sábado, 11 de junio de 2011

Proliferaciones melanocitarias benignas en la infancia

Cuando hablamos de proliferaciones melanocitarias benignas, nos referimos especialmente a los nevos melanocíticos (NM), que forman parte de la piel normal. Estas proliferaciones se pueden clasificar de una forma sencilla en congénitas o adquiridas. La incidencia de NM congénitos (NMC) en el recién nacido oscila entre el 0,2 y el 6%; en cuanto a los NM adquiridos (NMA), la incidencia aumenta durante de la infancia y la pubertad, y se adquieren el máximo de elementos a los 25 años de edad1-3.

Los NM son un factor de riesgo para el desarrollo de melanoma maligno. Globalmente, se cita un aumento de incidencia de este tumor, no sólo en adultos, sino también en niños. Afortunadamente, el melanoma es muy raro en la infancia, con una incidencia anual de 0,7 por millón en niños de edades comprendidas entre los 0 y los 9 años. En el niño prepúber y en el adolescente, continúa siendo infrecuente el melanoma, salvo en los casos con factores predisponentes de riesgo, como sucede en las situaciones de immunodepresión, síndrome del nevo atípico, xeroderma pigmentosum o en individuos con un gran número de nevos4.

Los pediatras son la primera línea de detección de una posible lesión melánica maligna, y un diagnóstico temprano puede condicionar el pronóstico vital. Por ello, vale la pena remarcar la importancia del conocimiento de los diferentes tipos de lesiones pigmentadas más prevalentes en la infancia (aunque sea de forma somera), así como los signos de alarma o las pautas de actuación a seguir




http://www.apcontinuada.com/contenidos/pdf/v6n3a333pdf001.pdf

Tratamiento con corticoides en neumonía grave, lesión pulmonar aguda y SDRA


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Artículo nº 1644. Vol 11 nº 6, junio 2011.
Autor: Ana Loza Vázquez

