-26S. doi: 10.1002/j.1875-9114.2012.01183.x.
Abstract
Local anesthetics are a cornerstone of multimodal pain control strategies in the surgical setting as they have a long history of use and an established safety profile. Although effective, their duration of action is relatively short, which usually leads to the use of other agents, such as opioids, for effective postsurgical pain control in most patients. A medical need exists to extend the duration of analgesia with local anesthetics to help reduce the reliance on opioids in the postsurgical setting. Liposomal bupivacaine uses a product delivery platform to release bupivacaine slowly over 96 hours after infiltration at the surgical site. Liposomal bupivacaine was compared with placebo in two pivotal, multicenter, randomized, double-blind, parallel-group trials in 189 adults undergoing soft-tissue surgery (hemorrhoidectomy) and 193 adults undergoing orthopedic surgery (bunionectomy). Among patients undergoing hemorrhoidectomy, liposomal bupivacaine significantly reduced cumulative pain scores for up to 72 hours (primary end point) as measured by the area under the curve of pain scores on the numeric rating scale (p<0.0001), reduced overall opioid consumption (p≤0.0006), increased the proportion of patients who did not receive opioids (p<0.0008), delayed time to first opioid by more than 13 hours (p<0.0001), and was associated with significantly higher rates of patient satisfaction (p=0.0007) compared with placebo. Similarly, in patients undergoing bunionectomy, liposomal bupivacaine significantly reduced total consumption of rescue opioids (p=0.0077) and cumulative pain scores as measured by the area under the curve of pain scores on the numeric rating scale (p=0.0005) during the first 24 postsurgical hours (primary end point) relative to placebo. Furthermore, liposomal bupivacaine also significantly delayed the time to first use of opioid rescue (p<0.0001) and increased the proportion of patients requiring no rescue opioid treatment (p≤0.0404) compared with placebo. The most common adverse events with liposomal bupivacaine were nausea, vomiting, and constipation. No adverse effects on the QTc interval or cardiac safety signal have been detected in the clinical trial development program (823 patients) when liposomal bupivacaine was infiltrated into the surgical site. The beneficial effects of liposomal bupivacaine on postsurgical pain management and opioid use, significantly reducing both, are likely to translate into improved clinical and economic outcomes.
http://onlinelibrary.wiley.com/doi/10.1002/j.1875-9114.2012.01183.x/pdf





Articaína: revisión de su uso para anestesia local y regional


Articaine: a review of its use for local and regional anesthesia.
Snoeck M.
Department of Anaesthesia, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
Local Reg Anesth. 2012;5:23-33. Epub 2012 Jun 5.
Abstract
Articaine is an intermediate-potency, short-acting amide local anesthetic with a fast metabolism due to an ester group in its structure. It is effective with local infiltration or peripheral nerve block in dentistry, when administered as a spinal, epidural, ocular, or regional nerve block, or when injected intravenously for regional anesthesia. In comparative trials, its clinical effects were not generally significantly different from those of other short-acting local anesthetics like lidocaine, prilocaine, and chloroprocaine, and there is no conclusive evidence demonstrating above-average neurotoxicity. Articaine proved to be suitable and safe for procedures requiring a short duration of action in which a fast onset of anesthesia is desired, eg, dental procedures and ambulatory spinal anesthesia, in normal and in special populations.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3417979/pdf/lra-5-023.pdf





Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Vía aérea en obesidad

Impactos de la súper obesidad versus la obesidad mórbida sobre la mecánica respiratoria y los parámetros hemodinámicos simples durante la cirugía bariátrica


The Impacts of Super Obesity Versus Morbid Obesity on Respiratory Mechanics and Simple Hemodynamic Parameters During Bariatric Surgery.
Salihoglu T, Salihoglu Z, Zengin AK, Taskin M, Colakoglu N, Babazade R.
Department of Anesthesiology and Reanimation, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey, tsalihoglu@hotmail.com.
Obes Surg. 2012 Oct 3. [Epub ahead of print]
Abstract
BACKGROUND: This study was designed to determine the impact of the degree of obesity on respiratory mechanics and simple hemodynamic parameters at laparoscopic bariatric surgery. METHODS: The patients were divided into two groups, each of which included 24 patients (a morbidly obese group and a super obese group) undergoing laparoscopic bariatric surgery. Dynamic respiratory compliance, respiratory resistance, and peak inspiratory pressures were measured at four time points: 10 min after anesthesia induction (T1: induction), 10 min after pneumoperitoneum (T2: pneumoperitoneum), 10 min after terminating pneumoperitoneum (T3: end-pneumoperitoneum), and before extubation (T4: extubation). The systolic, diastolic, and mean arterial pressures and the heart rate values were measured noninvasively in T0 (10 min before operation). RESULTS: Obesity was found to cause a statistically significant increase in respiratory resistance and a peak inspiratory pressure and a decrease in dynamic respiratory compliance. In the morbidly obese group, the lowest dynamic respiratory compliance was 37mL/cm H(2)O, but it was 33mL/cm H(2)O in the super obese group. The systolic pressure, diastolic pressure, and mean arterial pressure were found to decrease significantly in both groups. CONCLUSIONS: Morbid obesity and super obesity have negative effects on hemodynamics and respiratory mechanics.
http://www.springerlink.com/content/uq123946442l8103/fulltext.pdf

