Computational modeling of electromechanical propagation in the helical ventricular anatomy of the heart.

The classical interpretation of myocardial activation assumes that the myocardium is homogeneous and that the electrical propagation is radial. However, anatomical studies have described a layered anatomical structure resulting from a continuous anatomical helical disposition of the myocardial fibers. To further investigate the sequence of electromechanical propagation based on the helical architecture of the heart, a simplified computational model was designed. This model was then used to test four activation patterns, which were generated by propagating the action potential along the myocardial band from different activation sites.

Simulation and study of the behaviour of the transversalis fascia in protecting against the genesis of inguinal hernias.

Simulating the muscular system has many applications in biomechanics, biomedicine and the study of movement in general. We are interested in studying the genesis of a very common pathology: human inguinal hernia. We study the effects that some biomechanical parameters have on the dynamic simulation of the region, and their involvement in the genesis of inguinal hernias. We use the finite element method (FEM) and current models for the muscular contraction to determine the deformed fascia transversalis for the estimation of the maximum strain. We analysed the effect of muscular tissue density, Young's modulus, Poisson's coefficient and calcium concentration in the genesis of human inguinal hernia. The results are the estimated maximum strain in our simulations, has a close correlation with experimental data and the accepted commonly models by the medical community. Our model is the first study of the effect of various biological parameters with repercussions on the genesis of the inguinal hernias.

Cirugía mayor ambulatoria. Evaluación de pautas analgésicas postoperatorias agrupadas por procedimientos quirúrgicos / No disponible

Objetivos: Desde el inicio de la Cirugía Ambulatoria en nuestro hospital, se prescribió la analgesia estableciendo pautas agrupadas según procedimientos quirúrgicos. Se intentaba evitar la variabilidad, minimizar los errores de prescripción y detectar y subsanar posibles deficiencias de la analgesia postoperatoria de forma rápida y ágil. Material y método: Se evaluaron un total de 13.735 pacientes intervenidos en régimen ambulatorio entre los años 1999-2006, a los que se les aplicaron las pautas analgésicas establecidas. La recogida del grado de dolor medido según escala visual analógica (EVA) se realizó por grupos de analgesia establecidos, mediante encuesta telefónica a las 24 horas de la intervención. Resultados: Los resultados se analizaron por grupos de analgesia y de forma global relacionando este resultado con el índice de sustitución y con el grado de riesgo anestésico según la escala ASA y el índice de ingreso y reingresos por dolor. En todos los grupos hubo una disminución del grado de dolor, que inició una tendencia a aumentar en el año 2006, posiblemente debido a un aumento de complejidad en los procedimientos quirúrgicos. Ninguna de las pautas de analgesia superó el 25% de pacientes con dolor medido en la escala EVA superior a 3.Conclusiones: La aplicación de un protocolo de analgesia postoperatoria agrupada según niveles de dolor por procedimientos quirúrgicos, facilita el control del dolor postoperatorio y la posibilidad de modificar las pautas analgésicas de una forma rápida y ágil, adecuándolas a las necesidades de los pacientes de acuerdo con las patologías intervenidas (AU)

Objectives: From the start of our Ambulatory Surgical program at the Hospital de Mataró, postoperative analgesia was prescribed establishing grouped patterns according to surgical procedures. The purpose of this was to avoid variability, to minimize prescription errors and to detect and correct possible deficiencies of postoperative analgesia in a quick and dynamic way. Material and method: This evaluation was carried out between1999 and 2006 applying the established analgesic patterns to 13,735 patients in Ambulatory Surgery. The degree of pain measured by VAS (Visual Analog Scale)was evaluated according to the analgesic groups, using a telephone survey conducted within the first 24 hours after the procedure. Results: Results were analyzed according to the analgesic groups as well as globally, relating them to the substitution index and to the anaesthetic risk according to the ASA scale and also to the number of admissions and readmissions due to pain. There was a decrease in the grade of pain in all groups until2006 when a tendency to increase started, probably related to an increase in the complexity of surgical procedures. None of the analgesic patterns was over 25% of patients with a pain level measured by VAS of more than 3.Conclusions: The implementation of a protocol for postoperative analgesia grouped, according to levels of pain, by surgical procedures, helps in the control of postoperative pain and allows the possibility of changing analgesic patterns in a fast and easy way, adapting them to the needs of patients according to the procedures (AU)

[On publishing and publications]. / Publicar, por publicar y para publicar.