Tratamiento con corticoides en neumonía grave, lesión pulmonar aguda y SDRA
Artículo original: Corticosteroid therapy for acute lung injury, acute respiratory distress syndrome, and severe pneumonia: a meta-analysis of randomized controlled trials. Lamontagne F, Briel M, Guyatt GH, Cook DJ, Bhatnagar N, Meade M. Journal of critical care 2010; 25(3): 420-435. J Crit Care 2010; 25(3): 420-435. [Resumen] [Artículos relacionados]
Introducción: los corticoides modulan la mayoría de los pasos del proceso inflamatorio, causando una reducción significativa de los niveles circulantes del factor de necrosis tumoral α, de IL-1, y otros medidores proinflamatorios, con resultados contradictorios sobre el descenso de la mortalidad en la lesión pulmonar aguda (LPA) y el síndrome de dificultad respiratoria aguda (SDRA) [1-3].
Resumen: El objetivo principal fue tratar de determinar si los corticoides sistémicos reducen la mortalidad hospitalaria en LPA, SDRA, o neumonía grave. Se realizó una revisión sistemática de ensayos aleatorizados publicados y no publicados. La búsqueda se realizo en MEDLINE, EMBASE, CENTRAL y CINAHL y se revisaron las comunicaciones más relevantes de las reuniones de diferentes Sociedades Científicas. Dos revisores seleccionaron la literatura y extrajeron los datos de forma independiente. Para cada uno de los resultados, se utilizó la clasificación (GRADE) para evaluar la calidad de las pruebas. Se incluyeron 12 ensayos con 966 pacientes. En todos los ensayos, los corticoides no reducen significativamente la mortalidad hospitalaria (riesgo relativo 0,84; IC 95% 0,66-1,06). En un análisis de subgrupos por la dosis de corticoides, los ensayos con una dosis ≤ 2 mg kg/día o equivalentes de metilprednisolona (9 ensayos) encuentran una menor mortalidad hospitalaria con la terapia con corticoides (RR 0,68; IC 95% 0,49-0,96).
Comentario: Los autores concluyen que el uso de corticoides a bajas dosis en los primeros 14 días de la enfermedad disminuye la mortalidad, en los 7 días aumenta el número de días libres de ventilación mecánica, y que el número de infecciones aumenta con dosis altas de corticoides. Sin embargo, la calidad de las pruebas impide llegar a conclusiones definitivas sobre el uso de corticosteroides en esta población. Existen varias limitaciones del estudio: 1) los beneficios de mortalidad se basan en el análisis de subgrupos que son incompatibles (basados en la inclusión selectiva de subgrupos de los datos del ensayo LateSteroid Rescue y en un punto de corte de la dosis, que estaban influidos por los resultados publicados) e imprecisos (dado el pequeño tamaño muestral y número de eventos); 2) suponiendo el beneficio, tampoco estaría claro qué regimen terapéutico, porque los tres EC utilizados para obtener beneficios pueden haber sesgado los resultados a favor de la intervención al detener la administración; 3) Este análisis combinado carece de poder para detectar efectos nocivos potencialmente significativos (diferencias en la naturaleza de los eventos adversos, no todos informaron sobre infecciones y dentro de los que informaron la definición varió considerablemente)
Ana Loza Vázquez
Hospital Universitario de Valme, Sevilla.
© REMI, http://medicina-intensiva.com. Junio 2011.
Enlaces:
  1. Corticosteroids in the prevention and treatment of acute respiratory distress syndrome (ARDS) in adults: Meta-analysis. Peter JV, John P, Graham PL, Moran JL, George IA, Bersten A. BMJ 2008; 336: 1006-1009. [PubMed]
  2. Steroid treatment in ARDS: A critical appraisal of the ARDS network trial and the recent literature. Meduri GU, Marik PE, Chrousos GP, Pastores SM, Arlt W, Beishuizen A, Bokhari F, Zaloga G, Annane D. Intensive Care Med 2008; 34: 61-69. [PubMed]
  3. Corticosteroids for severe sepsis and septic shock: a systematic review and meta-analysis. Annane D, Bellissant E, Bollaert PE, Briegel J, Keh D, Kupfer Y. BMJ 2004; 329: 480. [PubMed]
Búsqueda en PubMed:
  • Enunciado: Ensayos clínicos sobre esteroides en LPA, SDRA o neumonía
  • Sintaxis: randomized controlled trial[pt] AND steroids[mh] AND (respiratory distress syndrome, adult[mh] OR acute lung injury[mh] OR pneumonia[mh])
  • [Resultados]

Anestesia epidural para cesárea en una paciente con síndrome de Marfan y ectasia dural. Informe de caso


Anestesia epidural para cesárea en una paciente con síndrome de Marfan y ectasia dural. Informe de caso
Epidural anesthesia for cesarean section in a patient with Marfan syndrome and dural ectasia -A case report.
Kim G, Ko JS, Choi DH.
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea.
Korean J Anesthesiol. 2011 Mar;60(3):214-6. Epub 2011 Mar 30.
Abstract
Pregnancy is considered a period of high risk for cardiovascular complications in patients with Marfan syndrome. Therefore the choice of anesthetic technique for delivery should be focused on minimizing hemodynamic fluctuations, and preferably provide adequate post-operative pain control. For this purpose, neuraxial blocks, such as spinal or epidural anesthesia, may be deemed a safe option. However, dural ectasia is present in 63-92% of patients with Marfan syndrome, and the increased amount of cerebrospinal fluid volume is thought to be one of main reasons for spinal anesthesia failure. We report herein the peri-operative management of a patient with Marfan syndrome and dural ectasia for cesarean section using epidural anesthesia

http://ekja.org/Synapse/Data/PDFData/0011KJAE/kjae-60-214.pdf  
Embarazo exitoso en una paciente con hipoxemia severa con proteinosis alveolar pulmonar
Successful pregnancy in a severely hypoxemic patient with pulmonary alveolar proteinosis.
Belchior I, Cerdeira AS, Santos M, Sousa Braga J, Aragão I, Martins A.
Pneumologia, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal.
Rev Port Pneumol. 2011 May - June;17(3):139-142. Epub 2011 Apr 13.
Abstract
Pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by abnormal accumulation of a lipoproteinaceous material in the alveoli, which may lead to respiratory failure and has an associated high risk for infections. The mainstay treatment for PAP is whole lung lavage. A pregnant woman, previously diagnosed with primary PAP, the most common form of PAP, was admitted with dyspnea and worsening respiratory function. In one month period, a whole-lung bronchopulmonary lavage was performed twice, with clinical and functional improvement. Pregnancy was carried to term and a healthy baby was delivered. The mechanisms of respiratory impairment are discussed as well as treatment options and response.

