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
La patología de la aorta siempre supone un reto para la medicina. Tanto para sudiagnóstico como para su tratamiento, dicha patología requiere ser abordada de forma multidisciplinar debido a la complejidad técnica y tecnológica de los medios empleados. Gracias a los esfuerzos durante años se están obteniendo frutos en forma de mejora de resultados, mediante un abordaje sistemático y protocolizado llevado acabo en el seno de un grupo de expertos (Comités de aorta o Aortic team) en el quese implican cardiólogos, cirujanos cardíacos, cirujanos vasculares, anestesiólogos y radiólogos, entre otros. Con este documento, realizado entre los grupos de trabajo de Aorta de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del dolor (SEDAR) y la Sociedad Española de Cirugía Torácica y Cardiovascular (SECTCV) se busca difundir protocolos de trabajo consensuados por ambas sociedades. La EACTS y la ESVS en el último documento de consenso de expertos definen el concepto de AORTIC TEAM(1). El equipo debe estar estrechamente involucrado en todo el proceso de diagnóstico, tratamiento y seguimiento y debe estar compuesto por miembros de cirugía cardiovascular en colaboración con anestesiología, cardiología, radiología y genética. Se recomienda la centralización de la atención de las patologías del arco aórtico en grandes centros porque es la única forma de comprender de manera efectiva el curso natural de la enfermedad, proporcionar toda la gama de opciones de tratamiento bajo un mismo prisma y tratar las posibles complicaciones. Debe estar disponible una vía simplificada de atención de emergencias (con disponibilidad 24h al día y 7 días a la semana), una adecuada capacidad de transporte y transferencia de pacientes, así como la posibilidad de una activación rápida del equipo multidisciplinar.(AU)
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.(AU)
Subject(s)
Humans , Aorta/surgery , Aorta, Thoracic/surgery , Spain , Aorta/pathology , Thoracic Surgery , Aortic Aneurysm , Airway Management , Anesthesia/adverse effects , General Surgery , Anesthesiology , Cardiopulmonary Resuscitation , Consensus Development Conferences as Topic , SpecializationABSTRACT
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)
Humans , Male , Female , Pain Management , Anesthesiology , Anesthesia , Thoracic SurgeryABSTRACT
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
A 37-year-old woman came to our hospital at the beginning of labor. She reported a history of depression with attempted suicide some years earlier and had also undergone dilation and curettage following an abortion; on admission to our hospital, she was euthymic and not receiving treatment. The patient requested epidural analgesia. Several hours later, she reported dorsal foot numbness and difficulty performing dorsal flexion. After an organic cause had been ruled out, a diagnosis of conversion disorder was considered. The incidence of this psychiatric disorder is high, though it is usually underdiagnosed. Conversion disorder involves at least 1 neurologic symptom suggestive of organic disease. Symptoms are not feigned and cannot be ascribed to a medical disease, the effects of a toxic substance, or culturally normal behavior, yet there is significant clinical, social, and occupational deterioration.
