ABSTRACT
BACKGROUND AND OBJECTIVE: Studies on the use of systemic therapy for psoriasis in pediatric patients are scarce. The main aim of this study was to describe the systemic treatments used for moderate to severe psoriasis in pediatric clinical settings. The second aim was to describe the effectiveness and safety of these treatments. MATERIAL AND METHODS: Descriptive, cross-sectional, multicenter study of patients under 18 years of age with moderate to severe psoriasis who were being treated or had been treated with a systemic drug (conventional or biologic) or phototherapy. We recorded demographic and clinical information, treatments received, tolerance, adverse effects, and response to treatment. RESULTS: Data were collected for 40 patients (60% female; mean age, 13 years) who had received 63 treatments in total. The most common first treatment (n=40) was phototherapy (administered to 68% of patients), followed by acitretin (15%). The most common treatments overall (n=63) were phototherapy (57%) and methotrexate (16%). At week 12 (evaluation of systemic treatment and phototherapy), 66% of the patients were classified as good responders and 22% as partial responders. The respective rates for week 24 (evaluation of systemic treatment only) were 36% and 32%. The treatments were well tolerated (97%) and adverse effects were reported in just 11% of cases. There were no treatment discontinuations because of adverse effects. CONCLUSIONS: Phototherapy, followed by methotrexate, was the most common treatment for moderate to severe psoriasis in this series of patients under 18 years. The treatments showed a favorable safety profile and were associated with a good response rate of 66% at week 12 (systemic treatment and phototherapy) and 36% at week 24 (systemic treatment only).
Subject(s)
Psoriasis/therapy , Acitretin/therapeutic use , Adolescent , Child , Comorbidity , Cross-Sectional Studies , Drug Utilization , Humans , Methotrexate/therapeutic use , Phototherapy , Procedures and Techniques Utilization , Psoriasis/drug therapy , Psoriasis/epidemiology , SpainABSTRACT
ANTECEDENTES Y OBJETIVO: Los trabajos sobre el tratamiento sistémico de la psoriasis en edad pediátrica son escasos. El objetivo principal de este trabajo consistió en describir qué tratamientos sistémicos se emplean en práctica clínica en psoriasis moderada-grave en edad pediátrica. Secundariamente se describió la efectividad y perfil de seguridad de dichos tratamientos. MATERIALES Y MÉTODOS: Estudio descriptivo transversal multicéntrico, de los pacientes con psoriasis moderada-grave, que siendo menores de 18 años estuviesen recibiendo o hubieran recibido tratamiento sistémico (clásico o biológico) o fototerapia. Se recogieron datos clínico-demográficos, tipo de tratamiento recibido, y tolerancia, efectos indeseables y respuesta al mismo. RESULTADOS: Se obtuvieron datos de 40 pacientes (60% sexo femenino, edad media 13 años), que realizaron 63 ciclos de tratamiento. Teniendo en cuenta el primer tratamiento (n = 40), la fototerapia fue la opción más frecuente (68%), seguida de acitretino (15%). Considerando el total de ciclos de tratamiento (n = 63), el tratamiento más frecuentemente empleado fue la fototerapia (57%), seguida de metotrexato (16%). En la semana 12 (incluye evaluación de fototerapia), el 66% y el 22% fueron buenos respondedores o respondedores parciales, respectivamente. En la semana 24 (datos exclusivos sobre fármacos sistémicos), el 36% y el 32% continuaron con respuestas buenas y parciales. Los tratamientos fueron bien tolerados (97%) y los efectos indeseables escasos (11%), sin que en ningún caso motivasen la suspensión del fármaco. CONCLUSIONES: En la población menor de 18 años con psoriasis moderada-grave evaluada la fototerapia fue el tratamiento más utilizado, seguida de metotrexato. Los tratamientos consiguieron porcentajes de buenos respondedores del 66% en la semana 12 (incluida fototerapia), y del 36% en la semana 24 (fármacos sistémicos sin fototerapia), presentando un buen perfil de seguridad