The publication of a scientific article represents the culmination of work by a group of researchers who at some point decided to pool their efforts to shed light on a scientific problem. Before an article appears in a biomedical journal, an original manuscript will have passed through a series of filters known as the "editorial process". That process provides a guarantee to future readers that information in the article contains a full and critical view of the subject. It is the authors' job to make their best effort when drafting and revising a report and checking the final version before submitting it for review. The manuscript should have the 3 main attributes of scientific writing: clarity, accuracy, and economy. In this article we discuss the sections of an article and guidelines for good clinical research practice. We also review how to present a manuscript that meets style requirements for publication.

Publicar, por publicar y para publicar / On publishing and publications

La publicación de un trabajo científico representa laculminación del esfuerzo de un colectivo de investigadoresque en su día decidieron abordar un problema deinvestigación existente y unificar sus fuerzas para intentaraportar un poco más de luz sobre el mismo. Antes desu aparición en una revista biomédica, el manuscrito originalhabrá pasado por una serie de filtros correspondientesal “proceso editorial” que garantiza a los futuroslectores del artículo la visión completa y crítica de lainformación aportada.Corresponde a los autores del trabajo, poner el máximocuidado en la redacción, corrección y validación dela versión final del estudio antes de solicitar su publicacióny es fundamental que el texto propuesto posea lostres atributos principales del lenguaje científico: claridad,precisión y economía.En este trabajo se revisan todos los apartados y normasde buena práctica clínica para que la presentaciónde un artículo original cumpla con las principales reglasde estilo y pueda ser publicado

The publication of a scientific article represents theculmination of work by a group of researchers who atsome point decided to pool their efforts to shed light ona scientific problem. Before an article appears in a biomedicaljournal, an original manuscript will have passedthrough a series of filters known as the “editorialprocess”. That process provides a guarantee to futurereaders that information in the article contains a fulland critical view of the subject.It is the authors' job to make their best effort whendrafting and revising a report and checking the finalversion before submitting it for review. The manuscriptshould have the 3 main attributes of scientific writing:clarity, accuracy, and economy.In this article we discuss the sections of an article andguidelines for good clinical research practice. We alsoreview how to present a manuscript that meets stylerequirements for publication

¿Qué piensan los pacientes de la anestesia? Encuesta de satisfacción postoperatoria en cirugía ambulatoria comparando anestesia general y subaracnoidea / What do patients think about anesthesia? Survey of satisfaction after outpatient surgery under general or spinal anesthesia

OBJETIVOS: Conocer mediante encuesta telefónica postoperatoria, el grado de satisfacción de los pacientes, en función de la técnica anestésica aplicada, en cirugía ambulatoria artroscópica de rodilla. MATERIAL v MÉTODOS: Registramos los rechazos a participar y sus causas. Los pacientes fueron distribuidos aleatoriamente en tres grupos: grupo TIVA, anestesia general endovenosa continua con propofol y remifentanilo a 2 y 0,2-0,4 WKg/h, respectivamente; grupo LIDO, anestesia subaracnoidea con lidocaína y grupo PRILO, anestesia subaracnoidea con prilocaína al 1,5 por ciento. En estos dos últimos grupos se administró una dosis fija de 3 ml del anestésico local. Todos los pacientes fueron entrevistados telefónicamente 48 horas postintervención mediante una encuesta de 8 preguntas que evaluaban: experiencia anestésica previa, grado de satisfacción respecto al tipo de anestesia aplicada, valoración del dolor postoperatorio, calidad de la información recibida sobre el procedimiento anestésico y efectos indeseables. RESULTADOS: Entrevistamos un total de 120 pacientes y otros 32 pacientes rechazaron participar. Todos los pacientes del grupo TIVA frente al 85 por ciento y 82 por ciento en los grupos LIDO y PRILO, respectivamente, permitirían que se les realizara la misma anestesia en futuras intervenciones (p = 0,026). La satisfacción respecto a la anestesia, el dolor postoperatorio y la calidad de la información recibida sobre el procedimiento anestésico no mostraron diferencias entre grupos. No hubo efectos indeseables destacables en ninguno de los grupos de estudio. CONCLUSIONES: La satisfacción global de los pacientes ambulatorios de cirugía artroscópica de rodilla tiene características muy similares en función del tipo de anestesia realizada, por lo que se debe tener más en cuenta la opinión o preferencias del paciente por una u otra técnica (AU)