Efectos del neumoperitoneo sobre la mecánica respiratoria durante cirugía bariátrica


The Effects of Pneumoperitoneum on Respiratory Mechanics During Bariatric Surgery
Sener Demiroluk, MD1; Ziya Salihoglu, MD1; Kagan Zengin, MD2; Yildiz
Kose, MD1; Mustafa Taskin, MD2
University of Istanbul, Cerrahpasa Medical School, Department of 1Anaesthesiology and 2General Surgery, Istanbul, Turkey
Obesity Surgery, 12, 376-379
Background: The aim of this study was to investigate the influence of laparoscopic and conventional open surgery on respiratory mechanics, and blood gases, and to determine convenient techniques from the point of view of intraoperative respiratory mechanics, for bariatric surgery. Method: 40 morbidly obese patients were divided into 2 groups, patients undergoing laparoscopy Group 1, and patients undergoing conventional open surgery Group 2. Resistance of airway, dynamic compliance, and peak inspiratory pressure were measured. Measurement was performed in 4 periods: a) after anesthesia induction, b) after pneumoperitoneum in the Group 1 and after incision in the Group 2, c) after gastric band placement, d) and 5 min before extubation. Blood gases were recorded concomitantly. Results: There was no significant difference between the 2 groups in values of blood gases and respiratory mechanics. Conclusion: In the morbidly obese, laparoscopic and open surgery did not cause a significant difference for respiratory mechanics when compared with each other.
Key words: Morbid obesity, laparotomy, pneumoperitoneum, respiratory mechanics, compliance, bariatric
surgery
http://www.springerlink.com/content/l46m466075335353/fulltext.pdf

Desafíos en la evaluación del riesgo pulmonar y el manejo perioperatorio en pacientes sometidos a cirugía bariátrica


Challenges in pulmonary risk assessment and perioperative management in bariatric surgery patients.
Kaw R, Aboussouan L, Auckley D, Bae C, Gugliotti D, Grant P, Jaber W, Schauer P, Sessler D.
Department of Hospital Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue-S70, Cleveland, OH 44195, USA. Kawr@ccf.org
Obes Surg. 2008 Jan;18(1):134-8. Epub 2007 Nov 16.
Abstract
Bariatric surgery has serious associated medical comorbidity and procedure-related risks and is, thus, considered an intermediate-to-high-risk non-cardiac surgery. Altered respiratory mechanics, obstructive sleep apnea (OSA), and less often, pulmonary hypertension and postoperative pulmonary embolism are the major contributors to poor pulmonary outcomes in obese patients. Attention to posture and positioning is critical in patients with OSA. Suspected OSA patients requiring intravenous narcotics should be kept in a monitored setting with frequent assessments and naloxone kept at the bedside. Use of reverse Tredelenburg position, preinduction, maintenance of positive end-expiratory pressure, and use of continuous positive airway pressure can help improve oxygenation in the perioperative period.

