Ketamina

#ketamina El uso temprano de ketamina antagonista del receptor NMDA en estado epiléptico refractario y súper refractario. Early Use of the NMDA Receptor Antagonist Ketamine in Refractory and Super refractory Status Epilepticus. Zeiler FA. Crit Care Res Pract. 2015;2015:831260. doi: 10.1155/2015/831260. Epub 2015 Jan 12. Abstract Refractory status epilepticus (RSE) and superrefractory status epilepticus (SRSE) pose a difficult clinical challenge. Multiple cerebral receptor and transporter changes occur with prolonged status epilepticus leading to pharmacoresistance patterns unfavorable for conventional antiepileptics. In particular, n-methyl-d-aspartate (NMDA) receptor upregulation leads to glutamate mediated excitotoxicity. Targeting these NMDA receptors may provide a novel approach to otherwise refractory seizures. Ketamine has been utilized in RSE. Recent systematic review indicates 56.5% and 63.5% cessation in seizures in adults and pediatrics, respectively. No complications were described. We should consider earlier implementation of ketamine or other NMDA receptor antagonists, for RSE. Prospective study of early implementation of ketamine should shed light on the role of such medications in RSE. PDF Ketamina como un potencial manejo de ideación suicida. Revisión sistemática de la literatura Ketamine as a potential treatment for suicidal ideation: a systematic review of the literature. Reinstatler L, Youssef NA. Drugs R D. 2015 Mar;15(1):37-43. doi: 10.1007/s40268-015-0081-0. Abstract OBJECTIVE: To review the published literature on the efficacy of ketamine for the treatment of suicidal ideation (SI). METHODS: The PubMed and Cochrane databases were searched up to January 2015 for clinical trials and case reports describing therapeuticketamine administration to patients presenting with SI/suicidality. Searches were also conducted for relevant background material regarding the pharmacological function of ketamine. RESULTS: Nine publications (six studies and three case reports) met the search criteria for assessing SI after administration of subanestheticketamine. There were no studies examining the effect on suicide attempts or death by suicide. Each study demonstrated a rapid and clinically significant reduction in SI, with results similar to previously described data on ketamine and treatment-resistant depression. A total of 137 patients with SI have been reported in the literature as receiving therapeutic ketamine. Seven studies delivered a dose of 0.5 mg/kg intravenously over 40 min, while one study administered a 0.2 mg/kg intravenous bolus and another study administered a liquid suspension. The earliest significant results were seen after 40 min, and the longest results were observed up to 10 days postinfusion. CONCLUSION: Consistent with clinical research on ketamine as a rapid and effective treatment for depression, ketamine has shown early preliminary evidence of a reduction in depressive symptoms, as well as reducing SI, with minimal short-term side effects. Additional studies are needed to further investigate its mechanism of action, long-term outcomes, and long-term adverse effects (including abuse) and benefits. In addition,ketamine could potentially be used as a prototype for further development of rapid-acting antisuicidal medication with a practical route of administration and the most favorable risk/benefit ratio. PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Bibliotecas populares. Alerta

bibliotecas populares

NOTICIAS

UADER inaugura su biblioteca
Diario El Argentino
Gualeguaychú será una de las sedes nacionales de la Red de Bibliotecas Populares para la Integración Latinoamericana. Con la celebración de la ...




Tiempo de San Juan

"Identidad": el stand con el que San Juan se presentará en una nueva Feria del Libro
Tiempo de San Juan
Luego será el turno del libro "Cultura Popular Cuyana – Patrimonio ... que 56 personas pertenecientes a 21 bibliotecas populares de la provincia, ...




Diario La Verdad

Giaccone: “La tecnología nunca pudo destruir al libro ni lo va a hacer”
Diario La Verdad
La diputada participó en Olavarría del Quinto Foro de Bibliotecas de la ... y a las necesidades de las 500 bibliotecas populares que hoy tienen sede ...



Sancionaron Ley que dona al Arzobispado de Corrientes un inmueble en San Miguel
El Litoral
En tanto que la creación del Fondo de Asistencia a Bibliotecas Populares y de la Comisión Protectora de Bibliotecas Populares; volvió a comisión, ...



Extenso temario para la sesión de Diputados
El Litoral
... la creación del Fondo de Asistencia a Bibliotecas Populares y de la Comisión Protectora de Bibliotecas Populares(diputado Fernández Affur).



