Trasplante hepático / Liver transplant

Mayo 8, 2017. No. 2683

Hemorragia masiva en trasplante hepático: Consecuencias, predicción y manejo Massive haemorrhage in liver transplantation: Consequences, prediction and management. Cleland S1, Corredor C1, Ye JJ1, Srinivas C1, McCluskey SA1. World J Transplant. 2016 Jun 24;6(2):291-305. doi: 10.5500/wjt.v6.i2.291. Abstract From its inception the success of liver transplantation has been associated with massive blood loss. Massive transfusion is classically defined as > 10 units of red blood cells within 24 h, but describing transfusion rates over a shorter period of time may reduce the potential for survival bias. Both massive haemorrhage and transfusion are associated with increased risk of mortality and morbidity (need for dialysis/surgical site infection) following liver transplantation although causality is difficult to prove due to the observational design of most trials. The blood loss associated with liver transplantation is multifactorial. Portal hypertension secondary to cirrhosis results in extensive collateral circulation, which can bleed during hepatectomy particular if portal pressures are increased. Avoiding volume loading and maintenance of a low central venous pressure together with the use of vasopressors have been shown to reduce blood loss and transfusion during liver transplantation, but may increase the risk of renal impairment post-operatively. Coagulation defects may be present pre-transplant, but haemostasis is often re-balanced due to a deficit in both pro- and anti-coagulation factors. Further derangement of haemostasis may develop in the anhepatic and neohepatic phases due to absent hepatic metabolic function, hyperfibrinolysis and platelet sequestration in the donor liver. Point-of-care tests of coagulation such as the viscoelastic tests rotation thromboelastometry/thromboelastometry allow and more accurate and rapid assessment of these derangements in coagulation and guide the use of factor replacement and antifibrinolytics. Transfusion protocols guided by these tests have been shown to reduce transfusion rates compared with conventional coagulation tests, but have not shown improvements in mortality or morbidity. Pre-operative factors associated with massive transfusion include previous surgery, re-do transplantation, the aetiology and severity of liver disease. Intra-operatively the use of piggy-back technique and avoiding veno-veno bypass has been shown to reduced blood loss. KEYWORDS: Coagulopathy; Liver transplantation; Massive transfusion PDF Complicaciones trombóticas perioperatorias en trasplante hepático Perioperative thrombotic complications in liver transplantation. Feltracco P1, Barbieri S1, Cillo U1, Zanus G1, Senzolo M1, Ori C1. World J Gastroenterol. 2015 Jul 14;21(26):8004-13. doi: 10.3748/wjg.v21.i26.8004. Abstract Although the perioperative bleeding complications and the major side effects of blood transfusion have always been the primary concern in liver transplantation (OLT), the possible cohesion of an underestimated intrinsic hypercoagulative state during and after the transplant procedure may pose a major threat to both patient and graft survival. Thromboembolism during OLT is characterized not only by a complex aetiology, but also by unpredictable onset and evolution of the disease. The initiation of a procoagulant process may be triggered by various factors, such as inflammation, venous stasis, ischemia-reperfusion injury, vascular clamping, anatomical and technical abnormalities, genetic factors, deficiency of profibrinolytic activity, and platelet activation. The involvement of the arterial system, intracardiac thrombosis, pulmonary emboli, portal vein thrombosis, and deep vein thrombosis, are among the most serious thrombotic events in the perioperative period. The rapid detection of occlusive vascular events is of paramount importance as it heavily influences the prognosis, particularly when these events occur intraoperatively or early after OLT. Regardless of the lack of studies and guidelines on anticoagulant prophylaxis in this setting, many institutions recommend such an approach especially in the subset of patients at high risk. However, the decision of when, how and in what doses to use the various chemical anticoagulants is still a difficult task, since there is no common consensus, even for high-risk cases. The risk of postoperative thromboembolism causing severe hemodynamic events, or even loss of graft function, must be weighed and compared with the risk of an important bleeding. In this article we briefly review the risk factors and the possible predictors of major thrombotic complications occurring in the perioperative period, as well as their incidence and clinical features. Moreover, the indications to pharmacological prophylaxis and the current treatment strategies are also summarized. KEYWORDS: Hepatic artery occlusion; Liver transplantation; Postoperative complications; Pulmonary emboli; Thromboembolic phenomena; Vascular  PDF Falla renal aguda después de trasplante hepático. Revisión sistemática de modelos predictivos publicados Acute kidney injury following liver transplantation: a systematic review of published predictive models. Caragata R1, Wyssusek KH2, Kruger P3. Anaesth Intensive Care. 2016 Mar;44(2):251-61. Abstract Acute kidney injury is a frequent postoperative complication amongst liver transplant recipients and is associated with increased morbidity and mortality. This systematic review analysed the existing predictive models, in order to solidify current understanding. Articles were selected for inclusion if they described the primary development of a clinical prediction model (either an algorithm or risk score) to predict AKI post liver transplantation. The database search yielded a total of seven studies describing the primary development of a prediction model or risk score for the development of AKI following liver transplantation. The models span thirteen years of clinical research and highlight a gradual change in the definitions of AKI, emphasising the need to employ standardised definitions for subsequent studies. Collectively, the models identify a diverse range of predictive factors with several common trends. They emphasise the impact of preoperative renal dysfunction, liver disease severity and aetiology, metabolic risk factors as well as intraoperative variables including measures of haemodynamic instability and graft quality. Although several of the models address postoperative parameters, their utility in predictive modelling seems to be of questionable relevance. The common risk factors identified within this systematic review provide a minimum list of variables, which future studies should address. Research in this area would benefit from prospective, multi-site studies with larger cohorts as well as the subsequent internal and external validation of predictive models. Ultimately, the ability to identify patients at high risk of post-transplant AKI may enable early intervention and perhaps prevention. KEYWORDS: acute kidney injury; liver transplantation; prediction model; risk score PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Lesión en Asa de Balde meniscal