ttp://www.springerlink.com/content/u333063w537375kj/fulltext.pdf





Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org


viernes, 2 de noviembre de 2012

Ketamina, inflamación y analgesia

Revisión sistemática de ketamina intravenosa para analgesia postoperatoria


A systematic review of intravenous ketamine for postoperative analgesia.
Laskowski K, Stirling A, McKay WP, Lim HJ.
Department of Anesthesiology, Perioperative Medicine and Pain Management, College of Medicine, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada. kevin.laskowski@usask.ca
Can J Anaesth. 2011 Oct;58(10):911-23. Epub 2011 Jul 20.
Abstract
PURPOSE: Perioperative intravenous ketamine may be a useful addition in pain management regimens. Previous systematic reviews have included all methods of ketamine administration, and heterogeneity between studies has been substantial. This study addresses this issue by narrowing the inclusion criteria, using a random effects model, and performing subgroup analysis to determine the specific types of patients, surgery, and clinical indications which may benefit from perioperative ketamine administration. SOURCE: We included published studies from 1966 to 2010 which were randomized, double-blinded, and placebo-controlled using intravenous ketamine (bolus or infusion) to decrease postoperative pain. Studies using any form of regional anesthesia were excluded. No limitation was placed on the ketamine dose, patient age, or language of publication. PRINCIPAL FINDINGS: Ninety-one comparisons in seventy studies involving 4,701 patients met the inclusion criteria (2,652 in ketamine groups and 2,049 in placebo groups). Forty-seven of these studies were appropriate for evaluation in the core meta-analysis, and the remaining 23 studies were used to corroborate the results. A reduction in total opioid consumption and an increase in the time to first analgesic were observed across all studies (P < 0.001). The greatest efficacy was found for thoracic, upper abdominal, and major orthopedic surgical subgroups. Despite using less opioid, 25 out of 32 treatment groups (78%) experienced less pain than the placebo groups at some point postoperatively when ketamine was efficacious. This finding implies an improved quality of pain control in addition to decreased opioid consumption. Hallucinations and nightmares were more common with ketamine but sedation was not. When ketamine was efficacious for pain, postoperative nausea and vomiting was less frequent in the ketamine group. The dose-dependent role of ketamine analgesia could not be determined. CONCLUSION: Intravenous ketamine is an effective adjunct for postoperative analgesia. Particular benefit was observed in painful procedures, including upper abdominal, thoracic, and major orthopedic surgeries. The analgesic effect of ketamine was independent of the type of intraoperative opioid administered, timing of ketamine administration, and ketamine dose.
http://www.oana.org/pdf/Canadian%20Article.pdf


La administración continua de S-(+)-ketamina durante el bypass coronario electivo atenua la respuesta proinflamatoria de las citokinas durante y después del cortocircuito cardiopulmonar


Continuous S-(+)-ketamine administration during elective coronary artery bypass graft surgery attenuates pro-inflammatory cytokine response during and after cardiopulmonary bypass.
Welters ID, Feurer MK, Preiss V, Müller M, Scholz S, Kwapisz M, Mogk M, Neuhäuser C.
Department of Anaesthesiology, Intensive Care and Pain Therapy, Universitätsklinikum Gießen und Marburg, Standort Gießen, D-35392 Giessen, Germany.
Br J Anaesth. 2011 Feb;106(2):172-9. Epub 2010 Dec 7.

CONCLUSION: Our data demonstrate that S-(+)-ketamine possesses anti-inflammatory potential. Anaesthesia with S-(+)-ketamine may have beneficial effects in attenuating the CPB-induced systemic inflammatory response.


http://bja.oxfordjournals.org/content/106/2/172.full.pdf




Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Bibliotecas. Alerta

El GobEx destaca el papel "fundamental" de las bibliotecas ...
La Vanguardia
El secretario general de Educación, César Díez Solís, ha destacado el papel "fundamental" que desempeñan las bibliotecas escolares en el fomento de la lectura como "herramienta básica" de aprendizaje y conocimiento, aspecto que supone un "objetivo ...
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Llegan códices de Da Vinci a internet
Milenio.com
Madrid • La Biblioteca Nacional de España presentó hoy los códices interactivos Madrid I y II de Leonardo da Vinci, que ofrecen en un contexto intelectual la transcripción de los estudios mecánicos y físicos en una base multimedia. El secretario de ...
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Bibliotecas Públicas: 15 años compartiendo lectura
Zamora Ciudad Red
Las Bibliotecas Públicas del Ayuntamiento de Oviedo parten de una concepción de bibliotecaorientada fundamentalmente al usuario, a la satisfacción de sus necesidades de formación, información y ocio, son un punto de encuentro y centro de cultura para ...
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La biblioteca del IES Rusadir, presente en las I Jornadas de ...
InfoMelilla
La biblioteca del Instituto Rusadir de Melilla se encuentra hoy participando en las I Jornadas deBibliotecas que se celebran en Extremadura, hasta donde se han desplazado dos profesoras que componen el grupo responsable de la biblioteca.
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Misiones OnLine
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SER Madrid Norte
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Valor de las bibliotecas para la alfabetización
Listín Diario
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La biblioteca lanza la campaña 'Conoce mejor la cultura cubana'
Diario Vasco
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Música de violín en la Biblioteca Municipal de Santander
El Diario Montanes
La Biblioteca Municipal ofrecerá mañana miércoles a partir de las 19.30 horas, un concierto del violinista cántabro Borja Ruiz. Músico cántabro multiinstrumentista, especializado en el violín. De formación tanto clásica como moderna, sus principales ...
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absysNET Opac Red de Bibliotecas de Canarias
Este es el sistema de información de la Red de Bibliotecas de Canarias (BICA). Desde aquí puede: Consultar los fondos de la red de bibliotecas. Solicitar ...
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Espacio para las noticias y hechos más importan