[What do patients think about anesthesia? Survey on postoperative satisfaction in ambulatory surgery comparing general and subarachnoid anesthesia]. / Qué piensan los pacientes de la anestesia? Encuesta de satisfacción postoperatoria en cirugía ambulatoria comparando anestesia general y subaracnoidea.

OBJECTIVES: To conduct a telephone survey to determine the degree of patient satisfaction with the anesthetic technique applied during outpatient arthroscopic surgery on the knee. MATERIAL AND METHODS: We recorded refusals to respond to the survey and the reasons. The patients were distributed randomly in 3 groups to receive 1) general anesthesia with propofol and remifentanil by continuous intravenous infusion at rates of 2 and 0.2-0.4 microgram/Kg/h, respectively; 2) subarachnoid anesthesia with lidocaine, and 3) subarachnoid anesthesia with 1.5% prilocaine. The second and third group received fixed doses of 3 mL of the local anesthetic. All patients were telephoned 48 hours after surgery and asked to answer 8 questions concerning prior experience of anesthesia, degree of satisfaction with the type of anesthesia used, postoperative pain, quality of information received about the anesthetic procedure, and undesirable side effects. RESULTS: We interviewed 120 patients and 32 refused to participate. All patients in the general anesthesia group would accept the same anesthetic technique again in future operations, whereas 85% and 82% in the lidocaine and prilocaine groups, respectively, would accept the same technique (p = 0.026). Satisfaction with anesthesia, postoperative pain, and quality of information about the anesthetic procedure was similar in all 3 groups. No important undesirable side affects were reported in any of the groups. CONCLUSIONS: The overall satisfaction with various types of anesthesia is similar among outpatients undergoing arthroscopic surgery on the knee; therefore, patient preferences for one technique over another should be taken into more consideration.

Effectiveness of a clinical guide for the treatment of postoperative pain in a major ambulatory surgery unit.

A retrospective study to evaluate a clinical guide for the treatment of postoperative pain in our One Day Surgery Unit (ODSU) is presented. A total of 2783 patients, treated during 1 year, were studied. Postoperative pain was evaluated 24 h after surgery by phone-call using a visual analogue scale (VAS) and a verbal response scale (VRS). Results were analysed by groups of analgesia and pain scale values. Admissions due to insufficient analgesia were also evaluated. Mean values obtained in all analgesic groups in relation to the VAS were lower than 2.5. It was found that 86% of patients presented a value of VAS<3, while 84.6% had a VRS value 2. Only two patients were admitted for uncontrolled postoperative pain. The level of postoperative analgesia in our patients was satisfactory. Despite this continuous evaluation of the clinical guides for the treatment of postoperative pain, the use of new powerful analgesic drugs is necessary because the surgical complexity in ODSU is increasing and patients with associated diseases are increasingly accepted.

[Ketorolac versus tramadol: comparative study of analgesic efficacy in the postoperative pain in abdominal hysterectomy]. / Ketorolaco frente a tramadol: estudio comparativo de la eficacia analgésica en el dolor postoperatorio de histerectomías abdominales.

