[Syncytial intramedullary meningioma associated with cervical syringomyelia. Reply]. / Meningioma sincitial intramedular asociado a siringomielia cervical. Réplica.

TITLE: Meningioma sincitial intramedular asociado a siringomielia cervical. Réplica.

[Syncytial intramedullary meningioma associated with cervical syringomyelia]. / Meningioma sincitial intramedular asociado a siringomielia cervical.

TITLE: Meningioma sincitial intramedular asociado a siringomielia cervical.

A Comparison of Mechanical Properties of Different Hydroxyapatite (HAp) Based Nanocomposites: The Influence of Morphology and Preferential Orientation.

Three different types of hydroxyapatite (HAp) based porous ceramic materials were obtained through the modified gel casting method; one of them was made of commercial HAp particles and used as a reference in the mechanical characterization. Other type of ceramic was elaborated using HAp nanofibers, which were synthesized through the microwave assisted hydrothermal method and they possess a high crystallinity, purity and a preferential crystalline orientation in the [300], such were grown along the [001]. The third type of porous ceramic was elaborated using a combination of HAp nanofibers and particles. The HAp nanofibers and particles were previously analyzed by using X-ray diffraction to study their crystal structure, the topology and morphology of those HAp aggregates were observed with scanning electron microscopy (SEM); high-resolution transmission electron microscopy was useful to carry out a detailed crystallographic analysis. Afterwards, an organic phase made of gelatin was added to the porous ceramics in order to obtain nanocomposite materials. Two different concentrations of gelatin were used separately, and the combination of three types of porous ceramics and two concentrations of gelatin produced six different nanocomposite materials. All of these composite materials were observed through the SEM to see their topology and porosity and after that, they were probed under compression tests and their corresponding mechanical behavior was analyzed. All the composites showed mechanical properties similar to those observed in cellular materials. The Young modulus and ultimate strength were compared, finally, it was determined the contribution to the mechanical properties of the morphology, crystalline quality and preferential crystalline orientation in the HAp nanofibers. According to such properties, the composite material made of HAp nanofibers has bone tissue implant potential applications.

Outcomes of laparoscopic management of multicompartmental pelvic organ prolapse.

BACKGROUND: Pelvic organ prolapse (POP) is an increasing medical problem with complex diagnostics and controversial surgical management. It causes a series of dysfunctions in the gynecological, urinary, and anorectal organs. Numerous procedures have been proposed to treat these conditions, but in recent years, ventral mesh rectocolposacropexy (VMRCS) has emerged as the procedure of choice for the surgical treatment of POP, especially by a laparoscopic approach. This surgical technique limits the risk of autonomic nerve damage, and the colpopexy allows the correction of concomitant prolapse of the middle compartment. However, symptoms derived from anterior compartment prolapse remain a major morbidity and sometimes require an additional procedure. The aim of this study is to evaluate the results of laparoscopic prosthetic rectocolposacropexy (LRCS) and colposacropexy (LCS) procedures performed to manage combined multicompartmental POP. METHODS: Between November 2008 and December 2017, 38 patients with symptomatic POP underwent rectocolposacropexy (RCS) or colposacropexy (CS) by a laparoscopic approach. Demographics, mortality, morbidity, hospital stay, and functional outcomes were retrospectively analyzed. RESULTS: The median operating time was 200 min (IQR 160-220). Additional simultaneous surgery for POP was performed in nine cases: five suburethral slings and four hysterectomies were performed. No mortality was recorded. The conversion rate was 7.89%. There were two intraoperative complications (5.26%): one enterotomy and one urinary bladder tear. Late complications occurred in 5.26% of cases. After a mean follow-up of 20 months, constipation was completely resolved or improved in 83.33% of patients, urinary stress incontinence was resolved or improved in 52.94%, and gynecological symptomatology was resolved or improved in 93.75%. The recurrence rate was 5.26%. CONCLUSIONS: Laparoscopic mesh rectocolposacropexy and colposacropexy are safe and effective techniques associated with very low morbidity. In the medium term, they provide good results for POP and associated symptoms, but urinary symptomology has a worse outcome.

Seeding Dates and Cultivars Effects on Stink Bugs Population and Damage on Common Bean Phaseolus vulgaris L.

Fields experiments were conducted during two growing seasons (2010-2011 and 2012-2013) at three seeding dates to identify stink bug (Hemiptera: Pentatomidae) species and to determine their seasonal population density fluctuation and damage caused to three common bean (Phaseolus vulgaris L.) cultivars "Ica Pijao," "Cubacueto 25-9," and "Chévere." Stink bug species observed were Nezara viridula (L.), Piezodorus guildinii (Westwood), Chinavia rolstoni (Rolston), Chinavia marginatum (Palisot de Beauvois), and Euschistus sp. The most prevalent species was N. viridula in both seasons. The largest number of stink bugs was found in beans seeded at the first (mid September) and third (beginning of January) seeding dates. Population peaked at BBCH 75 with 1.75, 0.43, and 1.25 stink bugs/10 plants in 2010-2011 and with 2.67, 0.45, and 1.3 stink bugs/10 plants in 2012-2013 in the fields seeded the first, second, and third seeding dates, respectively. The lowest numbers of stink bugs were found in beans seeded at the second (mid November) seeding date. A significant negative correlation between relative humidity and number of stink bugs was found in 2010-2011, and a similar tendency was observed in 2012-2013. The highest seed and pod damage levels occurred in cv. "Chévere" and the lowest in cv. "ICA Pijao" during both seasons. Results suggest that cv. "ICA Pijao" and the second (mid November) seeding date is the best choice to reduce stink bug damage.