BACKGROUND AND OBJECTIVE: Studies on the use of systemic therapy for psoriasis in pediatric patients are scarce. The main aim of this study was to describe the systemic treatments used for moderate to severe psoriasis in pediatric clinical settings. The second aim was to describe the effectiveness and safety of these treatments. MATERIAL AND METHODS: Descriptive, cross-sectional, multicenter study of patients under 18 years of age with moderate to severe psoriasis who were being treated or had been treated with a systemic drug (conventional or biologic) or phototherapy. We recorded demographic and clinical information, treatments received, tolerance, adverse effects, and response to treatment. RESULTS: Data were collected for 40 patients (60% female; mean age, 13 years) who had received 63 treatments in total. The most common first treatment (n = 40) was phototherapy (administered to 68% of patients), followed by acitretin (15%). The most common treatments overall (n =63) were phototherapy (57%) and methotrexate (16%). At week 12 (evaluation of systemic treatment and phototherapy), 66% of the patients were classified as good responders and 22% as partial responders. The respective rates for week 24 (evaluation of systemic treatment only) were 36% and 32%. The treatments were well tolerated (97%) and adverse effects were reported in just 11% of cases. There were no treatment discontinuations because of adverse effects. CONCLUSIONS: Phototherapy, followed by methotrexate, was the most common treatment for moderate to severe psoriasis in this series of patients under 18 years. The treatments showed a favorable safety profile and were associated with a good response rate of 66% at week 12 (systemic treatment and phototherapy) and 36% at week 24 (systemic treatment only)
Subject(s)
Humans , Male , Female , Adolescent , Psoriasis/drug therapy , Treatment Outcome , Cross-Sectional Studies/methods , Phototherapy , Biological TherapyABSTRACT
Multiple chemical sensitivity syndrome is a group of complex disorders that include psychiatric disorders, chronic fatigue and/or respiratory problems. This syndrome could be triggered by specific allergens and toxins that cause neurophysiological sensitization and the appearance of the clinical symptomatology. Anaesthesia for these patients always poses a challenge for the anaesthetist, because they need to find and use drugs that do not trigger or aggravate the symptoms of the disease. Therefore, sevoflurane in these circumstances might be "the ideal anaesthetic". Performing general anaesthesia with sevoflurane as the sole anaesthetic agent, together with a series of environmental measures formed the basis for successful anaesthesia and surgery in our patient with a multiple chemical sensitivity syndrome.
Subject(s)
Anesthetics, Inhalation , Multiple Chemical Sensitivity , Nasal Surgical Procedures , Adult , Anesthetics, Inhalation/administration & dosage , Female , Humans , Sevoflurane/administration & dosageABSTRACT
BACKGROUND: The goal of the current study is to assess the difference in connective tissue adherence to laser microtextured versus machined titanium abutments. MATERIAL AND METHODS: Six patients were selected and each of them received 2 implants, one combined with a laser treated abutment and one with a machined abutment. After three months, the abutments were retrieved together with their surrounding gingival tissue for histological analysis. Qualitative and quantitative evaluation of microscopical images was performed to assess the presence or absence of adherence between the soft tissues and the abutment, and the percentage of soft tissue adhered to the two different surfaces. RESULTS: Intimate adherence between connective tissue and the laser treated abutments, while on machined abutments no adherence was detected. A significant difference was found in the percentage of surface in contact with soft tissue between both implant abutments p=0.03. CONCLUSIONS: Within the limitation of the current study, it can be concluded that connective tissues show enhanced adherence to microtextured abutments compared to machined abutments.
