Un siglo con las pinzas de Magill / A century with the Magill forceps

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[Controversies surrounding pain and inhalation anesthesia in nineteenth century Spain]. / Controversias en torno al dolor y la anestesia inhalatoria en la España del siglo XIX.

The introduction of inhaled anesthetics to Spain in 1847 brought appearances by enthusiastic promotors, prudent and reserved admirers and stubborn adversaries - sparking controversy over the use of the new gases. In some cases debate involved the discussion of various concepts of pain, as is shown by heated exchanges among Eusebio Castelo Serra, Manuel Santos Guerra and Zacarías Benito González in the pages of the journal Boletín de Medicina, Cirugía y Farmacia, in three articles appearing between 1850 and 1851 on the concept of pain: Sobre el dolor de las enfermedades y principalmente en las operaciones quirúrgicas, Modificación de dos instrumentos and Estudios sobre el dolor. Investigation into the authors' biographies and an analysis of the content of the articles has permitted us to reconstruct some aspects of the concept of pain in Spain in the middle of the nineteenth century.

Controversias en torno al dolor y la anestesia inhalatoria en la España del siglo XIX / Controversies surrounding pain and inhaled anesthesia in nineteenth century Spain

En el año 1847, la introducción de la anestesia inhalatoria en España implicó también la aparición de partidarios entusiastas, apreciadores prudentes y reservados, y algunos adversarios pertinaces, lo que llevó a controversias sobre su utilidad. En algunos casos, la polémica derivó a la discusión de las distintas concepciones sobre el dolor; es el caso de los enfrentamientos que llevaron a cabo, a través del Boletín de Medicina, Cirugía y Farmacia, Eusebio Castelo Serra, Manuel Santos Guerra y Zacarías Benito González, y que supuso la aparición, entre 1850 y 1851, de tres artículos sobre el concepto de dolor: "Sobre el dolor de las enfermedades y principalmente en las operaciones quirúrgicas", "Modificación de dos instrumentos" y "Estudios sobre el dolor". La descripción del perfil biográfico de los autores y el análisis del contenido de los artículos nos ha permitido conocer algunos aspectos del concepto que sobre el dolor se tenía en nuestro país a mediados del siglo XIX (AU)

Colectomía subtotal por estreñimiento crónico idiopático / Subtotal colectomy to treat chronic idiopathic constipation

El estreñimiento crónico idiopático rara vez necesita tratamiento quirúrgico, pero puede estar indicado ante el grado avanzado del cuadro, la mala calidad de vida o la existencia de complicaciones. Están indicadas diversas técnicas, según el segmento de colon y/o recto afectado y las alteraciones funcionales responsables del estreñimiento. Presentamos el caso de una mujer adulta que precisó de una colectomía subtotal con anastomosis cecorrectal ante la existencia de un gran megacolon, la realización de deposiciones cada 20-25 días y la existencia de dolores abdominales secundarios a crisis de volvulaciones transitorias (AU)

[Characterization of major ambulatory surgery in a basic general hospital]. / Caracterización de la cirugia mayor ambulatoria en un hospital general básico.

BACKGROUND: Outpatient surgery initially came into being and further developed as a result of the progressive increase in the demand and in hospital expenses. Although it has afforded the possibility of lowering the cost per procedure and of improving the efficiency of the hospitals by maintaining the degrees of patient satisfaction and safety, it has also made it necessary to question the customary activity indicators. This had led us to assess the outpatient surgery units of the recently-opened Algeciras Hospital based on the customary system of payment in other countries, the Related Diagnostic Groups (RDG's). METHODS: Descriptive study regarding 3,051 surgical procedures performed on a scheduled basis in 1997 (not including the minor surgery using a local anesthetic), using as a source of information the minimum basic set of data for hospital discharge, obtaining and analyzing the RDG's. The hospital stays avoided based on the average stay of those patients admitted for the same RDG within the time period under study have been calculated. RESULTS: Major surgery performed on an outpatient basis afforded the possibility of an overall replacement percentage of 50.4% (33.3% of all of the patients who underwent surgery on a scheduled basis, that is, 4.1% of all of this Hospital's admissions), which meant an savings of 2,112 hospital stays. The most frequent RDG's having the greatest impact on stays avoided were the surgical procedures performed on the crystalline lens and the scraping or conization procedures performed for reasons other than malignant neoplasia. The readmission rate was 1.5%. CONCLUSIONS: The overall replacement rate obtained by this major outpatient surgery unit is considered to be acceptable, although it must increase within the next few years. We found differences in the spread of the processes dealt with as compared to other units in our environment, this being explainable due to the difficulties involved in starting up surgery of these characteristics.

