ABSTRACT
Introducción: El bloqueo retrobulbar es el gold standard en cirugía vitreo-retiniana. Sin embargo, esta técnica no está exenta de complicaciones; para evitar estas presentamos una técnica alternativa, como es el bloqueo peribulbar anterior. Material y métodos: Diseñamos un estudio prospectivo con 27 pacientes divididos en dos grupos: grupo A (12 pacientes con desprendimiento de retina) y grupo B (15 pacientes con otras patologías susceptibles de vitrectomias) en los que evaluamos la eficacia y seguridad del bloqueo peribulbar anterior en cirugía ocular de polo posterior. Resultados: La aquinesia fue total o adecuada a la cirugía en el 100 % de los pacientes de los dos grupos. Ningún paciente requirió analgesia intraoperatoria o técnicas de rescate en ninguno de los dos grupos. Discusión: La alta eficacia de esta técnica anestésica en cuanto a la aquinesia y ausencia de dolor intraoperatorio en los resultados obtenidos, y la falta de complicaciones graves (solo 7 casos de quemosis que no impidieron la cirugía) nos animan a pensar en el bloqueo peribulbar anterior como una alternativa al bloqueo retrobulbar en la cirugia vitreo-retiniana (AU)
Introduction: Retrobulbar block is the gold standard in vitreoretinal surgery. However, this technique is not free of complications; to prevent them we present an alternative technique such as anterior peribulbar block. Methods: We have designed a prospective study in 27 patients divided into two groups: group A (12 patients with retinal detachment) and group B (15 patients subjected to other vitrectomys) in order to evaluate the effectiveness and safety of anterior peribulbar block in vitreoretinal surgery. Results: Akinesia was total or adequate to surgery in 100 % of the patients of both groups. No patient from either group needed intraoperative analgesia or rescue techniques. Discussion: The high efficacy of this anaesthesic technique in our study, with regard to akinesia and the absence of intraoperative pain as well as to the absence of serious complications (only seven cases of chemosis) encourages us to think of anterior peribulbar block as an alternative to retrobulbar block in vitreoretinal surgery (AU)
Subject(s)
Humans , Ambulatory Surgical Procedures/methods , Vitreoretinal Surgery/methods , Nerve Block/methods , Anesthesia/methods , ImmobilizationABSTRACT
Objetivo: Analizar la existencia de componentes monocional en enfermos con cirrosis hepática. Material (Casuística): 380 enfermos diagnosticados de cirrosis hepática (220 hombres y 160 mujeres; edad media 61 +/- 5 años). Métodos: Electroforesis de proteínas en celogel: inmunoelectroforesis en gel de agar; inmunodifusión radial de Mancini; proteinuria de Bence Jones por termoprecipitación. Radiografías de esqueleto axial (cráneo, columna, pelvis). Punción aspiración esternal y estudio de médula ósea. Resultados: Se descubrieron cinco casos de cirrosis hepática con componente monocional, tres de migración gamma (correspondían a IgG) y dos de migración Beta-2 (correspondían a gammapatias IgA e IgM). El componente monocional IgG fue inferior a 3.5 g/l y el IgA e IgM inferior a 2g/l. Radiografía de esqueleto axial normal en los cinco enfermos. Punción esternal: médula ósea conservada: 2-5% de células plasmáticas ortotípicas. Conclusiones: Entre 380 enfermos de cirrosis hepática se observaron 5 casos con gammapatía monocional de significdo incierto, a cuyo diagnóstico se llegó por exclusión tras estudio de la médula ósea y radiografía de esqueleto que fueron normales
Objetive: To analyze the existence of monocional components in patients with liver cirrhosis. Materials (casuistry): Three hundred and eighty patients were diagnoses as having liver cirrhosis (220 males and 160 females; mean age 61 +/- 5 years). Method: Protein electrophoresis with celogel, immunoelectrophoresis in agar gel, mancini´s radial inmunodifusion, Bence Jones´ proteinuria by thermoprecipitation. Radiography of axial skeleton (skull, spine, pelvis). Sternal puncture and aspiration and bone marrow study. Results: Five cases of liver cirrhosis with monocional component, three gamma migrations (corresponding to IgG) and two Beta-2 migrations (corresponding to IgA and IgM gammopathy) were found out. IgG monocional component was below 3.5g/ÑL and IgA and IgM levels were below 2g/l. Radiography of axial skeleton was normal in the patients. Sternal puncture: Degree of conservation of bone marrow; 2-5% of plasma cells with normal morphology. Conclusion: Among 380 patients with liver cirrhosis, five cases of monocional gammopathy with uncertain meaning were observed. Said diagnosis was reached by exclusion after studying bone marrow and the skeleton x-ray, which were normal (AU)
Subject(s)
Humans , Paraproteinemias/complications , Liver Cirrhosis/physiopathology , Blood Protein Electrophoresis , Immunoglobulin G/analysis , Immunoglobulin A/analysis , Immunoglobulin M/analysisABSTRACT
BACKGROUND: The epidemiology of primary biliary cirrhosis (PBC) in Spain is still poorly known. In fact, remarkable differences between areas have been found. METHODS: The epidemiology of PBC was investigated in the South area of the city and the province of Granada from 1976 through 1989. Several clinical and epidemiological data were collected from 25 patients who met the criteria for PBC and the yearly incidence and prevalence were calculated. RESULTS: The ages of patients which PBC ranged from 31 to 74 years (mean age 50 +/- 10.5); 88% were females and 28% were diagnosed in the asymptomatic phase of the disease. The incidence for the study period was variable, with a maximum of 6.8 cases/million and an overall yearly incidence rate of 4.1 +/- 2.3 cases/million (7.1 +/- 4.3 cases/million for females). When the risk population was considered (people over 25 years) the respective values were 11.5 and 6.9 +/- 3.7 cases/million (12.1 +/- 7.2 cases/million for females). The prevalence showed a progressive increase, being 36.4 cases/million at the end of the study; for the "risk" population it was 61.5/million (100 cases/million for females). CONCLUSIONS: Incidence and prevalence of PBC in the area of study are within medium and medium-high values for Spain and Europe. As in other studies, personal environmental or social factors with epidemiological significance were not identified.
