Miocardiopatía periparto / Peripartum cardiomyopathy

Agosto 18, 2017. No. 2784

La miocardiopatía periparto como causa de insuficiencia cardiaca en el embarazo y el puerperio Margarita Gallardo Arozena, Tania de Ganzo Suarez, Beatriz Contreras Gonzalez, Ivan Bernaldo de Quiros Huguet, Nieves Sierra Medina y Domingo Mendez Mora Prog Obstet Ginecol. 2015;58(8):363-367 Resumen La miocardiopatía periparto es una enfermedad con una elevada morbimortalidad y que, a pesar de sus riesgos potenciales, no es posible prevenirla. Por ello, solo podremos actuar sobre los factores de riesgo asociados a su aparición y sobre las complicaciones una vez diagnosticada. Debido a su baja incidencia, es difícil el conocimiento real de esta enfermedad, ya que se basa en artículos publicados sobre series reducidas de casos. El propósito de esta revisión es realizar una descripción de la fisiopatología, las manifestaciones clínicas, el diagnóstico y el tratamiento de la enfermedad, enfocada principalmente en el manejo obstétrico de la gestante PDF Tratamiento práctico de la cardiomiopatía periparto Practical management of peripartum cardiomyopathy. Kim MJ1, Shin MS2. Korean J Intern Med. 2017 May;32(3):393-403. doi: 10.3904/kjim.2016.360. Epub 2017 Apr 14. Abstract Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy that causes systolic heart failure (HF) in previously healthy young women. Despite latest remarkable achievement, unifying pathophysiologic mechanism is not well established. Considering close temporal relationship to pregnancy, the recent prolactin theory is promising. Abnormal short form of 16-kDa prolactin may be produced in the oxidative stress milieu, show anti-angiogenic effect and damage cardiovascular structure in late pregnancy. Future study is needed to determine whether abnormal prolactin system is useful as a biomarker for diagnosis and therapy of PPCM. Diagnosis is made based on the finding of left ventricular systolic dysfunction after excluding other causes of HF. A multidisciplinary team approach is essential for acute HF, antepartum, labor and postpartum care. Recovery from left ventricular dysfunction is critical for prognosis. As PPCM can recur and cause serious clinical events, subsequent pregnancy is not recommended. This review focuses on the practical management of PPCM. KEYWORDS: Cardiomyopathies; Heart failure; Peripartum cardiomyopathy; Pregnancy PDF Miocardiopatía periparto Peripartum Cardiomyopathy. Arany Z1, Elkayam U2. Circulation. 2016 Apr 5;133(14):1397-409. doi: 10.1161/CIRCULATIONAHA.115.020491. Abstract Peripartum cardiomyopathy is a potentially life-threatening pregnancy-associated disease that typically arises in the peripartum period and is marked by left ventricular dysfunction and heart failure. The disease is relatively uncommon, but its incidence is rising. Women often recover cardiac function, but long-lasting morbidity and mortality are not infrequent. Management of peripartum cardiomyopathy is largely limited to the same neurohormonal antagonists used in other forms of cardiomyopathy, and no proven disease-specific therapies exist yet. Research in the past decade has suggested that peripartum cardiomyopathy is caused by vascular dysfunction, triggered by late-gestational maternal hormones. Most recently, information has also indicated that many cases of peripartum cardiomyopathy have genetic underpinnings. We review here the known epidemiology, clinical presentation, and management of peripartum cardiomyopathy, as well as the current knowledge of the pathophysiology of the disease. KEYWORDS: cardiomyopathies; heart failure; pre-eclampsia; pregnancy PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información/Information Videoclip

