Lesión masiva de mango rotador y su reparación artroscopica

En este video mostramos una lesión masiva de mango rotador y su reparación artroscopica El manguito de los rotadores...
Posted by Dr. Francisco Cruz Ortopedia del Deporte de Alto Rendimiento México on Viernes, 11 de septiembre de 2015

Cirugía bariátrica y embarazo/Bariatric surgery and pregnancy

Septiembre 8, 2015. No. 2079

Nutrición y embarazo después de cirugía bariátrica Nutrition and pregnancy after bariatric surgery. Kaska L, Kobiela J, Abacjew-Chmylko A, Chmylko L, Wojanowska-Pindel M, Kobiela P, Walerzak A,Makarewicz W, Proczko-Markuszewska M, Stefaniak T. ISRN Obes. 2013 Jan 30;2013:492060. doi: 10.1155/2013/492060. eCollection 2013. Abstract Obesity is an escalating problem in all age groups and it is observed to be more common in females than males. About 25% of women meet the criteria of obesity and one-third of them are in the reproductive age. Because morbid obesity requiring surgical treatment is observed with increasing frequency, surgeons and gynecologists are undergoing new challenges. It is not only a matter of women's health and their quality of life but also proper development of the fetus, which should be a concern during bariatric treatment. Therefore complex perinatal care has to be provided for morbid obesity patients. The paper reviews pregnancy and fertility issues in bariatric surgery patients. PDF Efectos de la cirugía de bypass gástrico sobre la función reproductiva femenina Effects of gastric bypass surgery on female reproductive function. Legro RS, Dodson WC, Gnatuk CL, Estes SJ, Kunselman AR, Meadows JW, Kesner JS, Krieg EF Jr,Rogers AM, Haluck RS, Cooney RN. J Clin Endocrinol Metab. 2012 Dec;97(12):4540-8. doi: 10.1210/jc.2012-2205. Epub 2012 Oct 12. Abstract CONTEXT: Reproductive function may improve after bariatric surgery, although the mechanisms and time-related changes are unclear. OBJECTIVE: The objective of the study was to determine whether ovulation frequency/quality as well as associated reproductive parameters improve after Roux en Y gastric bypass surgery. DESIGN: This was a prospective cohort study that enrolled female subjects from 2005 to 2008 with study visits at baseline and then 1, 3, 6, 12, and up to 24 months after surgery. SETTING: The study was conducted at an academic health center. PATIENTS: Twenty-nine obese, reproductive-aged women not using confounding medications participated in the study. MAIN OUTCOME MEASURES: The primary outcome was integrated levels of urinary progestin (pregnanediol 3-glururonide) from daily urinary collections at 12 months postoperatively. Secondary outcomes were changes in vaginal bleeding, other biometric, hormonal, ultrasound, dual-energy x-ray absorptiometry measures, and Female Sexual Function Index. RESULTS: Ninety percent of patients with morbid obesity had ovulatory cycles at baseline, and the ovulatory frequency and luteal phase quality (based on integrated pregnanediol 3-glururonide levels) were not modified by bariatric surgery. The follicular phase was shorter postoperatively [6.5 d shorter at 3 months and 7.9-8.9 d shorter at 6-24 months (P < 0.01)]. Biochemical hyperandrogenism improved, largely due to an immediate postoperative increase in serum SHBG levels (P < 0.01), with no change in clinical hyperandrogenism (sebum production, acne, hirsutism). Bone density was preserved, contrasting with a significant loss of lean muscle mass and fat (P < 0.001), reflecting preferential abdominal fat loss (P < 0.001). Female sexual function improved 28% (P = 0.02) by 12 months. CONCLUSIONS: Ovulation persists despite morbid obesity and the changes from bypass surgery. Reproductive function after surgery is characterized by a shortened follicular phase and improved female sexual function. PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Libros y revistas gratuitos / Free journals and books