Libro Blanco: La sistematización del aprendizaje informal. Thot . Frances

[Identidad Bibliotecaria] Biblos:cuna del alfabeto

Biblos (en árabe, جبيل Ŷubayl) es una ciudad en Líbano, situada en la costa del norte del país, a 30 km de Beirut. Situada en una colina, fue una antigua ciudad fenicia, denominada Gubla en los textos cuneiformes y Gebal en la Biblia. Se cree que fue fundada alrededor del año 5000 AC, y según fuentes atribuidas al historiador fenicio Sanjuniatón, fue construida por Crono, y fue la primera ciudad fenicia. Actualmente, es ampliamente reconocida como la ciudad más antigua del mundo habitada ininterrumpidamente.


Su etimología proviene de la colina en que estaba situada Gubla, «montaña» en fenicio) que derivó en su nombre bíblico Gebal, pasando de aquí a la forma griega Byblos y de allí la palabra Biblion “libro”, que también originará el término Biblia. El nombre árabe, Ŷubayl, es diminutivo de ŷabal, “montaña”.
Fue una activa ciudad mercantil, mercado de papiros, madera de cedro, y cobre del Cáucaso, convertida en el centro comercial del Mediterráneo oriental. Mantuvo vasallaje con los faraones del antiguo Egipto; posteriormente fue ciudad tributaria de asirios y persas.

De la antigua Biblos se conserva una muralla de comienzos de la Edad del Bronce, el templo Baalat Gebal, una necrópolis y numerosos restos de la época romana y medieval. Fue declarada Patrimonio de la Humanidad por la Unesco en el año 1984.

El alfabeto, abecedario o abecé de una lengua o idioma es el conjunto ordenado de sus letras. Es también la agrupación, con un orden determinado, de las grafías utilizadas para representar el lenguaje que sirve de sistema de comunicación.

El término alfabeto procede del griego ἀλφάβετον (alfábeton), derivado de las dos primeras letras griegas ἄλφα (alfa, α) y βῆτα (beta, β), derivadas a su vez de las letras fenicias ‘alp y bet, que significaban «buey» y «casa» respectivamente. El alfabeto griego es una adaptación del alfabeto fenicio, que también dio lugar entre otros al hebreo y al árabe. Por su parte, el término abecedario proviene del latín tardío abecedārium, también derivado del nombre de las primeras letras, en este caso cuatro: a (a), b (be), c (ce) yd (de).
Algunas letras pueden recibir uno o varios diacríticos con el fin de diferenciar los sonidos de la lengua o poder evitar las ambigüedades. De la misma forma, el alfabeto puede ser entendido por el uso de letras suplementarias. Las evoluciones fonéticas de una lengua se crean a un ritmo diferente de la evolución escrita. La escritura alfabética no garantiza una correspondencia unívoca entre los fonemas y los grafemas.
En otros ámbitos (matemáticas, por ejemplo), un alfabeto es un conjunto finito y ordenado de símbolos.

El alfabeto fenicio supone una creación. Es al final de esa cadena donde se nota una progresiva prioridad del análisis sobre la síntesis. De la pictografía, que es una representación global, se pasa a signos que descomponen el discurso en sus partes constitutivas. Las formas más antiguas de la escritura fenicia se han encontrado en las inscripciones arcaicas de Biblos, cuyo origen se remonta a los siglos XIII y XI a.C. El fenicio arcaico comprendía 22 letras, únicamente consonantes, y está libre ya de elementos ideográficos, de determinativos y de toda huella de silabismo.

http://www.youtube.com/watch?feature=player_embedded&v=bVFRQ2Kd9Q0


Fuente: http://bibliotecas1978.wordpress.com/2012/10/30/biblos-cuna-del-alfabeto/

Cirugía y obesidad

Manejo operatorio de la obesidad


Surgical treatment of obesity: a review.
Fobi MA.
Center for Surgical Treatment of Obesity, Hawaiian Gardens, CA 90716, USA. info@cstobesity.com
J Natl Med Assoc. 2004 Jan;96(1):61-75.
Abstract
Obesity is a chronic disease due to excess fat storage, a genetic predisposition, and strong environmental contributions. This problem is worldwide, and the incidence is increasing daily. There are medical, physical, social, economic, and psychological comorbid conditions associated with obesity. There is no cure for obesity except possibly prevention. Nonsurgical treatment has been inadequate in providing sustained weight loss. Currently, surgery offers the only viable treatment option with longterm weight loss and maintenance for the morbidly obese. Surgeries for weight loss are called bariatric surgeries. There is no one operation that is effective for all patients. Gastric bypass operations are the most common operations currently used. Because there are inherent complications from surgeries, bariatric surgeries should be performed in a multidisciplinary setting. The laparoscopic approach is being used by some surgeons in performing the various operations. The success rate--usually defined as >50% excess weight loss that is maintained for at least five years from bariatric surgery--ranges from 40% in the simple to >70% in the complex operations. The weight loss from surgical treatment results in significant improvements and, in some cases, complete resolution of comorbid conditions associated with obesity. Patients undergoing surgery for obesity need lifelong nutritional supplements and medical monitoring.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2594758/pdf/jnma00301-0063.pdf