The effect of intravenous ondansetron on maternal haemodynamics during elective caesarean delivery under spinal anaesthesia: a double-blind, randomised, placebo-controlled trial.

BACKGROUND: Spinal anaesthesia for caesarean delivery is frequently associated with adverse effects such as maternal hypotension and bradycardia. Prophylactic administration of ondansetron has been reported to provide a protective effect. We studied the effect of different doses of ondansetron in obstetric patients. METHODS: This prospective double-blind, randomised, placebo-controlled study included 128 healthy pregnant women scheduled for elective caesarean delivery under spinal anaesthesia. Women were randomly allocated into four groups (n=32) to receive either placebo or ondansetron 2, 4 or 8 mg intravenously before induction of spinal anaesthesia. Demographic, obstetric, intraoperative timing and anaesthetic variables were assessed at 16 time points. Anaesthetic variables assessed included blood pressure, heart rate, oxygen saturation, nausea, vomiting, electrocardiographic changes, skin flushing, discomfort or pruritus and vasopressor requirements. RESULTS: There were no differences in the number of patients with hypotension in the placebo (43.8%) and ondansetron 2mg (53.1%), 4 mg (56.3%) and 8 mg (53.1%) groups (P=0.77), nor the percentage of time points with systolic hypotension (7.3% in the placebo group and 11.1%, 15.7% and 12.6% in the ondansetron 2, 4 and 8 mg groups, respectively, P=0.32). There were no differences between groups in ephedrine (P=0.11) or phenylephrine (P=0.89) requirements and the number of patients with adverse effects. CONCLUSIONS: In our study, prophylactic ondansetron had little effect on the incidence of hypotension in healthy parturients undergoing spinal anaesthesia with bupivacaine and fentanyl for elective caesarean delivery.

[An update of the obstetrics hemorrhage treatment protocol]. / Actualización del protocolo de tratamiento de la hemorragia obstétrica.

Obstetric hemorrhage is still a major cause of maternal and fetal morbimortality in developed countries. This is an underestimated problem, which usually appears unpredictably. A high proportion of the morbidity of obstetric hemorrhage is considered to be preventable if adequately managed. The major international clinical guidelines recommend producing consensus management protocols, adapted to local characteristics and keep them updated in the light of experience and new scientific publications. We present a protocol updated, according to the latest recommendations, and our own experience, in order to be used as a basis for those anesthesiologists who wish to use and adapt it locally to their daily work. This last aspect is very important to be effective, and is a task to be performed at each center, according to the availability of resources, personnel and architectural features.

[Analgesic techniques for labour: alternatives in case of epidural failure]. / Técnicas analgésicas para el parto: alternativas en caso de fallo de la epidural.

Epidural analgesia is now the method of choice for the treatment of pain in labour and delivery. However, this technique may fail and provide inadequate or null alleviation to the mother. This paper reviews the risk factors, possible causes and possible therapeutic alternatives to inadequate analgesia, whether pharmacological therapies (neuroaxial, peripheral blocks or analgesic administration via intravenous or inhalational routes) or non-pharmacological ones (relaxation techniques, psychological or mechanical). In all possible cases the efficacy and indications of alternative therapies based on the published literature are reviewed, especially from the point of view of evidence-based medicine. The need is underscored of a multifactorial therapeutic approach to the pregnant woman, not just restricting ourselves to eliminating the pain of childbirth.

Minimally invasive hip surgery: the approach did not make the difference.

BACKGROUND: We hypothesized that minimally invasive surgery was superior to conventional surgery for total hip arthroplasty procedure. PURPOSE: To compare the results of total hip replacement (THR) made by minimally invasive lateral approach with the results of THR made by conventional lateral approach. MATERIALS AND METHODS: Prospective, randomized trial. Fifty patients were selected and then divided into two groups based on utilized approach. DATA COLLECTED: Perioperative bleeding, postoperative pain, time of recovery, components orientation, complications and functional results. Five-year follow-up. RESULTS: No differences were found in blood loss, postoperative pain, surgical time, components orientation, rate of complications or functional result. Minimally invasive lateral approach produced faster recovery with less hospital stay and earlier walking start. CONCLUSION: Our results suggested that minimally invasive lateral approach has not provided significant benefits over conventional lateral approach for the implantation of a total hip arthroplasty.

[Clinical and pharmacological study of the efficacy of carbetocin in elective caesareans compared to low and usual doses of oxytocin]. / Estudio clínico y farmacoeconómico de la eficacia de la carbetocina en cesáreas electivas respecto a la oxitocina a dosis bajas y a dosis habituales.

