Evaluación del polimorfismo Arg72Pro de p53 como factor pronóstico del traumatismo craneoencefálico grave y su participación en la construcción de un modelo predictivo / Evaluation of the p53 Arg72Pro polymorphism as a prognostic factor in severe head injury and the inclusion of this indicator in a predictive model

OBJETIVO: Clásicamente se han estudiado variablesfisiológicas para conocer los factores pronósticos en laevolución de los pacientes que han padecido un traumatismocraneoencefálico grave, pero hasta hace poco tiempono se pensaba que los factores genéticos pudieraninfluir. El objetivo principal del estudio fue elaborar unmodelo de regresión logística que agrupara parámetrosfisiológicos y el polimorfismo genético Arg72Pro de p53,ya que éste puede condicionar la muerte neuronal porapoptosis.MATERIAL Y MÉTODO: Incluimos en el estudio 90pacientes que ingresaron en la Unidad de Reanimacióncon traumatismo craneoencefálico grave. Se excluyeronaquellos con déficit neurológico previo. Se registraronlas variables clínicas y se analizó el polimorfismoArg72Pro de p53 mediante amplificación por PCR(Polymerase Chain Reaction) de ADN sanguíneo. La evoluciónneurológica se valoró con la Glasgow OutcomeScale. Posteriormente se elaboró un modelo de regresiónlogística con fines predictivos con aquellas variablesrelevantes (que resultaron ser sexo, edad, peor Glasgow,APACHE II, tamaño de las pupilas, reactividad de laspupilas, hemorragia subaracnoidea, número de días deestancia en reanimación, número de días con ventilaciónmecánica y aparición de hipotensión arterial precoz), asícomo el polimorfismo genético Arg72Pro de p53.RESULTADOS: El polimorfismo Arg/Arg fue un predictorindependiente de mala evolución (OR: 3,55; IC del95%: 1,11-11,32; p=0,032). El modelo seleccionado incluyólas variables edad, polimorfismo genético, reactividadpupilar y escala de Glasgow, cuyo poder de discriminaciónes adecuado [sensibilidad 82,3% (IC del 95% 72,8-91,8) y especificidad 78,6% (IC del 95% 63,4-93,8)], presentandoun 81,1% de clasificaciones correctas...(AU)

BACKGROUND AND OBJECTIVE: Physiologic variableshave traditionally been studied as prognostic factors insevere head injury. Until recently it was not thought thatgenetic factors might play a role. The main objective ofthis study was to construct a logistic regression modelincluding physiologic variables and the p53 Arg72Propolymorphism, which can promote neuron deaththrough apoptosis.MATERIAL AND METHODS: We included 90 patientsadmitted to the postoperative recovery unit with severehead injury. Patients with previous neurologic deficitswere excluded. Clinical variables were recorded. Thep53 Arg72Pro polymorphism was analyzed using polymerasechain reaction of DNA in blood. Neurologic outcomewas assessed on the Glasgow Outcome Scale. Apredictive logistic regression model was then constructedbased on relevant candidate variables (sex, age, poorGlasgow score, the Acute Physiology and ChronicHealth Evaluation II score, pupil size, pupil reactivity,subarachnoid hemorrhage, number of days in the recoveryunit, number of days on mechanical ventilation, andthe early development of hypotension) in addition to thep53 Arg72Pro polymorphism.RESULTS: The Arg/Arg polymorphism was an independentpredictor of poor outcome (odds ratio, 3.55;95% confidence interval [CI], 1.11-11.32; P=.032). Theselected model (including the variables age, gene polymorphism,pupil reactivity, and Glasgow score) had funcioadequatediscriminatory power (sensitivity 82.3%, 95%CI 72.8%-91.8%; specificity 78.6%, 95% CI 63.4%-93.8%), classifying 81.1% of the patients correctly. Thep53 Arg72Pro polymorphism, along with pupil reactivity,age and Glasgow score, is useful in a predictivemodel of good or poor outcome on discharge after headinjury(AU)

[Evaluation of the p53 Arg72Pro polymorphism as a prognostic factor in severe head injury and the inclusion of this indicator in a predictive model]. / Evaluación del polimorfismo Arg72Pro de p53 como factor pronóstico del traumatismo craneoencefálico grave y su participación en la construcción de un modelo predictivo.

