Tópícos sobre transplantes / Topics in transplantation

No.1843                                                                                   6 de enero 2015 Nuevo portal / New website Ya pueden visitar nuestro nuevo portal anestesia-dolor.org. Seguiremos trabajando por una mejor educación virtual. You can now visit our new website anestesia-dolor.org . We will continue working for a better virtual education.

Las soluciones de preservación de injertos de donantes cardíacos y pulmonares: una revisión de la literatura actual. Preservation solutions for cardiac and pulmonary donor grafts: a review of the current literature. Latchana N, Peck JR, Whitson B, Black SM. J Thorac Dis. 2014 Aug;6(8):1143-9. doi: 10.3978/j.issn.2072-1439.2014.05.14. Abstract Hypothermic preservation of donor grafts is imperative to ameliorate ischemia related cellular damage prior to organ transplantation. Numerous solutions are in existence with widespread variability among transplant centers as to a consensus regarding the optimal preservation solution. Here, we present a concise review of pertinent preservation studies involving cardiac and pulmonary allografts in an attempt to minimize the variability among institutions and potentially improve graft and patient survival. A biochemical comparison of common preservation solutions was undertaken with an emphasis on Euro Collins (EC), University of Wisconsin (UW), histidine-tryptophan-ketoglutarate (HTK), Celsior (CEL), Perfadex (PER), Papworth, and Plegisol. An appraisal of the literature ensued containing the aforementioned preservation solutions in the setting of cardiac and pulmonary transplantation. Available evidence supports UW solution as the preservation solution of choice for cardiac transplants with encouraging outcomes relative to notable contenders such as CEL. Despite its success in the setting of cardiac transplantation, its use in pulmonarytransplantation remains suboptimal and improved outcomes may be seen with PER. Together, we suggest, based on the literature that the use of UW solution and PER for cardiac and pulmonary transplants, respectively may improve transplant outcomes such as graft and patient survival. KEYWORDS: Preservation; cardiac; donor; pulmonary; transplantation PDF Infusión de manitol en los 15 minutos de pinzamiento mejora la conservación renal de donante vivo. Mannitol infusion within 15 min of cross-clamp improves living donor kidney preservation. Andrews PM, Cooper M, Verbesey J, Ghasemian S, Rogalsky D, Moody P, Chen A, Alexandrov P, Wang HW, Chen Y. Transplantation. 2014 Oct 27;98(8):893-7. doi: 10.1097/TP.0000000000000154. Abstract BACKGROUND: Optical coherence tomography (OCT) revealed that cells lining proximal convoluted tubules of living donor kidneys (LDKs) procured by laparoscopic procedures were very swollen in response to the brief period of ischemia experienced between the time of arterial vessel clamping and flushing the excised kidney with cold preservation solution. Damage to the tubules as a result of this cell swelling resulted in varying degrees of acute tubular necrosis (ATN) that slowed the recovery of the donor kidneys during the first 2 weeks after their transplantation. METHODS: To prevent this cell damage during LDK procurement, we changed the protocol for intravenous administration of mannitol (i.e., 12.5 or 25 g) to the donor. Specifically, we reduced the time of mannitol administration from 30 to 15 min or less before clamping the renal artery. RESULT: OCT revealed that this change in the timing of mannitol administration protected the human donor proximal tubules from normothermic-induced cell swelling. An evaluation of posttransplant recovery of renal function showed that patients treated with this modified protocol returned to normal renal function significantly faster than those treated with mannitol 30 min or more before clamping the renal artery. CONCLUSION: Because slow graft recovery in the first weeks after transplantation represents a risk factor for long-term graft function and survival, we believe that this change in pretreatment protocol will improve renal transplants in patients receiving LDK. PDF Custodiol para protección y preservación miocárdica. Revisión sistemática Custodiol for myocardial protection and preservation: a systematic review. Edelman JJ, Seco M, Dunne B, Matzelle SJ, Murphy M, Joshi P, Yan TD, Wilson MK, Bannon PG, Vallely MP, Passage J. Ann Cardiothorac Surg. 2013 Nov;2(6):717-28. doi: 10.3978/j.issn.2225-319X.2013.11.10. Abstract INTRODUCTION: Custodiol cardioplegia is attractive for minimally invasive cardiac surgery, as a single dose provides a long period of myocardial protection. Despite widespread use in Europe, there is little data confirming its efficacy compared with conventional (blood or crystalloid) cardioplegia. There is similar enthusiasm for its use in organ preservation for transplant, but also a lack of data. This systematic review aimed to assess the evidence for the efficacy of Custodiol in myocardial protection and as a preservation solution in heart transplant. METHODS: Electronic searches were performed of six databases from inception to October 2013. Reviewers independently identified studies that compared Custodiol with conventional cardioplegia (blood or extracellular crystalloid) in adult patients for meta-analysis; large case series that reported results using Custodiol were analyzed. Next, we identified studies that compared Custodiol with other organ preservation solutions for organ preservation in heart transplant. RESULTS: Fourteen studies compared Custodiol with conventional cardioplegia for myocardial protection in adult cardiac surgery. No difference was identified in mortality; there was a trend for increased incidence of ventricular fibrillation in the Custodiol group that did not reach statistical significance. No difference was identified in studies that compared Custodiol with other solutions for heart transplant. CONCLUSIONS: Despite widespread clinical use, the evidence supporting the superiority of Custodiol over other solutions for myocardial protection or organ preservation is limited. Large randomised trials are required. KEYWORDS: Custodiol solution; cardiac transplantation; heart arrest; histidine-tryptophan-ketoglutarate solution; induced PDF