http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=90020264&pident_usuario=0&pcontactid=&pident_revista=420&ty=50&accion=L&origen=elsevier&web=www.elsevier.es&lan=en&fichero=320v17n03a90020264pdf001_2.pdf 
 
Anestesia para cesárea en presencia de enfermedad cardiaca multivalvular e hipertensión pulmonar severa: reporte de un caso
Anaesthesia for caesarean section in the presence of multivalvular heart disease and severe pulmonary hypertension: a case report.
Coskun D, Mahli A, Korkmaz S, Demir FS, Inan GK, Erer D, Ozdogan ME.
Department of Anesthesiology, Gazi University Faculty of Medicine, Besevler, Ankara, Turkey.
Cases J. 2009 Dec 22;2:9383.
Abstract
INTRODUCTION: Pulmonary hypertension is a rare condition and in combination with pregnancy, it can result in high maternal mortality. Mitral stenosis is one of the complicated cardiac diseases that may occur during pregnancy. In this report, we describe our management of such a case, which was even more difficult in combination with pulmonary hypertension, mitral stenosis, and aortic and tricuspid valve insufficiency requiring emergency caesarean section under general anaesthesia. CASE PRESENTATION: A 29-year-old primiparae was presented to the anaesthetic department for an urgent caesarean section with a diagnosis of severe pulmonary hypertension in combination with mitral stenosis. The patient was hospitalized prepartum and received oxygen therapy and anticoagulation with heparin. The patient was monitored during labour and delivery with oximetry and arterial and central venous pressure line. Pulmonary arterial lines were not used due to an increased risk and questionable usefulness. Echocardiography revealed a systolic pulmonary arterial pressure of 75 mmHg, and mitral stenosis, aortic and tricuspid valve insufficiency. We decided to proceed under general anaesthesia. Anaesthesia was induced with etomidate, and succinylcholine. Dopamine and nitroglycerin infusion was preoperatively started and infusion was also preoperatively continued. Hemodynamic parameters were stable during delivery. Neonatal weight and apgar score were satisfactory. After the delivery of a healthy baby, oxytocin was administered. Surgery was completed uneventfully. During the postoperative period, the patient received furosemide and morphine. As the arterial blood gas analyses were stable and the chest-ray was normal, the patient was extubated postoperatively in the second hour in ICU. CONCLUSION: Patients with significant multivalvular heart disease require careful preoperative, multidisciplinary assessment and anesthetic planning before delivery in order to optimize cardiac function during the peripartum period and make informed decisions regarding the mode of delivery and anaesthetic technique.

http://www.casesjournal.com/content/pdf/1757-1626-2-9383.pdf 
 
Anestesia combinada espinal-peridural para cesárea en un paciente con enfermedad de Moyamoya. Informe de un caso
Combined spinal-epidural anesthesia for cesarean section in a patient with Moyamoya disease -A case report.
Shim KS, Kim EJ, Lee JH, Lee SG, Ban JS, Min BW.
Department of Anesthesiology and Pain Medicine, Fatima Hospital, Daegu, Korea.
Korean J Anesthesiol. 2010 Dec;59 Suppl:S150-3. Epub 2010 Dec 31.
Abstract
Moyamoya disease is a rare progressive occlusive disease of the internal carotid arteries. We report a case of combined spinal-epidural anesthesia in a patient with Moyamoya disease presenting for Cesarean section. Hypotension associated with spinal anesthesia for Cesarean section is the most common and serious adverse effect despite the use of uterine displacement and volume preload. We continuously infused phenylephrine and ephedrine to prevent hypotension. The intraoperative hemodynamic state was stable. The patient had no significant postoperative complications.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3030023/pdf/kjae-59-S150.pdf

Atentamente
Dr. Benito Cortes-Blanco 
Anestesiología y Medicina del Dolor

Education review


High school students, above, considering science-related majors, visiting an engineering lab at Yale.
Christopher Capozziello for The New York Times
High school students, above, considering science-related majors, visiting an engineering lab at Yale.
Educators and technologists say films like “The Social Network” and celebrity entrepreneurs are inspiring more students to earn computer science degrees.
Hazel N. Dukes, center, state leader of the N.A.A.C.P., at a news conference last week after she caused a stir in attacking a critic.

