sábado, 10 de noviembre de 2012

Actualización en el manejo perioperatorio del niño asmático

Actualización en el manejo perioperatorio del niño asmático

Update on perioperative management of the child with asthma.
Dones F, Foresta G, Russotto V.
Department of Anesthesia and Intensive Care AOUP, University of Palermo, Italy.
Pediatr Rep. 2012 Apr 2;4(2):e19. Epub 2012 Apr 5.
Abstract
Asthma represents the leading cause of morbidity from a chronic disease among children. Dealing with this disease during the perioperative period of pediatric surgical procedures is, therefore, quite common for the anesthesiologist and other professionalities involved. Preoperative assessment has a key role in detecting children at increased risk of perioperative respiratory complications. For children without an optimal control of symptoms or with a recent respiratory tract infection elective surgery should be postponed, if possible, after the optimization of therapy. According to clinical setting, loco-regional anesthesia represents the desirable option since it allows to avoid airway instrumentation. Airway management goals are preventing the increase of airflow resistance during general anesthesia along with avoiding triggers of bronchospasm. When their use is possible, face mask ventilation and laringeal mask are considered more reliable than tracheal intubation for children with asthma. Sevoflurane is the most commonly used anesthetic for induction and manteinance. Salbutamol seems to be useful in preventing airflow resistance rise after endotracheal intubation. Mechanical ventilation should be tailored according to pathophysiology of asthma: an adequate expiratory time should be setted in order to avoid a positive end-expiratory pressure due to expiratory airflow obstruction. Pain should be prevented and promptly controlled with a loco-regional anesthesia technique when it is possible. Potential allergic reactions to drugs or latex should always be considered during the whole perioperative period. Creating a serene atmosphere should be adopted as an important component of interventions in order to guarantee the best care to the asthmatic child.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395977/pdf/pr-2012-2-e19.pdf

Atentamente
Dr. Enrique Hernández-Cortez
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

[Identidad Bibliotecaria] [Bibliópolis: ...] El arte de Discutir y Argumentar

Enrique Campang Chang (Desde Guatemala. Especial para ARGENPRESS CULTURAL)

Discutir y argumentar son parte del conocimiento para formular conclusiones, recomendaciones y acciones; pero también es algo fuerte que atrae, apasiona, que en no pocas oportunidades puede ser molesto y una pérdida de tiempo.

Discutir y argumentar debe ser un arte, pero para otros una forma de simplemente llevar la contraria, hostigar o ganas de fastidiar. El argumento es improvisado, poco sólido, se aborda desde el defecto en vez de la virtud, o la visión fecal de las cosas.

Es una discusión necia, entre fanáticos, pobre en argumentos; en círculo vicioso, que degenera en insultos y ataques personales; es una forma de discusión que llamo DENTRO DE AGUAS TURBIAS Y AGITADAS, donde no se escucha al otro; un monólogo; no se llega a nada, (entre fanáticos palestinos y judíos).

Estas son las más frecuentes en política, religión, o deportes; entre inmaduros o tercos. Donde cada uno ya tiene su criterio; no se acepta discusión alguna, es el esfuerzo de imponer sus ideas a otro; o si no, se les descalifica. Es imposible discutir entre impacientes que demandan argumentos en pocas palabras en una competencia de egos ofuscados.

Es una discusión estéril, sobre temas difíciles que no comprenden; cada opinión revuelve más las aguas; no hay serenidad, empatía; no se quedan conformes hasta que el otro dice lo que quiere oír.

En las reuniones, cuando se discute en aguas turbias o agitadas, sobre el fútbol, las modas, religión o política, por salud mental es mejor verlas desde afuera. Son discusiones que no llevan a nada.

Otro tipo es la DISCUSIÓN SIN SALIRSE DEL AGUA, se discute con respeto, pero cada postura está comprometida a no modificarla; hay límites entre los grupos de intereses; donde no es posible ir más allá de la línea oficial. Se sabe cuándo es el momento de no seguir. Se evita tocar temas a fondo, dogmas, sus limitaciones o intereses ocultos.

Es donde el religioso, político, subalterno están atados. Hay condiciones que restringen la libertad del argumento en temas delicados. Son llamados al orden si se apartan. Se aplica con rigor el peso de los libros, las citas del Diccionario de la RAE y las normas formales de la APA. Con procedimientos técnicamente correctos, pero posiblemente falsos o superficiales. Se mantienen dentro del círculo.

Es la discusión donde se evitan los temas tabú, prohibidos o incómodos. El capitalista, comunista, cristiano o musulmán hablan dentro de su ideología o credo, cuidándose de no tocar sus temas controversiales, eso si, pueden atacar a otros.
En una reunión de vegetarianos, nadie habla a favor de comer un delicioso asado de res.

Se mantiene la altura, pero con sus limitaciones, que termina con un discreto cambio de tema, cuando seguir resulta incómodo. Son discusiones con argumentos “cuadrados” política o moralmente correctos. No se pone en duda nada, se evitan las ideas escandalosas. Toda autoridad desde el presidente de los Estados Unidos a los papas debe mantenerse dentro del agua, no pueden salirse.

Son argumentos en refrito: repetición y machacado de ideas viejas, de autores encumbrados, en variaciones sobre los mismos temas; no se permiten las ideas propias; el que se atreve a salirse de la olla es regresado por los otros cangrejos…

Luego, la DISCUSIÓN ENCIMA DEL AGUA, es la de alto nivel, es la discusión amplia, productiva, libre, donde se pueden criticar esquemas, es creativa; cuando las partes pueden admitir su error; trascienden las posturas personales, se abre a ideas nuevas, sin insultos, pueden parecer irreverentes, romper con paradigmas, dogmas o posturas históricamente aceptadas pero equivocadas. Estas discusiones por sus aportes novedosos pueden caer dentro de lo subversivo, herético, profético o peligroso.

Se llega a niveles superiores; diferentes a la discusión de aguas turbias; las personas no se sienten ofendidas, hay entusiasmo, acompañamiento, inquietud sana. Hay atrevimiento, riesgo de enfrentarse a niveles desconocidos, de alterar esquemas propios. Se marcan caminos nuevos,

Cuando Jesús rompe con la tradición religiosa y política de sus tiempos; habla de temas revolucionarios como el amor al prójimo, el bien común, la dignidad de las personas, la atención por los pobres. Está encima del agua, libera a las personas de los errores tradicionales, se eleva en el sentido de la parábola de caminar sobre las aguas.

