AINES y riesgo CV/Nonsteroidal anti-inflammatory drugs and CV risk

Riesgo cardiovascular causa-específico asociado con los AINES entre los pacientes con infarto del miocardio. Un estudio a nivel nacional  Cause-specific cardiovascular risk associated with nonsteroidal anti-inflammatory drugs among myocardial infarction patients--a nationwide study. Olsen AM, Fosbøl EL, Lindhardsen J, Andersson C, Folke F, Nielsen MB, Køber L, Hansen PR, Torp-Pedersen C, Gislason GH. Department of Cardiology, Copenhagen University Hospital, Hellerup, Denmark. amschjerning@gmail.com PLoS One. 2013;8(1):e54309. doi: 10.1371/journal.pone.0054309. Epub 2013 Jan 30. Abstract BACKGROUND: Non steroidal anti-inflammatory drugs (NSAIDs) increase mortality and morbidity after myocardial infarction (MI). We examined cause-specific mortality and morbidity associated with NSAIDs in a nationwide cohort of MI patients. METHODS AND RESULTS: By individual-level linkage of nationwide registries of hospitalization and drug dispensing from pharmacies in Denmark, patients aged >30 years admitted with first-time MI during 1997-2009 and their subsequent NSAID use were identified. The risk of three cardiovascular specific endpoints: cardiovascular death, the composite of coronary death and nonfatal MI, and the composite of fatal and nonfatal stroke, associated with NSAID use was analyzed by Cox proportional hazard analyses. Of 97,698 patients included 44.0% received NSAIDs during follow-up. Overall use of NSAIDs was associated with an increased risk of cardiovascular death (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.36-1.49). In particular use of the nonselective NSAID diclofenac and the selective cyclooxygenase-2 inhibitor rofecoxib was associated with increased risk of cardiovascular death (HR 1.96 [1.79-2.15] and HR1.66 [1.44-1.91], respectively) with a dose dependent increase in risk. Use of ibuprofen was associated with increased risk of cardiovascular death (HR 1.34[1.26-1.44]), whereas naproxen was associated with the lowest risk of (e.g., HR 1.27[1.01-1.59].CONCLUSION: Use of individual NSAIDs is associated with different cause-specific cardiovascular risk and in particular rofecoxib and diclofenac were associated with increased cardiovascular morbidity and mortality. These results support caution with use of all NSAIDs in patients with prior MI. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3559685/pdf/pone. 0054309.pdf     Riesgo cardiovascular con AINES: Revisión sistemática de estudios poblacionales observacionales controlados  Cardiovascular risk with non-steroidal anti-inflammatory drugs: systematic review of population-based controlled observational studies. McGettigan P, Henry D. Hull York Medical School, Hull, United Kingdom. PLoS Med. 2011 Sep;8(9):e1001098. doi: 10.1371/journal.pmed.1001098. Epub 2011 Sep 27. Abstract BACKGROUND: Randomised trials have highlighted the cardiovascular risks of non-steroidal anti-inflammatory drugs (NSAIDs) in high doses and sometimes atypical settings. Here, we provide estimates of the comparative risks with individual NSAIDs at typical doses in community settings. METHODS AND FINDINGS: We performed a systematic review of community-based controlled observational studies. We conducted comprehensive literature searches, extracted adjusted relative risk (RR) estimates, and pooled the estimates for major cardiovascular events associated with use of individual NSAIDs, in different doses, and in populations with low and high background risks of cardiovascular events. We also compared individual drugs in pair-wise (within study) analyses, generating ratios of RRs (RRRs). Thirty case-control studies included 184,946 cardiovascular events, and 21 cohort studies described outcomes in >2.7 million exposed individuals. . CONCLUSIONS: This review suggests that among widely used NSAIDs, naproxen and low-dose ibuprofen are least likely to increase cardiovascular risk. Diclofenac in doses available without prescription elevates risk. The data for etoricoxib were sparse, but in pair-wise comparisons this drug had a significantly higher RR than naproxen or ibuprofen. Indomethacin is an older, rather toxic drug, and the evidence on cardiovascular risk casts doubt on its continued clinical use. Please see later in the article for the Editors' Summary. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181230/pdf/pmed.1 001098.pdf    La duración del tratamiento con medicamentos anti-inflamatorios no esteroideos y el impacto en el riesgo de muerte e infarto de miocardio recurrente en pacientes con infarto de miocardio previo: un estudio de cohorte nacional  Duration of treatment with nonsteroidal anti-inflammatory drugs and impact on risk of death and recurrent myocardial infarction in patients with prior myocardial infarction: a nationwide cohort study. Schjerning Olsen AM, Fosbøl EL, Lindhardsen J, Folke F, Charlot M, Selmer C, Lamberts M, Bjerring Olesen J, Køber L, Hansen PR, Torp-Pedersen C, Gislason GH. Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark. aols0073@geh.regionh.dk Circulation. 2011 May 24;123(20):2226-35. doi: 10.1161/CIRCULATIONAHA.110.004671. Epub 2011 May 9. Abstract BACKGROUND: Despite the fact that nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated among patients with established cardiovascular disease, many receive NSAID treatment for a short period of time. However, little is known about the association between NSAID treatment duration and risk of cardiovascular disease. We therefore studied the duration of NSAID treatment and cardiovascular risk in a nationwide cohort of patients with prior myocardial infarction (MI). METHODS AND RESULTS: Patients ≥30 years of age who were admitted with first-time MI during 1997 to 2006 and their subsequent NSAID use were identified by individual-level linkage of nationwide registries of hospitalization and drug dispensing from pharmacies in Denmark. Risk of death and recurrent MI according to duration of NSAID treatment was analyzed by multivariable time-stratified Cox proportional-hazard models and by incidence rates per 1000 person-years. Of the 83 677 patients included, 42.3% received NSAIDs during follow-up. There were 35 257 deaths/recurrent MIs. Overall, NSAID treatment was significantly associated with an increased risk of death/recurrent MI (hazard ratio, 1.45; 95% confidence interval, 1.29 to 1.62) at the beginning of the treatment, and the risk persisted throughout the treatment course (hazard ratio, 1.55; 95% confidence interval, 1.46 to 1.64 after 90 days). Analyses of individual NSAIDs showed that the traditional NSAID diclofenac was associated with the highest risk (hazard ratio, 3.26; 95% confidence interval, 2.57 to 3.86 for death/MI at day 1 to 7 of treatment). CONCLUSIONS: Even short-term treatment with most NSAIDs was associated with increased risk of death and recurrent MI in patients with prior MI. Neither short- nor long-term treatment with NSAIDs is advised in this population, and any NSAID use should be limited from a cardiovascular safety point of view. http://circ.ahajournals.org/content/123/20/2226.full.pdf  Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