OBJECTIVES: To evaluate uterine contractility, bleeding, haemodynamic performance, and side effects of different doses of oxytocin after delivery under spinal anaesthesia in caesarean section without prior labour in childbirth. We also perform a pharmacoeconomic evaluation. MATERIAL AND METHODS: A randomised, descriptive, observational and multicentre prospective study was conducted, which included 104 ASA 1 patients divided into 3 groups. Group 1 (n=52) received after removal of the foetus and coinciding with foetal umbilical cord clamping, 1 IU of oxytocin followed by an infusion of 2.5 UI×h(-1); Group 2 (n=52) a continuous infusion of 20IU oxytocin at a rate of 700mUI×min(-1) followed later by 10UI×h(-1), and group 3, 100µg bolus dose of carbetocin only. RESULTS: There were no statistical differences between groups in anthropometric, obstetric or anaesthetic variables. Significant differences in uterine contraction in vaginal bleeding and the incidence of side effects, particularly headache and tremor, were more pronounced in the carbetocin group. CONCLUSIONS: With these results, we cannot recommend the routine use of carbetocin in caesarean sections, because it is accompanied by an increased incidence of side effects without any improvement in the prevention of obstetric haemorrhage. Finally, it is economically more expensive than the use of low doses of oxytocin, which may be the trend that should be considered in the future, due to the clinical outcomes, and its lower cost.

[Efficacy of low-dose oxytocin during elective cesarean section]. / Eficacia de la oxitocina a dosis bajas en cesáreas electivas.

BACKGROUND AND OBJECTIVE: In cesarean section, the optimal dose of oxytocin to reduce the risk of hemorrhage with the least risk of adverse effects has yet to be defined. We studied the effects of using 2 different doses of oxytocin in women undergoing elective cesarean section under spinal anesthesia. The women had had no prior labor. MATERIAL AND METHODS: Randomized multicenter trial enrolling 104 patients classified as ASA 1. Following fetal extraction and coinciding with umbilical cord clamping, a group of 52 women received 1 IU of oxytocin followed by an infusion of 2.5 IU x h(-1); a second group of 52 women received a continuous infusion of 20 IU at a rate of 700 mlU x min(-1) followed by 10 IU x min(-1). We compared uterine contractility (assessed as absent, moderate, satisfactory), postoperative vaginal bleeding (absent, light, moderate, heavy), hemodynamics, and adverse effects after administration of oxytocin and fetal extraction (electrocardiographic abnormalities, nausea, vomiting, discomfort, headache, blushing, trembling, chills, or chest pain). RESULTS: No significant between-group differences in patient, obstetric, or anesthetic variables were detected. Uterine contraction was satisfactory in over 90% of the patients in both groups on initial assessment during surgery. After surgery, vaginal bleeding was absent or light in over 90% of the women. No significant differences in adverse events were detected between groups. CONCLUSIONS: The incidence of obstetric bleeding is not higher when a lower dose of oxytocin is used; the rate of postoperative adverse events also does not increase.

Allergy to low dose sugammadex.

We describe the case of a fit 17-year-old man who developed a severe allergic reaction to a low clinical dose of sugammadex (3.2 mg kg(-1) , 200 mg intravenously), 1 min after its administration. This was manifest by an intense erythema over the anterior part of the thorax, severe lip and palpebral oedema and bilateral wheeze. On later investigation, the patient had a positive skin prick test to sugammadex (5-mm diameter response, with a negative saline control and positive histamine control of 5 mm) and no response to any other drug tested. Other diagnostic tests supported a diagnosis of allergic reaction to sugammadex.

[Phase II blockade after a subclinical dose of succinylcholine: importance of neuromuscular monitoring]. / Bloqueo fase II después de una dosis subclínica de succinilcolina. Importancia de la monitorización neuromuscular.

Neuromuscular monitoring is not a routine practice in clinical settings worldwide. The little interest expressed is mainly because clinicians lack information and documentation, even though the literature on the subject is vast and experts agree that routine monitoring reduces morbidity related to the use of neuromuscular blockers. We report a case of an unusual phase II neuromuscular block from a subclinical dose of succinylcholine. The blockade lasted longer than expected in a patient with diminished plasma cholinesterase activity. We emphasize that monitoring neuromuscular function aided diagnosis and observation of the block during emergency surgery.

[Neuromuscular blockade monitoring. Part 1]. / Monitorización del bloqueo neuromuscular. 1a parte.

Many recent studies have underlined the importance of quantitative neuromuscular monitoring and the high incidence of residual block in clinical practice in spite of the use of nondepolarizing neuromuscular blockers of intermediate duration. Neuromuscular monitoring facilitates the tailoring of the muscular paralysis and appropriate patient recovery at the end of surgery. Monitoring also controls or prevents residual block and serves to guide the use of reversing agents. This review describes the physiology of neuromuscular junctions as well as the principles and patterns of nerve stimulation and clinical monitoring. In addition to drawing on their own experience, the authors have reviewed the literature available through evidence-based indexes and other databases up to December 2008. Most references found were case series and reviews. Quantitative monitoring is an evidence-based practice that should be applied in all situations in which a neuromuscular block is established.