N.A.A.C.P. on Defensive as Suit on Charter Schools Splits Group’s Supporters

The N.A.A.C.P. says traditional New York City schools suffer when charter schools grow, but some black leaders say charter schools give minorities more opportunity.

Big Kindergarten Wait List Limits City’s Pre-K Slots

A space crunch in New York City has arisen partly because of cuts endured in recent years to programs that offer services at day care centers.

College Fights Subpoena of Interviews Tied to I.R.A.

Boston College filed a motion this week to stop British authorities from obtaining confidential interviews of paramilitary fighters for the Provisional Irish Republican Army.
Interns from SUNY New Paltz are trained in emergency management and disaster response at the Emergency Services Center in nearby Orange County.

Colleges Now Offering Education in Disaster

Many schools, including SUNY New Paltz, have set up popular programs in emergency management and disaster response.

Governor Seeks Sharp Tuition Increase in Five-Year Plan for SUNY

The plan was offered as an alternative to larger, one-time increases, and as a means to strengthen research and academics.
President Obama visiting Northern Virginia Community College in Alexandria on Wednesday.

Obama Tries to Focus on Economic Fears

In an effort to restore confidence in his handling of the economy, President Obama visited Alexandria, Va., to tout a $2 billion program focused on manufacturing.

Partnership to Further Global Quest by N.Y.U.

New York University, on its way to becoming the first truly global university, is starting a new partnership with an online school that offers free classes to students around the world.

Year After a Drowning, New York Schools Chief Tightens Rules for Field Trips

The new guidelines, adopted on an emergency basis, are intended to address loopholes and oversights that contributed to a 12-year-old’s death.
The Web site of Ivy Consulting Group, another tutoring company in the city. The proliferation of tutors for students angling for A's is a new phenomenon that is beginning to incite a backlash.

Push for A’s at Private Schools Is Keeping Costly Tutors Busy

Private SAT tutors have been de rigueur at New York private schools for years, but the proliferation of subject-matter tutors is a newer phenomenon that is inciting a backlash.
STRATEGIES A study at New Roads School in Santa Monica, Calif., asked high school sophomores to match graphs and equations in an online drill.

Brain Calisthenics for Abstract Ideas

Traditional classroom learning is generally rules first, application later. However, researchers are finding that repeated exposure to patterns seems to deepen understanding.
Levent Sakar tested a homemade hovercraft in his physics class at Harmony Science Academy High School. The larger point of the project was developing excitement about science for his students, he said.

Charter Schools Tied to Turkey Grow in Texas

A foundation that operates 33 publicly financed charter schools in Texas has ties to a Turkish religious movement.
Elena Aprile

Women Atop Their Fields Dissect the Scientific Life

Four researchers taking part in the World Science Festival talked with The Times about their lives as scientists, the joys and struggles of research, and the specific challenges women in science face.
  •  Women in Science: Gina Kolata Interviews Elena Aprile, Joy Hirsch, Mary-Claire King and Tal Rabin
Education Life
EDUCATION LIFE
The Global Campus
Articles on study abroad, majoring in business, blogging scholars, the fastest growing fields for students to consider and more.
Multimedia
New York School Test Scores
A complete summary of demographics and student performance over the past decade for every school in New York.
Multimedia
Timeline: Dennis M. Walcott
The life and career of the new chancellor for New York City schools.
From Opinion
EDITORIAL

Subprime Education

Congress needs to rein in for-profit colleges that leave students with crushing debt.

Michael Winerip

“On Education” looks beyond the discourse to the teachers, principals and students at the heart of learning.

The Motherlode

Lisa Belkin writes about homework, friends, grades, bullying, baby sitters, the work-family balance and much more.