BACKGROUND AND OBJECTIVE: Physiologic variables have traditionally been studied as prognostic factors in severe head injury. Until recently it was not thought that genetic factors might play a role. The main objective of this study was to construct a logistic regression model including physiologic variables and the p53 Arg72Pro polymorphism, which can promote neuron death through apoptosis. MATERIAL AND METHODS: We included 90 patients admitted to the postoperative recovery unit with severe head injury. Patients with previous neurologic deficits were excluded. Clinical variables were recorded. The p53 Arg72Pro polymorphism was analyzed using polymerase chain reaction of DNA in blood. Neurologic outcome was assessed on the Glasgow Outcome Scale. A predictive logistic regression model was then constructed based on relevant candidate variables (sex, age, poor Glasgow score, the Acute Physiology and Chronic Health Evaluation II score, pupil size, pupil reactivity, subarachnoid hemorrhage, number of days in the recovery unit, number of days on mechanical ventilation, and the early development of hypotension) in addition to the p53 Arg72Pro polymorphism. RESULTS: The Arg/Arg polymorphism was an independent predictor of poor outcome (odds ratio, 3.55; 95% confidence interval [CI], 1.11-1132; P = .032). The selected model (including the variables age, gene polymorphism, pupil reactivity, and Glasgow score) had adequate discriminatory power (sensitivity 823%, 95% CI 72.8%-91.8%; specificity 78.6%, 95% CI 63.4%-93.8%), classifying 81.1% of the patients correctly. The p53 Arg72Pro polymorphism, along with pupil reactivity, age and Glasgow score, is useful in a predictive model of good or poor outcome on discharge after head injury.

[Incidences of early- and late-onset ventilator-associated pneumonia in a postanesthesia and critical care unit]. / Incidencia de las neumonías nosocomiales precoces y tardías asociadas a ventilación mecánica en una unidad de reanimación- críticos polivalente.

OBJECTIVES: To ascertain the frequency, risk factors, and causes of early- and late-onset ventilator-associated pneumonia (VAP) in a postanesthesia and critical care unit. MATERIAL AND METHODS: A prospective study was carried out between January 1, 1996 and December 31, 2001 of all ventilated patients staying longer than 48 hours in the critical care unit, with follow-up for 48 hours following discharge from the unit. Descriptive statistics were compiled for episodes of early- and late-onset VAP for a period of up to 4 days after intubation; univariate and multiple variable Cox regression analyses were also carried out. RESULTS: A total of 3614 patients were admitted to the unit (study cohort, 652 patients). The mean length of stay in the unit for the study cohort was 13.64 days. The most frequent diagnosis was multiple trauma (50.46%). The incidence density of VAP was 20.31 cases per 1000 patient-days on mechanical ventilation. The pathogens most often isolated in early-onset VAP cases were Staphylococcus aureus and Pseudomonas aeruginosa. In late-onset cases, the pathogens were Pseudomonas species. Early-onset VAP was 2.54 and 2.81 times more frequent in comatose and head-injury patients, respectively. Those rates were significantly different in late-onset cases. CONCLUSIONS: Early-onset VAP was more common in comatose and head-injury patients. The risk of developing late-onset versus early-onset VAP was twice as great for postoperative patients.

Incidencia de las neumonías nosocomiales precoces y tardías asociadas a ventilación mecánica en una unidad de reanimacióncríticos polivalente / Incidences of early- and late-onset ventilator-associated pneumonia in a postanesthesia and critical care unit

OBJETIVO: Conocer la frecuencia, factores de riesgo y etiología de neumonía nosocomial (NN) asociada a ventilación mecánica (NAVM) precoz y tardía en Unidad de Críticos polivalente (UR). MATERIAL Y MÉTODOS: Estudio prospectivo desde 1/01/1996 al 31/12/2001 de todos los pacientes ventilados con ingreso superior a 48 horas, con seguimiento hasta las 48 horas posteriores al alta de la Unidad. Análisis descriptivo, univariante y multivariable con regresión de Cox para los episodios de NAVM precoz y tardía, con un periodo de corte de 4 días postintubación. RESULTADOS: El total de pacientes ingresados fue de 3.614 pacientes (cohorte de estudio: 652 pacientes). La media de la estancia en la UR para la cohorte fue de 13,64 días. El diagnostico más frecuente (50,46%) fue el paciente politraumatizado. La densidad de incidencia de NAVM fue de 20,31 NN por 1.000 pacientes-día de ventilación mecánica. En la neumonía precoz los patógenos más frecuentemente aislados fueron Staphylococcus aureus y Pseudomonas aeruginosa, en los casos de neumonías tardías resalta el género Pseudomonas. La NAVM precoz fue 2,54 y 2,81 veces más frecuente en pacientes en estados comatosos y en enfermos con traumatismo craneoencefálico de forma respectiva, con diferencias estadísticamente significativas con respecto a los pacientes con NAVM tardía. CONCLUSIONES: La NAVM precoz fue más frecuente en pacientes con estados comatosos y con traumatismo craneoencefálico. La presencia de intervención quirúrgica supuso el doble de riesgo de desarrollar una NAVM tardía en relación a las precoces