Los pensamientos revolucionarios e innovadores son por encima de las aguas, Es el nivel verdaderamente superior de la discusión y argumentación. Los conceptos tradicionales se corrigen, amplían o adaptan a los nuevos contextos.

Unos que llegan al nivel de estar por encima de las aguas como Buda, Lao Tse, Confucio, Giordano Bruno, Galileo, Newton, Darwin, Marx, Freud, son incomprendidos o perseguidos; o se dan cuenta que se quedan hablando solos. Son despreciados por los que no se atreven a salir de sus pensamientos, reglas o costumbres que les dan seguridad; y como decía una amiga: “muchas herejías e ideas subversivas son pensamientos antes de su tiempo”.

En las universidades y centros de decisión los espacios de discusión y argumentación de altura son necesarios para romper los estancamientos intelectuales. La humanidad pierde al no convertir la discusión y argumentación en un arte. En la política de muchos países se maneja la discusión en su nivel más bajo, con ignorancia, insultos y amenazas. (Ej. Congreso de Guatemala).

No se trata de discutir por discutir, se tiene que saber el nivel en que se está metiendo.

En: http://cultural.argenpress.info/2012/11/el-arte-de-discutir-y-argumentar.html

lunes, 5 de noviembre de 2012

Medicamentos para la obesidad: pasado, presente y futuro

Medicamentos para la obesidad: pasado, presente y futuro

Anti-obesity drugs: past, present and future.
Rodgers RJ, Tschöp MH, Wilding JP.
Behavioural Neuroscience Laboratory, Institute of Psychological Sciences, University of Leeds, LS2 9JT, UK. r.j.rodgers@leeds.ac.uk
Dis Model Mech. 2012 Sep;5(5):621-6. doi: 10.1242/dmm.009621.

Abstract
The ideal anti-obesity drug would produce sustained weight loss with minimal side effects. The mechanisms that regulate energy balance have substantial built-in redundancy, overlap considerably with other physiological functions, and are influenced by social, hedonic and psychological factors that limit the effectiveness of pharmacological interventions. It is therefore unsurprising that anti-obesity drug discovery programmes have been littered with false starts, failures in clinical development, and withdrawals due to adverse effects that were not fully appreciated at the time of launch. Drugs that target pathways in metabolic tissues, such as adipocytes, liver and skeletal muscle, have shown potential in preclinical studies but none has yet reached clinical development. Recent improvements in the understanding of peptidergic signalling of hunger and satiety from the gastrointestinal tract mediated by ghrelin, cholecystokinin (CCK), peptide YY (PYY) and glucagon-like peptide-1 (GLP-1), and of homeostatic mechanisms related to leptin and its upstream pathways in the hypothalamus, have opened up new possibilities. Although some have now reached clinical development, it is uncertain whether they will meet the strict regulatory hurdles required for licensing of an anti-obesity drug. However, GLP-1 receptor agonists have already succeeded in diabetes treatment and, owing to their attractive body-weight-lowering effects in humans, will perhaps also pave the way for other anti-obesity agents. To succeed in developing drugs that control body weight to the extent seen following surgical intervention, it seems obvious that a new paradigm is needed. In other therapeutic arenas, such as diabetes and hypertension, lower doses of multiple agents targeting different pathways often yield better results than strategies that modify one pathway alone. Some combination approaches using peptides and small molecules have now reached clinical trials, although recent regulatory experience suggests that large challenges lie ahead. In future, this polytherapeutic strategy could possibly rival surgery in terms of efficacy, safety and sustainability of weight loss.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3424459/

http://dmm.biologists.org/content/5/5/621.full.pdf

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

Bibliotecas. Alerta

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Andina
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Diario del Huila
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J. R. S. Bien es cierto que la parcela cultural será una de las más afectadas por los recortes económicos aplicados por el Consell para 2013, pero dentro de esa gran isla es, sin duda, el área de libros, archivos y bibliotecas la que sufre una nueva y ...
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Neiva tendrá la mejor biblioteca del país
La Nación.com.co
El proyecto que tiene un costo de 9.800 millones de pesos y que tiene un avance de obra del 85 por ciento será modelo a nivel nacional, pues su infraestructura cumple con los más altos estándares en términos de operación, tecnología y arquitectura, ...
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Momentos de delicadeza exhibe Nueva Biblioteca Ciudadela: Lynn ...
RadioFórmula
Fue inaugurada la Nueva Ciudadela donde habrán cinco bibliotecas, que albergarán 220 mil volúmenes que forman parte de Alí Chumacero, Jaime García Terrés, José Luis Martínez, Antonio Castro Leal y Carlos Monsiváis. El edificio que se encuentra ...
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Los vecinos de Parque Goya recogen libros para hacer una biblioteca
Heraldo de Aragon
La Biblioteca de Los Vecinos. Este es el nombre que recibirá, cuando entre en funcionamiento, el nuevo servicio de prestación de libros que la Asociación de Vecinos Parque Goya acaba de poner en marcha. Se trata de una iniciativa que pretende hacer las...
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Heraldo de Aragon

Bibliotecas norteamericanas ante la web social | blok de bid
¿Están usando las bibliotecas de los Estados Unidos las herramientas de la web social? Las que lo hacen, ¿con qué intenciones? ¿A través de qué tipo de ...
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domingo, 4 de noviembre de 2012

Estudio observacional sobre la elección de anestesia y la evolución de las pacientes con pre-eclampsia severa y cesárea urgente

Estudio observacional sobre la elección de anestesia y la evolución de las pacientes con pre-eclampsia severa y cesárea urgente

Observational study of choice of anaesthesia and outcome in patients with severe pre-eclampsia who present for emergency Caesarean section
Kiran Keerath, L Cronje
South Afr J Anaesth Analg 2012;18(4):206-212
Abstract
Objectives: Recent evidence in the literature suggests that regional anaesthesia may be the preferred choice over general anaesthesia for patients with severe pre-eclampsia who present for a Caesarean section. This study was conducted to determine if this applied to our population and to assess outcomes. Design: A retrospective comparative observational study was conducted. Setting and subjects: The study was carried out at the King Edward VIII Hospital and included patients with severe preeclampsia who presented for emergency Caesarean section. Eighty-four charts were analysed. Outcome measures: The type of anaesthetic that was administered was determined and compared for maternal intraoperative haemodynamic changes and maternal and neonatal outcomes. Results: Sixty-nine per cent of patients received spinal anaesthesia and 25% general anaesthesia (GA). Intraoperative systolic blood pressures of < 100 mmHg were recorded in 19% of GA and in 27.6% of spinal anaesthesia cases. A > 20% fall in mean arterial pressure from baseline was noted in 66.7% of GA and in 75.9% of spinal anaesthesia cases. There was no maternal mortality and one case of morbidity (a spinal anaesthesia case). An Apgar score of < 7 was recorded in 66.7% of GA cases and in 19% of spinal anaesthesia cases. Neonatal morbidity and mortality occurred in 33.3% of GA and in 10.3% of spinal anaesthesia cases. Conclusion: Maternal morbidity and mortality were not significantly different between the two groups. Neonatal outcomes were poorer in the GA group, but neonates in the GA group had significantly lower birthweights and gestational ages. Their mothers also had more severe disease. This study supports spinal anaesthesia as an appropriate anaesthetic choice in patients with severe pre-eclampsia.
http://www.ajol.info/index.php/sajaa/article/viewFile/82330/72486