Núcleo ceruleus/Locus coeruleus

                         http://www.smo.edu.mx/jornada2013/sociales.htm#DE

Las neuronas noradrenérgicas en el núcleo ceruleus contribuyen al dolor neuropático  Noradrenergic neurons in the locus coeruleus contribute to neuropathic pain. Brightwell JJ, Taylor BK. Department of Pharmacology, School of Medicine, Tulane University, New Orleans, LA 70112, USA. Neuroscience. 2009 Apr 21;160(1):174-85. doi: 10.1016/j.neuroscience.2009.02.023. Epub 2009 Feb 14. Abstract Current theories of neuropathic hypersensitivity include an imbalance of supraspinal inhibition and facilitation. Our overall hypothesis is that the locus coeruleus (LC), classically interpreted as a source of pain inhibition, may paradoxically result in facilitation after tibial and common peroneal nerve transection (spared sural nerve injury--SNI). We first tested the hypothesis that non-noxious tactile hind paw stimulation of the spared sural innervation territory increases neuronal activity in the LC in male rats. We observed a bilateral increase in the stimulus-evoked expression of transcription factors Fos and phosphorylated CREB (pCREB) in LC after SNI but not sham surgery; these markers of neuronal activity correlated with the intensity of tactile allodynia. We next tested the hypothesis that noradrenergic neurons contribute to the development of neuropathic pain. To selectively destroy these neurons, we delivered antidopamine-beta-hydroxylase saporin (anti-DbetaH-saporin) into the i.c.v. space 2 weeks before SNI. We found that anti-DbetaH-saporin, but not an IgG-saporin control, reduced behavioral signs of tactile allodynia, mechanical hyperalgesia, and cold allodynia from 3 to 28 days. after SNI. Our final experiment tested the hypothesis that the LC contributes to the maintenance of neuropathic pain. We performed SNI, waited 2 weeks for maximal allodynia and hyperalgesia to develop, and then administered the local anesthetic lidocaine (4%) directly into the LC parenchyma. Lidocaine reduced all behavioral signs of neuropathic pain in a reversible manner, suggesting that the LC contributes to pain facilitation. We conclude that, in addition to its well-known inhibition of acute and inflammatory pain, the LC facilitates the development and maintenance of neuropathic pain in the SNI model. Further studies are needed to determine the facilitatory pathways emanating from the LC. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2677992/pdf/nihms98071.pdf   Plasticidad molecular y celular inducida por opioides en las neuronas catecolaminérgicas del área tegmentaria ventral y el locus ceruleus   Opiate-induced molecular and cellular plasticity of ventral tegmental area and locus coeruleus catecholamine neurons. Mazei-Robison MS, Nestler EJ. Fishberg Department of Neuroscience and Friedman Brain Institute, Mount Sinai School of Medicine, New York, New York, USA. Cold Spring Harb Perspect Med. 2012 Jul;2(7):a012070 . doi: 10.1101/cshperspect.a012070. Abstract The study of neuronal adaptations induced by opiate drugs is particularly relevant today given their widespread prescription and nonprescription use. Although much is known about the acute actions of such drugs on the nervous system, a great deal of work remains to fully understand their chronic effects. Here, we focus on longer-lasting adaptations that occur in two catecholaminergic brain regions that mediate distinct behavioral actions of opiates: ventral tegmental area (VTA) dopaminergic neurons, important for drug reward, and locus coeruleus (LC) noradrenergic neurons, important for physical dependence and withdrawal. We focus on changes in cellular, synaptic, and structural plasticity in these brain regions that contribute to opiate dependence and addiction. Understanding the molecular determinants of this opiate-induced plasticity will be critical for the development of better treatments for opiate addiction and perhaps safer opiate drugs for medicinal use. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3385942/pdf/cshperspectmed-ADD-a012070.pdf     Núcleo Coeruleus. Neurotransmisores, Funciones y Patología.  Dr. Mauricio Valenzuela-Harrington, Dr. Vicente Negrete-Díaz, Dr. Antonio Rodríguez-Moreno Anestesia en México 2007;19:155-166. El Nucleus Coeruleus es la principal fuente de noradrenalina en el sistema nervioso central. Este complejo nuclear debido a sus aferencias y eferencias está involucrado en diversas y variadas funciones. Además está involucrado en diversas enfermedades y alteraciones del sistema nervioso central cuando su funcionamiento no es correcto. En esta revisión se describen estas funciones del nucleus coeruleus así como la forma en que participa en enfermedades del sistema nervioso tales como Enfermedad de Alzheimer, Parkinson, Depresión y estrés y su papel en procesos de drogodependencia y síndrome de abstinencia. Palabras claves: Locus Coeruleus, noradrenalina, neuromodulador, receptores a y b adrenérgicos. http://www.anestesiaenmexico.org/RAM9/RAM2007-19-3/007.pdf  Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