¿Solución rápida o cura a largo plazo? Pros y contras de la cirugía bariátrica


Quick fix or long-term cure? Pros and cons of bariatric surgery.
Madura JA 2nd, Dibaise JK.
Division of General Surgery Mayo Clinic Arizona, 13400 East Shea Boulevard, Scottsdale, AZ, USA 85259.
F1000 Med Rep. 2012;4:19. doi: 10.3410/M4-19. Epub 2012 Oct 2.
Abstract
The past decade has seen an enormous increase in the number of bariatric, or weight loss, operations performed. This trend is likely to continue, mirroring the epidemic of obesity around the world and its rising prevalence among children. Bariatric surgery is considered by many to be the most effective treatment for obesity in terms of maintenance of long-term weight loss and improvement in obesity-related comorbid conditions. Although overly simplified, the primary mechanisms of the surgical interventions currently utilized to treat obesity are the creation of a restrictive or malabsorptive bowel anatomy. Operations based on these mechanisms include the laparoscopic adjustable gastric band and laparoscopic vertical sleeve gastrectomy (considered primarily restrictive operations), the laparoscopic biliopancreatic diversion with or without a duodenal switch (primarily malabsorptive operation), and the laparoscopic Roux-en-Y gastric bypass (considered a combination restrictive and selective malabsorptive procedure). Each operation has pros and cons. Important considerations, for the patient and surgeon alike, in the decision to proceed with bariatric surgery include the technical aspects of the operation, postoperative complications including long-term nutritional problems, magnitude of initial and sustained weight loss desired, and correction of obesity-related comorbidities. Herein, the pros and cons of the contemporary laparoscopic bariatric operations are reviewed and ongoing controversies relating to bariatric surgery are discussed: appropriate patient selection, appropriate operation selection for an individual patient, surgeon selection, and how to measure success after surgery.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3470459/pdf/medrep-04-19.pdf



Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Más sobre hipertensión pulmonar en la infancia

Hallazgos clínicos en la hipertensión pulmonar infantil: un estudio de registro


Clinical features of paediatric pulmonary hypertension: a registry study.
Berger RM, Beghetti M, Humpl T, Raskob GE, Ivy DD, Jing ZC, Bonnet D, Schulze-Neick I, Barst RJ.
Centre for Congenital Heart Diseases-Paediatric Cardiology, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Netherlands. r.m.f.berger@umcg.nl
Lancet. 2012 Feb 11;379(9815):537-46. Epub 2012 Jan 11.
Abstract
BACKGROUND: Paediatric pulmonary hypertension, is an important cause of morbidity and mortality, and is insufficiently characterised in children. The Tracking Outcomes and Practice in Pediatric Pulmonary Hypertension (TOPP) registry is a global, prospective study designed to provide information about demographics, treatment, and outcomes in paediatric pulmonary hypertension. METHODS: Consecutive patients aged 18 years or younger at diagnosis with pulmonary hypertension and increased pulmonary vascular resistance were enrolled in TOPP at 31 centres in 19 countries from Jan 31, 2008, to Feb 15, 2010. Patient and disease characteristics, including age at diagnosis and at enrolment, sex, ethnicity, presenting symptoms, pulmonary hypertension classification, comorbid disorders, medical and family history, haemodynamic indices, and functional class were recorded. Follow-up was decided by the patients' physicians according to the individual's health-care needs. FINDINGS: 362 of 456 consecutive patients had confirmed pulmonary hypertension (defined as mean pulmonary artery pressure ≥25 mm Hg, pulmonary capillary wedge pressure ≤12 mm Hg, and pulmonary vascular resistance index ≥3 WU/m(-2)). 317 (88%) patients had pulmonary arterial hypertension (PAH), which was idiopathic [IPAH] or familial [FPAH] in 182 (57%), and associated with other disorders in 135 (43%), of which 115 (85%) cases were associated with congenital heart disease. 42 patients (12%) had pulmonary hypertension associated with respiratory disease or hypoxaemia, with bronchopulmonary dysplasia most frequent. Finally, only three patients had either chronic thromboembolic pulmonary hypertension or miscellaneous causes of pulmonary hypertension. Chromosomal anomalies, mainly trisomy 21, were reported in 47 (13%) of patients with confirmed disease. Median age at diagnosis was 7 years (IQR 3-12); 59% (268 of 456) were female. Although dyspnoea and fatigue were the most frequent symptoms, syncope occurred in 31% (57 of 182) of patients with IPAH or FPAH and in 18% (eight of 45) of those with repaired congenital heart disease; no children with unrepaired congenital systemic-to-pulmonary shunts had syncope. Despite severe pulmonary hypertension, functional class was I or II in 230 of 362 (64%) patients, which is consistent with preserved right-heart function.INTERPRETATION: TOPP identifies important clinical features specific to the care of paediatric pulmonary hypertension, which draw attention to the need for paediatric data rather than extrapolation from adult studies.
FUNDING: Actelion Pharmaceuticals.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3426911/pdf/