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

sábado, 3 de noviembre de 2012

Novedades en anestésicos locales

Bupivacaína liposomal: revisión de una nueva formulación de bupivacaína

Liposomal bupivacaine: a review of a new bupivacaine formulation.
Chahar P, Cummings KC 3rd.
Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
J Pain Res. 2012;5:257-64. doi: 10.2147/JPR.S27894. Epub 2012 Aug 14.
Abstract
Many attempts have been made to increase the duration of local anesthetic action. One avenue of investigation has focused on encapsulating local anesthetics within carrier molecules to increase their residence time at the site of action. This article aims to review the literature surrounding the recently approved formulation of bupivacaine, which consists of bupivacaine loaded in multivesicular liposomes. This preparation increases the duration of local anesthetic action by slow release from the liposome and delays the peak plasma concentration when compared to plain bupivacaine administration. Liposomal bupivacaine has been approved by the US Food and Drug Administration for local infiltration for pain relief after bunionectomy and hemorrhoidectomy. Studies have shown it to be an effective tool for postoperative pain relief with opioid sparing effects and it has also been found to have an acceptable adverse effect profile. Its kinetics are favorable even in patients with moderate hepatic impairment, and it has been found not to delay wound healing after orthopedic surgery. More studies are needed to establish its safety and efficacy for use via intrathecal, epidural, or perineural routes. In conclusion, liposomal bupivacaine is effective for treating postoperative pain when used via local infiltration when compared to placebo with a prolonged duration of action, predictable kinetics, and an acceptable side effect profile. However, more adequately powered trials are needed to establish its superiority over plain bupivacaine.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3442744/pdf/jpr-5-257.pdf

Bupivacaína liposomal; inovativo analgésico local no opioide para el manejo del dolor postoperatorio
Liposomal bupivacaine: an innovative nonopioid local analgesic for the management of postsurgical pain.
Candiotti K.
University of Miami Miller School of Medicine, Miami, Florida.
Pharmacotherapy. 2012 Sep;32(9 Pt 2):19S-26S. doi: 10.1002/j.1875-9114.2012.01183.x.
Abstract
Local anesthetics are a cornerstone of multimodal pain control strategies in the surgical setting as they have a long history of use and an established safety profile. Although effective, their duration of action is relatively short, which usually leads to the use of other agents, such as opioids, for effective postsurgical pain control in most patients. A medical need exists to extend the duration of analgesia with local anesthetics to help reduce the reliance on opioids in the postsurgical setting. Liposomal bupivacaine uses a product delivery platform to release bupivacaine slowly over 96 hours after infiltration at the surgical site. Liposomal bupivacaine was compared with placebo in two pivotal, multicenter, randomized, double-blind, parallel-group trials in 189 adults undergoing soft-tissue surgery (hemorrhoidectomy) and 193 adults undergoing orthopedic surgery (bunionectomy). Among patients undergoing hemorrhoidectomy, liposomal bupivacaine significantly reduced cumulative pain scores for up to 72 hours (primary end point) as measured by the area under the curve of pain scores on the numeric rating scale (p<0.0001), reduced overall opioid consumption (p≤0.0006), increased the proportion of patients who did not receive opioids (p<0.0008), delayed time to first opioid by more than 13 hours (p<0.0001), and was associated with significantly higher rates of patient satisfaction (p=0.0007) compared with placebo. Similarly, in patients undergoing bunionectomy, liposomal bupivacaine significantly reduced total consumption of rescue opioids (p=0.0077) and cumulative pain scores as measured by the area under the curve of pain scores on the numeric rating scale (p=0.0005) during the first 24 postsurgical hours (primary end point) relative to placebo. Furthermore, liposomal bupivacaine also significantly delayed the time to first use of opioid rescue (p<0.0001) and increased the proportion of patients requiring no rescue opioid treatment (p≤0.0404) compared with placebo. The most common adverse events with liposomal bupivacaine were nausea, vomiting, and constipation. No adverse effects on the QTc interval or cardiac safety signal have been detected in the clinical trial development program (823 patients) when liposomal bupivacaine was infiltrated into the surgical site. The beneficial effects of liposomal bupivacaine on postsurgical pain management and opioid use, significantly reducing both, are likely to translate into improved clinical and economic outcomes.
http://onlinelibrary.wiley.com/doi/10.1002/j.1875-9114.2012.01183.x/pdf

Articaína: revisión de su uso para anestesia local y regional

Articaine: a review of its use for local and regional anesthesia.
Snoeck M.
Department of Anaesthesia, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
Local Reg Anesth. 2012;5:23-33. Epub 2012 Jun 5.
Abstract
Articaine is an intermediate-potency, short-acting amide local anesthetic with a fast metabolism due to an ester group in its structure. It is effective with local infiltration or peripheral nerve block in dentistry, when administered as a spinal, epidural, ocular, or regional nerve block, or when injected intravenously for regional anesthesia. In comparative trials, its clinical effects were not generally significantly different from those of other short-acting local anesthetics like lidocaine, prilocaine, and chloroprocaine, and there is no conclusive evidence demonstrating above-average neurotoxicity. Articaine proved to be suitable and safe for procedures requiring a short duration of action in which a fast onset of anesthesia is desired, eg, dental procedures and ambulatory spinal anesthesia, in normal and in special populations.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3417979/pdf/lra-5-023.pdf

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

Vía aérea en obesidad

Impactos de la súper obesidad versus la obesidad mórbida sobre la mecánica respiratoria y los parámetros hemodinámicos simples durante la cirugía bariátrica