Destacan apertura de un nuevo “Centro de Prevención, Asesoramiento y Testeo de VIH”
Shelknamsur
En tal sentido, dijo, “pensamos en bibliotecas populares, centros comunitarios y lugares deportivos”, para confirmar que “actualmente funcionan tres ...



Abrió un nuevo Centro de Prevención, Asesoramiento y Testeo de VIH en Ushuaia
El Diario del Fin del Mundo
En este marco informó que actualmente funcionan tres CPAT: en la Biblioteca Popular Alfonsina Storni en Chubut 1843, esquina Santa Cruz, abierto ...

Más de gabapentina en DPO/More on gabapentin for POP

Comparación del efecto pre-emptivo de gabapentina y pregabalina orales en dolor agudo postoperatorio después de cirugía con anestesia espinal A comparison of effect of preemptive use of oral gabapentin and pregabalin for acute post-operative pain after surgery under spinal anesthesia. Bafna U1, Rajarajeshwaran K1, Khandelwal M1, Verma AP1. J Anaesthesiol Clin Pharmacol. 2014 Jul;30(3):373-7. doi: 10.4103/0970-9185.137270. Abstract BACKGROUND AND AIMS: Preemptive analgesia is an antinociceptive treatment that prevents establishment of altered processing of afferent input. Pregabalin has been claimed to be more effective in preventing neuropathic component of acute nociceptive pain of surgery. We conducted a study to compare the effect of oral gabapentin and pregabalin with control group for post-operative analgesia. MATERIALS AND METHODS: A total of 90 ASA grade I and II patients posted for elective gynecological surgeries were randomized into 3 groups (group A, B and C of 30 patients each). One hour before entering into the operation theatre the blinded drug selected for the study was given with a sip of water. Group A- received identical placebo capsule, Group B- received 600mg of gabapentin capsule and Group C - received 150 mg of pregabalin capsule. Spinal anesthesia was performed at L3-L4 interspace and a volume of 3.5 ml of 0.5% bupivacaine heavy injected over 30sec through a 25 G spinal needle. VAS score at first rescue analgesia, mean time of onset of analgesia, level of sensory block at 5min and 10 min interval, onset of motor block, total duration of analgesia and total requirement of rescue analgesia were observed as primary outcome. Hemodynamics and side effects were recorded as secondary outcome in all patients. RESULTS: A significantly longer mean duration of effective analgesia in group C was observed compared with other groups (P < 0.001). The mean duration of effective analgesia in group C was 535.16 ± 32.86 min versus 151.83 ± 16.21 minutes in group A and 302.00 ± 24.26 minutes in group B. The mean numbers of doses of rescue analgesia in the first 24 hours in group A, B and C was 4.7 ± 0.65, 4.1 ±0.66 and 3.9±0.614. (P value <0.001). CONCLUSION: We conclude that preemptive use of gabapentin 600mg and pregabalin 150 mg orally significantly reduces the postoperative rescue analgesic requirement and increases the duration of postoperative analgesia in patients undergoing elective gynecological surgeries under spinal anesthesia. KEYWORDS: Gabapentin; pregabalin; spinal anesthesia PDF  Reanálisis de consumo de morfina a partir de dos ensayos controlados aleatorios de gabapentina utilizando métodos estadísticos longitudinales controlados. Reanalysis of morphine consumption from two randomized controlled trials of gabapentin using longitudinal statistical methods. Zhang S, Paul J, Nantha-Aree M, Buckley N, Shahzad U, Cheng J, DeBeer J, Winemaker M, Wismer D, Punthakee D, Avram V, Thabane L. J Pain Res. 2015 Feb 9;8:79-85. doi: 10.2147/JPR.S56558. eCollection 2015. Abstract BACKGROUND: Postoperative pain management in total joint replacement surgery remains ineffective in up to 50% of patients and has an overwhelming impact in terms of patient well-being and health care burden. We present here an empirical analysis of two randomized controlled trials assessing whether addition of gabapentin to a multimodal perioperative analgesia regimen can reduce morphine consumption or improve analgesia for patients following total joint arthroplasty (the MOBILE trials). METHODS: Morphine consumption, measured for four time periods in patients undergoing total hip or total knee arthroplasty, was analyzed using a linear mixed-effects model to provide a longitudinal estimate of the treatment effect. Repeated-measures analysis of variance and generalized estimating equations were used in a sensitivity analysis to compare the robustness of the methods. RESULTS: There was no statistically significant difference in morphine consumption between the treatment group and a control group (mean effect size estimate 1.0, 95% confidence interval -4.7, 6.7, P=0.73). The results remained robust across different longitudinal methods. CONCLUSION: The results of the current reanalysis of morphine consumption align with those of the MOBILE trials. Gabapentin did not significantly reduce morphine consumption in patients undergoing major replacement surgeries. The results remain consistent across longitudinal methods. More work in the area of postoperative pain is required to provide adequate management for this patient population. KEYWORDS: gabapentin; postoperative morphine consumption; randomized controlled trials; reanalysis PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

