Efectividad de la acupuntura en el tratamiento del dolor agudo postquirúrgico en adultos, en comparación con tratamientos activos o con acupuntura simulada / Acupuncture for postoperative pain, a literature review

Background: There is evidence that acupuncture may relieve pain. Aim: To assess the evidence about the effectiveness of acupuncture to relieve postoperative pain. Material and Methods: A systematic review of the literature selecting controlled clinical trials and systematic reviews comparing acupuncture with standard pain management. The value and quality of reports were evaluated using Jadad scale and STRICTA protocol. Pain intensity and analgesic consumption were the primary endpoints sought. Results: Five controlled trials and two systematic reviews were selected. A meta-analysis was not feasible due to the heterogeneity of studies. In the postoperative period of tonsillectomy, acupuncture reduced pain by 36 and 22% at 20 minutes and two hours, respectively. In knee replacement, acupuncture reduced pain by 2% and analgesic consumption by 42%. In the postoperative period of dental interventions, acupuncture reduced pain by 24% at two hours. Conclusions: Acupuncture may be useful to manage postoperative pain, but more controlled studies are required.

Ecotomografía doppler arterial intrarrenal en pacientes cirróticos con ascitis, con y sin síndrome hepatorrenal / Intrarenal arterial doppler ultrasonography in cirrhotic patients with ascites, with and without hepatorenal syndrome

Background: The pathophysiological hallmark of the hepatorenal syndrome (HRS) is renal vasoconstriction. Doppler ultrasonography can be used to assess the vascular resistance in small renal intraparenchymal vessels through analysis of the Doppler waveform by a parameter termed Resistive Index (RI). We postulated that the RI could be important for the diagnosis and prognosis of HRS. Aims: to assess the RI in cirrhotic patients with ascites, with and without HRS. Patients and methods: We studied 48 cirrhotics with ascites, of whom 12 were with and 36 without HRS and other 23 were normal subjects. We measured the intrarenal arterial RI (Resistive index = Peak systolic velocity - Minimum diastolic velocity/Peak systolic velocity) with color Doppler ultrasonography after visualization of interlobular or arcuate arteries. It was considered abnormal when higher than 0.70. Results: The RI values, mean and SD) were: normal subjects: 0.58 ñ 0.05, cirrhotics with ascites: 0.65 ñ 0.05 and cirrhotics with ascites and HRS: 0.78 ñ 0.11. Patients with HRS had significantly higher values than those without HRS (p < 0.001). The Relative Risk of developing the HRS in patients with a RI ü 0.70 were 3.32 (CI 95 percent = 1.79 - 6.2) Conclusions: The RI was useful in patients with cirrhosis and ascites for the prognosis of HRS and could suggest diagnosis of HRS with values of 0.78 or higher, if other clinical conditions that produce renal vasoconstriction are excluded

Diagnóstico de trombosis venosa profunda y embolia pulmonar / Diagnosis of deep venous thrombosis and pulmonary embolism

Este artículo tiene dos objetivos. El primero es revisar los fundamentos diagnósticos del tromboembolismo pulmonar (TEP), y el segundo, analizar críticamente los términos sensibilidad, especificidad, valor predictivo positivo y negativo, y likelihood ratio (probabilidad proporcional) que son la forma habitual de expresar los resultados de un examen diagnóstico en las publicaciones biomédicas. Como el examen clásico en el estudio diagnóstico del TEP ha sido el cintigrama pulmonar, y se presta muy bien para un análisis crítico de un estudio diagnóstico comenzaremos por él, y posteriormente analizaremos la clínica del TEP y otros exámenes diagnósticos (dímero D plasmático, eco - Doppler venoso tomografía axial computada helicoidal y angiografía pulmonar)