http://www.clinicadeartroscopia.com.mx/academia/lesion-en-asa-de-balde-meniscal/

Lesión en Asa de Balde meniscal                                                                                                                                                       

Imagen de doble cruzado posterior correspondiente a lesión en Asa de Balde meniscal se realizo sutura con fast fix 360 más reconstrucción de ligamento cruzado anterior autologo femenino 21 años

www.clinicadeartroscopia.com.mx
www.findmed.com.mx 

Grupo Cirugía y Reconstrucción Articular 

#Lesión en Asa#balde meniscal#ligamento cruzado anterior

Fractura de Jones

Fractura de Jones manejado con tornillo canulado doble compresión por mínima invasión, fractura consolidada al 100%
http://www.clinicadeartroscopia.com.mx/academia/fractura-de-jones/

Características de los motociclistas implicados en accidentes entre motocicletas y automóviles

http://www.traumaysiniestros.com.mx/academia/caracteristicas-de-los-motociclistas-implicados-en-accidentes-entre-motocicletas-y-automoviles-2/

Characteristics of motorcyclists involved in accidents between motorcycles and automobiles

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/25909211

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302015000100017&lng=en&nrm=iso&tlng=en

De:

Oliveira AL¹, Petroianu A², Gonçalves DM³, Pereira GA³, Alberti LR⁴.

Rev Assoc Med Bras (1992). 2015 Jan-Feb;61(1):61-4. doi: 10.1590/1806-9282.61.01.061. Epub 2015 Jan 1.

Todos los derechos reservados para:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

INTRODUCTION:

traffic accidents are one of the main causes of death and disability, with motorcyclists representing the great majority of both the victims and the perpetrators.

OBJECTIVE:

this work studied the characteristics of motorcyclists injured in accidents involving motorcycles and automobiles.

METHOD:

this study sought to interview 100 motorcyclists who had been injured in collisions between motorcycles and automobiles, and who were undergoing emergency hospital treatment in the region of Belo Horizonte, Brazil. The questionnaires included demographic information (age, gender, skin color, education level, profession) and questions about years of licensed driving practice, how often they would drive an automobile, how long they had had a motorcycle driver’s license, how often they would ride a motorcycle, the number of prior accidents involving a car, and the number of prior accidents not involving a car.

RESULTS:

of the 100 consecutive accidents studied, 91 occurred with men and 9 with women, aged between 16 and 79 (m = 29 ± 11) years. Regarding their reason for using a motorcycle, 83% reported using it for transport, 7% for work, and 10% for leisure. Most of these accident victims had secondary or higher education (47%). Of the motorcyclists who held a car driver’s license, 68.3% drove the vehicle daily or weekly and held the license for more than one year. Sixty-seven percent of the accident victims used a motorcycle daily and had a motorcycle driver’s license for at least one year.