nihms382071.pdf


Clasificación funcional de la hipertensión pulmonar en niños: informe de la fuerza de trabajo pediátrica PVRI, Panamá 2012
Functional classification of pulmonary hypertension in children: Report from the PVRI pediatric taskforce, Panama 2011.
Lammers AE, Adatia I, Cerro MJ, Diaz G, Freudenthal AH, Freudenthal F, Harikrishnan S, Ivy D, Lopes AA, Raj JU, Sandoval J, Stenmark K, Haworth SG.
Great Ormond Street Hospital for Children, London, UK.
Pulm Circ. 2011 Aug 2;1(2):280-285.
Abstract
The members of the Pediatric Task Force of the Pulmonary Vascular Research Institute (PVRI) were aware of the need to develop a functional classification of pulmonary hypertension in children. The proposed classification follows the same pattern and uses the same criteria as the Dana Point pulmonary hypertension specific classification for adults. Modifications were necessary for children, since age, physical growth and maturation influences the way in which the functional effects of a disease are expressed. It is essential to encapsulate a child's clinical status, to make it possible to review progress with time as he/she grows up, as consistently and as objectively as possible. Particularly in younger children we sought to include objective indicators such as thriving, need for supplemental feeds and the record of school or nursery attendance. This helps monitor the clinical course of events and response to treatment over the years. It also facilitates the development of treatment algorithms for children. We present a consensus paper on a functional classification system for children with pulmonary hypertension, discussed at the Annual Meeting of the PVRI in Panama City, February 2011.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3161406/




Características de los pacientes recién nacidos en la hipertensión pulmonar persistente


Patient characteristics in persistent pulmonary hypertension of the newborn.
Roofthooft MT, Elema A, Bergman KA, Berger RM.
Department of Paediatric Cardiology, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
Pulm Med. 2011;2011:858154. Epub 2011 May 24.
Abstract
Objective. To assess the impact of PPHN on mortality, morbidity, and behavioural skills. Methods. A retrospective observational study of 143 newborns with PPHN, over an 11-year period, using objective health-status data from medical records and family doctors, and subjective health status data from a standardized Child Behaviour Checklist. Results. The majority of patients were males, treated with inhaled nitric oxide had maladaptation/maldevelopment as pathophysiological mechanism and a gestational age >37 weeks. In term newborns, types of pathophysiological mechanism (P < .001) and Oxygen Index (P = .02) were independent predicting risk factors for PPHN-related mortality. Analysis of preexisting disease and outcome categories in term newborns showed only a significant correlation between the use of iNO and respiratory complaints (P = .03), not confirmed by multivariate analysis and regression analysis. Conclusions. PPHN is a serious, often fatal condition. The incidence of PPHN in preterm newborns is high. In term survivors, PPHN had no additional role in morbidity/outcome.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109632/pdf/PM2011-858154.pdf



