The effect of patient sex on the incidence of early adverse effects in a population of elderly patients.

Patient sex is known to influence the response to general and regional anaesthesia and recovery after surgery. However, most studies come from analyses carried out on middle-aged patients. As most of the patients admitted to the post-anaesthesia recovery room in our institution are elderly, we took the opportunity to investigate the association between sex and incidence of early adverse events in this older population of patients after major surgery. Consecutive patients undergoing general, orthopaedic, urological and gynaecological surgery, admitted to the recovery room of our institution over a 15-month period, were retrospectively studied. The following adverse events were considered in the analysis: shivering, postoperative nausea and vomiting, hypotension and hypertensive responses, new arrhythmias requiring treatment, acute respiratory failure and desaturation. A total of 1347 patients (mean age 73.3±15.1 years, 61.4% women) were included. Women showed a higher incidence of shivering (relative difference +48%, P=0.0003), postoperative nausea and vomiting (+91%, P<0.0001), hypotension (+32%, P=0.044) and desaturation (+60%, P=0.0030) than men. The incidence of hypertensive response, arrhythmias and acute respiratory failure were not statistically significantly different. The findings of this exploratory study suggest that women have a higher risk of early postoperative adverse events even in a more elderly population.

Treatment of pseudomyxoma peritonei with two times--cytoreduction and hypertermic antiblastic peritoneal perfusion (HAPP).

Pseudomyxoma peritonei is a rare neoplasia with a low grade of clinical malignity in which neoplastic masses product large amount of mucinous material. Its treatment advocates an aggressive cytoreduction of all visceral and peritoneal lesions and Hyperthermic Antiblastic Peritoneal Perfusion (HAPP). In three cases we programmed a two stage surgical approach for the massive amount of peritoneal implants. Two times we achieved our aim, while one time, the wide progression of the disease during the two surgical procedures made useless our efforts to have a complete cytoreduction and the following HAPP. This last patient refused systemic chemotherapy between the two surgeries and we think that this should be one of the reasons of the failure.

Z-plastia en el manejo de los síndromes de compresión de los ligamentos del Carpo / Z-plastic compression syndrome treatment of the Carpus ligaments

Presenta una nueva técnica quirúrgica para el manejo de los síndromes de los ligamentos del carpo, por medio de la cual se busca ampliar el área seccional del túnel carpiano y de los seis túneles del renáculo extensor, manejando el ligamento que se encuentra conformando el techo de cada uno de dichos túneles, por medio de dos incisiones de relajación, que permiten modificar la geometría del mismo. Presenta el desarrollo original de la técnica, realizada por los autores en estudios previos de composición, estructura, propiedades físicas y biomecánicas del primer túnel dorsal del carpo. Esto permitió tener un mejor conocimiento del tejido ligamentario y su comportamiento, permitiendo conservar la función de polea de cada uno de estos túneles, facilitándose la realización de procedimientos accesorios, como son la sección del tabique o séptum intertendinoso, en el caso del primer túnel dorsal, y la sinovectomía, cuando éstos son necesarios. De esta manera se logra un tratamiento más antómico y fisiológico para este tipo de patología. Se presenta además la experiencia con 73 pacientes intervenidos quirúrgicamente con la técnica descrita y los resultados de su seguimiento.