CONCLUSION:

among the motorcyclists injured, most were men aged 20 years or older, with complete secondary education, and experienced in driving both motorcycles and cars, indicating that recklessness while driving the motorcycle is the main cause of traffic accidents.

Resumen

INTRODUCCIÓN:

Los accidentes de tránsito son una de las principales causas de muerte y discapacidad, siendo los motociclistas los que representan a la gran mayoría tanto de las víctimas como de los perpetradores.

OBJETIVO:

Este trabajo estudió las características de los motociclistas lesionados en accidentes con motocicletas y automóviles.

MÉTODO:

Este estudio buscó entrevistar a 100 motociclistas que habían sufrido heridas en choques entre motocicletas y automóviles, y que se encontraban bajo tratamiento hospitalario de emergencia en la región de Belo Horizonte, Brasil. Los cuestionarios incluyeron información demográfica (edad, sexo, color de la piel, nivel de educación, profesión) y preguntas sobre años de prácticas de conducción con licencia, la frecuencia con la que manejarían un automóvil, cuánto tiempo llevaban una licencia de conducir de motocicleta, Una motocicleta, el número de accidentes previos relacionados con un coche, y el número de accidentes anteriores que no implican un coche.

RESULTADOS:

De los 100 accidentes consecutivos estudiados, 91 ocurrieron con hombres y 9 con mujeres, entre 16 y 79 años (m = 29 ± 11) años. Con respecto a su razón para usar una motocicleta, el 83% informó usarla para el transporte, el 7% para el trabajo y el 10% para el ocio. La mayoría de estas víctimas de accidentes tenían educación secundaria o superior (47%). De los motociclistas que poseían una licencia de conducir de automóvil, el 68,3% conducía el vehículo diariamente o semanalmente y tenía la licencia por más de un año. El sesenta y siete por ciento de las víctimas del accidente usaban una motocicleta diariamente y tenían una licencia de conducir de motocicleta por al menos un año.

CONCLUSIÓN:

Entre los motociclistas lesionados, la mayoría eran hombres de 20 años o más, con educación secundaria completa y con experiencia en la conducción de motocicletas y automóviles, lo que indica que la imprudencia al conducir la motocicleta es la principal causa de accidentes de tráfico.PMID:   25909211   DOI:  

10.1590/1806-9282.61.01.061

[Indexed for MEDLINE]

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#motociclistas lesionados#hombres#educación secundaria#motocicletas#automoviles#accidentes

Dislocación de la rótula en niños y adolescentes

http://www.columnavertebralpediatricaygeriatrica.com.mx/academia/dislocacion-de-la-rotula-en-ninos-y-adolescentes/

Patella Dislocation in Children and Adolescents

Fuente
Este artículo es originalmente publicado en:


https://www.ncbi.nlm.nih.gov/pubmed/28454185
https://www.thieme-connect.com/DOI/DOI?10.1055/s-0042-122855



De:


Höhne S1, Gerlach K1, Irlenbusch L2, Schulz M2, Kunze C3, Finke R1.
Z Orthop Unfall. 2017 Apr;155(2):169-176. doi: 10.1055/s-0042-122855. Epub 2017 Apr 28.



Todos los derechos reservados para:


© 2017 Georg Thieme Verlag KG





Abstract


Introduction Patellar dislocation is one of the commonest knee injuries in adolescents. Although treatment usually leads to good results, the influence of anatomical and functional factors on therapeutic strategy has been underestimated, especially in cases of recurrence. Patients and Methods The course of treatment has been analysed in 88 patients with 136 patellar dislocations. The importance of anatomical conditions was studied using X-ray and MRI findings. The treatment results were critically evaluated in comparison with current recommendations. Results From 2000 to 2015, 109 patellar dislocations occurred in 88 patients; a further 27 previous dislocations were reported by the patients (mean age 14 years, 47 boys and 41 girls). About one-third of patients (35.2 %) suffered one or more recurrences. Almost half (48.6 %) of the dislocations occurred during physical exercise, particularly ball sports. Osteochondral flake fracture was found in 9 % of the patients, and a lesion of the medial patellofemoral ligament in 96 %. There was an anatomical predisposition to patellar dislocation in almost all cases. The sulcus angle, patellar and trochlear dysplasia, and patellar height were highly significantly different between the patient group and controls. The TT-TG distance was subsequently calculated, but had no impact on therapy. Seventy-seven patients were treated conservatively and 32 patients surgically. The conservative procedure included partial immobilisation for six weeks. Surgical reconstruction or tightening was performed in 27 cases; in five, in combination with other surgical procedures. Plasty of the medial patellofemoral ligament with a tendon graft was performed in five patients, and osteochondral or meniscal lesions were repaired in 10 patients. Recurrences occurred in 41.7 % of conservatively treated knees and in 29.6 % of surgically treated knees (without reconstruction with a tendon graft). No recurrence was seen after reconstruction of the medial patellofemoral ligament with a tendon graft. Fifty-four patients underwent a follow-up examination. Fourteen of these (25.9 %) had suffered a recurrence. The outcome 16 months after the end of treatment was mostly good, as were the results of self-assessment (Larson-Lauridsen Score). Conclusion An anatomical predisposition is detectable in almost all cases of patellar dislocation, but frequently occurs with an accident event, e.g. in ball sports. Primary patellar dislocations without serious concomitant injuries may be treated conservatively. In the event of recurrence, the indication for surgery is given, even in young patients and in any patient with an osteochondral flake fracture. Tightening reconstruction of the MPFL used to be frequently performed, but is associated with a high rate of recurrence.




Resumen


Introducción



La dislocación rotuliana es una de las lesiones de rodilla más frecuentes en adolescentes. Aunque el tratamiento suele conducir a buenos resultados, se ha subestimado la influencia de los factores anatómicos y funcionales en la estrategia terapéutica, especialmente en los casos de recurrencia. Pacientes y métodos El tratamiento se ha analizado en 88 pacientes con 136 dislocaciones rotulianas. La importancia de las condiciones anatómicas se estudió mediante radiografías y resonancia magnética. Los resultados del tratamiento fueron evaluados críticamente en comparación con las recomendaciones actuales. Resultados De 2000 a 2015, 109 dislocaciones rotulianas ocurrieron en 88 pacientes; Otras 27 luxaciones anteriores fueron reportadas por los pacientes (edad media 14 años, 47 varones y 41 niñas).Alrededor de un tercio de los pacientes (35,2%) sufrió una o más recurrencias. Casi la mitad (48,6%) de las luxaciones ocurrieron durante el ejercicio físico, particularmente deportes de pelota. Se encontró fracturas de escamas osteocondrales en el 9% de los pacientes, y una lesión del ligamento patelofemoral medial en el 96%. En casi todos los casos existía una predisposición anatómica a la dislocación rotuliana. El ángulo del surco, la displasia rotuliana y troclear y la altura de la rótula fueron significativamente diferentes entre el grupo de pacientes y los controles. La distancia TT-TG se calculó posteriormente, pero no tuvo impacto en el tratamiento. Setenta y siete pacientes fueron tratados de manera conservadora y 32 pacientes quirúrgicamente. El procedimiento conservador incluyó inmovilización parcial durante seis semanas. Se realizó reconstrucción o endurecimiento quirúrgico en 27 casos; En cinco, en combinación con otros procedimientos quirúrgicos. Se realizó plastia del ligamento patelofemoral medial con injerto de tendón en cinco pacientes y se repararon lesiones osteocondrales o meniscales en 10 pacientes. Las recurrencias ocurrieron en el 41,7% de las rodillas tratadas de forma conservadora y en el 29,6% de las rodillas tratadas quirúrgicamente (sin reconstrucción con un tendón). No se observó recidiva después de la reconstrucción del ligamento patelofemoral medial con un injerto de tendón.Cincuenta y cuatro pacientes se sometieron a un examen de seguimiento. Catorce de ellos (25,9%) habían sufrido una recurrencia. El resultado 16 meses después del final del tratamiento fue en su mayoría bueno, al igual que los resultados de la autoevaluación (Larson-Lauridsen Score). Conclusión Una predisposición anatómica es detectable en casi todos los casos de dislocación rotuliana, pero con frecuencia ocurre con un accidente, p. En los deportes de pelota. Las dislocaciones patelar primarias sin lesiones concomitantes graves pueden ser tratadas de forma conservadora. En caso de recurrencia, la indicación para la cirugía se da, incluso en pacientes jóvenes y en cualquier paciente con una fractura de escamas osteocondrales. La reconstrucción de apriete de la MPFL solía ser realizada con frecuencia, pero se asocia con una alta tasa de recurrencia