The Impacts of Super Obesity Versus Morbid Obesity on Respiratory Mechanics and Simple Hemodynamic Parameters During Bariatric Surgery.
Salihoglu T, Salihoglu Z, Zengin AK, Taskin M, Colakoglu N, Babazade R.
Department of Anesthesiology and Reanimation, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey, tsalihoglu@hotmail.com.
Obes Surg. 2012 Oct 3. [Epub ahead of print]
Abstract
BACKGROUND: This study was designed to determine the impact of the degree of obesity on respiratory mechanics and simple hemodynamic parameters at laparoscopic bariatric surgery. METHODS: The patients were divided into two groups, each of which included 24 patients (a morbidly obese group and a super obese group) undergoing laparoscopic bariatric surgery. Dynamic respiratory compliance, respiratory resistance, and peak inspiratory pressures were measured at four time points: 10 min after anesthesia induction (T1: induction), 10 min after pneumoperitoneum (T2: pneumoperitoneum), 10 min after terminating pneumoperitoneum (T3: end-pneumoperitoneum), and before extubation (T4: extubation). The systolic, diastolic, and mean arterial pressures and the heart rate values were measured noninvasively in T0 (10 min before operation). RESULTS: Obesity was found to cause a statistically significant increase in respiratory resistance and a peak inspiratory pressure and a decrease in dynamic respiratory compliance. In the morbidly obese group, the lowest dynamic respiratory compliance was 37mL/cm H(2)O, but it was 33mL/cm H(2)O in the super obese group. The systolic pressure, diastolic pressure, and mean arterial pressure were found to decrease significantly in both groups. CONCLUSIONS: Morbid obesity and super obesity have negative effects on hemodynamics and respiratory mechanics.
http://www.springerlink.com/content/uq123946442l8103/fulltext.pdf

Efectos del neumoperitoneo sobre la mecánica respiratoria durante cirugía bariátrica

The Effects of Pneumoperitoneum on Respiratory Mechanics During Bariatric Surgery
Sener Demiroluk, MD1; Ziya Salihoglu, MD1; Kagan Zengin, MD2; Yildiz
Kose, MD1; Mustafa Taskin, MD2
University of Istanbul, Cerrahpasa Medical School, Department of 1Anaesthesiology and 2General Surgery, Istanbul, Turkey
Obesity Surgery, 12, 376-379
Background: The aim of this study was to investigate the influence of laparoscopic and conventional open surgery on respiratory mechanics, and blood gases, and to determine convenient techniques from the point of view of intraoperative respiratory mechanics, for bariatric surgery. Method: 40 morbidly obese patients were divided into 2 groups, patients undergoing laparoscopy Group 1, and patients undergoing conventional open surgery Group 2. Resistance of airway, dynamic compliance, and peak inspiratory pressure were measured. Measurement was performed in 4 periods: a) after anesthesia induction, b) after pneumoperitoneum in the Group 1 and after incision in the Group 2, c) after gastric band placement, d) and 5 min before extubation. Blood gases were recorded concomitantly. Results: There was no significant difference between the 2 groups in values of blood gases and respiratory mechanics. Conclusion: In the morbidly obese, laparoscopic and open surgery did not cause a significant difference for respiratory mechanics when compared with each other.
Key words: Morbid obesity, laparotomy, pneumoperitoneum, respiratory mechanics, compliance, bariatric
surgery
http://www.springerlink.com/content/l46m466075335353/fulltext.pdf

Desafíos en la evaluación del riesgo pulmonar y el manejo perioperatorio en pacientes sometidos a cirugía bariátrica

Challenges in pulmonary risk assessment and perioperative management in bariatric surgery patients.
Kaw R, Aboussouan L, Auckley D, Bae C, Gugliotti D, Grant P, Jaber W, Schauer P, Sessler D.
Department of Hospital Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue-S70, Cleveland, OH 44195, USA. Kawr@ccf.org
Obes Surg. 2008 Jan;18(1):134-8. Epub 2007 Nov 16.
Abstract
Bariatric surgery has serious associated medical comorbidity and procedure-related risks and is, thus, considered an intermediate-to-high-risk non-cardiac surgery. Altered respiratory mechanics, obstructive sleep apnea (OSA), and less often, pulmonary hypertension and postoperative pulmonary embolism are the major contributors to poor pulmonary outcomes in obese patients. Attention to posture and positioning is critical in patients with OSA. Suspected OSA patients requiring intravenous narcotics should be kept in a monitored setting with frequent assessments and naloxone kept at the bedside. Use of reverse Tredelenburg position, preinduction, maintenance of positive end-expiratory pressure, and use of continuous positive airway pressure can help improve oxygenation in the perioperative period.

ttp://www.springerlink.com/content/u333063w537375kj/fulltext.pdf

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

viernes, 2 de noviembre de 2012

Ketamina, inflamación y analgesia

Revisión sistemática de ketamina intravenosa para analgesia postoperatoria

A systematic review of intravenous ketamine for postoperative analgesia.
Laskowski K, Stirling A, McKay WP, Lim HJ.
Department of Anesthesiology, Perioperative Medicine and Pain Management, College of Medicine, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada. kevin.laskowski@usask.ca
Can J Anaesth. 2011 Oct;58(10):911-23. Epub 2011 Jul 20.
Abstract
PURPOSE: Perioperative intravenous ketamine may be a useful addition in pain management regimens. Previous systematic reviews have included all methods of ketamine administration, and heterogeneity between studies has been substantial. This study addresses this issue by narrowing the inclusion criteria, using a random effects model, and performing subgroup analysis to determine the specific types of patients, surgery, and clinical indications which may benefit from perioperative ketamine administration. SOURCE: We included published studies from 1966 to 2010 which were randomized, double-blinded, and placebo-controlled using intravenous ketamine (bolus or infusion) to decrease postoperative pain. Studies using any form of regional anesthesia were excluded. No limitation was placed on the ketamine dose, patient age, or language of publication. PRINCIPAL FINDINGS: Ninety-one comparisons in seventy studies involving 4,701 patients met the inclusion criteria (2,652 in ketamine groups and 2,049 in placebo groups). Forty-seven of these studies were appropriate for evaluation in the core meta-analysis, and the remaining 23 studies were used to corroborate the results. A reduction in total opioid consumption and an increase in the time to first analgesic were observed across all studies (P < 0.001). The greatest efficacy was found for thoracic, upper abdominal, and major orthopedic surgical subgroups. Despite using less opioid, 25 out of 32 treatment groups (78%) experienced less pain than the placebo groups at some point postoperatively when ketamine was efficacious. This finding implies an improved quality of pain control in addition to decreased opioid consumption. Hallucinations and nightmares were more common with ketamine but sedation was not. When ketamine was efficacious for pain, postoperative nausea and vomiting was less frequent in the ketamine group. The dose-dependent role of ketamine analgesia could not be determined. CONCLUSION: Intravenous ketamine is an effective adjunct for postoperative analgesia. Particular benefit was observed in painful procedures, including upper abdominal, thoracic, and major orthopedic surgeries. The analgesic effect of ketamine was independent of the type of intraoperative opioid administered, timing of ketamine administration, and ketamine dose.
http://www.oana.org/pdf/Canadian%20Article.pdf