Los recientes avances en la comprensión de la hipertensión pulmonar pediátrica.
Recent progress in understanding pediatric pulmonary hypertension.
Abman SH, Ivy DD.
Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital, Aurora, Colorado, USA.
Curr Opin Pediatr. 2011 Jun;23(3):298-304. doi: 10.1097/MOP.0b013e3283464a52.
Abstract
PURPOSE OF REVIEW: Pulmonary artery hypertension (PAH) in children contributes significantly to morbidity and mortality in diverse pediatric cardiac, lung, hematologic and other diseases. Advances in pulmonary vascular biology over the past few decades have significantly expanded therapeutic strategies; however, many unique issues persist regarding our understanding of pediatric PAH. RECENT FINDINGS: Recent studies of pediatric PAH include those that highlight gaps in our understanding of pediatric diseases associated with PAH from those of adult onset, emphasizing the strong need for specific studies regarding unique aspects of the pathogenesis and treatment of children with PAH. Registries have begun to provide new data showing differences in physiology, course, and genetics between adult and pediatric forms of PAH. Unfortunately, therapeutic strategies in pediatric pulmonary hypertension are often limited to small observational studies in children and are dependent on results from larger adult studies. In addition, clinical endpoints for studies and care remain poorly defined in infants and children. SUMMARY: Despite many advances, long-term outcomes for children with PAH remain guarded and substantial challenges persist, especially with regard to understanding mechanisms and approach to severe PAH. Future studies are needed to develop novel biomarkers, clinical endpoints and interventions for young children with diverse causes of PAH.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3128451/pdf/nihms300909.pdf




Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Más sobre cirugía bariátrica

Manga gástrica laparoscópica versus banda gástrica ajustable para el tratamiento de la obesidad severa en pacientes de alto riesgo


Laparoscopic sleeve gastrectomy versus laparoscopic adjustable gastric banding for the treatment severe obesity in high risk patients.
Varela JE.
Department of Surgery, Washington University, St. Louis, MO, USA.varelae@wustl.edu
JSLS. 2011 Oct-Dec;15(4):486-91.
Abstract
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has emerged as an alternative restrictive bariatric procedure to the most popular laparoscopic adjustable gastric banding (LAGB). We analyze and compare the clinical and weight loss outcomes of LSG versus LAGB for the treatment of severe obesity in high-risk patients. METHODS: Forty severely obese veterans (20/group) received either LSG or LAGB and were followed prospectively for 2 years. Outcome measures included operating room (OR) time, estimated blood loss (EBL), length of hospital stay (LOS), morbidity, mortality, reoperations, readmission rates, and weight loss over time. RESULTS: The cohort primarily comprised high-risk and older male veterans. Patient's baseline demographics were similar between groups. LSG was associated with prolonged OR time (116±31 vs. 94±28min), higher EBL (34±28 vs. 17±19mL), and LOS (2±.9 vs. 1±.4days) when compared with LAGB. Minor morbidity and readmissions were similar between groups, while no major morbidity, reoperations, or mortality occurred. Total weight and BMI decreased significantly after surgery in both groups (LSG: 302±52 to 237lbs and 45±5 to 36±5kg/m(2) vs. LAGB: 280±36 to 231±29lbs and 43±5 to 36±5kg/m(2), respectively). Total weight loss was superior in the LSG vs. LAGB group at 2 years (TWL=65±24 vs. 49±28 lbs (P=.03); %EWL=51±20 vs. 46±23%; %EBMI loss=48±22 vs. 45±23%, and %BWL=21±8 vs. 17±9%, respectively). CONCLUSION: In severely obese and high-risk patients, laparoscopic sleeve gastrectomy provides superior total weight loss at 2 years.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3340957/pdf/jls486.pdf

Gastrectomía en manga laparoscópica viable para la cirugía de revisión bariátrica


Laparoscopic sleeve gastrectomy feasible for bariatric revision surgery.
Berende CA, de Zoete JP, Smulders JF, Nienhuijs SW.
Catharina Hospital, Eindhoven, the Netherlands. niels.berende@cze.nl
Obes Surg. 2012 Feb;22(2):330-4.
Abstract
Bariatric revision surgery is associated with several complications that can be attributed to decreased quality of tissue and complexity of the surgery. A laparoscopic sleeve gastrectomy is a simple technique with potential advantages. Therefore, the results of this procedure were evaluated as a revisional option. Fifty-one patients underwent laparoscopic sleeve gastrectomy (LSG). Indications for the LSG were insufficient weight loss (34 patients, group 1) or vomiting (17 patients, group 2) following a laparoscopic adjustable gastric banding (LAGB) or vertical banded gastroplasty (VBG). Patient and procedure characteristics as well as outcome were collected prospectively. From October 2006 to June 2010, 51 patients with a failed prior bariatic procedure (VBG or LAGB) were converted to (L)SG. The conversion rate was zero. The median procedure time was 99 min (range 54-221) and hospital stay was 3 days (range 2-38). There was no mortality after 30 days. Complications included bleeding (six) and leakage of the staple line (seven). Mean follow-up was 13.8 (2-46) months. LSG as revision surgery for insufficient weight loss resulted in extra weight loss of 52.7%, and the overall extra weight loss was 49.3%. When LSG was performed because of vomiting, 82% was able to eat solid food at follow-up. Of the 65 pre-existent co-morbidities, 21 were resolved and 18 improved. LSG as a revision procedure is feasible. An additional weight loss and further resolution of co-morbidity seem achievable, however, at the cost of a high number of complications. Therefore, revision bariatric surgery should be limited to expert tertiary bariatric centers
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266499/pdf/11695