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Aditivos espinales en cesárea / Spinal Additives for Cesarean Section

Comparación de dexmedetomidina espinal versus fentanilo espinal con bupivacaína epidural en analgesia obstétrica combinada 


A comparison of intrathecal dexmedetomidine verses intrathecal fentanyl with epidural bupivacaine for combined spinal epidural labor analgesia .
Dilesh P K, Eapen S, Kiran S, Chopra V.
J Obstet Anaesth Crit Care [serial online] 2014 [cited 2014 Nov 1];4:69-74.
Abstract
Context: Combined spinal epidural (CSE) analgesia technique is effective for labor analgesia and various concentrations of bupivacaine and lipophilic opioids like fentanyl have been studied. Dexmedetomidine is a highly selective alpha 2 adrenoreceptor agonist with analgesic properties and has been used intrathecally with bupivacaine for prolonged postoperative analgesia. Recent reviews have shown that it is highly lipophilic and does not cross placenta significantly. Aim: The aim of this study is to compare the duration and quality of analgesia, maternal and neonatal outcomes after CSE labor analgesia with intrathecal dexmedetomidine and intrathecal fentanyl followed by epidural bupivacaine. Settings and Design: A randomized observational study with 112 parturients in a tertiary care hospital. Materials and Methods: 112 parturients were randomly divided to two groups. Group D (n = 58) received dexmedetomidine 10 μg and group F (n = 54) received fentanyl 20 μg intrathecally for labor analgesia. The time of onset, time to maximum analgesia, duration and quality of analgesia were noted. Maternal parameters of heart rate, noninvasive blood pressure, motor block and side-effects of pruritus, nausea and vomiting were recorded. Neonatal outcome in terms of mode of delivery, neonatal APGAR score, time to first cry, need for resuscitation, umbilical cord blood pH, initiation of breast feeding, Neurologic and Adaptive Capacity Score at 24 h and exclusivity of breast feeding at 6 weeks were recorded. Results: Duration of analgesia was 160.54 ± 52.4 min with dexmedetomidine and 124.1 ± 46.93 min with fentanyl (P < 0.001). Visual analog score (VAS) recorded at maximal analgesia was significantly lesser in the fentanyl group compared to dexmedetomidine group, denoting a significantly deeper level of analgesia with fentanyl. However, all the mothers in the dexmedetomidine group achieved a VAS <3 and were satisfied with the quality of analgesia. About 74% patients in the fentanyl group experienced pruritus after intrathecal injection whereas none of the mothers in dexmedetomidine group experienced pruritus (P < 0.001). There were no significant differences in neonatal outcome between the two groups. Conclusion: 10 μg dexmedetomidine intrathecally provides a longer duration of analgesia with lesser incidence of pruritus compared to 20 μg fentanyl intrathecally for CSE labor analgesia with comparable neonatal side-effects.
Keywords: Combined spinal epidural labor analgesia, dexmedetomidine, fentanyl
http://www.joacc.com/text.asp?2014/4/2/69/143875