Georg Thieme Verlag KG Stuttgart · New York.
PMID: 28454185 DOI: 10.1055/s-0042-122855

Desarrollo de pautas de mejores prácticas basadas en el consenso para el cuidado postoperatorio después de la fusión vertebral posterior para la escoliosis idiopática en adolescentes.

Development of Consensus-Based Best Practice Guidelines for Postoperative Care Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis.


Fuente

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28441684
http://insights.ovid.com/crossref?an=00007632-201705010-00013


De:

Fletcher ND1, Glotzbecker MP, Marks M, Newton PO; Harms Study Group.
Spine (Phila Pa 1976). 2017 May 1;42(9):E547-E554. doi: 10.1097/BRS.0000000000001865.


Todos los derechos reservados para:

Copyright © 2016 Ovid Technologies, Inc., and its partners and affiliates. All Rights Reserved.
Some content from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.





Abstract


OBJECTIVE:


The aim of this study was to use expert opinion to achieve consensus on various aspects of postoperative care following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).
SUMMARY OF BACKGROUND DATA:


Significant variability exists in postoperative care following PSF for AIS, despite a relatively healthy patient population and continuously improving operative techniques. Current practice appears based either on lesser quality studies or the perpetuation of long-standing protocols.
METHODS:


An expert panel composed of 26 pediatric spine surgeons was selected. Using the Delphi process and iterative rounds using a nominal group technique, participants in this panel were presented with a detailed literature review and asked to voice opinion collectively during three rounds of voting (one electronic and two face-to-face). Agreement >80% was considered consensus. Interventions without consensus were discussed and revised, if feasible.
RESULTS:


Consensus was reached to support 19 best practice guideline (BPG) measures for postoperative care addressing non-ICU admission, perioperative pain control, dietary management, physical therapy, postoperative radiographs, surgical bandage management, and indications for discharge.
CONCLUSION:


We present a consensus-based BPG consisting of 19 recommendations for the postoperative management of patients following PSF for AIS. This can serve to reduce variability in practice in this area, help develop hospital specific protocols, and guide future research.








Resumen



OBJETIVO:El objetivo de este estudio fue utilizar la opinión de expertos para lograr un consenso sobre varios aspectos de la atención postoperatoria después de la fusión espinal posterior (PSF) para la escoliosis idiopática adolescente (AIS).



RESUMEN DE DATOS ANTERIORES:Existe una variabilidad significativa en la atención postoperatoria después de la PSF para AIS, a pesar de una población de pacientes relativamente sana y mejorando continuamente las técnicas operativas. La práctica actual se basa en estudios de menor calidad o en la perpetuación de protocolos de larga data.



MÉTODOS:Se seleccionó un panel de expertos formado por 26 cirujanos pediátricos de columna.Utilizando el proceso de Delphi y rondas iterativas usando una técnica de grupo nominal, los participantes en este panel se presentaron con una revisión detallada de la literatura y se les pidió expresar su opinión colectivamente durante tres rondas de votación (una electrónica y dos cara a cara). Acuerdo> 80% se consideró consenso.Las intervenciones sin consenso fueron discutidas y revisadas, si es factible.



RESULTADOS:Se logró un consenso para apoyar 19 medidas de la guía de buenas prácticas (BPG) para la atención postoperatoria dirigida a la admisión sin UCI, control perioperatorio del dolor, manejo dietético, fisioterapia, radiografías postoperatorias, manejo del vendaje quirúrgico e indicaciones para el alta.



CONCLUSIÓN:Presentamos un BPG consensuado que consta de 19 recomendaciones para el manejo postoperatorio de los pacientes después de PSF para AIS. Esto puede servir para reducir la variabilidad en la práctica en esta área, ayudar a desarrollar protocolos específicos de hospitales y guiar la investigación futura.

LEVEL OF EVIDENCE:


5.
PMID: 28441684 DOI: 10.1097/BRS.0000000000001865