Subject(s)
Connective Tissue/anatomy & histology , Connective Tissue/physiology , Dental Abutments , Dental Implants , Adult , Aged , Dental Prosthesis Design , Female , Humans , Lasers , Male , Middle Aged , Pilot Projects , Surface Properties , TitaniumABSTRACT
El bloqueo del ganglio estrellado es utilizado con frecuencia por anestesiólogos y otros especialistas para el tratamiento del síndromes de dolor regional complejo del miembro superior. Esta técnica interrumpe la inervación simpática cardíaca y ha sido propuesta como tratamiento de arritmias refractarias. Presentamos el caso de un paciente con arritmias refractarias a tratamiento farmacológico que fueron controladas mediante un bloqueo continuo del ganglio estrellado izquierdo. El ganglio estrellado izquierdo es clave en el manejo de las arritmias cardiacas por ser una estructura en la que se originan gran parte de las fibras simpáticas posganglionares que se encargarán de inervar preferentemente el nodo auriculoventricular, haz de His y masa ventricular, elementos fundamentales en la génesis y mantenimiento de las arritmias ventriculares (AU)
Stellate ganglion block is a technique that is often used by anesthesiologists for the treatment of complex regional pain syndromes of the upper extremity. This technique interrupts cardiac sympathetic innervation and has been proposed as treatment for refractory arrhythmias. We present the case of a patient with arrhythmias that were refractory to pharmacological treatment, and were finally treated by continuous stellate ganglion block. Left stellate ganglion is a lynchpin of cardiac arrhythmias due to being a structure where the majority of postganglion sympathetic fibers responsible for preferentially innervating the atriventricular node, bundle of His and ventricular mass are originated, fundamentals in the origin and maintenance of ventricular arrhythmias (AU)
Subject(s)
Humans , Male , Middle Aged , Arrhythmias, Cardiac/drug therapy , Stellate Ganglion , Cricoid Cartilage , Bupivacaine/therapeutic use , Ultrasound, High-Intensity Focused, Transrectal/instrumentation , Ultrasound, High-Intensity Focused, Transrectal/methods , Anesthesiology/methods , Anesthesiology/standards , Anesthesiology/trendsABSTRACT
Stellate ganglion block is a technique that is often used by anesthesiologists for the treatment of complex regional pain syndromes of the upper extremity. This technique interrupts cardiac sympathetic innervation and has been proposed as treatment for refractory arrhythmias. We present the case of a patient with arrhythmias that were refractory to pharmacological treatment, and were finally treated by continuous stellate ganglion block. Left stellate ganglion is a lynchpin of cardiac arrhythmias due to being a structure where the majority of postganglion sympathetic fibers responsible for preferentially innervating the atriventricular node, bundle of His and ventricular mass are originated, fundamentals in the origin and maintenance of ventricular arrhythmias.
Subject(s)
Autonomic Nerve Block/methods , Heart Conduction System/physiopathology , Stellate Ganglion/physiopathology , Tachycardia, Ventricular/therapy , Ultrasonography, Interventional/methods , Atrioventricular Node/innervation , Autonomic Nerve Block/instrumentation , Bupivacaine/administration & dosage , Bupivacaine/therapeutic use , Cardiovascular Agents/therapeutic use , Catheters, Indwelling , Combined Modality Therapy , Counterpulsation , Defibrillators, Implantable , Drug Resistance , Electric Countershock , Humans , Male , Middle Aged , Recurrence , Sympathetic Fibers, Postganglionic/physiopathology , Tachycardia, Ventricular/diagnostic imaging , Tachycardia, Ventricular/drug therapyABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Myocardial Infarction/complications , Myocardial Infarction/diagnosis , Heart Failure/complications , Heart Failure/diagnosis , Amiodarone/therapeutic use , Anesthesia, Local/instrumentation , Anesthesia, Local/methods , Adrenergic beta-Antagonists/therapeutic use , Electrocardiography/instrumentation , Electrocardiography/methods , Myocardial Infarction/physiopathology , Myocardial Infarction , Heart Failure/physiopathology , Heart Failure , Electrocardiography/trends , ElectrocardiographyABSTRACT