http://www.madrimasd.org/informacionidi/noticias/noticia.asp?id=63344&origen=notiweb&dia_suplemento=miercoles

Nuestro cerebro funciona como Internet

Durante años, los científicos que estudian el cerebro se han fijado casi exclusivamente en lo que podían ver: lóbulos cerebrales, surcos, pliegues... Ahora, sin embargo, y gracias a un esquema más completo de cómo las neuronas se conectan unas a otras, los investigadores han podido descubrir la existencia de auténticas 'redes de área local' neuronales, anidadas unas dentro de otras como conchas. "La corteza cerebral es como un Internet en miniatura -afirma Larry Swanson, de la Universidad del Sur de California y uno de los autores del estudio-. Internet tiene innumerables redes de área local que luego se conectan con las redes regionales más grandes y en última instancia con la columna vertebral de Internet. El cerebro funciona de una manera similar". Lea el artículo completo aquí

Hipertension pulmonar y embarazo. Experiencia de 15 años en una institución de tercer nivel.

No.1940                                                                                   Abril 13, 2015

Hipertension pulmonar y embarazo. Experiencia de 15 años en una institución de tercer nivel. Pulmonary hypertension and pregnancy: The experience of a tertiary institution over 15 years. Monagle J, Manikappa S, Ingram B, Malkoutzis V. Ann Card Anaesth 2015;18:153-60 Abstract Background: Pulmonary hypertension (PH) in pregnancy is associated with a high maternal mortality and morbidity and has been found to be as high as 30-56%. Aim: To review the management of such patients in a tertiary center over a 15 year period, as the current literature consists of a few case reports, a few small case series and 2 meta-analyses. Materials and Methods: A review of all patients admitted to our institution for management of PH in pregnancy between 1994 and February 2009 was undertaken. Cases were identified from the high-risk pregnancy database within the department of anesthesia and from the hospital medical records. Severity of PH, type of PH, NYHA functional status at presentation and delivery, mode of delivery, peripartum monitoring and APGAR scores were noted. Patients were reviewed by a multidisciplinary team and management planned accordingly. Results: 19 eligible patients were identified. Patients who were significantly sick due to their PH were aggressively managed during pregnancy. Overall there was an improvement in NYHA functional status at the time of delivery. Epidural analgesia and anesthesia for labor and operatively delivery seem to be the ideal choice. Conclusion: Multidisciplinary approach is a key to the successful management of these patients. Secondary PH results in higher morbidity and mortality, in particular, older the age higher the maternal morbidity and mortality. Keywords: Anesthesia; pregnancy; pulmonary hypertension PDF

Atentamente Helen Gharaee Anestesia y Medicina del Dolor anestesia-dolor.org

Dexmedetomidina en pediatría/Dexmedetomidine in pediatrics

No.1947                                                                                   Abril 20, 2015