La administración continua de S-(+)-ketamina durante el bypass coronario electivo atenua la respuesta proinflamatoria de las citokinas durante y después del cortocircuito cardiopulmonar

Continuous S-(+)-ketamine administration during elective coronary artery bypass graft surgery attenuates pro-inflammatory cytokine response during and after cardiopulmonary bypass.
Welters ID, Feurer MK, Preiss V, Müller M, Scholz S, Kwapisz M, Mogk M, Neuhäuser C.
Department of Anaesthesiology, Intensive Care and Pain Therapy, Universitätsklinikum Gießen und Marburg, Standort Gießen, D-35392 Giessen, Germany.
Br J Anaesth. 2011 Feb;106(2):172-9. Epub 2010 Dec 7.

CONCLUSION: Our data demonstrate that S-(+)-ketamine possesses anti-inflammatory potential. Anaesthesia with S-(+)-ketamine may have beneficial effects in attenuating the CPB-induced systemic inflammatory response.

http://bja.oxfordjournals.org/content/106/2/172.full.pdf

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

Bibliotecas. Alerta

El GobEx destaca el papel "fundamental" de las bibliotecas ...
La Vanguardia
El secretario general de Educación, César Díez Solís, ha destacado el papel "fundamental" que desempeñan las bibliotecas escolares en el fomento de la lectura como "herramienta básica" de aprendizaje y conocimiento, aspecto que supone un "objetivo ...
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Llegan códices de Da Vinci a internet
Milenio.com
Madrid • La Biblioteca Nacional de España presentó hoy los códices interactivos Madrid I y II de Leonardo da Vinci, que ofrecen en un contexto intelectual la transcripción de los estudios mecánicos y físicos en una base multimedia. El secretario de ...
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Milenio.com

Bibliotecas Públicas: 15 años compartiendo lectura
Zamora Ciudad Red
Las Bibliotecas Públicas del Ayuntamiento de Oviedo parten de una concepción de bibliotecaorientada fundamentalmente al usuario, a la satisfacción de sus necesidades de formación, información y ocio, son un punto de encuentro y centro de cultura para ...
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La biblioteca del IES Rusadir, presente en las I Jornadas de ...
InfoMelilla
La biblioteca del Instituto Rusadir de Melilla se encuentra hoy participando en las I Jornadas deBibliotecas que se celebran en Extremadura, hasta donde se han desplazado dos profesoras que componen el grupo responsable de la biblioteca.
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Un Sueño para Misiones llegó a la meta de diez bibliotecas ...
Misiones OnLine
El movimiento solidario Un sueño para Misiones inauguró la décima biblioteca popular en un salón comunitario a 5 kilómetros de Caraguatay, en un barrio de 4.000 habitantes dispersos en una zona rural. La coordinadora del grupo, Patricia Ocampo ...
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Misiones OnLine

Las bibliotecas de Colmenar Viejo presentan su programa de ...
SER Madrid Norte
Las bibliotecas de Colmenar Viejo presentan su programa de actividades para noviembre. Talleres literarios, libro-forum, club del libro, exposiciones, cuentacuentos y cine infantil, protagonizan la oferta para todos los públicos. Actividades que se ...
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SER Madrid Norte

Valor de las bibliotecas para la alfabetización
Listín Diario
Alfabetizar no sólo es asunto de enseñar a leer y a escribir. Es mucho más que eso, opina Teresa Peralta, especialista en educación y bibliotecología. Entiende que lasbibliotecas tienen un rol protagónico en todo proceso de mejoras en el sector ...
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Listín Diario

La biblioteca lanza la campaña 'Conoce mejor la cultura cubana'
Diario Vasco
La biblioteca municipal de Ermua ha puesto en marcha, organizada por el Gobierno Vasco y en colaboración con once bibliotecas de la comunidad, la campaña Munduko Paisaiak-Paisajes del Mundo. Con esta campaña se pretende acercar las diferentes ...
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Música de violín en la Biblioteca Municipal de Santander
El Diario Montanes
La Biblioteca Municipal ofrecerá mañana miércoles a partir de las 19.30 horas, un concierto del violinista cántabro Borja Ruiz. Músico cántabro multiinstrumentista, especializado en el violín. De formación tanto clásica como moderna, sus principales ...
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absysNET Opac Red de Bibliotecas de Canarias
Este es el sistema de información de la Red de Bibliotecas de Canarias (BICA). Desde aquí puede: Consultar los fondos de la red de bibliotecas. Solicitar ...
www.gobiernodecanarias.org/bibliotecavirtual/.../IDbc0afcf0?...
Bibliotecas Públicas de Colombia | Espacio para las noticias y ...
Espacio para las noticias y hechos más importan

Libro Blanco: La sistematización del aprendizaje informal. Thot . Frances

Libro Blanco: La sistematización del aprendizaje informal. Thot . Frances from Eraser Haikus

[Identidad Bibliotecaria] Biblos:cuna del alfabeto

Biblos (en árabe, جبيل Ŷubayl) es una ciudad en Líbano, situada en la costa del norte del país, a 30 km de Beirut. Situada en una colina, fue una antigua ciudad fenicia, denominada Gubla en los textos cuneiformes y Gebal en la Biblia. Se cree que fue fundada alrededor del año 5000 AC, y según fuentes atribuidas al historiador fenicio Sanjuniatón, fue construida por Crono, y fue la primera ciudad fenicia. Actualmente, es ampliamente reconocida como la ciudad más antigua del mundo habitada ininterrumpidamente.

