Reducing by 50% the incidence of maternal hypotension during elective caesarean delivery under spinal anesthesia: Effect of prophylactic ondansetron and/or continuous infusion of phenylephrine - a double-blind, randomized, placebo controlled trial.

BACKGROUND: Prophylactic administrations of ondansetron or phenylephrine have been reported to provide a protective effect against hypotension in women undergoing cesarean delivery under spinal anesthesia (SA). The main hypothesis is that ondansetron improves the hemodynamic response, especially combined with phenylephrine infusion. METHODS: This prospective, double-blind, randomized, placebo-controlled study included 265 healthy pregnant women scheduled for elective cesarean delivery under SA. Women were randomly allocated into four groups to receive either placebo (control), ondansetron (O) 8 mg intravenously before induction of SA, phenylephrine infusion (50 mcg/min) (P) or ondansetron plus phenylephrine (OP). Demographic, obstetric, intraoperative timing, and anesthetic variables were assessed at 16 time points. Anesthetic variables assessed included blood pressure, heart rate, oxygen saturation, nausea, vomiting, electrocardiographic changes, skin flushing, discomfort or pruritus, and vasopressor requirements. RESULTS: There were differences (P = 0.0001) in the number of patients with hypotension (50.8% control, 44.6% O, 20.9% P, 25.0% OP), the percentage of time points (P = 0.0001) with systolic hypotension per patient (17.4% control, 8.7% O, 2.1% P, 6.7% OP) and the number of patients requiring supplementary boluses of ephedrine (P = 0.003), phenylephrine (P = 0.017) or atropine (P = 0.0001). CONCLUSIONS: A 50 µg/min phenylephrine infusion reduces by 50%, the incidence of maternal hypotension compared with placebo, but infusions of phenylephrine are still not routine in our environment. Prophylactic ondansetron 8 mg might be considered in this situation, because it does not reduce the incidence of maternal hypotension but diminishes its severity, reducing the number of hypotensive events per patient by 50%.

The demand for dermatology and the spectrum of skin disease in the immigrant population of Southeast Spain. Differences depending on the geographical origin.

The aim of this study was to describe the dermatoses seen in the immigrant population and to perform a comparative study according to the different geographical areas. A prospective study performed from February 2005 to February 2006. All the visits of economic immigrants seen in the Dermatology Section were prospectively recorded. We examined 1,085 immigrant patients. Latin American patients were more frequently seen (n=706) and they consulted dermatologists more (8.9 visits per 100 people). Benign tumoral pathology was more frequent in Latin American patients (21.9 vs 15.7%; p=0.009). The percentage of infectious dermatoses was greater in the North African population (23.3 vs 17.9%; p=0.009). There was a lower percentage of pigmentary alterations in the Eastern European population (0.7% vs 6.6%; p=0.009). Pruritus was more common in Sub-Saharan immigrants (8.1% vs 1.4%; p=0.001), In the field of dermatology it is not possible to consider the immigrant population as a homogenous group since the dermatoses vary depending on the patients' geographical origin.

Eczema de contacto alérgico por tilosina en un criador de canarios / Allergic contact eczema from tylosin in a canary breeder

Las personas dedicadas a la cría de animales entran en contacto con múltiples sustancias añadidas a los piensos. Algunas de ellas pueden dar lugar a dermatitis de contacto. Se presenta el caso de un paciente aficionado a la cría de canarios que desarrolló una dermatitis de contacto alérgica secundaria a tilosina, un antibiótico macrólido de amplio espectro muy utilizado en veterinaria (AU)

Presentation of telangiectasia macularis eruptiva perstans as a long-standing solitary plaque associated with renal carcinoma.

BACKGROUND: Mastocytosis is a rare disease characterized by a primary pathological increase in mast cells in different tissues. The skin is the most frequently affected organ. Cutaneous mastocytosis, including urticaria pigmentosa, solitary mastocytoma, diffuse cutaneous mastocytosis, and telangiectasia macularis eruptiva perstans (TMEP), is usually distinguished from systemic mastocytosis. TMEP is characterized mainly by telangiectatic macules. OBJECTIVE AND METHODS: We report a case of TMEP with an unusual clinical presentation as a solitary plaque of telangiectatic macules. A renal clear cell carcinoma was detected in a workup for systemic mastocytosis. We discuss the clinical and histological findings and treatment of TMEP. CONCLUSIONS: TMEP is a rare form of mastocytosis, which occurs mainly in adults, generally has a good prognosis, and little tendency to urticate or show constitutional symptoms. Clinicians should consider this disorder when confronted with a progressive atypical telangiectatic lesion. However, the malignant neoplasm also found in this patient is of uncertain significance.