Dosis elevadas de dexmedetomidina. Efectiva como agente único para sedación en niños programados en RNM High dose dexmedetomidine: effective as a sole agent sedation for children undergoing MRI. Ahmed SS, Unland T, Slaven JE, Nitu ME. Int J Pediatr. 2015;2015:397372. doi: 10.1155/2015/397372. Epub 2015 Jan 29. PDF  La dexmedetomidina ofrece una opción para la sedación segura y efectiva para imágenes de medicina nuclear en niños. Dexmedetomidine offers an option for safe and effective sedation for nuclear medicine imaging in children. Mason KP, Robinson F, Fontaine P, Prescilla R. Radiology. 2013 Jun;267(3):911-7. doi: 10.1148/radiol.13121232. Epub 2013 Feb 28. Abstract PURPOSE: To determine the safety, efficacy, and outcomes of bradycardia, hypotension, and hypertension with dexmedetomidine (DEX), a recently approved sedative used for procedural sedation that has not been described previously for pediatric nuclear medicine imaging. MATERIALS AND METHODS: Between March 2005 and August 2011, 669 patients (mean age, 5.7 years ± 4.5 [standard deviation]; median age, 4.5 years; age range, 0.1-22.5 years) received DEX in this HIPAA-compliant study. Sedation was administered with DEX, an α-2 adrenergic agonist, as an intravenous bolus (2 μg per kilogram of body weight) over a 10-minute period; this was followed by continuous infusion at a rate of 1 μg/kg/h until imaging was complete. The bolus could be repeated up to two times, if needed, to achieve the targeted level of a Ramsay sedation score of 4. After institutional review board approval, collected quality assurance data were reviewed. RESULTS: Adequate sedation was achieved within 8.6 minutes ± 4.6 (median, 8.0 minutes; range, 1.0-40.0 minutes) on average in studies that averaged 41.3 minutes ± 25.5 (median, 31.5 minutes; range, 9.0-183.0 minutes). Of 669 studies, 667 (99.7%) were completed successfully. Six children (0.9%) had brief periods of oxygen desaturation below 95%, none of which required airway intervention. Hypotension, hypertension, and bradycardia (all defined as deviations of more than 20% from age-adjusted awake norms), occurred in 58.7% (n = 393), 2.1% (n = 14), and 4.3% (n = 29) of patients, respectively. Both hypotension and bradycardia were related to age (P = .033 and P = .002, respectively); older children tended to experience more of these events. None of these fluctuations required pharmacologic therapy. Discharge criteria (modified Aldrete score ≥ 9) were met, on average, within 41.4 minutes ± 27.9 (median, 36.0 minutes; range, 1.0-220.0 minutes). CONCLUSION: DEX offers advantages for pediatric sedation for nuclear medicine imaging. DEX produces a condition similar to natural sleep, with no detrimental effect on respiration. The hemodynamic variability anticipated with DEX did not require pharmacologic treatment, and the drug was well tolerated. PDF Sedación pediátrica en un centro de RNM ambulatoria en un hospital de la comunidad Pediatric sedation in a community hospital-based outpatient MRI center. Mason KP1, Fontaine PJ, Robinson F, Zgleszewski S. AJR Am J Roentgenol. 2012 Feb;198(2):448-52. doi: 10.2214/AJR.11.7346. Abstract OBJECTIVE: Although the demand for pediatric MRI is increasing, it is uncommon to find sedation being offered at community hospital-based outpatient centers. We present our safety, efficacy, and outcome data at a community hospital-based outpatient imaging center. MATERIALS AND METHODS: I.v. dexmedetomidine sedation was administered as a bolus of 3 μg/kg and maintained with a continuous infusion of 1 μg/kg/hr until imaging was complete. The dexmedetomidine bolus could be repeated up to two times, if needed. Quality assurance data were reviewed. RESULTS: From April 2009 to July 2010, 279 children (mean age, 4.2 years; age range, 0.2-17.2 years) were sedated. All received a first bolus, 46 required a second dose, and two received a third. The average time to achieve sedation was 7.8 minutes (SD, ± 3.8 minutes). Total duration of imaging (82% brain MRI) averaged 38.1 minutes (range, 8.0-126.0 minutes). On average, discharge criteria were met within 21.3 minutes of arrival in recovery room (± 17.8 minutes). The heart rate and blood pressure deviated from baseline by more than 20% in 5% and 33% of the patients, respectively. No pharmacologic therapy was administered to treat the hemodynamic variability. There were no adverse respiratory events. All imaging studies were successfully completed. CONCLUSION: Dexmedetomidine offers an option for pediatric sedation for MRI at community hospital-based outpatient settings. It preserves respiration but elicits deviations in blood pressure and heart rate that have not required pharmacologic intervention. Dexmedetomidine offers a safe, effective, and efficient agent for sedation for children undergoing MRI in an outpatient setting. PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Fuente
Este artículo es originalmente publicado en:
http://www.madrimasd.org/informacionidi/noticias/noticia.asp?id=63448&origen=notiweb&dia_suplemento=lunes