Casos de interés/Interesting cases

                   http://www.smo.edu.mx/jornada2013/
                     

Como médicos, y en especial como especialistas en medicina perioperatoria podemos enfrentar pacientes con patologías poco frecuentes como la miastenia gravis, la hipertermia maligna, el síndrome del corazón roto, feocromocitomas y muchas otras entidades raras. Cada mes le enviaremos una serie de informe de casos con patologías poco frecuentes que esperamos le sean de utilidad. As physicians, as well as specialists in perioperative medicine, we confront patients with rare diseases such as myasthenia gravis, malignant hyperthermia, broken heart syndrome, pheochromocytomas and many other rare entities. Each month we will send to you a series of case report articles with rare diseases, that we hope will be useful. Como especialistas em medicina perioperatória pode tratar pacientes com doenças raras, como a miastenia gravis, hipertermia maligna, síndrome do coração partido, feocromocitomas e muitas outras entidades raras. Cada mês vamos enviar uma série de relatos de casos com doenças raras, que esperamos que seja útil.  Ceguera cortical transitoria despues de cirugía de columna presentándose como signo inicial de trombofilia hereditaria  Transient cortical blindness after spinal surgery as initial presenting sign of hereditary thrombophilia. Tugcu B, Araz-Ersan B, Eren G, Selçuk H, Yigit U. Indian J Ophthalmol [serial online] 2013 [cited 2013 Mar 21];61:139-40.  Cortical blindness is a rare complication of spine surgery, and is followed by a period of recovery due to resolution of inflammation and edema around the lesion and to the re-activation of partially damaged perilesional tissue. Bilateral occipital abnormalities caused by hypotension, ischemia and infarction are associated with poor prognosis. Herein, we report complete recovery of a case with cortical blindness, despite having an ischemic infarct.  http://www.ijo.in/text.asp?2013/61/3/139/97565  Síndrome de Tapia despues de laminoplastía cervical. Reporte de un caso  Tapia's syndrome following cervical laminoplasty -A case report-. Lim KJ, Kim MH, Kang MH, Lee HM, Park EY, Kwon KJ, Lee SK, Choi H, Moon HS. Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Anyang, Korea. Korean J Anesthesiol. 2013 Feb;64(2):172-4. doi: 10.4097/kjae.2013.64.2.172. Epub 2013 Feb 15. Abstract Tapia's syndrome is the palsy of the 10th and 12th cranial nerves, resulting in ipsilateral paralysis of the vocal cord and tongue. It is a rare complication which is related to the anesthetic airway management and positioning of the patient's head during the surgery. We describe a patient with a postoperative unilateral Tapia's syndrome, after general anesthesia, with uncomplicated endotracheal intubation. The patient's symptoms improved gradually for three months. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3581789/pdf/kjae-64-172.pdf    Megaesófago: Un reto para los anestesiólogos  Megaesophagus: A challenge for anesthesiologists. Tewari P, Gupta D. Ann Card Anaesth [serial online] 2013 [cited 2013 Jan 2];16:61-2.  A fifty-nine-year male farmer presented with a history of low grade dysphagia, both for solids and liquids for twenty-five years that progressively increased in severity. He had lost weight significantly in recent years and developed spontaneous regurgitation of liquids and food content, heart burn, chest pain after eating and cough. Chest X-ray (PA-view) showed a large curvilinear, radio-opaque density lesion occupying medial 2/3 rd of right hemi thorax with Ryle's tube within the shadow suggesting a large dilated esophagus. This was not silhouetting the right cardiac border suggesting posterior mediastinal mass; moreover, there was no mediastinal shift. Barium swallow confirmed achalasia-cardia with huge, more than 10 cm in diameter, pouch of esophagus with lower constricted part. The patient did not show any cardiac compromise but lung function tests showed reduced inspiratory and forced vital capacity (60%) and borderline Peak Expiratory Flow Rate (70%). The laboratory investigations were within normal limits. He was planned for transhiatal esophagectomy (THO) with cervical esophago-gastrotomy (OG) and feeding jejunostomy (FJ). He was given one week of rigorous chest physiotherapy under guidance of professional therapists http://www.annals.in/text.asp?2013/16/1/61/105374    Síndrome de Sturge-Weber con manifestaciones oculares extremas y asociación rara con agioma de la vía aérea superior con dificultad anticipada para el manejo de la vía aérea              Sturge-Weber-Syndrome with extreme ocular manifestation and rare association of upper airway angioma with anticipated difficult airway. Wong HS, Abdul Rahman R, Choo SY, Yahya N. Universiti Kebangsaan Malaysia Medical Centre, Department of Opthalmology, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur 56000, Malaysia. whs1975@gmail.com Med J Malaysia. 2012 Aug;67(4):435-7. Abstract We report a rare case of an 18 year old girl with Sturge-Weber syndrome, she had extensive facial port wine stains, right bupthalmos and advanced glaucoma involving both eyes. She underwent right eye glaucoma drainage device surgery under general anaesthesia, and had a difficult intubation due to extensive angiomatous like soft tissue swelling at her upper airway. This report highlights the importance of being aware of the need for continuous follow-up in Sturge-Weber syndrome patients as this syndrome can lead to blindness due to advance glaucoma and the awareness of possible difficult intubation for this group of patients http://www.e-mjm.org/2012/v67n4/Sturge-Weber-Syndrome.pdf  Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