http://www.joacc.com/downloadpdf.asp?issn=2249-4472;year=2014;volume=4;issue=2;spage=69;epage=74;aulast=Dilesh;type=2


Efecto ahorrador de bupivacaína con el midazolam intratecal en anestesia subaracnoidea para cesárea.


Bupivacaine sparing effect of intrathecal midazolam in sub-arachnoid block for cesarean section
Sanwal MK, Baduni N, Jain A..
J Obstet Anaesth Crit Care [serial online] 2013 [cited 2014 Nov 1];3:27-31.
Abstract
Background: Hypotension during subarachnoid block for caesarean section (CS) is the most common and potentially dangerous complication. Bupivacaine has been implicated for this effect in a dose dependent manner. Hypotension can be prevented by using lower doses of bupivacaine with intrathecal midazolam as an adjuvant drug, though the optimum dose-ratio of bupivacaine with midazolam remains unaddressed. Materials and Methods: A prospective, randomized, double-blind study was conducted enrolling 120 consecutive ASA grade I obstetric patients undergoing elective CS in a tertiary care hospital. A baseline supine position noninvasive blood pressure (BP) was recorded. All patients were preloaded with 500 ml of lactated Ringers' solution. Varying doses of 0.5% hyperbaric bupivacaine were used (7.5mg in group II, 6mg in group III and 5mg in group IV), in combination with 2mg midazolam in each group. Appropriately matched controls were given 11mg bupivacaine alone (Group I). Intra-operatively, BP was measured at every 2 minutes till 30 minutes and every 10 minutes thereafter. Hypotensive episodes [Systolic BP (SBP) < 100 mmHg] were recorded in each group. Quality of surgical anesthesia was graded as "excellent", "good" and "poor" as per the validated scoring system. The outcomes in different groups were compared by one-way ANOVA . intra group comparisons were done with t test. Results: All the four groups had 30 patients each. The incidence of hypotension was significantly lower in the groups using low-dose bupivacaine and midazolam, with a lesser fall in SBP than group I. Onset of sensory and motor blocks, and quality of surgical anesthesia were unaffected in group II while significant deterioration was noticed in groups III and IV. Conclusion: We found that 7.5 mg bupivacaine with 2 mg midazolam is the optimum dose ratio combination to be used in subarachnoid block for caesarean section.
Keywords: Cesarean section, intrathecal, midazolam, sub-arachnoid block
http://www.joacc.com/downloadpdf.asp?issn=2249-4472;year=2013;volume=3;issue=1;spage=27;epage=31;aulast=Sanwal;type=2

http://www.joacc.com/text.asp?2013/3/1/27/114288

Aditivos espinales en raquianestesia para operación cesárea

Spinal Additives in Subarachnoid Anaesthesia for Cesarean Section
Hala M. Goma, Juan C. Flores-Carrillo and Víctor Whizar-Lugo
Topics in Spinal Anaesthesia