Su etimología proviene de la colina en que estaba situada Gubla, «montaña» en fenicio) que derivó en su nombre bíblico Gebal, pasando de aquí a la forma griega Byblos y de allí la palabra Biblion “libro”, que también originará el término Biblia. El nombre árabe, Ŷubayl, es diminutivo de ŷabal, “montaña”.
Fue una activa ciudad mercantil, mercado de papiros, madera de cedro, y cobre del Cáucaso, convertida en el centro comercial del Mediterráneo oriental. Mantuvo vasallaje con los faraones del antiguo Egipto; posteriormente fue ciudad tributaria de asirios y persas.

De la antigua Biblos se conserva una muralla de comienzos de la Edad del Bronce, el templo Baalat Gebal, una necrópolis y numerosos restos de la época romana y medieval. Fue declarada Patrimonio de la Humanidad por la Unesco en el año 1984.

El alfabeto, abecedario o abecé de una lengua o idioma es el conjunto ordenado de sus letras. Es también la agrupación, con un orden determinado, de las grafías utilizadas para representar el lenguaje que sirve de sistema de comunicación.

El término alfabeto procede del griego ἀλφάβετον (alfábeton), derivado de las dos primeras letras griegas ἄλφα (alfa, α) y βῆτα (beta, β), derivadas a su vez de las letras fenicias ‘alp y bet, que significaban «buey» y «casa» respectivamente. El alfabeto griego es una adaptación del alfabeto fenicio, que también dio lugar entre otros al hebreo y al árabe. Por su parte, el término abecedario proviene del latín tardío abecedārium, también derivado del nombre de las primeras letras, en este caso cuatro: a (a), b (be), c (ce) yd (de).
Algunas letras pueden recibir uno o varios diacríticos con el fin de diferenciar los sonidos de la lengua o poder evitar las ambigüedades. De la misma forma, el alfabeto puede ser entendido por el uso de letras suplementarias. Las evoluciones fonéticas de una lengua se crean a un ritmo diferente de la evolución escrita. La escritura alfabética no garantiza una correspondencia unívoca entre los fonemas y los grafemas.
En otros ámbitos (matemáticas, por ejemplo), un alfabeto es un conjunto finito y ordenado de símbolos.

El alfabeto fenicio supone una creación. Es al final de esa cadena donde se nota una progresiva prioridad del análisis sobre la síntesis. De la pictografía, que es una representación global, se pasa a signos que descomponen el discurso en sus partes constitutivas. Las formas más antiguas de la escritura fenicia se han encontrado en las inscripciones arcaicas de Biblos, cuyo origen se remonta a los siglos XIII y XI a.C. El fenicio arcaico comprendía 22 letras, únicamente consonantes, y está libre ya de elementos ideográficos, de determinativos y de toda huella de silabismo.

http://www.youtube.com/watch?feature=player_embedded&v=bVFRQ2Kd9Q0

Fuente: http://bibliotecas1978.wordpress.com/2012/10/30/biblos-cuna-del-alfabeto/

Cirugía y obesidad

Manejo operatorio de la obesidad

Surgical treatment of obesity: a review.
Fobi MA.
Center for Surgical Treatment of Obesity, Hawaiian Gardens, CA 90716, USA. info@cstobesity.com
J Natl Med Assoc. 2004 Jan;96(1):61-75.
Abstract
Obesity is a chronic disease due to excess fat storage, a genetic predisposition, and strong environmental contributions. This problem is worldwide, and the incidence is increasing daily. There are medical, physical, social, economic, and psychological comorbid conditions associated with obesity. There is no cure for obesity except possibly prevention. Nonsurgical treatment has been inadequate in providing sustained weight loss. Currently, surgery offers the only viable treatment option with longterm weight loss and maintenance for the morbidly obese. Surgeries for weight loss are called bariatric surgeries. There is no one operation that is effective for all patients. Gastric bypass operations are the most common operations currently used. Because there are inherent complications from surgeries, bariatric surgeries should be performed in a multidisciplinary setting. The laparoscopic approach is being used by some surgeons in performing the various operations. The success rate--usually defined as >50% excess weight loss that is maintained for at least five years from bariatric surgery--ranges from 40% in the simple to >70% in the complex operations. The weight loss from surgical treatment results in significant improvements and, in some cases, complete resolution of comorbid conditions associated with obesity. Patients undergoing surgery for obesity need lifelong nutritional supplements and medical monitoring.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2594758/pdf/jnma00301-0063.pdf

¿Solución rápida o cura a largo plazo? Pros y contras de la cirugía bariátrica

Quick fix or long-term cure? Pros and cons of bariatric surgery.
Madura JA 2nd, Dibaise JK.
Division of General Surgery Mayo Clinic Arizona, 13400 East Shea Boulevard, Scottsdale, AZ, USA 85259.
F1000 Med Rep. 2012;4:19. doi: 10.3410/M4-19. Epub 2012 Oct 2.
Abstract
The past decade has seen an enormous increase in the number of bariatric, or weight loss, operations performed. This trend is likely to continue, mirroring the epidemic of obesity around the world and its rising prevalence among children. Bariatric surgery is considered by many to be the most effective treatment for obesity in terms of maintenance of long-term weight loss and improvement in obesity-related comorbid conditions. Although overly simplified, the primary mechanisms of the surgical interventions currently utilized to treat obesity are the creation of a restrictive or malabsorptive bowel anatomy. Operations based on these mechanisms include the laparoscopic adjustable gastric band and laparoscopic vertical sleeve gastrectomy (considered primarily restrictive operations), the laparoscopic biliopancreatic diversion with or without a duodenal switch (primarily malabsorptive operation), and the laparoscopic Roux-en-Y gastric bypass (considered a combination restrictive and selective malabsorptive procedure). Each operation has pros and cons. Important considerations, for the patient and surgeon alike, in the decision to proceed with bariatric surgery include the technical aspects of the operation, postoperative complications including long-term nutritional problems, magnitude of initial and sustained weight loss desired, and correction of obesity-related comorbidities. Herein, the pros and cons of the contemporary laparoscopic bariatric operations are reviewed and ongoing controversies relating to bariatric surgery are discussed: appropriate patient selection, appropriate operation selection for an individual patient, surgeon selection, and how to measure success after surgery.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3470459/pdf/medrep-04-19.pdf