[Postoperative complications in a case of iatrogenic hypothyroidism induced by diet drugs]. / Complicaciones postoperatorias de un hipotiroidismo iatrógeno no detectado inducido por fármacos adelgazantes.

Oral thyroid preparations, which were first administered in 1892 to treat myxedema, are the oldest effective endocrine medications. Since thyroxin became available, such drugs have been dispensed without a physician's prescription and have come to be mistakenly referred to as "diet pills". Self-prescription of such products can cause changes in thyroid function, with systemic repercussions. We report the case of a woman who took thyroid extracts, among other diet drugs to enhance weight loss without medical supervision. The patient failed to report taking such drugs during the preanesthetic visit. Interrupting therapy several days before surgery produced a state of hypothyroidism that led to marked postoperative hemodynamic changes necessitating transfer to the intensive care unit.

[Latex allergy. Reaction to intraoperative anaphylaxis]. / Alergia al látex. Reacción de anafilaxia intraoperatoria.

We report a case of anaphylaxis during surgery as a result of reaction to latex. The patient was a 26-year old woman undergoing emergency exploratory laparotomy. Sixty minutes after the start of the procedure, rash, confluent cutaneous wheals and severe bronchospasm appeared. An allergic reaction was suspected and treatment with corticoids, H1 and H2 antihistamines, theophylline and adrenalin was begun, after which the symptoms disappeared. We wish to emphasize that in the presurgical taking of the patient's case history, no relevant diseases or known allergies were mentioned, and that all complementary analytical data obtained before surgery were within the normal limits. The woman had had a cesarean section seven months before, with no anesthetic complications. Later, the patient mentioned suffering sinusitis and food allergies, describing a clear history of atopy.

[Analysis of the anesthesiology doctoral theses in Cadiz during the Six-Year Revolution]. / Análisis de las tesis doctorales anestésicas gaditanas del Sexenio Revolucionario.

Manuel Ruiz Zorrilla, after the 1868 Revolution, made possible in Spain the decentralization of doctorate's studies, which traditionally were done in Madrid. It was because of that fact that the Doctor degree could be obtained at the Faculty of Medicine in Cadiz during the Sexenio Revolucionario. The intention of this work is to analyse the anaesthesiologist doctorate thesis defended at the Faculty of Medicine in Cadiz during that period. We give unpublished news about the evolution of the obstetrics anaesthesia in Spain and different opinions about the use of anaesthetics in labours at that time.

[The Medical Telegraph (1847-1850) and the introduction of anesthesiology in Spain]. / El Telégrafo Médico (1847-1850) y la introducción de la anestesiología en España.

The object of our study is to amplify the knowledge of Spanish anesthesiology in the 19th century analyzing the role filled by El Telégrafo Médico (1847-1850) at the introduction of anesthesiology in Spain. We have obtained 32 articles on anaesthesiology. Ten of them (31,25%) were written by Spanish authors and 22 (68,75%) by foreign authors. Eleven articles refer to ether, 17 to chloroform and 4 to other anesthetics. Spanish medical professionals received relevant information about this subject from this medical journal edited in Barcelona.