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

Daño pulmonar asociado al ventilador / Ventilator-associated lung injury

Agosto 22, 2017. No. 2788

Previniendo lesión pulmonar asociada al ventilador, Perspectiva perioperatoria Preventing Ventilator-Associated Lung Injury: A Perioperative Perspective. Kimura S1, Stoicea N1, Rosero Britton BR1, Shabsigh M1, Branstiter A1, Stahl DL1. Author information Front Med (Lausanne). 2016 May 30;3:25. doi: 10.3389/fmed.2016.00025. eCollection 2016. Abstract INTRODUCTION: Research into the prevention of ventilator-associated lung injury (VALI) in patients with acute respiratory distress syndrome (ARDS) in the intensive care unit (ICU) has resulted in the development of a number of lung protective strategies, which have become commonplace in the treatment of critically ill patients. An increasing number of studies have applied lung protective ventilation in the operating room to otherwise healthy individuals. We review the history of lung protective strategies in patients with acute respiratory failure and explore their use in patients undergoing mechanical ventilation during general anesthesia. We aim to provide context for a discussion of the benefits and drawbacks of lung protective ventilation, as well as to inform future areas of research. METHODS: We completed a database search and reviewed articles investigating lung protective ventilation in both the ICU and in patients receiving general anesthesia through May 2015. RESULTS: Lung protective ventilation was associated with improved outcomes in patients with acute respiratory failure in the ICU. Clinical evidence is less clear regarding lung protective ventilation for patients undergoing surgery. CONCLUSION: Lung protective ventilation strategies, including low tidal volume ventilation and moderate positive end-expiratory pressure, are well established therapies to minimize lung injury in critically ill patients with and without lung disease, and may provide benefit to patients undergoing general anesthesia. KEYWORDS: acute respiratory distress syndrome; general anesthesia; low tidal volume ventilation; lung protective ventilation; ventilator-associated lunginjury; ventilator-induced lung injury PDF Convocatoria para el Curso de Posgrado en Medicina del Dolor y Paliativa 2018, para Mexicanos y extranjeros. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Informes en el teléfono (52) 55 5487 0900 ext. 5011 de lunes a viernes de 9.00 a 14 h (hora de México).  Informes / Information XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información/Information Videoclip

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

Manejo de Fracturas Acetabulares en Ancianos

http://www.artroscopiayreemplazos.com.mx/academia/manejo-de-fracturas-acetabulares-en-ancianos/

Management of Acetabular Fractures in the Elderly

Fuente

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed?term=Antell+Nicholas[au]

http://journals.lww.com/jaaos/Abstract/2017/08000/Management_of_Acetabular_Fractures_in_the_Elderly.4.aspx#P55

De:

Antell NB1,Switzer JA,Schmidt AH.

J Am Acad Orthop Surg.

2017 Aug;25(8):577-585. doi: 10.5435/JAAOS-D-15-00510.

Todos los derechos reservados para:

© 2017 by American Academy of Orthopaedic Surgeons

Abstract

The incidence of acetabular fractures in the elderly population is increasing. Fractures in this population differ from those in younger patients, with more frequent involvement of the anterior column, more comminution, and more severe articular impaction in elderly patients. Although acetabular fractures in geriatric patients are more likely the result of low-energy trauma, outcomes are generally poorer than those in young patients. Multiple management options have been proposed, but no intervention has become the standard of care for these fractures in the elderly. Patient characteristics (eg, prior ambulation status, functional capacity, bone quality), the nature of the fracture, and the experience of the treating orthopaedic surgeon all must be considered when choosing among nonsurgical treatment, percutaneous fixation, open reduction and internal fixation, and immediate or delayed arthroplasty. Each treatment option has the potential for satisfactory results in properly selected patients.

Resumen

La incidencia de fracturas acetabulares en la población de ancianos está aumentando. Las fracturas de esta población difieren de las de los pacientes más jóvenes, con una afectación más frecuente de la columna anterior, más trastornos y una impactación articular más grave en los pacientes de edad avanzada. Aunque las fracturas acetabulares en pacientes geriátricos son más probablemente el resultado de un trauma de baja energía, los resultados son generalmente más pobres que los de pacientes jóvenes. Se han propuesto múltiples opciones de manejo, pero ninguna intervención se ha convertido en el estándar de atención para estas fracturas en los ancianos. Las características del paciente (p. Ej., Estado de deambulación previo, capacidad funcional, calidad ósea), la naturaleza de la fractura y la experiencia del cirujano ortopédico tratante deben considerarse al elegir entre el tratamiento no quirúrgico, la fijación percutánea, la reducción abierta y la fijación interna. Artroplastia inmediata o tardía. Cada opción de tratamiento tiene el potencial de resultados satisfactorios en pacientes correctamente seleccionados.

PMID:  28737617   DOI:  

10.5435/JAAOS-D-15-00510

#ancianos#fracturas acetabulares