BPD para cesárea/Epidural block for C-section

http://www.smo.edu.mx/jornada2013/

Comparación de los efectos maternos y neonatales de bupivacaína más fentanil y ropivacaína más fentanil durante operación cesárea  Comparison of the maternal and neonatal effects of bupivacaine plus fentanyl and ropivacaine plus fentanyl during cesarean delivery. Canan U, Örnek D, Kilci O, Dönmez F, Gamli M, Dikmen B. Niger J Clin Pract [serial online] 2013 [cited 2013 Apr 6];16:195-200. Abstract Purpose: The aim of the present study was to compare the anesthetic efficacy, and fetal and maternal effects of 7.5 mg (1 ml) intrathecal 0.75% hyperbaric ropivacaine + 25 μg (0.5 ml) fentanyl versus 5 mg (l ml) intrathecal 0.5% hyperbaric bupivacaine + 25 μg (0.5 ml) fentanyl in elective cesarean delivery. Materials and Methods: The study included 40 ASA I-II cases scheduled for cesarean delivery that were randomized into two groups of 20 cases each. Cases in the RF group were administered 0.75% hyperbaric ropivacaine + 25 μg (0.5 ml) fentanyl and those in the BF group were administered 5 mg (l ml) hyperbaric bupivacaine + 25 μg (0.5 ml) fentanyl into the spinal space. The time until spinal anesthesia in the T4 dermatome, overall duration of analgesia, hemodynamic parameters, Apgar score of newborns at 1-5 min, fetal blood gas values (pH, PO2, PCO2, HCO3−, and BE), maternal side effects, the degree of motor block, maternal need for ephedrine, objective pain scale score, and patient satisfaction were recorded in each group. Results: There were no significant differences between the groups in terms of the parameters evaluated (P > 0.05). Conclusion: In elective cesarean delivery, the combinations of bupivacaine + fentanyl or ropivacaine + fentanyl exhibited similar anesthetic efficacy, and fetal and maternal effects. Keywords: Bupivacaine, cesarean, opioid, ropivacaine. http://www.njcponline.com/text.asp?2013/16/2/195/110154 Atentamente Dr. Benito Cortes-Blanco Anestesiología y Medicina del Dolor www.anestesia-dolor.org

PCA transdérmica en dolor agudo postoperatorio

PCA transdérmica en dolor agudo postoperatorio

Transdermal PCA in acute postoperative pain

Anesthesiology News March 2013

http://www.anesthesiologynews.com/download/SR1230_WM.pdf

Bibliotecas. Alerta

Las bibliotecas públicas celebrarán el Día Internacional del Libro
Diario de Navarra
Las bibliotecas públicas de San Francisco, Chantrea, Yamaguchi y Mendillorri celebran este martes, 23 de abril, el Día Internacional del Libro con distintas actividades, todas ellas con entrada gratuita. Así, a las cinco y media de la tarde en la ...
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Diario de Navarra



La Red de Bibliotecas Municipales y Bidebarrieta Kulturgunea ...
Europa Press
La Red de Bibliotecas Municipales de Bilbao y Bidebarrieta Kulturgunea han organizado una serie de actividades especiales con motivo de la celebración del Día Internacional del Libro, que tendrá lugar en este martes, 23 de abril. Según ha informado el ...
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IU pide mejorar la dotación presupuestaria y las suscripciones a ...
Europa Press
El concejal del grupo municipal de IU en el Ayuntamiento de Zaragoza, Raúl Ariza, ha propuesto un conjunto de iniciativas para mejorar el servicio en las bibliotecasmunicipales, que comprenden desde la mejora presupuestaria a las suscripciones a ...
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Europa Press



Las bibliotecas municipales de Gijón tuvieron 950.000 visitantes en ...
ABC.es
Las bibliotecas municipales de Gijón recibieron durante el año pasado casi 950.000 visitantes y realizaron 328.000 préstamos de sus fondos documentales y bibliográficos. El Ayuntamiento de Gijón, a través de un comunicado, hace un balance "positivo" de ...
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Bibliotecas y escuelas públicas, ejes para fomentar la lectura
Milenio.com
Para fomentar esta actividad en el país, se requiere fortalecer la formación de docentes y expertos, establecer bibliotecas en todos los planteles de educación básica y promover la imagen de estos recintos como espacios que complementan y apoyan la ...
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Visitas guiadas, tertulias y concursos, propuestas de las bibliotecas ...
20minutos.es
La red de bibliotecas públicas de Navarra ha preparado a lo largo de esta semana un "amplio" programa de actividades tanto para público adulto como infantil para celebrar el Día Internacional del Libro. En concreto, se han programado visitas guiadas, ...
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Junot Díaz, finalista en premios de Bibliotecas Americanas
El Universal
La asociación de bibliotecas anunció el lunes a los candidatos y entregará las medallas a los ganadores el 30 de junio en su conferencia anual en Chicago.Creados en el 2012, los premios Carnegie son posibles gracias a una dádiva de la Carnegie Corp.
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El Universal