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

Más sobre hipertensión pulmonar en la infancia

Hallazgos clínicos en la hipertensión pulmonar infantil: un estudio de registro

Clinical features of paediatric pulmonary hypertension: a registry study.
Berger RM, Beghetti M, Humpl T, Raskob GE, Ivy DD, Jing ZC, Bonnet D, Schulze-Neick I, Barst RJ.
Centre for Congenital Heart Diseases-Paediatric Cardiology, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Netherlands. r.m.f.berger@umcg.nl
Lancet. 2012 Feb 11;379(9815):537-46. Epub 2012 Jan 11.
Abstract
BACKGROUND: Paediatric pulmonary hypertension, is an important cause of morbidity and mortality, and is insufficiently characterised in children. The Tracking Outcomes and Practice in Pediatric Pulmonary Hypertension (TOPP) registry is a global, prospective study designed to provide information about demographics, treatment, and outcomes in paediatric pulmonary hypertension. METHODS: Consecutive patients aged 18 years or younger at diagnosis with pulmonary hypertension and increased pulmonary vascular resistance were enrolled in TOPP at 31 centres in 19 countries from Jan 31, 2008, to Feb 15, 2010. Patient and disease characteristics, including age at diagnosis and at enrolment, sex, ethnicity, presenting symptoms, pulmonary hypertension classification, comorbid disorders, medical and family history, haemodynamic indices, and functional class were recorded. Follow-up was decided by the patients' physicians according to the individual's health-care needs. FINDINGS: 362 of 456 consecutive patients had confirmed pulmonary hypertension (defined as mean pulmonary artery pressure ≥25 mm Hg, pulmonary capillary wedge pressure ≤12 mm Hg, and pulmonary vascular resistance index ≥3 WU/m(-2)). 317 (88%) patients had pulmonary arterial hypertension (PAH), which was idiopathic [IPAH] or familial [FPAH] in 182 (57%), and associated with other disorders in 135 (43%), of which 115 (85%) cases were associated with congenital heart disease. 42 patients (12%) had pulmonary hypertension associated with respiratory disease or hypoxaemia, with bronchopulmonary dysplasia most frequent. Finally, only three patients had either chronic thromboembolic pulmonary hypertension or miscellaneous causes of pulmonary hypertension. Chromosomal anomalies, mainly trisomy 21, were reported in 47 (13%) of patients with confirmed disease. Median age at diagnosis was 7 years (IQR 3-12); 59% (268 of 456) were female. Although dyspnoea and fatigue were the most frequent symptoms, syncope occurred in 31% (57 of 182) of patients with IPAH or FPAH and in 18% (eight of 45) of those with repaired congenital heart disease; no children with unrepaired congenital systemic-to-pulmonary shunts had syncope. Despite severe pulmonary hypertension, functional class was I or II in 230 of 362 (64%) patients, which is consistent with preserved right-heart function.INTERPRETATION: TOPP identifies important clinical features specific to the care of paediatric pulmonary hypertension, which draw attention to the need for paediatric data rather than extrapolation from adult studies.
FUNDING: Actelion Pharmaceuticals.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3426911/pdf/

nihms382071.pdf

Clasificación funcional de la hipertensión pulmonar en niños: informe de la fuerza de trabajo pediátrica PVRI, Panamá 2012
Functional classification of pulmonary hypertension in children: Report from the PVRI pediatric taskforce, Panama 2011.
Lammers AE, Adatia I, Cerro MJ, Diaz G, Freudenthal AH, Freudenthal F, Harikrishnan S, Ivy D, Lopes AA, Raj JU, Sandoval J, Stenmark K, Haworth SG.
Great Ormond Street Hospital for Children, London, UK.
Pulm Circ. 2011 Aug 2;1(2):280-285.
Abstract
The members of the Pediatric Task Force of the Pulmonary Vascular Research Institute (PVRI) were aware of the need to develop a functional classification of pulmonary hypertension in children. The proposed classification follows the same pattern and uses the same criteria as the Dana Point pulmonary hypertension specific classification for adults. Modifications were necessary for children, since age, physical growth and maturation influences the way in which the functional effects of a disease are expressed. It is essential to encapsulate a child's clinical status, to make it possible to review progress with time as he/she grows up, as consistently and as objectively as possible. Particularly in younger children we sought to include objective indicators such as thriving, need for supplemental feeds and the record of school or nursery attendance. This helps monitor the clinical course of events and response to treatment over the years. It also facilitates the development of treatment algorithms for children. We present a consensus paper on a functional classification system for children with pulmonary hypertension, discussed at the Annual Meeting of the PVRI in Panama City, February 2011.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3161406/

Características de los pacientes recién nacidos en la hipertensión pulmonar persistente

Patient characteristics in persistent pulmonary hypertension of the newborn.
Roofthooft MT, Elema A, Bergman KA, Berger RM.
Department of Paediatric Cardiology, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
Pulm Med. 2011;2011:858154. Epub 2011 May 24.
Abstract
Objective. To assess the impact of PPHN on mortality, morbidity, and behavioural skills. Methods. A retrospective observational study of 143 newborns with PPHN, over an 11-year period, using objective health-status data from medical records and family doctors, and subjective health status data from a standardized Child Behaviour Checklist. Results. The majority of patients were males, treated with inhaled nitric oxide had maladaptation/maldevelopment as pathophysiological mechanism and a gestational age >37 weeks. In term newborns, types of pathophysiological mechanism (P < .001) and Oxygen Index (P = .02) were independent predicting risk factors for PPHN-related mortality. Analysis of preexisting disease and outcome categories in term newborns showed only a significant correlation between the use of iNO and respiratory complaints (P = .03), not confirmed by multivariate analysis and regression analysis. Conclusions. PPHN is a serious, often fatal condition. The incidence of PPHN in preterm newborns is high. In term survivors, PPHN had no additional role in morbidity/outcome.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109632/pdf/PM2011-858154.pdf

Los recientes avances en la comprensión de la hipertensión pulmonar pediátrica.
Recent progress in understanding pediatric pulmonary hypertension.
Abman SH, Ivy DD.
Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital, Aurora, Colorado, USA.
Curr Opin Pediatr. 2011 Jun;23(3):298-304. doi: 10.1097/MOP.0b013e3283464a52.
Abstract
PURPOSE OF REVIEW: Pulmonary artery hypertension (PAH) in children contributes significantly to morbidity and mortality in diverse pediatric cardiac, lung, hematologic and other diseases. Advances in pulmonary vascular biology over the past few decades have significantly expanded therapeutic strategies; however, many unique issues persist regarding our understanding of pediatric PAH. RECENT FINDINGS: Recent studies of pediatric PAH include those that highlight gaps in our understanding of pediatric diseases associated with PAH from those of adult onset, emphasizing the strong need for specific studies regarding unique aspects of the pathogenesis and treatment of children with PAH. Registries have begun to provide new data showing differences in physiology, course, and genetics between adult and pediatric forms of PAH. Unfortunately, therapeutic strategies in pediatric pulmonary hypertension are often limited to small observational studies in children and are dependent on results from larger adult studies. In addition, clinical endpoints for studies and care remain poorly defined in infants and children. SUMMARY: Despite many advances, long-term outcomes for children with PAH remain guarded and substantial challenges persist, especially with regard to understanding mechanisms and approach to severe PAH. Future studies are needed to develop novel biomarkers, clinical endpoints and interventions for young children with diverse causes of PAH.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3128451/pdf/nihms300909.pdf

