ABSTRACT
Aortic pathology is always a challenge for the clinician, and must be diagnosed and treated by a multidisciplinary team due to the technical and technological complexity of the resources used. Ongoing efforts to implement a systematic, protocolized approach involving "Aortic teams" made up of cardiologists, cardiac surgeons, vascular surgeons, anaesthesiologists and radiologists, among others are now leading to improved outcomes. The aim of this consensus document drawn up by the Aortic working groups of the Spanish Society of Anaesthesiology, Resuscitation and Pain Therapy (SEDAR) and the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) is to disseminate a set of working protocols. The latest consensus document of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS) define the concept of "AORTIC TEAM"(1). The aortic team should be closely involved from diagnosis to treatment and finally follow-up, and should be formed of cardiac and vascular surgeons working together with anaesthesiologists, cardiologists, radiologists and geneticists. Treatment of aortic pathologies should be centralised in large centres, because this is the only way to effectively understand the natural course of the disease, provide the entire range of treatment options under one umbrella and treat potential complications. A streamlined emergent care pathway (24/7 availability), adequate transportation and transfer capabilities, as well as rapid activation of the multidisciplinary team must be available. In light of the complexity and constant evolution of therapeutic options, we present this first version of the Anaesthesiology and surgical guidelines for surgery of the ascending aorta and aortic arch. Some questions will no doubt remain unanswered, and future versions will include new techniques that, though implemented in some centres, are still not widely recommended.
Subject(s)
Anesthesiology , Anesthetics , Aorta, Thoracic/surgery , Consensus , Humans , PainABSTRACT
Aortic pathology is always a challenge for the clinician, and must be diagnosed and treated by a multidisciplinary team due to the technical and technological complexity of the resources used. Ongoing efforts to implement a systematic, protocolized approach involving "Aortic teams" made up of cardiologists, cardiac surgeons, vascular surgeons, anaesthesiologists and radiologists, among others are now leading to improved outcomes. The aim of this consensus document drawn up by the Aortic working groups of the Spanish Society of Anaesthesiology, Resuscitation and Pain Therapy (SEDAR) and the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) is to disseminate a set of working protocols. The latest consensus document of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS) define the concept of "AORTIC TEAM"(1). The aortic team should be closely involved from diagnosis to treatment and finally follow-up, and should be formed of cardiac and vascular surgeons working together with anaesthesiologists, cardiologists, radiologists and geneticists. Treatment of aortic pathologies should be centralised in large centres, because this is the only way to effectively understand the natural course of the disease, provide the entire range of treatment options under one umbrella and treat potential complications. A streamlined emergent care pathway (24/7 availability), adequate transportation and transfer capabilities, as well as rapid activation of the multidisciplinary team must be available. In light of the complexity and constant evolution of therapeutic options, we present this first version of the Anaesthesiology and surgical guidelines for surgery of the ascending aorta and aortic arch. Some questions will no doubt remain unanswered, and future versions will include new techniques that, though implemented in some centres, are still not widely recommended.