Cesarean section is among the most commonly performed surgeries in women and neuroaxial anaesthesia is the technique of choice for this procedure. Although numerous side effects related to obstetric anaesthesia had been described, [1, 2, 3, 4] subarachnoid anaesthesia has a clear tendency to be used more often than epidural and combined spinal-epidural technique. It is safe, easy to perform, effective, low failure rate, no systemic local anaesthetic toxicity, inexpensive, prevents aspiration pneumonia, and has a high rate of maternal satisfaction. [5,6, 7] Produces a deep anaesthesia, inhibits the stress response to surgery, blunts the autonomic and somatic responses to pain, and facilitate breathing, coughing, sighing and early ambulation [8, 9] Finally, efferent sympathetic blockade results in increased blood flow to the blocked area resulting in better wound healing. It also reduces the risk of deep vein thrombosis and thromboembolism.

http://cdn.intechopen.com/pdfs-wm/47285.pdf


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

http://richardebury.blogspot.mx/2014/11/el-resurgir-de-las-bibliotecas-publicas.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed:+IdentidadBibliotecaria+(Identidad+Bibliotecaria)

El resurgir de las BIBLIOTECAS PÚBLICAS: suman socios y atraen público joven

 

Por primera vez se sumaron a La Noche de los Libros.En la era de Internet habían perdido espacio. Pero las modernizaron y consiguieron acercar los ejemplares a la gente. Hoy ya se consultan 20 mil libros por mes.

En tiempos de e-books e Internet, las bibliotecas siguen siendo un bastión del libro. En sus salas confluyen jóvenes que van a estudiar con jubilados que se dan el gusto de leer a sus anchas. En las 29 que integran la red de Bibliotecas Públicas porteñas se consultan 20.000 libros por mes. Y ayer, por primera vez, participaron en La Noche de los Libros, organizada por los ministerios de Cultura y Desarrollo Económico de la Ciudad.

La red tiene 81.589 socios y cuenta con 360.468 ejemplares de 84.676 obras. En 15 de sus 29 bibliotecas hay dispositivos para leer e-books. Y existe un catálogo centralizado (catalogo.bibliotecas.gov.ar), que en lo que va del año recibió 224.488 consultas.

En una sala de planta baja de la Biblioteca Ricardo Güiraldes, en Retiro, los libros están al alcance de quien los desee. Igual que en una librería, la gente puede hojearlos y elegir el que quiera para leerlo allí o llevarlo a su casa. Prestan hasta tres a la vez, por 15 días. El bibliotecario siempre está cerca, para ayudar, sugerir y responder dudas.

Elsa Sábato, una historiadora del arte de 68 años, toma “El buen dolor”, de Guillermo Saccomanno. “Me gusta mucho esta generación de escritores argentinos”, cuenta. Hace seis años que se asoció a la red. “Desde que me jubilé, leo tres libros por semana –afirma–. Poder venir a este lugar y acceder a todos estos volúmenes es un sueño hecho realidad. Es mucho más de lo que yo podría adquirir”.

“La biblioteca es igualadora. A la Güiraldes vienen chicos de la Villa 31 y de los colegios privados de la zona para participar en los grupos de apoyo escolar”, apunta Alejandra Ramírez, la directora general del Libro, Bibliotecas y Promoción de la Lectura de la Ciudad, que tiene su oficina en el primer piso. La funcionaria admite que, en la era de Internet, las bibliotecas se alejaron de las personas y las personas de las bibliotecas, “Hoy eso se está revirtiendo. Para lograrlo, las modernizamos, armando estanterías abiertas para que la gente tenga contacto directo con los libros”. Según Ramírez, las bibliotecas públicas reciben muchos estudiantes, extranjeros y jubilados. Y lo que más se lee es la narrativa.

“Estudio Psicología y empecé a venir para buscar libros de estudio –cuenta Federico (22), en la Biblioteca Miguel–. Después comencé a llevarme literatura. En los prólogos de los libros, suelen recomendar otros, o le pido al bibliotecario que me aconseje. Leo unos cinco por mes”, asegura. Y muestra los tres que pidió prestados: las obras completas de Dostoyevski, “El extranjero”, de Albert Camus, y “Modernidad líquida”, del sociólogo Zygmunt Bauman.

“Llega toda clase de lectores, desde el que busca best sellers hasta el que quiere pensar y se lleva filosofía”, dice Osvaldo Ponce, el director de la biblioteca.