Subject(s)
Anesthesia, Epidural/adverse effects , Anesthesia, Obstetrical/adverse effects , Conversion Disorder/diagnosis , Foot Diseases/diagnosis , Paresthesia/diagnosis , Puerperal Disorders/diagnosis , Adult , Conversion Disorder/psychology , Depressive Disorder/complications , Diagnosis, Differential , Female , Foot Diseases/etiology , Foot Diseases/psychology , Gait Disorders, Neurologic/diagnosis , Hematoma, Epidural, Spinal/diagnosis , Humans , Magnetic Resonance Imaging , Neurologic Examination , Paresthesia/etiology , Paresthesia/psychology , Peripheral Nervous System Diseases/diagnosis , Pregnancy , Puerperal Disorders/psychology , Spinal Cord Diseases/diagnosis , Stress, Psychological/complicationsABSTRACT
Una gestante de 37 años acudió al hospital al iniciar eltrabajo de parto. Como antecedentes personales de interésrefería una depresión con un intento autolítico unosaños antes, estando eutímica sin necesidad de tratamientoal ingreso; y un legrado por un aborto. La pacientesolicitó analgesia epidural y horas después de realizar latécnica presentó anestesia en zona dorsal del pie y dificultadpara la flexión dorsal del mismo. Tras descartarpatología orgánica, se consideró el diagnóstico de trastornoconversivo, una enfermedad psiquiátrica de granincidencia pero habitualmente infradiagnosticada y quese caracteriza por uno o más déficit neurológicos quesugieren enfermedad orgánica, que no son intencionadosni fingidos y que no pueden ser achacados a una enfermedadmédica, a los efectos de una sustancia tóxica o aun comportamiento culturalmente normal; causando undeterioro significativo a nivel clínico, social y ocupacional(AU)
A 37-year-old woman came to our hospital at thebeginning of labor. She reported a history of depressionwith attempted suicide some years earlier and had alsoundergone dilation and curettage following an abortion;on admission to our hospital, she was euthymic and notreceiving treatment. The patient requested epiduralanalgesia. Several hours later, she reported dorsal footnumbness and difficulty performing dorsal flexion. Afteran organic cause had been ruled out, a diagnosis ofconversion disorder was considered. The incidence ofthis psychiatric disorder is high, though it is usuallyunderdiagnosed. Conversion disorder involves at least 1neurologic symptom suggestive of organic disease.Symptoms are not feigned and cannot be ascribed to amedical disease, the effects of a toxic substance, orculturally normal behavior, yet there is significantclinical, social, and occupational deterioration(AU)
Subject(s)
Humans , Female , Adult , Anesthesia, Epidural/adverse effects , Diagnosis, Differential , Conversion Disorder/psychology , Anesthesia, Obstetrical/adverse effects , Conversion Disorder/diagnosis , Foot Diseases/diagnosis , Gait Disorders, Neurologic/diagnosis , Paresthesia/diagnosis , Peripheral Nervous System Diseases/diagnosis , Spinal Cord Diseases/diagnosis , Depressive Disorder/complications , Foot Diseases/etiology , Foot Diseases/psychology , Hematoma, Epidural, Spinal/diagnosis , Magnetic Resonance Imaging/methods , Neurologic Examination , Paresthesia/etiology , Paresthesia/psychology , Peripheral Nervous System Diseases/psychology , Stress, Physiological/complicationsABSTRACT
Las patologías orgánicas pueden debutar con sintomatologíapsiquiátrica, lo que hace importante la necesidadde una anamnesis adecuada que permita detectarlo.A continuación relatamos un caso clínico cuya sintomatologíase presenta como un cuadro afectivo francode tinte endógeno, sin embargo la paciente presentaalteraciones en analítica (marcador tumoral) que noshacen plantearnos diagnóstico diferencial con otrasenfermedades médicas(AU)
Organic diseases may begin with psychiatric symptoms,which make an important need for adequate medicalhistory to detect it.Then we report a case where clinical symptoms arepresented as a serious depression, but she presents alterationsin blood test (tumor marker) that make us considerdifferential diagnosis with another medical illness(AU)
Subject(s)
Humans , Male , Female , Depressive Disorder, Major , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/etiology , Depressive Disorder, Major/pathology , Depressive Disorder, Major/therapy , /therapeutic use , Depression , Sleep Initiation and Maintenance Disorders , Chronic DiseaseABSTRACT
Borderline personality disorder is a disorder with important social and clinical repercussions, which has been treated mainly by psychotherapy. In recent years, the syndromic analysis of this disorder has allowed us to identify different symptoms capable of being improved with psychopharmacology treatment. Thus, its complex symptomatology could be included in four clinical dimensions: impulsive-aggressive, affective instability, cognitive- perceptive and anxiety-inhibition. Antidepressants, mood stabilizers, antipsychotics, anxiolytics, or more recently omega-3 fatty acids have shown efficacy in the treatment of symptomatic dimensions of this disease. We have reviewed scientific articles (reviews, clinical trials or clinical guidelines) published over the last ten years and have proposed therapeutic algorithms for psychopharmacology management in these patients.