OBJECTIVE: To compare the analgesic efficacy of tramadol to that of ketorolac trometamol administered intravenously and at fixed times over the 24 hours after abdominal hysterectomy. PATIENTS AND METHODS: This controlled, double blind, randomized clinical trial enrolled 76 women undergoing abdominal hysterectomies. Two treatment groups were formed: the TRA (Tramadol) group received 100 mg and the KET (Ketorolac) group 30 mg administered every 6 hours intravenously. Patients were ASA I-II and aged 35 to 65 years old. Patients were excluded from the study if hysterectomy was performed because of a tumor, or if there was a history of bleeding dyscrasias, of gastric or duodenal ulcers or of allergy to drugs in the study or if other analgesics had been used within 15 days of surgery. Analgesic efficacy was assessed using a visual analog scale (VAS) and a verbal response scale (VRS). Need for top-up analgesia was recorded, as were the number of patients withdrawing before the end of the study and the side effects attributable to treatment. RESULTS: The mean VAS score throughout the study was 3.6 for the TRA group and 4.4 for the KET group (non-significant, p = 0.05). Likewise, VRS scores were similar. In the first 12 h after surgery, VAS scores in the TRA group were statistically lower than those of the KET group (p < 0.05). Nine patients abandoned the study before it ended: 3 in group TRA and 1 in the KET group. Three withdrew in the TRA group (2 because of vomiting and 1 for administrative reasons). Six left the KET group (4 for uncontrolled pain, 1 for impossible intubation and 1 for administrative reasons. In the TRA group, 38% experienced vomiting whereas only 8% did so in the KET group. No serious postoperative complications were recorded. CONCLUSIONS: During the first 12 hours following surgery, a 100 mg dose of tramadol has been shown to provide more effective pain relief than 30 mg of ketorolac administered intravenously every 6 hours. The only drawback to administering the drug intravenously was the high incidence of postoperative vomiting.

Meningitis bacteriana después de una anestesia subaracnoidea / Bacterial meningitis after spinal anesthesia

No disponible

Ketorolaco frente a tramadol: estudio comparativo de la eficacia analgésica en el dolor postoperatorio de histerectomías abdominales / Ketorolac versus tramadol: comparison of analgesic efficacy for pain after abdominal hysterectomy

Objetivo: Comparar la eficacia analgésica del tramadol frente al ketorolaco trometamol, administrados por vía intravenosa y pauta de administración fija en las 24 h postoperatorias de histerectomías abdominales. Pacientes y métodos: Realizamos un ensayo clínico controlado aleatorio y doble ciego en un total de 76 mujeres intervenidas de histerectomía abdominal. Las pacientes se dividieron en dos grupos de tratamiento: TRA (tramadol) 100 mg y KET (ketorolaco) 30 mg, administrados a intervalos de 6 h por vía intravenosa. Incluimos pacientes de 35 a 65 años de edad y estado físico ASA I-II. Fueron excluidas: histerectomías por tumor, antecedentes de discrasias sanguíneas, historias de ulcus gástrico o duodenal, antecedentes de hipersensibilidad a los fármacos en estudio o uso de otros fármacos analgésicos los 15 días previos a la intervención. La eficacia de la analgesia se valoró mediante la escala visual analógica (EVA) y una escala de respuesta verbal (VRS). Se registraron también las necesidades de analgesia de rescate, abandonos antes de finalizar el estudio y efectos secundarios del tratamiento. Resultados: La media de EVA durante el estudio fue de 3,6 para el grupo TRA y de 4,4 para el grupo KET, no siendo estas diferencias significativas (p > 0,05). Los valores de la escala VRS tampoco evidenciaron diferencias significativas entre los dos grupos de estudio. En las primeras 12 h del postoperatorio, el grupo TRA mostró valores de EVA inferiores y estadísticamente significativos (p < 0,05) frente al grupo KET. Abandonaron el estudio antes de su finalización un total de 9 pacientes: 3 en el grupo TRA (2 por vómitos, uno por causa administrativa) y 6 en el grupo KET (4 por dolor no controlable, uno por intubación imposible y uno por causa administrativa). En el grupo TRA hubo un 38 por ciento de vómitos frente a un 8 por ciento en el grupo KET y no se detectaron complicaciones postoperatorias graves en ninguno de los grupos. Conclusiones: Durante las primeras 12 h del postoperatorio, el tramadol a dosis 100 mg ha evidenciado mayor eficacia analgésica postoperatoria que 30 mg de ketorolaco administrados ambos por vía intravenosa cada 6 h. El único inconveniente de la administración intravenosa de tramadol ha sido la elevada incidencia de vómitos postoperatorios (AU)

No disponible

[Evaluation of the system of direct purchase and distribution of urinary incontinence pads in primary care centers]. / Evaluación del sistema de compra y dispensación directa de pañales absorbentes de orina en los centros de atención primaria.