La Miguel Cané fue fundada en 1927 y, desde 1935, funciona en Carlos Calvo y Muñiz, Boedo. Sus muebles y estanterías son los mismos que estaban cuando, entre 1938 y 1946, Jorge Luis Borges fue auxiliar de la biblioteca. El padre de Bioy Casares se lo recomendó al entonces director, el poeta Francisco Bernardez. En el primer piso, hay un cuartito donde Borges solía leer y escribir, que ahora está dedicado al escritor. Hay primeras ediciones y ejemplares originales que leyó en ese lugar. Como Historia de la decadencia y caída del Imperio romano, de Edward Gibbon.

“Siempre se le dio un tratamiento a las bibliotecas como si fueran lugares solemnes, con libros intocables, cuando son lugares de familiarización con los libros y su función es acercárselos a la gente”, dice el ministro de Cultura porteño, Hernán Lombardi. Y explica que las sumaron a la Noche de las Librerías para darles visibilidad.

Participaron 50 bibliotecas, incluyendo a las 29 públicas, donde hubo desde encuentros corales hasta liberaciones de libros. La gente llevó un ejemplar para soltar y pudo apropiarse de otro, “olvidado” con la contraseña: “Llevame, estoy liberado”. Esta actividad también se hizo en la Miguel Cané, donde Borges se inspiró para escribir “La Biblioteca de Babel”. Un cuento que empieza así: “El universo (que otros llaman la Biblioteca) ...”

Fuente: http://www.clarin.com/ciudades/biblioetcas-resurgir-libros_0_1258074214.html 

Transplante hepático / Liver transplant

No.1841                                                                                   4 de enero 2015 Nuevo portal / New website Ya pueden visitar nuestro nuevo portal anestesia-dolor.org. Seguiremos trabajando por una mejor educación virtual. You can now visit our new website anestesia-dolor.org . We will continue working for a better virtual education.

Riesgos asociados con la reoperación por sangrado después de transplante hepático Risk Factors Associated with Reoperation for Bleeding following Liver Transplantation. Thompson MA, Redden DT, Glueckert L, Smith AB, Crawford JH, Jones KA, Eckhoff DE, Gray SH, White JA, Bloomer J, DuBay DA. HPB Surg. 2014;2014:816246. doi: 10.1155/2014/816246. Epub 2014 Nov 20. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258335/pdf/HPB2014-816246.pdf  Comparación de dos dispositivos para calentar líquidos para mantener la temperatura corporal durante transplante hepático de donador vivo.  Comparison of two fluid warming devices for maintaining body core temperature during living donor liver transplantation: Level 1 H-1000 vs. Fluid Management System 2000. Han S1, Choi J1, Ko JS1, Gwak M1, Lee SK2, Kim GS1. Korean J Anesthesiol. 2014 Oct;67(4):264-9. doi: 10.4097/kjae.2014.67.4.264. Epub 2014 Oct 27. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4216789/pdf/kjae-67-264.pdf  Restricción de cristaloides durante cirugía de trnasplante hepático ortotópico y sus efectos sobre la respiración y falla renal en el periodo preoperatorio temprano  Restricted Crystalloid Fluid Therapy during Orthotopic Liver Transplant Surgery and its Effect on Respiratory and Renal Insufficiency in the Early Post-operative Period: A Randomized Clinical Trial. Sahmeddini MA1, Janatmakan F2, Khosravi MB1, Ghaffaripour S1, Eghbal MH1, Nickeghbalian S3, Malek-Hosseini SA3. Int J Organ Transplant Med. 2014;5(3):113-9. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4149738/pdf/ijotm-5-113.pdf  Hipertensión portopulmonar y síndrome hepatopulmonar Portopulmonary hypertension and hepatopulmonary syndrome. Aldenkortt F1, Aldenkortt M1, Caviezel L1, Waeber JL1, Weber A1, Schiffer E1. World J Gastroenterol. 2014 Jul 7;20(25):8072-81. doi: 10.3748/wjg.v20.i25.8072. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4081678/pdf/WJG-20-8072.pdf  Manejo de la transfusión y coagulación en transplante hepático Transfusion and coagulation management in liver transplantation. Clevenger B1, Mallett SV1. World J Gastroenterol. 2014 May 28;20(20):6146-58. doi: 10.3748/wjg.v20.i20.6146. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4033453/pdf/WJG-20-6146.pdf Complicaciones respiratorias tempranas después de transplante de hígado Early respiratory complications after liver transplantation. Feltracco P1, Carollo C1, Barbieri S1, Pettenuzzo T1, Ori C1. World J Gastroenterol. 2013 Dec 28;19(48):9271-81. doi: 10.3748/wjg.v19.i48.9271 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3882400/pdf/WJG-19-9271.pdf  Trasplante hepático. Protocolo de anestesia Servicio de Anestesiología y Reanimación Unidad de Trasplante Hepático Hospital Clínic. Barcelona. http://chguv.san.gva.es/Inicio/ServiciosSalud/ServiciosHospitalarios/AnestRea/Documents/Protocolos/CLINIC%20BARCELONA-Anestesia%20transplante%20HEPATICO-Protocolo%20Anestesia.pdf  La anestesia en transplante hepático http://www.cirugiasanchinarro.es/pdf/libro/Gonzales37.pdf