Smartphones para evitar la desorientación espacial de personas mayores

El Grupo de Bioingeniería y Telemedicina (GBT) de la Universidad Politécnica de Madrid (UPM) ha desarrollado un servicio de localización mediante smartphones para detectar de forma temprana episodios de desorientación espacial que con cierta frecuencia sufren las personas mayores con deterioro cognitivo leve. La detección de la situación de desorientación y pérdida tiene en cuenta información del contexto de la persona mayor, como por ejemplo la cercanía a su domicilio o lugar de interés, si está acompañado por un familiar, si se está moviendo en transporte público, o intervalos de tiempo determinados. Si ocurre dicho episodio de desorientación, el servicio pondrá en contacto a la persona mayor con su contacto (familiar, personal sanitario, amigos, etc.) más próximo para confirmar si la persona necesita ayuda.... Lea el artículo completo, AQUÍ

Dexmedetomidine

Dexmedetomidina en la práctica anestésica actual. Un revisión Dexmedetomidine in current anaesthesia practice- a review. Naaz S, Ozair E. J Clin Diagn Res. 2014 Oct;8(10):GE01-4. doi: 10.7860/JCDR/2014/9624.4946. Epub 2014 Oct 20. Abstract Dexmedetomidine is an alpha 2 adrenergic receptor agonist, even ten times more selective than clonidine. It is a very versatile drug in anaesthesia practice, finding place in increasing number of clinical scenarios and is no more limited to intensive care unit (ICU) sedation. It is analgesic, has anaesthetic sparing effect, sympatholytic property, useful in other procedural sedation and also has cardiovascular stabilizing property. It reduces delirium and preserves respiratory function which adds benefits to its uses. The aim of this review is to make awareness of its role in present anaesthesia and discuss its limitations at the same time. KEYWORDS: Alpha 2 adrenergic agonist; Anaesthesia; Dexmedetomidine; Intensive care unit PDF   Variabilidad interpacientes de la respuesta a dexmedetomidina. Revisión de la literatura Interpatient variability in dexmedetomidine response: a survey of the literature. Holliday SF1, Kane-Gill SL2, Empey PE2, Buckley MS3, Smithburger PL2. ScientificWorldJournal. 2014 Jan 16;2014:805013. doi: 10.1155/2014/805013. eCollection 2014 Abstract Fifty-five thousand patients are cared for in the intensive care unit (ICU) daily with sedation utilized to reduce anxiety and agitation while optimizing comfort. The Society of Critical Care Medicine (SCCM) released updated guidelines for management of pain, agitation, and delirium in the ICU and recommended nonbenzodiazepines, such as dexmedetomidine and propofol, as first line sedation agents. Dexmedetomidine, an alpha-2 agonist, offers many benefits yet its use is mired by the inability to consistently achieve sedation goals. Three hypotheses including patient traits/characteristics, pharmacokinetics in critically ill patients, and clinically relevant genetic polymorphisms that could affect dexmedetomidineresponse are presented. Studies in patient traits have yielded conflicting results regarding the role of race yet suggest that dexmedetomidine may produce more consistent results in less critically ill patients and with home antidepressant use. Pharmacokinetics of critically ill patients are reported as similar to healthy individuals yet wide, unexplained interpatient variability in dexmedetomidine serum levels exist. Genetic polymorphisms in both metabolism and receptor response have been evaluated in few studies, and the results remain inconclusive. To fully understand the role ofdexmedetomidine, it is vital to further evaluate what prompts such marked interpatient variability in critically ill patients. PDF