ABSTRACT
Este artículo ha sido retirado por indicación del Editor Jefe de la revista, después de constatar que parte de su contenido había sido plagiado, sin mencionar la fuente original: European Heart Journal (2014) 35, 2873 926.: https://academic.oup.com/eurheartj/article/35/41/2873/407693#89325738 El autor de correspondencia ha sido informado de la decisión y está de acuerdo con la retirada del artículo. El Comité Editorial lamenta las molestias que esta decisión pueda ocasionar. Puede consultar la política de Elsevier sobre la retirada de artículos en https://www.elsevier.com/about/our-business/policies/article-withdrawal
Subject(s)
Anesthesia , Anesthesiology , Thoracic Surgery , Aorta, Abdominal , ConsensusABSTRACT
La prevalencia y los costes asociados a la diabetes mellitus (DM) aumentanprogresivamente. Mejorar el control glucémico ha demostrado reducir suscomplicaciones, y la automonitorización de la glucosa capilar es una de lasherramientas básicas para conseguirlo. Es comúnmente aceptada la automonitorizaciónglucémica como una herramienta indispensable en la DM tipo 1.En el caso de pacientes con DM tipo 2 tratados con insulina, varios estudiosseñalan que se trata de un recurso coste-efectivo, especialmente cuando lainformación se utiliza para ajustar el tratamiento. Más complejo es cuantificarsu efectividad en pacientes con diabetes tipo 2 no tratados con insulina. Losmetaanálisis publicados indican una discreta reducción de la hemoglobina glicosilada(HbA1c) (~0,3%) en los sujetos que utilizan la automonitorización, sibien el resultado depende de la HbA1c inicial y de otros condicionantes. Losdatos en España confirman un continuo aumento del presupuesto asignado aeste concepto. Su adopción parece coste-efectiva, especialmente en determinadasindicaciones. Es necesario realizar nuevos estudios con un tamañomuestral y un tipo de población adecuados. Una decidida intervención paramejorar la educación terapéutica en diabetes permitiría conseguir una mejorratio de coste-efectividad de la automonitorización de la glucosa capilar(AU)
Prevalence and the costs associated with diabetes care are gradually increasing.Improving glycaemic control has proven to reduce the complications ofdiabetes, and self-monitoring of blood glucose (SMBG) is one of the basictools for achieving it. It is commonly accepted as an indispensable tool in type1 diabetes. In the case of patients with type 2 diabetes treated with insulin,several studies suggest that this is a cost-effective resource, especially whenthe information is used to adjust treatment. More complex is to quantify its effectivenessin type 2 diabetic patients not treated with insulin. Published metaanalysisshow a modest reduction in HbA1c (~0.3%) of subjects using SMBG,although the result depends on the initial HbA1c and other constraints. In Spain,data confirm a continuous increase in the budget for this concept. Its adoptionseems to be cost-effective, especially in certain indications. New studies areneeded with appropriate sample size and type of population to be studied. Adetermined intervention to improve therapeutic education in diabetes may allowachieving better cost-effectiveness ratio of SMBG(AU)
Subject(s)
Humans , Diabetes Mellitus/physiopathology , Hyperglycemia/diagnosis , /economics , Glycemic Index , Blood Glucose/analysisABSTRACT
The vertebrate system of steroid hormones appears to have been conserved widely throughout the animal kingdom. The sex hormone estrogen, 17-beta-estradiol (E2), long considered to be exclusively a vertebrate hormone, is found also in invertebrates related to reproductive and developmental processes such as spawning, vitellogenesis and molting. These processes are affected by estrogen induced changes at the genomic level and take place at a large time scale. The discovery of surface membrane receptors for E2 has opened new possibilities for the involvement of estrogen in biological functions other than reproductive. These processes take place within a few seconds to minutes and involve sudden cytosolic calcium transients, activation of adenylate cyclase or activation of phospholipase C (PLC). E2 can modulate the production of nitric oxide (NO) in endotheliar and other cells. A similar mechanism linking estrogen to cNOS catalized nitric oxide (NO) release is reported herein for the first time in several tissues of the giant cockroach Blaberus craniifer. This process has been identified in the brain, nerve cord, vasculature and ovaries. This effect is concentration dependent and is inhibited by tamoxifen an estrogen receptor blocker.