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Feliz 2015/Happy 2015

No.1838                                                                                   1 de enero 2015 Nuevo portal / New website Ya pueden visitar nuestro nuevo portal anestesia-dolor.org. Seguiremos trabajando por una mejor educación virtual. You can now visit our new website anestesia-dolor.org . We will continue working for a better virtual education.

Mensaje de Año Nuevo Los integrantes de Anestesiología y Medicina del Dolor desean que este año 2015 que inicia hoy esté pleno de Salud, de Alegría, de Amor y de Éxitos personales y profesionales en compañía de sus seres más queridos. Hoy cumplimos 5 años con el Programa Educativo Alfa y los resultados nos animan a seguir mejorando nuestras metas académicas para su beneficio profesional ya que sabemos que el resultado final privilegia a cada uno de sus pacientes. Son ya 1838 envíos electrónicos con información médica contenida en artículos completos, tesis, videoclips, y libros disponibles en la WEB, además de información sobre cursos, y consultoría médica que han sido bien recibidos en múltiples países de los cinco continentes. En Anestesiología y Medicina del Dolor sabemos lo difícil que es mantenerse actualizado en nuestro saber cómo médicos en una época de crecimiento exponencial del conocimiento, y es por eso que la parte más importante de este programa es la selección y envío de información disponible en la WEB que le sea de utilidad práctica. Se ha actualizado nuestro portal www.anestesia-dolor.org para hacerlo más fácil de navegar tanto en Español como en Inglés. Se mantienen las secciones más visitadas de revistas y libros con acceso libre y el listado de eventos científicos. Encontrará otros cambios realizados para facilitar la actualización médica continuada. Deseamos agradecerle el hecho de facilitarnos el poder llegar hasta su computadora con este programa académico y queremos solicitarle nos apoye a difundirlo entre sus colegas. Si quiere ser parte activa de este grupo internacional originado en México, o tiene algunas sugerencias para mejorarlo le pedimos nos escriba en breve. The staff of Anestesiología y Medicina del Dolor wishes you that this year 2015 that begins today is full of Health, Joy, Love and personal and professional successes together with of your loved ones. Today we have five years with the Alfa Education Program, and the results encourage us to continue improving our academic goals for your professional benefit, because we know that the outcome favors each of your patients. There are already 1838 electronic submissions with medical information including full articles, theses, videos, and books available on the web, plus information on courses, and medical consulting that have been well received in many countries on five continents. Anestesiología y Medicina del Dolor know how hard it is to stay updated as a doctors in a time of exponential growth of knowledge, and that is why the most important part of this program is the selection and delivery of information available on the WEB that will be of practical use. We updated our site www.anestesia-dolor.org to make it easier to navigate in Spanish and English. The most visited sections of journals and books with free access and a list of scientific events are held. You can