Aumenta un 26 por ciento el número de usuarios de las bibliotecas ...
ABC.es
El número de usuarios de la red de Bibliotecas de Menorca, que depende del Consell insular, ha aumentado en un 26,36 por ciento durante 2012 respecto a 2011. Según el informe anual redactado por la Conselleria de Cultura y Patrimonio, difundido hoy ...
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El Gobierno premia a cinco bibliotecas de la provincia dentro del ...
leonoticias.com
El Gobierno, a través del Ministerio de Educación, Cultura y Deporte, ha premiado a 17 bibliotecaspúblicas de Castilla y León, según se recoge en el fallo de la comisión de evaluación del Concurso 'María Moliner' de 2012, para proyectos de animación a ...
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Creando un “lugar” para las bibliotecas públicas « Beyond Access
Empecemos por lo obvio: las bibliotecas públicas pueden ser (y en muchos casos son) espacios poderosos para el cambio, creación y desarrollo. Esto es, sin ...
beyondaccess.net/.../creando-un-lugar-para-las-bibliotecas-pub...


Remodelación de bibliotecas va en un 52 % - Actualidad nacional y ...
De acuerdo con María Elisa Holguín; directora ejecutiva de BiblioTEC; a la fecha en Cali ya se han remodelado diez bibliotecas.. MSN Colombia te trae noticias ...
noticias.co.msn.com/.../remodelación-de-bibliotecas-va-en-un-...




Presentación corporativa para bibliotecas // Speaker Deck
Presentación corporativa para bibliotecas. by Libranda. Published April 20, 2013 in Business. Servicios de Libranda para el préstamo digital. Plataforma de ...
https://speakerdeck.com/.../presentacion-corporativa-para-bibli...


El Gobierno premia a cinco bibliotecas de León por su fomento de ...
El Gobierno, a través del Ministerio de Educación, Cultura y Deporte, ha premiado a diecisietebibliotecas públicas de Castilla y León, cinco de las cuales son ...
www.leondirecto.com/el-gobierno-premia-a-cinco-bibliotecas-...

XXVII Jornada Nacional de Ortopedia, 58° Reunión Anual

Detección de displasia de la cadera en desarrollo en menores de un año

Bibliomanazteca

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Dolor y su computadora/Pain and your computer