Subject(s)
Estradiol/physiology , Gonads/metabolism , Neurons/metabolism , Nitric Oxide/metabolism , Animals , Cell Membrane/metabolism , Cockroaches , Estradiol/metabolism , Gonads/drug effects , Insecta , Nerve Tissue/drug effects , Nerve Tissue/metabolism , Neurons/drug effects , Signal Transduction , Time Factors , Type C Phospholipases/metabolismABSTRACT
Immunocytes of mussels are the chief immune defense in these organisms. When an immunocyte becomes activated there is a conspicuous change in its morphology (i.e., from round to amoeboid) that can be quantified using image analytical tools. Active immunocytes will typically show larger perimeters and areas and a smaller shape factor. Immunocytes exposed to heavy metals become inactive (Cd, Hg and Pb) thus with smaller perimeters (e.g., Pb2+ 2 ppm: P = 69.72 micron) and areas (e.g., Pb2+ 2 ppm: A = 270 micron2) and larger shape factors (Pb2 2 ppm: SF = 0.65) than the unexposed control cells (alpha = 0.05). Xenobiotics may also interfere with neuroimmunomodulation processes such as nitric oxide (NO) release. The release of NO is catalyzed by a calcium dependent constitutive nitric oxide synthase (cNOS). Presently, we are exploring the effects of heavy metals and other pollutants on cNOS activity, measured as real time NO release, in immunocytes and pedal ganglia from M. edulis. Preliminary results suggest that immunocytes exposed to Pb2+ (5 ppm) cause NO release and does not seem to inhibit further NO release in the presence of morphine. The possible implications of NO mediated Pb2+ neurotoxicity are also explored.
Subject(s)
Bivalvia/drug effects , Metals, Heavy/toxicity , Neuroimmunomodulation/drug effects , Animals , Bivalvia/immunology , Bivalvia/physiology , Cadmium/toxicity , Cell Size/drug effects , Environmental Pollutants/toxicity , Hemocytes/cytology , Hemocytes/drug effects , Hemocytes/immunology , In Vitro Techniques , Lead/toxicity , Mercury/toxicity , Nitric Oxide/physiologyABSTRACT
Morphine significantly stimulated invertebrate immunocyte intracellular calcium level increases in a concentration-dependent manner in cells preloaded with Fura 2/AM. Morphine's action was blocked by prior exposure of the cells to the opiate receptor antagonist naloxone. Various opioid peptides did not exhibit this ability, indicating a morphine-mu 3 mediated process. In comparing the sequence of events concerning morphine's action in stimulating both [Ca2+]i and NO production in these cells, we found that the first event precedes the second by 42 +/- 7 s. The opiate stimulation of [Ca2+]i- was attenuated in cells leached of calcium. strongly suggesting that intracellular calcium levels regulate cNOS activity in invertebrate immunocytes.
Subject(s)
Calcium/metabolism , Hemocytes/metabolism , Morphine/pharmacology , Nitric Oxide/metabolism , Animals , Bivalvia , Cells, Cultured , Enkephalin, Ala(2)-MePhe(4)-Gly(5)- , Enkephalins/pharmacology , Fura-2 , Hemocytes/drug effects , Kinetics , Naloxone/pharmacology , Narcotic Antagonists/pharmacology , Nitric Oxide Synthase/metabolism , Signal TransductionABSTRACT
The effects of irradiation-induced luminescence enhancement by ZnS:Mn(2+) nanoparticles in poly(vinyl butyral) films are reported. The luminescence intensity increases several times when fresh samples are irradiated by a 248-nm excimer laser. The decay time also increases with exposure time. The increase in the initial intensity of the slow component of luminescence makes the main contribution to the enhancement effect. A tentative model is proposed in which the efficiency of the energy transfer to Mn(2+) ions increases with exposure. States at interfaces are expected to play an important role in this process.
ABSTRACT
We report three cases of injury of the brachial plexus after coronary revascularization surgery. During the postoperative phase all patients presented plexopathy involving the left C8 and D1 roots. The symptoms were pain, paresthesia, and motor deficits. The proposed mechanisms for injury of the brachial plexus during cardiac surgery are: hyperabduction of the arm, direct traumatism produced by the needle during catheterization of the internal jugular vein, and traction and compression associated with sternal retraction. In the three patients we ruled out alterations during cannulation of the internal jugular vein and malposition of the arms. We think that in our cases the fundamental mechanism was an excessive and assymetrical opening of sternal and Favoloro's separators that were used in all cases during dissection of the left internal mammary artery. We conclude that injury of the brachial plexus can be minimized by reducing the opening of both separators and by placing Favaloro's separator in a lower position.