OBJECTIVES: To ascertain the frequency, risk factors, and causes of early- and late-onset ventilator-associated pneumonia (VAP) in a postanesthesia and critical care unit. MATERIAL AND METHODS: A prospective study was carried out between January 1, 1996 and December 31, 2001 of all ventilated patients staying longer than 48 hours in the critical care unit, with follow-up for 48 hours following discharge from the unit. Descriptive statistics were compiled for episodes of early- and lateonset VAP for a period of up to 4 days after intubation; univariate and multiple variable Cox regression analyses were also carried out. RESULTS: A total of 3614 patients were admitted to the unit (study cohort, 652 patients). The mean length of stay in the unit for the study cohort was 13.64 days. The most frequent diagnosis was multiple trauma (50.46%). The incidence density of VAP was 20.31 cases per 1000 patientdays on mechanical ventilation. The pathogens most often isolated in early-onset VAP cases were Staphylococcus aureus and Pseudomonas aeruginosa. In late-onset cases, the pathogens were Pseudomonas species. Early-onset VAP was 2.54 and 2.81 times more frequent in comatose and head-injury patients, respectively. Those rates were significantly different in late-onset cases. CONCLUSIONS: Early-onset VAP was more common in comatose and head-injury patients. The risk of developing late-onset versus early-onset VAP was twice as great for postoperative patients

Fístula traqueoesofágica en paciente politraumatizado / Tracheoesophageal fistula in a politraumatized patient

No disponible

[Response to presurgical stress in outpatient surgery: effects on lymphocyte populations of psychological treatment to prevent surgical anxiety]. / Respuesta al estrés prequirúrgico en la cirugía sin ingreso: efectos sobre las poblaciones linfocitarias de un procedimiento de psicoprofilaxis quirúrgica.

OBJECTIVE: To determine the effect of a psychological stress control intervention on lymphocyte populations in patients preparing for outpatient surgery. PATIENTS AND METHODS: A prospective randomized controlled trial enrolling 74 patients scheduled for major outpatient surgery at the Hospital Universitario de Albacete in Spain. The patients were randomized to a control (n = 37) or experimental group (n = 37). Measurements were recorded at baseline (preoperative visit) and before entering the operating room (just before surgery). The experimental group received treatment in a psychological stress control program consisting of an interview, watching a video, provision of informative literature about the operation and techniques for controlling anxiety. Anxiety was measured with the State-Trait Anxiety Inventory. The General Health Questionnaire (Goldberg) was applied, and lymphocyte populations were assessed (total white cell count; CD3, CD4, CD4RA, CD4RO, CD8, CD56, CD19, and CD56 lymphocyte counts). Values were expressed as means (SD). RESULTS: The group that received psychological stress prevention therapy had significantly lower CD19 (B lymphocyte) cell counts than did the control group just before surgery. No differences were found between the groups for any other variables. CONCLUSIONS: Psychological stress control therapy prevents a decrease in B cell populations before outpatient surgery.

Respuesta al estrés prequirúrgico en la cirugía sin ingreso: efectos sobre las poblaciones linfocitarias de un procedimiento de psicoprofilaxis quirúrgica / Response to presurgical stress in outpatient surgery: effects on lymphocyte populations of psychological treatment to prevent surgical anxiety