                                                  http://www.smo.edu.mx/jornada2013/

Síntomas musculoesqueléticos y uso de computadoras en adolescentes Finlandeses- La intensidad del dolor y molestias de la vida cotidiana: Un estudio transversal  Musculoskeletal symptoms and computer use among Finnish adolescents--pain intensity and inconvenience to everyday life: a cross-sectional study. Hakala PT, Saarni LA, Punamäki RL, Wallenius MA, Nygård CH, Rimpelä AH. School of Health Sciences, University of Tampere, Tampere, Finland.paula.t.hakala@uta.fi BMC Musculoskelet Disord. 2012 Mar 22;13:41. doi: 10.1186/1471-2474-13-41. Abstract BACKGROUND: Musculoskeletal symptoms among adolescents are related to the time spent using a computer, but little is known about the seriousness of the symptoms or how much they affect everyday life. The purpose of the present study was to examine the intensity of musculoskeletal pain and level of inconvenience to everyday life, in relation to time spent using a computer. METHODS: In a survey, 436 school children (12 to 13 and 15 to 16 years of age), answered a questionnaire on musculoskeletal and computer-associated musculoskeletal symptoms in neck-shoulder, low back, head, eyes, hands, and fingers or wrists. Pain intensity (computer-associated symptoms) and inconvenience to everyday life (musculoskeletal symptoms) were measured using a visual analogue scale. Based on the frequency and intensity, three categories were formed to classify pain at each anatomic site: none, mild, and moderate/severe. The association with time spent using the computer was analyzed by multinomial logistic regression. RESULTS: Moderate/severe pain intensity was most often reported in the neck-shoulders (21%); head (20%); and eyes (14%); and moderate/severe inconvenience to everyday life was most often reported due to head (29%), neck-shoulders (21%), and low back (16%) pain. Compared with those using the computer less than 3.6 hours/week, computer use of ≥ 14 hours/week, was associated with moderate/severe increase in computer-associated musculoskeletal pain at all anatomic sites (odds ratio [OR] = 2.9-4.4), and moderate/severe inconvenience to everyday life due to low back (OR = 2.5) and head (OR = 2.0) pain. CONCLUSIONS: Musculoskeletal symptoms causing moderate/severe pain and inconvenience to everyday life are common among adolescent computer users. Daily computer use of 2 hours or more increases the risk for pain at most anatomic sites. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3348031/pdf/1471-2474-13-41.pdf     Tratamiento de dolor lumbar en usadores de computadoras: Un abordaje multidisciplinario  Management of low back pain in computer users: A multidisciplinary approach Shete KM, Suryawanshi P, Gandhi N. J Craniovert Jun Spine [serial online] 2012 [cited 2013 Apr 5];3:7-10. Abstract Background: Low back pain is a very common phenomenon in computer users. More than 80% people using computers for more than 4 h complain of back pain. Objective: To compare the effectiveness of multidisciplinary treatment approach and conventional treatment approach amongst computer users. Materials and Methods: A prospective interventional study was carried out at a private spine clinic amongst the computer users with the complaint of low back pain. The study participants were randomly distributed in two groups. The first group comprised the study participants treated by conventional approach and the second group was treated by multidisciplinary approach. Primary outcomes analyzed were pain intensity, sick leave availed, and quality of life. Statistical analysis was done using proportions, unpaired "t" test, and Wilcoxon signed-rank test. Results: Totally 44 study participants were randomly assigned to groups I and II, and each group had 22 study participants. Intensity of pain was reduced significantly in the group treated by multidisciplinary approach (t = 5.718; P = 0.0001). Similarly only 4 (19.19%) of the study participants of the group treated by multidisciplinary approach availed sick leave due to low back pain, while 14 (63.63%) study participants availed sick leave in the other group (P = 0.02). The quality of life amongst the study participants treated by multidisciplinary approach was significantly improved compared to the group treated by conventional approach (t = 7.037; P = 0.0001). Conclusion and Recommendation: The multidisciplinary treatment approach was better than the conventional treatment approach in low back pain cases when some factors like pain and quality of life were assessed. The multidisciplinary approach for treatment of low back pain should be promoted over conventional approach. Larger studies are required to confirm the findings in different settings. Keywords: Computer users, low back pain, multidisciplinary approach. http://www.jcvjs.com/article.asp?issn=0974-8237;year=2012;volume=3;issue=1;spage=7;epage=10;aulast=Shete     http://www.jcvjs.com/text.asp?2012/3/1/7/110117    Factores de riesgo para alteraciones del cuello y de las extremidades en usadores de ordenadores y el efecto de las intervenciones. Una visión general de revisiones sistemáticas  Risk Factors for Neck and Upper Extremity Disorders among Computers Users and the Effect of Interventions: An Overview of Systematic Reviews Johan H. Andersen, Nils Fallentin, Jane F. Thomsen, and Sigurd Mikkelsen PLoS One. 2011; 6(5): e1969. 1 Published online 2011 May 12. doi:  10.1371/journal.pone.0019691 Abstract Background. To summarize systematic reviews that 1) assessed the evidence for causal relationships between computer work and the occurrence of carpal tunnel syndrome (CTS) or upper extremity musculoskeletal disorders (UEMSDs), or 2) reported on intervention studies among computer users/or office workers. Methodology/Principal Findings PubMed, Embase, CINAHL and Web of Science were searched for reviews published between 1999 and 2010. Additional publications were provided by content area experts. The primary author extracted all data using a purpose-built form, while two of the authors evaluated the quality of the reviews using recommended standard criteria from AMSTAR; disagreements were resolved by discussion. The quality of evidence syntheses in the included reviews was assessed qualitatively for each outcome and for the interventions. Altogether, 1,349 review titles were identified, 47 reviews were retrieved for full text relevance assessment, and 17 reviews were finally included as being relevant and of sufficient quality. The degrees of focus and rigorousness of these 17 reviews were highly variable. Three reviews on risk factors for carpal tunnel syndrome were rated moderate to high quality, 8 reviews on risk factors for UEMSDs ranged from low to moderate/high quality, and 6 reviews on intervention studies were of moderate to high quality. The quality of the evidence for computer use as a risk factor for CTS was insufficient, while the evidence for computer use and UEMSDs was moderate regarding pain complaints and limited for specific musculoskeletal disorders. From the reviews on intervention studies no strong evidence based recommendations could be given. Conclusions/Significance. Computer use is associated with pain complaints, but it is still not very clear if this association is causal. The evidence for specific disorders or diseases is limited. No effective interventions have yet been documented. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3093401/pdf/pone. 0019691.pdf    Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

De la serie: Un diagnóstico?

OOM
Ortopedia Oncológica México
Dr Ernesto Delgado
Ortopedista oncólogo
Medico adscrito en el Instituto Nacional de Rehabilitación SSA
drdelgado@hotmail.com
Un diagnóstico?
La respuesta en:
http://tumoresoseosenmexico.blogspot.mx/