Septiembre 11, 2015. No. 2082

J Obstet Anaesth Crit Care  Volume 5 | Issue 2. Page Nos. 49-96 July-December 2015 Revista/Journal Journal of Human Reproductive Sciences (J Hum Reprod Sci) 2015 | July-September | Volume 8 | Issue 3 Revista/Journal Cesarean Delivery Edited by Raed Salim, ISBN 978-953-51-0638-8, 210 pages, Publisher: InTech, Chapters published May 23, 2012 under CC BY 3.0 license DOI: 10.5772/1459 Libro/Book Contemporary Gynecologic Practice Edited by Atef Darwish , ISBN 978-953-51-1736-0, 242 pages, Publisher: InTech, Chapters published February 04, 2015 under CC BY 3.0 license DOI: 10.5772/58510 Libro/Book

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Obesidad, embarazo y anestesia / Obesity, pregnancy and anesthesia

Septiembre 10, 2015. No. 2081

Preparación para el manejo del embarazo después de cirugía bariátrica Preparing for and managing a pregnancy after bariatric surgery. Kominiarek MA. Semin Perinatol. 2011 Dec;35(6):356-61. doi: 10.1053/j.semperi.2011.05.022. Abstract The number of bariatric surgeries performed in the United States has increased exponentially. Given that most patients are female and of reproductive age, it is important for clinicians who manage women's health issues to be aware of the surgery, its long-term goals, and the potential effect on future pregnancies. Most pregnancies after bariatric surgery have successful outcomes with decreased occurrences of gestational diabetes and hypertension and lower birth weight compared with control patients. Following nutritional guidelines and supplementation in the event of deficiencies are critical in the provision of prenatal care to this unique population. Other important issues include a multidisciplinary team management, a different approach to screening for gestational diabetes, careful evaluation of any gastrointestinal complaints, and appropriate counseling for gravidas who still remain obese during pregnancy. Further research should investigate the long-term maternal outcomes in pregnancies after bariatric surgery as well as the effect on the offspring. PDF     Anestesia regional: todavía una alternativa adecuada en la parturienta con obesidad mórbida Teena Bansala,, Parshant Kumarb, Sarla Hooda Rev Colomb Anestesiol. 2013;41:302-5. - Vol. 41 Núm.04 DOI: 10.1016/j.rca.2013.08.001 Resumen La obesidad se ha identificado como un factor importante de riesgo de morbimortalidad relacionada con anestesia en obstetricia. La obesidad acentúa la mayoría de los cambios fisiológicos del embarazo. Las parturientas obesas tienen un mayor riesgo de presentar problemas médicos concomitantes o enfermedades prenatales, entre ellas la preeclampsia y la diabetes gestacional. Estas pacientes requieren valoración preoperatoria minuciosa, una preparación meticulosa y alistamiento para una vía aérea difícil, puesto que la incidencia de intubación fallida es mucho más alta en ellas. Siempre que sea posible, la anestesia regional es la mejor alternativa en este grupo de pacientes. PDF Obesidad y embarazo: implicancias anestésicas  Claudio Nazar J, Javier Bastidas E, Maximiliano Zamora H, Héctor J. Lacassie. Rev. Chil. Obstet. Ginecol. vol.79 no.6 Santiago  2014 RESUMEN La obesidad es una epidemia a nivel mundial, con más de 2.000 millones de adultos con sobrepeso u obesidad, por lo que cada vez es más probable enfrentarse a una embarazada obesa en la práctica clínica del equipo obstétrico. La obesidad incrementa los cambios fisiológicos del embarazo a nivel cardiovascular, respiratorio, metabólico y gastrointestinal, lo que tiene implicancias clínicas que aumentan los costos en salud y la morbimortalidad materna y fetal. Las embarazadas obesas son un constante desafío para el equipo obstétrico, anestesiológico y de salud, debiendo ser enfrentadas de forma multidisciplinaria para la obtención de mejores resultados obstétricos y perinatales. El anestesiólogo debe tener especial cuidado en el manejo analgésico del trabajo de parto y en la técnica anestésica para la operación cesárea. El objetivo central de la siguiente revisión es explicar, analizar y desarrollar las principales implicancias anestésicas a las cuales se ve enfrentado el especialista en una embarazada obesa. PALABRAS CLAVE: Obesidad, embarazo, trabajo de parto, cesárea, anestesia obstétrica, anestesia general PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015