_2011_Article_501.pdf









Manejo perioperatorio de los pacientes de cirugía bariátrica: enfermedad ósea metabólica
Perioperative management of bariatric surgery patients: focus on metabolic bone disease.
Williams SE, Cooper K, Richmond B, Schauer P.
Center for Nutrition and Metabolic Medicine, Greene Memorial Hospital Advanced Medical Group, Xenia, OH 45385, USA.swilliams@greenehealth.org
Cleve Clin J Med. 2008 May;75(5):333-4, 336, 338 passim.
Abstract
Chronic vitamin D deficiency, inadequate calcium intake, and secondary hyperparathyroidism are common in obese individuals, placing them at risk for low bone mass and metabolic bone disease. After bariatric surgery, they are at even higher risk, owing to malabsorption and decreased oral intake. Meticulous preoperative screening, judicious use of vitamin and mineral supplements, addressing modifiable risk factors, and monitoring the absorption of key nutrients postoperatively are essential in preventing metabolic bone disease in bariatric surgery patients.
http://www.ccjm.org/content/75/5/333.full.pdf




Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org


Books Update NYT



The New York Times

November 2, 2012

Books Update

On the Cover of Sunday's Book Review

'There Was a Country: A Personal History of Biafra'

By CHINUA ACHEBE
Reviewed by ADAM NOSSITER
Chinua Achebe's memoir about the moment when Nigeria split apart at a cost of more than a million lives.
Women await food distribution in West Darfur, Sudan, February 2008.

'Of Africa'

By WOLE SOYINKA
Reviewed by ADAM HOCHSCHILD
In this volume of sweeping reflections, the playwright and activist Wole Soyinka takes Africa's woes to heart.

Also in the Book Review

Dennis Lehane

Dennis Lehane: By the Book

The author of "Live by Night," "Gone, Baby, Gone" and "Mystic River" says George V. Higgins and Edwin O'Connor have written the best novels about Boston.

'The Story of Ain't'

By DAVID SKINNER
Reviewed by PATRICIA T. O'CONNER
Webster's Third New International was scorned for being less judgmental than its predecessor.

'The Signal and the Noise'

By NATE SILVER
Reviewed by NOAM SCHEIBER
Applying statistical analysis to the past, Nate Silver evaluates the claims of sports pundits, political handicappers and more.

'The Cursing Mommy's Book of Days'

By IAN FRAZIER
Reviewed by JUDITH NEWMAN
Ian Frazier's hard-pressed Cursing Mommy moves from New Yorker columns to a novel of her own.

'The Way the World Works: Essays'

By NICHOLSON BAKER
Reviewed by JOHN JEREMIAH SULLIVAN
In a collection spanning 15 years, Nicholson Baker ponders political controversies, personal intimacies and fascinating obscurities.
Emma Donoghue

'Astray'

By EMMA DONOGHUE
Reviewed by BROOKE ALLEN
Emma Donoghue explores the theme of emigration through historical fiction.

'May We Be Forgiven'

By A. M. HOMES
Reviewed by GARTH RISK HALLBERG
A. M. Homes's dark satire of 21st-century domestic life.

Happy Hunting

By BILL SCHEFT
Steven Rinella's quest for game and Davy Rothbart's search for love.
Willie Sutton

'Sutton'

By J. R. MOEHRINGER
Reviewed by ROBERT POLITO
A biographical novel of the notorious bank robber Willie Sutton.
CRIME

Given Up for Dead

By MARILYN STASIO
In Michael Robotham's "Say You're Sorry," two teenage girls are held captive in a cellar.

Back Page

SKETCHBOOK | GRANT SNIDER
Literary Consolation Prizes
The Thick Book Award, First Novel Encouragement Stickers and more.

Inside the List

By GREGORY COWLES
Rod Stewart, 67, and the former Kiss drummer Peter Criss, 66, join other grandfathers of rock on the list this week.

Editors' Choice

Recently reviewed books of particular interest.

Paperback Row

By IHSAN TAYLOR
Paperback books of particular interest.

Book Review Podcast

This week, Nate Silver talks about his new book, "The Signal and the Noise"; Parul Sehgal discusses publishing news; and Gregory Cowles has best-seller news. Sam Tanenhaus is the host.
ArtsBeat

Editor's Note

Thanks for taking the time to read this e-mail. Feel free to send feedback; I enjoy hearing your opinions and will do my best to respond.
John Williams
Books Producer
The New York Times on the Web