Obesidad, cirugía, anestesia/Obesity, Surgery, Anesthesia

Banda gástrica ajustable y ¨bypass¨ en Y-Roux laparoscópicos como procedimientos primarios para los súper-súper obesos (IMC > 60 kg/m²).  Laparoscopic adjustable banded roux-en-y gastric bypass as a primary procedure for the super-super-obese (body mass index > 60 kg/m²). Dillemans B, Van Cauwenberge S, Agrawal S, Van Dessel E, Mulier JP. Department of General Surgery, AZ Sint-Jan Hospital AV, Brugge, Belgium. bruno.dillemans@azbrugge.be BMC Surg. 2010 Nov 14;10:33. doi: 10.1186/1471-2482-10-33. Abstract BACKGROUND: Currently, there is no consensus opinion regarding the optimal procedure of choice in super-super-morbid obesity (Body mass index, BMI > 60 kg/m²). Roux-en-Y gastric bypass (RYGB) is associated with failure to achieve or maintain 50% excess weight loss (EWL) or BMI < 35 in approximately 15% of patients. Also, percent EWL is significantly less after 1-year in the super-super-obese group as compared with the less obese group and many patients are still technically considered to be obese (lowest post-surgical BMI > 35) following RYGB surgery in this group. The addition of adjustable gastric band (AGB) to RYGB has been reported as a revisional procedure but this combined bariatric procedure has not been explored as a primary operation. METHODS: In a primary laparoscopic RYGB, an AGB is drawn around the gastric pouch through a small opening between the blood vessels on the lesser curve and the gastric pouch. The band is then fixed by suturing the gastric remnant to the gastric pouch both above and below the band to prevent slippage. RESULTS: Between November 2009 and March 2010, 6 consecutive super-super-obese patients underwent a primary laparoscopic adjustable banded Roux-en-Y gastric bypass procedure at our institution. One male patient (21 years, BMI 70 kg/m²) developed a pneumonia postoperatively. No other postoperative complications were observed. CONCLUSION: To the best of our knowledge, this is the first series of patients that underwent a laparoscopic adjustable banded RYGB as a primary operation for the super-super obese in the indexed literature. With the combined procedure, a sequential action mechanism for weight loss is to be expected. The restrictive, malabsorptive and hormonal working mechanism of the RYGB will induce weight loss from the start reaching a stabilised plateau of weight after 12 - 18 months. At that time, filling of the band can be started resulting in further gastric pouch restriction and increased weight loss. Moreover, besides improving the results of total weight loss, a gradual filling of the band can as well prevent the RYGB patient from weight regain if restriction would fade away with time. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992483/pdf/1471-2482-10-33.pdf     Impacto de la posición corporal de los pacientes sobre el espacio intrabdominal de trabajo durante cirugía laparoscópica  Impact of the patient's body position on the intraabdominal workspace during laparoscopic surgery. Mulier JP, Dillemans B, Van Cauwenberge S. Department of Anaesthesiology, AZ Sint Jan Brugge-Oostende AV, Ruddershove 10, 8000 Brugge, Belgium. Jan.Mulier@azbrugge.be Surg Endosc. 2010 Jun;24(6):1398-402. doi: 10.1007/s00464-009-0785-8. Epub 2010 Jan 7. Abstract BACKGROUND: The effects of the patient's body position on the intraabdominal workspace in laparoscopic surgery were analyzed. METHODS: The inflated volume of carbon dioxide was measured after insufflation to a preset pressure of 15 mmHg for 20 patients with a body mass index (BMI) greater than 35 kg/m(2). The patients were anesthetized with full muscle relaxation. The five positions were (1) table horizontal with the legs flat (supine position), (2) table in 20 degrees reverse Trendelenburg with the legs flat, (3) table in 20 degrees reverse Trendelenburg with the legs flexed 45 degrees upward at the hips (beach chair position), (4) table horizontal with the legs flexed 45 degrees upward at the hips, and (5) table in 20 degrees Trendelenburg with the legs flat. The positions were performed in a random order, and the first position was repeated after the last measurement. Repeated measure analysis of variance was used to compare inflated volumes among the five positions. RESULTS: A significant difference in inflated volume was found between the five body positions (P = 0.042). Compared with the mean inflated volume for the supine position (3.22 +/- 0.78 l), the mean inflated volume increased by 900 ml for the Trendelenburg position or when the legs were flexed at the hips, and decreased by 230 ml for the reverse Trendelenburg position. CONCLUSIONS: The Trendelenburg position for lower abdominal surgery and reverse Trendelenburg with flexing of the legs at the hips for upper abdominal surgery effectively improved the workspace in obese patients, even with full muscle relaxation. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2869437/pdf/464_2009_ Article_785.pdf    Obesidad, anestesia y cirugía bariátrica  L. A. Fernandez Merea, M. Alvarez Blanco Servicio de Anestesiología, Reanimación y Terapéutica del Dolor. Servicio de Cirugía General. Hospital Universitario Central de Asturias (HUCA) - Centro Residencia Covadonga. Oviedo. Rev. Esp. Anestesiol. Reanim. 2004; 51: 80-94 Resumen La obesidad se ha convertido en una patología en constante aumento, constituyendo un grave problema de salud pública con la consiguiente repercusión sobre el gasto sanitario, sobre todo en los países desarrollados. Su principal rasgo es la asociación con numerosas patologías (respiratorias, cardiovasculares, endocrino-metabólicas), que hace que tenga una elevada morbimortalidad, afectando tanto a la calidad como a la duración de la vida. Un gran avance en el tratamiento de los obesos es la cirugía bariátrica. Es aplicable cuando han fallado otras medidas y está obteniendo resultados muy favorables, por lo que se trata de un arma terapéutica en constante auge. Desde el punto de vista anestésico, los obesos se sitúan en desventaja con respecto a la población no obesa, ya que los procedimientos están dificultados y se aumenta la peligrosidad. Esto hace que sea de primordial relevancia conocer los cambios fisiopatológicos que la obesidad produce, así como las implicaciones anestésicas dentro del marco de la cirugía bariátrica, para lograr que los resultados quirúrgicos sean lo más favorables posibles. https://www.sedar.es/vieja/restringido/2004/n2_2004/80-94.pdf  Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

Nuestro segundo caso del día con OOM

Nuestro 2° caso del día:

OOM
Ortopedia Oncológica México
Dr Ernesto Delgado
Ortopedista oncólogo
Medico adscrito en el Instituto Nacional de Rehabilitación SSA
drdelgado@hotmail.com
Un diagnóstico?
La respuesta en:
http://tumoresoseosenmexico.blogspot.mx/