La distrofia simpático refleja es una entidad que engloba diferentes situaciones patológicas caracterizada por dolor, alteraciones vaso, sudomotoras y cambios tróficos. La etiología es variopinta, destacando la cirugía, lesión por aplastamiento, fracturas y esguinces como causas más frecuentes, localizándose sobre todo en la parte distal de ambas extremidades. Fisiopatológicamente se cree que cambios estructurales a nivel nervioso periférico, en los ganglios y en el asta dorsal de la médula, junto con una actividad simpática exagerada, condicionan que las fibras nociceptivas se activen de forma anómala espontánea y repetitivamente. Los pacientes refieren dolor, alodinia, hiperestesia, cambios de coloración y temperatura de la extremidad; hiperhidrosis y cambios tróficos en los anejos de la piel. Clásicamente se describen tres fases: aguda o caliente, fría o distrófica y atrófica. El diagnóstico se basa fundamentalmente en la clínica y la exploración física. Ninguna prueba diagnóstica resulta concluyente excepto la desaparición del dolor tras el bloqueo simpático.La terapia farmacológica consiste en la utilización de antidepresivos, anestésicos locales, vasodilatadores, betabloqueantes, bloqueantes del calcio y sobre todo, los nuevos anticomiciales (gabapentina y topiramato).Ante el fracaso de ésta se puede recurrir a los bloqueos simpáticos (ganglio estrellado, regional intravenosos, epidurales). Otras técnicas consisten en la realización de simpatectomías quirúrgicas, bloqueos neurolíticos, estimulación de cordones posteriores o lesiones neuroquirúrgicas en los casos refractarios a otros tratamientos (AU)
Subject(s)
Humans , Reflex Sympathetic Dystrophy/physiopathology , Autonomic Nerve Block/methods , Antidepressive Agents/administration & dosage , Anesthetics, Local/administration & dosage , Adrenergic beta-Antagonists , Reflex Sympathetic Dystrophy/therapy , Reflex Sympathetic Dystrophy/classification , Diagnosis, DifferentialABSTRACT
No disponible
Subject(s)
Adolescent , Female , Humans , Tramadol , Analgesics, Non-Narcotic , Morphine , Narcotics , Pain , Osteogenesis Imperfecta , Drug Therapy, Combination , Analgesics , Amitriptyline , Severity of Illness IndexSubject(s)
Amitriptyline/therapeutic use , Analgesics, Non-Narcotic/therapeutic use , Analgesics/therapeutic use , Morphine/therapeutic use , Narcotics/therapeutic use , Osteogenesis Imperfecta/complications , Pain/drug therapy , Pain/etiology , Tramadol/therapeutic use , Adolescent , Drug Therapy, Combination , Female , Humans , Osteogenesis Imperfecta/diagnostic imaging , Radiography , Severity of Illness IndexSubject(s)
Anesthesia, Local/instrumentation , Anesthetics, Local/adverse effects , Bupivacaine/adverse effects , Cataract Extraction , Corneal Transplantation , Hematoma/etiology , Hypertension/etiology , Injections/adverse effects , Intraoperative Complications/etiology , Mental Disorders/etiology , Needles , Orbit , Postoperative Complications/etiology , Retrobulbar Hemorrhage/etiology , Tachycardia/etiology , Adult , Aged , Aged, 80 and over , Anesthetics, Local/administration & dosage , Blood Vessels/injuries , Bupivacaine/administration & dosage , Equipment Design , Headache/etiology , Humans , Injections/instrumentation , Male , Mydriasis/etiologyABSTRACT
No disponible
Subject(s)
Adult , Aged , Aged, 80 and over , Male , Humans , Corneal Transplantation , Needles , Cataract Extraction , Orbit , Tachycardia , Mydriasis , Retrobulbar Hemorrhage , Postoperative Complications , Blood Vessels , Mental Disorders , Bupivacaine , Anesthesia, Local , Anesthetics, Local , Hypertension , Intraoperative Complications , Injections , Equipment Design , Hematoma , HeadacheABSTRACT
El xantoma plano difuso es una forma de presentación poco frecuente de xantomatosis en general normolipémica. Frecuentemente se ha visto su asociación con trastornos hematológicos. Describimos el caso de un varón de 62 años que presentaba lesiones cutáneas de xantoma plano difuso asociado a gammapatía monoclonal de significado incierto que había sido diagnosticado años antes. Posteriormente se detecta una crioglobulinemia tipo 1, hipocomplementaria y hepatopatía no obstructiva con anticuerpos anti-LKM positivos. Destacamos la necesidad del seguimiento estrecho de estos pacientes, ya que otros procesos se pueden ir sumando a la patología inicial a lo largo del tiempo (AU)
Subject(s)
Aged , Male , Humans , Xanthomatosis , Paraproteinemias , Cryoglobulinemia , AntibodiesABSTRACT