Atentamente Helen Gharaee Anestesia y Medicina del Dolor anestesia-dolor.org

Hipertensión pulmonar y embarazo/Pregnancy in pulmonary hypertension

Hipertensión pulmonar en el embarazo: Manejo crítico Pulmonary Hypertension in Pregnancy: Critical Care Management Adel M. Bassily-Marcus, Carol Yuan, John Oropello, Anthony Manasia, Roopa Kohli-Seth, and Ernest Benjamin Pulmonary Medicine Volume 2012 (2012), Article ID 709407, 9 pages Abstract Pulmonary hypertension is common in critical care settings and in presence of right ventricular failure is challenging to manage. Pulmonary hypertension in pregnant patients carries a high mortality rates between 30-56%. In the past decade, new treatments for pulmonary hypertension have emerged. Their application in pregnant women with pulmonary hypertension may hold promise in reducing morbidity and mortality. Signs and symptoms of pulmonary hypertension are nonspecific in pregnant women. Imaging workup may have undesirable radiation exposure. Pulmonary artery catheter remains the gold standard for diagnosing pulmonary hypertension, although its use in the intensive care unit for other conditions has slowly fallen out of favor. Goal-directed bedside echocardiogram and lung ultrasonography provide attractive alternatives. Basic principles of managing pulmonary hypertension with right ventricular failure are maintaining right ventricular function and reducing pulmonary vascular resistance. Fluid resuscitation and various vasopressors are used with caution. Pulmonary-hypertension-targeted therapies have been utilized in pregnant women with understanding of their safety profile. Mainstay therapy for pulmonary embolism is anticoagulation, and the treatment for amniotic fluid embolism remains supportive care. Multidisciplinary team approach is crucial to achieving successful outcomes in these difficult cases. PDF La embarazada con hipertensión pulmonar. Una revisión The pregnant patient with pulmonary artery hypertension. A review. Frost EA. Middle East J Anaesthesiol. 2011 Jun;21(2):199-206. PDF Anestesia para cesárea en dos mujeres con hipertensión pulmonar severa secundaria a estenosis mitral Anaesthetic management for caesarean section surgery in two pregnant women with severe pulmonary hypertension due to mitral valve stenosis. Celik M, Dostbil A, Alici HA et al. Balkan Med J. 2013 Dec;30(4):439-41. doi: 10.5152/balkanmedj.2013.8416. Epub 2013 Dec 1. Abstract BACKGROUND: Mitral stenosis is the most important and common cardiac complication seen during pregnancy. Conception is discouraged in cases where pulmonary hypertension develops during the course of mitral stenosis. Successful general and regional anaesthetic interventions have been reported in some cases of severe pulmonary hypertension. CASE REPORTS: We present our experiences with anaesthetic management in two pregnant patients with pulmonary hypertension due to mitral valve stenosis. CONCLUSION: We preferred to continue spinal anaesthesia because gradually increasing the local anaesthetic dose during the procedure may minimise probable undesirable haemodynamic changes, such as hypotension and tachycardia. KEYWORDS: Mitral Stenosis; caesarean section; pulmonary hypertension; regional anaesthesia PDF

Atentamente Helen Gharaee Anestesia y Medicina del Dolor anestesia-dolor.org

Medwave

A continuación le informamos los artículos recientemente publicados en Medwave.


ESTUDIO PRIMARIO

Estudio transversal sobre tabaquismo y su relación con valores espirométricos en estudiantes de tercer año de medicina
Victor Hugo Fernández, Mariela Edith Beligoy, Yessica Vanesa Lima, Pablo Federico Barissi (Argentina)

Medwave 2015 Abr;15(3):e6124
http://dx.doi.org/10.5867/medwave.2015.03.6124


RESUMEN EPISTEMONIKOS

¿Debe indicarse acetilcisteína para prevenir la nefropatía por contraste?
Ariel Izcovich, Gabriel Rada (Argentina, Chile)

Medwave 2015 Abr;15(3):e6122
http://dx.doi.org/10.5867/medwave.2015.03.6122


ARTÍCULO DE REVISIÓN

Plantas latinoamericanas como fuente de nuevos antineoplásicos, situación actual y nuevas oportunidades contra el cáncer
Eduardo Freddy Orrego Escobar (Chile)

Medwave 2015 Abr;15(3):e6121
http://dx.doi.org/10.5867/medwave.2015.03.6121


RESUMEN EPISTEMONIKOS

¿La aspirina reduce la recurrencia de eventos tromboembólicos idiopáticos después de completado el tratamiento anticoagulante?
Andrés Valenzuela, Andrés Aizman (Chile)

Medwave 2015 Abr;15(3):e6118
http://dx.doi.org/10.5867/medwave.2015.03.6118


REVISIÓN CLÍNICA

Terapia de reemplazo con testosterona y cáncer de próstata: ¿la caída de un paradigma?
Octavio A. Castillo, Gastón López-Fontana, Ivar Vidal-Mora, José Daniel López Laur (Chile, Argentina)

Medwave 2015 Abr;15(3):e6115
http://dx.doi.org/10.5867/medwave.2015.03.6115



PORTADA MEDWAVE
www.medwave.cl