Subject(s)
Borderline Personality Disorder/therapy , Aggression/psychology , Amygdala/metabolism , Amygdala/physiopathology , Antidepressive Agents/therapeutic use , Antipsychotic Agents/therapeutic use , Benzodiazepines/therapeutic use , Borderline Personality Disorder/epidemiology , Borderline Personality Disorder/physiopathology , Corticotropin-Releasing Hormone/metabolism , Disruptive, Impulse Control, and Conduct Disorders/diagnosis , Disruptive, Impulse Control, and Conduct Disorders/epidemiology , Fatty Acids, Omega-3/therapeutic use , Fluoxetine/therapeutic use , Hippocampus/metabolism , Hippocampus/physiopathology , Humans , Lithium Carbonate/therapeutic use , Olanzapine , Septum Pellucidum/metabolism , Septum Pellucidum/physiopathology , Serotonin/metabolism , Selective Serotonin Reuptake Inhibitors/therapeutic use , Sertraline/therapeutic use , gamma-Aminobutyric Acid/metabolismABSTRACT
El trastorno límite de la personalidad es un trastorno con importantes repercusiones clínicas y sociales y del que hasta el momento se ha realizado un abordaje principalmente psicoterapéutico. En los últimos años el análisis sindrómico del trastorno ha posibilitado identificar diferentes síntomas susceptibles de ser tratados psicofarmacológicamente. Así, la compleja clínica del trastorno límite de la personalidad se podría englobar en cuatro dimensiones básicas: impulsivo-agresiva, inestabilidad afectiva, cognitiva-perceptiva y ansiedad inhibición. Tanto los antidepresivos como los eutimizantes, los antipsicóticos, los ansiolíticos o, más recientemente, los ácidos grasos omega 3 han demostrado eficacia en el tratamiento de las dimensiones sintomáticas de este cuadro. Se plantea realizar una revisión bibliográfica sobre los artículos científicos (revisiones, ensayos clínicos o guías clínicas, etc.) publicados en los últimos 10 años y proponer algoritmos terapéuticos de actuación en el manejo psicofarmacológico de estos pacientes (AU)
Borderline personality disorder is a disorder with important social and clinical repercussions, which has been treated mainly by psychotherapy. In recent years, the syndromic analysis of this disorder has allowed us to identify different symptoms capable of being improved with psychopharmacology treatment. Thus, its complex symptomatology could be included in four clinical dimensions: impulsive-aggressive, affective instability, cognitive-perceptive and anxiety-inhibition. Antidepressants, mood stabilizers, antipsychotics, anxiolytics, or more recentlyomega-3 fatty acids have shown efficacy in the treatment of symptomatic dimensions of this disease. We have reviewed scientific articles (reviews, clinical trials or clinical guidelines) published over the last ten years and have proposed therapeutic algorithms for psychopharmacology management in these patients (AU)
Subject(s)
Humans , Personality Disorders/drug therapy , Antidepressive Agents/therapeutic use , Antipsychotic Agents/therapeutic useABSTRACT
Cuando la Consejería de Familia tiene la custodia y/o guarda de un menor, otorga estas, en aplicación de la ley, al familiar más próximo que pueda y quiera hacerse cargo, dando prioridad a la familia sobre otras personas valorada su idoneidad. En la práctica clínica diaria de una unidad de salud mental infanto -juvenil, cada vez es más frecuente encontrarnos con esta situación. Partiendo de dos casos clínicos, analizamos las versiones de la aplicación de la ley así como la desaparición o no de los síntomas que presentan estos niños al acudir a consulta, según los acogedores familiares repitan o no los esquemas de funcionamiento de la familia de origen. Lo mejor según la ley, acaba en la práctica a veces siendo enemigo de lo bueno (AU)
When the Regional Govermment´s Family Ministry holds a minor´s custody and/or safekeeping, and it confers them, pursuant to the enforcement of the lay, to the closest relative who is able and wishes to be incharge, giving preference to the family over other people, once its suitablility has been asessed. In the daily clinical practice of a Child Mental Health Center this situation is increasingly more frequent. Starting from two case reports, we analyze the versions of the enforcement of the law as well as the disappearance or presence of the symptoms these children show when searching consultation deppending on wether the family minors´ caregivers reproduce or nt the dynamic patterns of the family of origin. The best thing, according to law may sometimes result in practice the "enemy of the good thing" (AU)