Se estudió la morbilidad y mortalidad del trauma craneoencefálico por accidente del tránsito en 165 pacientes ingresados en la unidad de terapia de cirugía del Hospital Militar "Dr. Carlos J. Finlay" durante el año 1990. Se concluyó que la contusión cerebral y el hematoma subdural son las causas más frecuentes de la alta letalidad. Se plantea que la medición intracraneal es necesaria y que la tomografía axial computarizada de cráneo debe ser realizada de urgencia, si está disponible, para mejorar el diagnóstico y tratamiento del trauma craneoencefálico (AU)
Subject(s)
Brain Injuries, Traumatic/diagnosis , Craniocerebral Trauma/diagnosis , Hematoma, Subdural/diagnosis , Intracranial Pressure , Tomography, X-Ray Computed , Accidents, Traffic , Emergency Service, HospitalABSTRACT
In a sample of 20 healthy men (ASA I) we studied the thermal effects induced after epidural anesthetic blockade with bupivacaine (0.625%) and their relationship with the level of sensitive blockade to puncture or to cold. After 30 min of epidural injection of bupivacaine the level of cephalic analgesia was D IX (D IX +/- 2 segments) and that of cold discrimination D VII (D VII +/- 2 segments) being the thermo-algesic differential blockade of 2 to 3 segments. During epidural anesthesia there was a significant increase in foot skin temperature (4.1 +/- 1 centigrade degrees, p less than 0.001) without any appreciable skin temperature change at the thorax, abdomen, thigh, and calves. It is concluded that epidural anesthesia with bupivacaine (0.625%) at a sensitive analgesic level D IX produces significant increases in skin temperature only at the foot. This indicates that the extension level of sympathetic blockade is lower that of the analgesia.
Subject(s)
Anesthesia, Epidural , Autonomic Nerve Block , Bupivacaine/pharmacology , Skin Temperature , Adult , Bupivacaine/administration & dosage , Humans , Lumbar Vertebrae , Male , Sensation/drug effects , Skin Temperature/drug effects , Skin Temperature/physiology , Vasomotor System/drug effects , Vasomotor System/physiologyABSTRACT
We have evaluated the effect of the infusion of hydroxyethylstarch (HES) on blood viscosity and its usefulness to prevent hypotension associated with intradural anesthetic blockade. The sample consisted of 20 healthy patients scheduled for elective surgery with intradural anesthesia (0.5% hyperbaric bupivacaine), in whom 500 ml of HES were infused in 20 minutes. Blood samples were taken before lumbar puncture and 20 minutes after it and once HES infusion had been finished. Blood viscosity, the erythrocyte and leukocyte mass parameters and biochemical values (total protein, BUN, creatinine, glucose) were measured. Blood pressure (systolic, diastolic, mean) and heart rate were monitored every 5 minutes. During the study time, systolic blood pressure did not show significant changes. Mean and diastolic blood pressure in the minutes 15 and 20 were reduced in less than 10 mmHg (p less than 0.01). Packed red cell volume diminished in 5.7% and the blood viscosity in 0.5-2.3 mPas. It was concluded that HES is a good option for intradural anesthesia because of its plasma volume expanding effect and the hemodilution it induces.
Subject(s)
Anesthesia, Spinal/adverse effects , Hemodilution , Hemodynamics/drug effects , Hydroxyethyl Starch Derivatives , Hypotension/prevention & control , Plasma Substitutes , Aged , Blood Viscosity/drug effects , Humans , Hydroxyethyl Starch Derivatives/pharmacology , Hypotension/etiology , Male , Middle Aged , Plasma Substitutes/pharmacology , RheologyABSTRACT
A patient with a hepatic hydatid cyst with fistula formation to inferior vena cava is reported. To carry out the resection, the cyst was isolated from systemic circulation by means of cardiopulmonary bypass. Inferior vena cava was cannulated through the right atrium until the implantation area of the cyst (above the hepatic veins) was surpassed. Bypass was carried out in 25 minutes by means of cannulation of the ascending aorta, without clamping the aorta, myocardial protection or hypothermia. Postoperative analgesia was achieved with a lumbar epidural catheter. Measures to prevent anaphylactic shock are recommended, an anesthetic technique based on the prevention of hypersensitivity reactions and a careful surgical technique to prevent hydatid dissemination.