find other changes made to provide continuing medical update. We wish to thank you for providing us the right to reach your computer with this academic material and want to ask you to spread it among your colleagues. If you want to be an active part of this international group originating in Mexico, or have any suggestions for improvement it, we ask you to write us shortly. Os membros de Anestesiología y Medicina del Dolor desejo que este ano de 2015 começa hoje está cheio de saúde, alegria, amor e pessoal e companhia profissional de seus queridos entes sucessos. Hoje nos encontramos cinco anos, com Programa de Educação Alfa e os resultados nos encorajam a continuar a melhorar as nossas metas acadêmicas para seu benefício profissional, pois sabemos que o resultado favorece cada um de seus pacientes. Já há 1.838 submissões eletrônicas com informações médicas em artigos completos, teses, vídeos e livros disponíveis na web, além de informações sobre cursos e consultoria médica têm sido bem recebidos em muitos países nos cinco continentes. Anestesiología y Medicina del Dolor sabe o quão difícil é para se manter atualizado sobre o nosso know how médicos em um momento de crescimento exponencial do conhecimento, e é por isso que a parte mais importante deste programa é a seleção e entrega de informações disponíveis na Web que vai ser de uso prático. Atualizado www.anestesia-dolor.org nosso site para torná-lo mais fácil de navegar tanto Espanhol e Inglês. As seções mais visitadas de revistas e livros com acesso gratuito e uma lista de eventos científicos são realizados. Você pode encontrar outras alterações feitas para proporcionar contínua atualização médica. Queremos agradecer-lhe por nos fornecer o poder de alcançar seu computador com este programa acadêmico e querem nos perguntar se espalhar apoio entre seus colegas. Se você quer ser uma parte ativa deste grupo originário internacional no México, ou tem alguma sugestão para melhoria que pedimos escrever em breve. کاربران بیهوشی و پزشکی درد آرزو می کنم که این سال 2015 آغاز می شود امروز پر از بهداشت، لذت و عشق و شخصی و حرفه ای شرکت عزیزان موفقیت آنها است. امروز ما ملاقات پنج سال با برنامه آموزش و پرورش آلفا و نتایج ما را تشویق به ادامه بهبود اهداف تحصیلی ما به نفع حرفه ای خود را از آنجا که ما می دانیم که نتیجه هر یک از بیماران خود به نفع. در حال حاضر 1838 ارسالی الکترونیکی با اطلاعات پزشکی در مقالات کامل، پایان نامه ها، فیلم ها، و کتاب های موجود در وب، به علاوه اطلاعات مربوط به دوره ها، و مشاوره پزشکی به خوبی در بسیاری از کشورها در پنج قاره دریافت شده است وجود دارد. بیهوشی و پزشکی درد می دانید چقدر سخت است به ماندن در دانش ما به روز چگونه پزشکان در زمان رشد نمایی از دانش، و همین دلیل است که مهم ترین بخش از این برنامه انتخاب و ارائه اطلاعات در دسترس بر روی وب که استفاده عملی باشد. به روز شده www.anestesia-dolor.org سایت ما آن را به آسان تر به حرکت در هر دو زبان اسپانیایی و انگلیسی.بخش بیشترین بازدید از مجلات و کتاب های با دسترسی آزاد و یک لیست از حوادث علمی برگزار می شود. شما می توانید تغییرات دیگر ساخته شده به ارائه ادامه به روز رسانی پزشکی پیدا کنید. ما مایل به او را برای ما فراهم قدرت برای رسیدن به کامپیوتر خود را با این برنامه دانشگاهی با تشکر از و می خواهید از ما بخواهید گسترش پشتیبانی در میان همکاران خود. اگر می خواهید به قسمت فعال از این نشات گروه بین المللی در مکزیک، و یا هر گونه پیشنهاد برای بهبود ما بخواهید ما ارسال به زودی.