OBJETIVO: Estudio prospectivo randomizado para averiguar el efecto de un programa de psicoprofilaxis quirúrgica sobre las poblaciones linfocitarias en sujetos que van a ser tratados con cirugía sin ingreso. MATERIAL Y MÉTODOS: Se estudiaron 74 pacientes que iban a ser tratados en la Unidad de Cirugía Mayor Ambulatoria del Hospital Universitario de Albacete. Los pacientes se asignaron de forma aleatoria a un grupo control (n=37) o a un grupo experimental (n= 37). Se consideraron dos momentos: basal (consulta preoperatoria) y antequirófano (antes de comenzar la cirugia). En el grupo experimental se realizó un procedimiento de psicoprofilaxis que consistía en una entrevista, un video y un boletín de información peroperatoria y entrenamiento en habilidades para controlar la ansiedad. Se midieron con pruebas psicométricas los niveles de ansiedad de estado (STAI) y salud general (Goldberg), así como las poblaciones linfocitarias (linfocitos totales, CD 3, CD 4, CD 4RA, CD 4RO, CD 8, CD 56, CD 19 y CD 57). Los valores observados se expresaron como media aritmética y su desviación estándar. RESULTADOS: En el grupo con psicoprofilaxis quirúrgica los niveles de CD 19 (linfocitos B) disminuyeron significativamente menos respecto al control en el antequirófano. No se encontraron diferencias en las demás variables estudiadas entre ambos grupos. CONCLUSIONES: La psicoprofilaxis en pacientes de cirugía ambulatoria previene la disminución de las células B antes de la cirugía

OBJECTIVE: To determine the effect of a psychological stress control intervention on lymphocyte populations in patients preparing for outpatient surgery. PATIENTS AND METHODS: A prospective randomized controlled trial enrolling 74 patients scheduled for major outpatient surgery at the Hospital Universitario de Albacete in Spain. The patients were randomized to a control (n=37) or experimental group (n=37). Measurements were recorded at baseline (preoperative visit) and before entering the operating room (just before surgery). The experimental group received treatment in a psychological stress control program consisting of an interview, watching a video, provision of informative literature about the operation and techniques for controlling anxiety. Anxiety was measured with the State-Trait Anxiety Inventory. The General Health Questionnaire (Goldberg) was applied, and lymphocyte populations were assessed (total white cell count; CD3, CD4, CD4RA, CD4RO, CD8, CD56, CD19, and CD56 lymphocyte counts). Values were expressed as means (SD). RESULTS: The group that received psychological stress prevention therapy had significantly lower CD19 (B lymphocyte) cell counts than did the control group just before surgery. No differences were found between the groups for any other variables. CONCLUSIONS: Psychological stress control therapy prevents a decrease in B cell populations before outpatient surgeryOBJECTIVE: To determine the effect of a psychological stress control intervention on lymphocyte populations in patients preparing for outpatient surgery. PATIENTS AND METHODS: A prospective randomized controlled trial enrolling 74 patients scheduled for major outpatient surgery at the Hospital Universitario de Albacete in Spain. The patients were randomized to a control (n=37) or experimental group (n=37). Measurements were recorded at baseline (preoperative visit) and before entering the operating room (just before surgery). The experimental group received treatment in a psychological stress control program consisting of an interview, watching a video, provision of informative literature about the operation and techniques for controlling anxiety. Anxiety was measured with the State-Trait Anxiety Inventory. The General Health Questionnaire (Goldberg) was applied, and lymphocyte populations were assessed (total white cell count; CD3, CD4, CD4RA, CD4RO, CD8, CD56, CD19, and CD56 lymphocyte counts). Values were expressed as means (SD). RESULTS: The group that received psychological stress prevention therapy had significantly lower CD19 (B lymphocyte) cell counts than did the control group just before surgery. No differences were found between the groups for any other variables. CONCLUSIONS: Psychological stress control therapy prevents a decrease in B cell populations before outpatient surgery

[Intravenous perfusion of 2,6-diisopropylphenol (propofol) in the maintenance of emergency anesthesia]. / Perfusión intravenosa de 2,6 diisopropilfenol (propofol) en el mantenimiento de anestesia de urgencias.

In the present study, we describe the use of 2,6 diisopropylphenol (propofol) in emergency surgery. Twenty ASA I and II patients underwent intravenous induction with thiopental (group I) and maintenance with a combination of oxygen/nitrous oxide (30/70%) and in other group of similar characteristics, propofol was used as single induction and maintenance hypnotic (group II). In both groups, atracurium besylate and fentanyl were used according to demand. In group II, there was a significant decrease in systolic blood pressure (16%; p less than 0.01) and diastolic blood pressure (12%; p less than 0.01) during induction as well as a lower incidence of side effects and a more progressive and rapid recovery (eye opening: group II = 16.3 +/- 3.3 minutes; group I = 39.7 +/- 6.3 minutes; p less than 0.01). On the basis of these findings, we believe propofol is a good alternative as single intravenous anesthetic for those patients undergoing emergency surgery and have no marked hemodynamic alterations.