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

Más sobre cirugía bariátrica

Manga gástrica laparoscópica versus banda gástrica ajustable para el tratamiento de la obesidad severa en pacientes de alto riesgo

Laparoscopic sleeve gastrectomy versus laparoscopic adjustable gastric banding for the treatment severe obesity in high risk patients.
Varela JE.
Department of Surgery, Washington University, St. Louis, MO, USA.varelae@wustl.edu
JSLS. 2011 Oct-Dec;15(4):486-91.
Abstract
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has emerged as an alternative restrictive bariatric procedure to the most popular laparoscopic adjustable gastric banding (LAGB). We analyze and compare the clinical and weight loss outcomes of LSG versus LAGB for the treatment of severe obesity in high-risk patients. METHODS: Forty severely obese veterans (20/group) received either LSG or LAGB and were followed prospectively for 2 years. Outcome measures included operating room (OR) time, estimated blood loss (EBL), length of hospital stay (LOS), morbidity, mortality, reoperations, readmission rates, and weight loss over time. RESULTS: The cohort primarily comprised high-risk and older male veterans. Patient's baseline demographics were similar between groups. LSG was associated with prolonged OR time (116±31 vs. 94±28min), higher EBL (34±28 vs. 17±19mL), and LOS (2±.9 vs. 1±.4days) when compared with LAGB. Minor morbidity and readmissions were similar between groups, while no major morbidity, reoperations, or mortality occurred. Total weight and BMI decreased significantly after surgery in both groups (LSG: 302±52 to 237lbs and 45±5 to 36±5kg/m(2) vs. LAGB: 280±36 to 231±29lbs and 43±5 to 36±5kg/m(2), respectively). Total weight loss was superior in the LSG vs. LAGB group at 2 years (TWL=65±24 vs. 49±28 lbs (P=.03); %EWL=51±20 vs. 46±23%; %EBMI loss=48±22 vs. 45±23%, and %BWL=21±8 vs. 17±9%, respectively). CONCLUSION: In severely obese and high-risk patients, laparoscopic sleeve gastrectomy provides superior total weight loss at 2 years.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3340957/pdf/jls486.pdf

Gastrectomía en manga laparoscópica viable para la cirugía de revisión bariátrica

Laparoscopic sleeve gastrectomy feasible for bariatric revision surgery.
Berende CA, de Zoete JP, Smulders JF, Nienhuijs SW.
Catharina Hospital, Eindhoven, the Netherlands. niels.berende@cze.nl
Obes Surg. 2012 Feb;22(2):330-4.
Abstract
Bariatric revision surgery is associated with several complications that can be attributed to decreased quality of tissue and complexity of the surgery. A laparoscopic sleeve gastrectomy is a simple technique with potential advantages. Therefore, the results of this procedure were evaluated as a revisional option. Fifty-one patients underwent laparoscopic sleeve gastrectomy (LSG). Indications for the LSG were insufficient weight loss (34 patients, group 1) or vomiting (17 patients, group 2) following a laparoscopic adjustable gastric banding (LAGB) or vertical banded gastroplasty (VBG). Patient and procedure characteristics as well as outcome were collected prospectively. From October 2006 to June 2010, 51 patients with a failed prior bariatic procedure (VBG or LAGB) were converted to (L)SG. The conversion rate was zero. The median procedure time was 99 min (range 54-221) and hospital stay was 3 days (range 2-38). There was no mortality after 30 days. Complications included bleeding (six) and leakage of the staple line (seven). Mean follow-up was 13.8 (2-46) months. LSG as revision surgery for insufficient weight loss resulted in extra weight loss of 52.7%, and the overall extra weight loss was 49.3%. When LSG was performed because of vomiting, 82% was able to eat solid food at follow-up. Of the 65 pre-existent co-morbidities, 21 were resolved and 18 improved. LSG as a revision procedure is feasible. An additional weight loss and further resolution of co-morbidity seem achievable, however, at the cost of a high number of complications. Therefore, revision bariatric surgery should be limited to expert tertiary bariatric centers
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266499/pdf/11695

_2011_Article_501.pdf

Manejo perioperatorio de los pacientes de cirugía bariátrica: enfermedad ósea metabólica
Perioperative management of bariatric surgery patients: focus on metabolic bone disease.
Williams SE, Cooper K, Richmond B, Schauer P.
Center for Nutrition and Metabolic Medicine, Greene Memorial Hospital Advanced Medical Group, Xenia, OH 45385, USA.swilliams@greenehealth.org
Cleve Clin J Med. 2008 May;75(5):333-4, 336, 338 passim.
Abstract
Chronic vitamin D deficiency, inadequate calcium intake, and secondary hyperparathyroidism are common in obese individuals, placing them at risk for low bone mass and metabolic bone disease. After bariatric surgery, they are at even higher risk, owing to malabsorption and decreased oral intake. Meticulous preoperative screening, judicious use of vitamin and mineral supplements, addressing modifiable risk factors, and monitoring the absorption of key nutrients postoperatively are essential in preventing metabolic bone disease in bariatric surgery patients.
http://www.ccjm.org/content/75/5/333.full.pdf

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

Books Update NYT

November 2, 2012

Books Update

On the Cover of Sunday's Book Review

'There Was a Country: A Personal History of Biafra'

By CHINUA ACHEBE
Reviewed by ADAM NOSSITER

Chinua Achebe's memoir about the moment when Nigeria split apart at a cost of more than a million lives.

Up Front: Adam Nossiter

Women await food distribution in West Darfur, Sudan, February 2008.

'Of Africa'

By WOLE SOYINKA
Reviewed by ADAM HOCHSCHILD

In this volume of sweeping reflections, the playwright and activist Wole Soyinka takes Africa's woes to heart.

Also in the Book Review

Dennis Lehane: By the Book

The author of "Live by Night," "Gone, Baby, Gone" and "Mystic River" says George V. Higgins and Edwin O'Connor have written the best novels about Boston.