OBJECTIVE: To evaluate the impact of the pilot experience of direct purchase and distribution of incontinence diapers in primary health care centres of the Balearic Islands after 10 months of implementation. DESIGN: Comparison of diapers's public expenditures and use during 10 months of pilot experience (9/1/1994-6/30/1995: POSTC) to a same length period prior to pilot experience implementation (11/1/1993-8/31/1994: PREC). SETTING: Primary health care centres of the Balearic Islands (Spain). MEASUREMENTS AND RESULTS: Monthly mean of packages used in the PREC period was 3,246 packages/month, whereas monthly mean of packages used in POSTC period was 4,541 packages/month. It means an increase of 1,295 packages/month. The mean price per package got by public tender was 4,426 ptas., nearly half of mean unit price per package paid through the usual dispensing system of medical prescription (8,583 ptas.), thus producing a saving of 4,157 ptas. per package. A decreasing trend to the monthly mean of diapers use of the PREC period was observed in the last months of the experience. The monthly expenditures in diapers was 27,790 milions ptas. in the PREC period and 21,024 milions ptas. during the POSTC period. CONCLUSIONS: The expected increase in diapers use during the first year of implementation of this measure was 34.86%. Of this increase, 70.5% is attributed to development of stock in centres and the undergoing trend of diapers demand increase observed throughout the country.

Effect of cyclosporin A on proteinuria in patients with Alport's syndrome.

Eight patients with Alport's syndrome and massive proteinuria (129 +/- 60.57 mg/m2 per hour) were treated with cyclosporin A (CyA) for 8 months. The average dose of CyA administered to all patients was 4.21 +/- 0.26 mg/kg per day and blood CyA levels of 63.4 +/- 4.1 ng/ml were attained. In five patients, proteinuria abated during the 3rd week of treatment. In the remaining three, all of whom had low creatinine clearance (82.0, 46.0 and 43.2 ml/min per 1.73 m2 respectively), proteinuria persisted but at levels lower than before treatment: 32.5 +/- 15.9 mg/m2 per hour versus 183.3 +/- 29.7 mg/m2 per hour. No permanent decrease in creatinine clearance was observed in any of these patients throughout treatment. In those patients in whom proteinuria abated, it reappeared 2 weeks after discontinuation of CyA treatment. We observed no significant increases in angiotensin II plasma levels in our patients during CyA administration. Although we have shown that CyA will reduce massive proteinuria in patients with Alport's syndrome, we cannot yet recommend its use as a therapeutic measure.

[Tubular handling of potassium in cystinosis]. / Manejo tubular del potasio en la cistinosis.

Seven patients with cystinosis (Ccr between 30 and 90 ml/m/1.73 m2), were studied attempting to delineate renal tubular handling of potassium. Ks, Ck/Ccr X 100, Aldou and UAldo V/Ks were determined in basal conditions; tubular handling of water and sodium, and clearance of potassium were studied during hypotonic saline diuresis. Results obtained in cystinosis were compared with normal values and with values found in renal insufficiencies in the same range of GFR. Studies performed indicate that in cystinosis Ks is lower and Ck/Ccr X 100 and UAldo V/Ks higher than in normal children. During hypotonic saline diuresis, patients with cystinosis presented higher fractional water, sodium and potassium clearances than control children with the same range of GFR.

Hepatitis B virus infection and vaccination in children undergoing hemodialysis.

Among 54 patients, between 2 and 18 years of age, submitted to hemodialysis due to severe chronic renal failure, the prevalence of hepatitis B virus markers was 66.7% and that of HBsAg was 13.0%. Eighteen children, with no evidence of hepatitis B virus infection, were vaccinated. Following three vaccine injections, only 2 patients did not respond and a third one developed low anti-HBs titers. The vaccine was well tolerated. No relationship was observed between the intensity of the humoral immune response and age, sex, type of renal disease and time on dialysis. Seroconversion rates (87.5%) and geometric means of anti-HBs titers (greater than 4 000 Ausab Units) of these patients are similar to those observed following vaccination of healthy adults.