Más de transplante renal/More on kidney transplant

Una llamada de acción. Variabilidad en las guías de valoración cardiaca antes de transplante renal A call to action: variability in guidelines for cardiac evaluation before renal transplantation. Friedman SE1, Palac RT, Zlotnick DM, Chobanian MC, Costa SP. Clin J Am Soc Nephrol. 2011 May;6(5):1185-91. doi: 10.2215/CJN.09391010. Epub 2011 Apr 21. Abstract BACKGROUND AND OBJECTIVES: Candidates for renal transplantation are at increased risk for complications related to cardiovascular disease; however, the optimal strategy to reduce this risk is not clear. The aim of this study was to evaluate the variability among existing guidelines forpreoperative cardiac evaluation of renal transplant candidates. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A consecutive series of renal transplant candidates (n=204) were identified, and four prominent preoperative cardiac evaluation guidelines, pertaining to this population, were retrospectively applied to determine the rate at which each guideline recommended cardiac stress testing. RESULTS: The rate of pretransplant cardiac stress testing would have ranged from 20 to 100% depending on which guideline was applied. The American Heart Association/American College of Cardiology (ACC/AHA) guideline resulted in the lowest rate of testing (20%). In our population, 178 study subjects underwent stress testing: 17 were found to have ischemia and 10 underwent revascularization. The ACC/AHA approach would have decreased the number of noninvasive tests from 178 to 39; it would have identified only 4 of the 10 patients who underwent revascularization. The three other guidelines (renal transplant-specific guidelines) recommended widespread pretransplant cardiac testing and thus identified nearly allpatients who had ischemia on stress testing. CONCLUSIONS: The ACC/AHA perioperative guideline may be inadequate for identifying renal transplant candidates with coronary disease; however, renal transplant-specific guidelines may provoke significant overtesting. An intermediate approach based on risk factors specific to the ESRD population may optimize detection of coronary disease and limit testing. Artículo/Article Valoración cardiaca antes de transplante renal Cardiac evaluation prior to kidney transplantation. Delos Santos R, Gmurczyk A, Obhrai JS, Watnick SG. Semin Dial. 2010 May-Jun;23(3):324-9. doi: 10.1111/j.1525-139X.2010.00725.x. Abstract Kidney transplantation is the treatment of choice for most patients with stage 5 chronic kidney disease and end-stage renal disease (ESRD), offering improved quality of life and overall survival rates. However, the limited supply of available organs makes this a scarce resource. Cardiovascular complications continue to be the leading cause of mortality in the kidney transplant population, accounting for over 30% of deaths with a functioning allograft. Thus, preoperative cardiac risk assessment is critical to optimize patient selection and outcomes. Currently there is no consensus for cardiovascular evaluation in the chronic kidney disease and ESRD population prior to kidney transplantation; the recommendations of the American Society of Nephrology and American Society of Transplantation differ from those of the American Heart Association and the American College of Cardiology. Previously developed risk scores have also been used to risk stratify this population. In this review, we discuss two cases that illustrate the difficulties of interpreting the prognostic value of current testing strategies. We also discuss the importance of different tests for cardiovascularevaluation as well as previous nonkidney transplant specific risk scores used in the pre-kidney transplant population. Artículo/Article Consideraciones sobre el diseño y la viabilidad de un ensayo clínico para examinar el cribado coronario antes del trasplante de riñón Design considerations and feasibility for a clinical trial to examine coronary screening before kidney transplantation (COST). Kasiske BL1, Israni AK, Snyder JJ, Camarena A; COST Investigators. Collaborators (26) Am J Kidney Dis. 2011 Jun;57(6):908-16. doi: 10.1053/j.ajkd.2011.01.020. Epub 2011 Mar 15. Abstract SETTING & PARTICIPANTS: Consecutive patients referred for kidney and/or pancreas transplant at 26 major transplant centers in the United States. PREDICTORS: Older age, diabetes, prior cardiovascular  Artículo/Article

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