Feocromocitoma y anestesia/Anesthesia and pheochromocytoma

                                                  http://www.smo.edu.mx/jornada2013/

Evaluación de la utilidad de las variaciones del monitoreo del volumen latido no invasivo para ajustar el aporte de líquidos durante adrenalectomía laparoscópica en pacientes con feocromocitoma  Examination of the usefulness of non-invasive stroke volume variation monitoring for adjusting fluid supplementation during laparoscopic adrenalectomy in patients with pheochromocytoma. Isosu T, Obara S, Ohashi S, Hosono A, Nakano Y, Imaizumi T, Mogami M, Iida H, Murakawa M. Department of Anesthesiology, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima, Japan. t-isosu@fmu.ac.jp Fukushima J Med Sci. 2012;58(1):78-81 Abstract PURPOSE OF THE STUDY: The measurement of stroke volume variation (SVV) using the FloTrac™ system (Edwards Lifescience, USA) is useful to estimate cardiac preload. We evaluated the benefits of SVV monitoring for adjusting fluid supplementation during laparoscopic adrenalectomy under anesthesia in patients with pheochromocytoma. SUBJECTS AND METHODS: Among 10 patients who underwent laparoscopic adrenalectomy for pheochromocytoma in our institution from June 2004 to December 2009, SVV was not monitored in 5 patients (group I) and in the other 5 patients (group II), SVV monitoring was performed. Subject age, height and body weight, total volume of fluid supplemented, blood loss, urine output and net fluid in-out balance during the procedure were retrospectively assessed. In those with SVV monitoring, infusion volume was adjusted for SVV less than 13%.RESULTS: There were significant differences in the patient age and body weight between the two groups (group I: 64.2 years old and 55.1 kg; group II: 43.6 years old and 71.7 kg). Both total infusion volume and urine output were significantly higher in group I compared with group II (5,610 vs. 2,400 ml and 1,125 vs. 750 ml, respectively). Total blood loss was similar between the two groups. Values of the net fluid balance divided by the body weight and total anesthesia period (hr) were significantly lower in group II compared with group I (I; +13.2 in group I and +6.2 in group II, ml/kg/hr). CONCLUSIONS: These data suggest that SVV monitoring is helpful to estimate the optimal volume for fluid supplementation and could prevent excessive fluid infusion during surgical procedures. https://www.jstage.jst.go.jp/article/fms/58/1/58_78/_pdf Manejo intraoperatorio de pacientes con tumores incidentales productores de catecolaminas: revisión y análisis de la literatura  Intraoperative management of patients with incidental catecholamine producing tumors: A literature review and analysis. Hariskov S, Schumann R. Department of Anesthesiology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA. J Anaesthesiol Clin Pharmacol. 2013 Jan;29(1):41-6. doi: 10.4103/0970-9185.105793. Abstract CONTEXT: Present knowledge about intraoperative management, morbidity, and mortality of patients with undiagnosed catecholamine-producing tumors is mostly based on published case reports and anecdotal evidence. AIMS: The aim was to summarize the management and outcomes of reported cases and analyze for practice patterns, deduct useful management recommendations as applicable. SETTINGS AND DESIGN: The Medline database was searched with specific keywords for the period of 1988-2010 for cases of incidental pheochromocytomas and paragangliomas. MATERIALS AND METHODS: Case reports in the English language with a postoperative diagnosis of pheochromocytoma and paraganglioma by histopathology were included. Systematic data extraction from case reports was done. STATISTICAL ANALYSIS USED: Descriptive statistics were applied.RESULTS: Of 823 retrieved records, 62 case reports met inclusion criteria. Hemodynamic instability occurred primarily during mass manipulation/intraoperatively (52%, n = 32) and induction/laryngoscopy (18%, n = 11). In cases reporting specific antihypertensive treatments, nitrates (67%, n = 30) represented the majority of medications used, followed by beta-blockers (47%, n = 21). Alpha receptor blockers were administered in 33% (n = 15). The perioperative mortality was 8% (n = 5), and none of these patients received intraoperative alpha blockade. A catecholamine-secreting tumor was suspected intraoperatively in 26% of cases. CONCLUSIONS: The perioperative mortality based on the reviewed cases of incidental catecholamine producing tumors was less than would traditionally be expected. Intraoperative alpha receptor blockade to treat hypertension was reported in 33% of cases, and none of the patients with a fatal outcome had received it. A higher intraoperative index of suspicion and a lower threshold to consider alpha blocking medications for severe intraoperative hypertension may improve outcomes. KEYWORDS: Adrenal gland neoplasms, adrenal incidentaloma, anesthesia - general, outcome assessment, paraganglioma http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3590540/      Manejo del feocromocitoma: ideas antiguas y nuevas drogas  Management of pheochromocytoma: old ideas and new drugs. Domi R, Laho H. Department of Anesthesia and Intensive Care, University Hospital Center, Mother Teresa, Albania. rudilaureta@hotmail.com Niger J Clin Pract. 2012 Jul-Sep;15(3):253-7. doi: 10.4103/1119-3077.100616. Abstract Pheochromocytoma presents a challenge to the surgery team because of its clinical features and implications. The patient must be treated before the surgery until a stable hemodynamically state is achieved. The preoperative treatment includes α2-short acting adrenergic blocking and β-blocker agents. The most crucial intraoperative moments are induction of anesthesia and hemodynamic oscillations. An adequate preoperative preparation, modern anesthetic drugs, good collaboration between the surgeons and the anesthesiologists, and postoperative care decrease the rate of complications and improve the outcome. This review aims to discuss all the possible pharmacological strategies of perioperative management of phoechromocytoma, focusing on new drugs and treatments. http://www.njcponline.com/article.asp?issn=1119-3077;year=2012;volume=15;issue=3;spage=253;epage=257;aulast=Domi  Atentamente Dr. Juan C. Flores-Carrillo Anestesiología y Medicina del Dolor www.anestesia-dolor.org