Falsos positivos en PET-TC con 18F-Colina en pacientes con cáncer de próstata / Pitfalls with 18F-Choline PET/CT in patients with prostate cancer

La PET-TC con 18F-Colina (FCH) posee un mayor rendimiento en la valoración de pacientes con cáncer de próstata que la 18F-FDG; no obstante, al igual que esta, tampoco es un radiotrazador específico tumoral. Presentamos cuatro estudios PET-TC realizados con 18F-FCH donde obtuvimos hallazgos falsos positivos catalogados correctamente tras la valoración con la TC, parámetros clínicos y/o análisis histológico (AU)

The 18F-choline PET-CT (FCH) has better performance in the assessment of patients with prostate cancer than 18F-FDG. However, similarly, it is also not a tumor specific radiotracer. We present four 18F-FCH PET-CT scans in which false positive findings were correctly assessed after evaluation with CT, clinical parameters and/or histological analysis (AU)

[Implementation of a quality management system according to the UNE-UN-ISO 9001:2008 standard in a nuclear medicine department]. / Implantación de un sistema de gestión de calidad según norma UNE-UN-ISO 9001:2008 en un servicio de medicina nuclear.

OBJECTIVE: To describe the process of implementing a quality management system according to UNE-EN-ISO 9001:2008 standard in a Nuclear Medicine Department. MATERIAL AND METHOD: In February 2008, the committee on internal quality of the Department was established, naming a responsible physician. The general operating plan was drawn up, following the requirements established by the ISO 9001:2008 standard. It defined the scope of the standard, defining, preparing and transcribing the various activities of our Department. Four training sessions were carried out. RESULTS: A total of nine general and two specific procedures were documented in which all the activities performed in our Department were included. Personnel records of each worker were created, including their profiles and training plan. A record of the equipment and service providers was created, as well as issues with the latter. Satisfaction surveys were obtained from external (patients) and internal customers (faculty applicants). Targets for improvement and activity markers were established. Two audits were performed to complete the process, one internal and one external. The Department was accredited in April 2010. CONCLUSION: The quality accreditation process is a tool that requires reflection on how we do things and how they can be improved. It makes it possible to measure what we do, to analyze and introduce improvement measures, and therefore, to achieve a higher level of quality in the service we provide our customers. The involvement of the Department workers with a commitment to team performance was essential.

[Pitfalls with 18F-choline PET/CT in patients with prostate cancer]. / Falsos positivos en PET-TC con (18)F-Colina en pacientes con cáncer de próstata.

The (18)F-choline PET-CT (FCH) has better performance in the assessment of patients with prostate cancer than (18)F-FDG. However, similarly, it is also not a tumor specific radiotracer. We present four (18)F-FCH PET-CT scans in which false positive findings were correctly assessed after evaluation with CT, clinical parameters and/or histological analysis.

Correlación de resultados clínicos y perfil sagital en escoliosis del adulto. Valor del ángulo espinosacro y del ángulo de inclinación del raquis / Relationship between clinical results and sagittal profile in adult scoliosis. Value of the spinal-sacral angle and the spinal inclination angle

Objetivos. Evaluar la validez clínica en EA de 2 nuevos parámetros (ASS y ST) descritos recientemente para la evaluación del perfil sagital espinopélvicos, y cuyo papel en EA no está aún definido. Material y método. Análisis prospectivo (no concurrente) radiográfico y clínico de 59 cirugías primarias de EA (Cobb > 40°), mínimo 2 años de seguimiento. Para este trabajo dispusimos de radiografías y cuestionarios de salud de 49 pacientes. Se evaluó el cambio de los parámetros radiográficos tras cirugía (test Wilcoxon) y la correlación resultados clínicos-radiográficos-edad (test de Spearman y regresión lineal múltiple). Resultados. Mediana de seguimiento postoperatorio 8,5 años. Mediana edad 49,5 años. Hubo cambio estadísticamente significativo con la cirugía en ASS y ST (en ambos inferior a 5°), cifosis torácica (CT), lordosis lumbar (LL), rotación pélvica (RP), balance sagital (BS) y Cobb frontal. No hubo correlación entre dolor y ASS-ST. Hubo correlación significativa entre actividad y ASS, ST, LL, BS) y edad. Tras análisis multivariante solo la edad (ni ASS ni ST) persistió como posible predictor de menor actividad. Discusión. Cuando predomina la deformidad frontal, los parámetros radiográficos sagitales, incluidos los más novedosos ángulos, si bien sí influyen en la actividad del paciente cuando se analizan de forma aislada, pierden esta influencia cuando se analizan en conjunto y junto a otros parámetros clínicos. Conclusiones. Los valores de SSA y ST varían escasamente con la cirugía. Solo se correlacionan con la actividad pero no pueden considerarse predictores de la misma. No parecen pues medidas de utilidad en EA (AU)

Objectives. To assess the clinical validity of two new recently described parameters (spinal-sacral angle (SSA) and spinal inclination angle (SIA) in adult scoliosis (AS) for evaluating the spinal-pelvic sagittal profile, as well as their still undefined role in AS. Material and method. A non-concurrent prospective radiographic and clinical study was conducted on 59 primary surgeries of AS (Cobb>40°), with a minimum of 2 years follow-up. The available X-rays and health questionnaires of 49 patients were used in the study. The changes in X-ray parameters after surgery were evaluated (Wilcoxon test), as well as the correlations as regards the clinical-radiography-age parameters (Spearman test and multiple linear regression). Results. The median post-surgical follow-up was 8.5 years, and the median age of the patients was 49.5 years. There was a statistically significant change with the surgery in the SSA and SIA (less than 5° in both), thoracic kyphosis, lumbar lordosis (LL), pelvic rotation, sagittal balance (SB) and frontal Cobb. There was no correlation between pain and SSA-ST. There was a significant relationship between activity and SSA, ST, LL, SB, and age. After the multivariate analysis only age (not SSA or SIA) remained as a possible predictor of lower activity. Discussion. When frontal deformity predominates, the sagittal radiographic parameters, including the newest angles, although they have an influence patient activity when analysed individually, they lose this influence when they are analysed together and with other clinical parameters. Conclusions. The SSA and SIA hardly change with surgery. They only correlate with activity, but cannot be considered predictors of this. Thus they do seem to be useful measurements in AS (AU)

¿Resulta rentable un estudio selectivo cerebral con 18F-FDG-PET/TAC en los pacientes con cáncer microcítico de pulmón? / Is a selective brain 18F-FDG PET/CT study profitable in patients with small cell lung cancer?

Objetivo. Evaluar la rentabilidad diagnóstica del estudio selectivo cerebral con 18F-FDG-PET/TAC en pacientes con cáncer microcítico de pulmón asintomáticos neurológicamente. Material y métodos. Se incluyeron en el estudio 21 pacientes derivados a nuestro servicio entre julio de 2008 y diciembre de 2009, para estadificación, con histología de carcinoma microcítico de pulmón y asintomáticos neurológicamente. A todos ellos se les realizó un estudio 18F-FDG-PET/TAC estándar y a continuación un estudio selectivo cerebral, y se confirmaron los hallazgos neurológicos mediante TAC con contraste intravenoso, RM o seguimiento clínico mínimo de 6 meses. Un estudio cerebral PET fue considerado positivo si mostraba cualquier alteración en la distribución de la FDG no relacionada con lesiones benignas previas en la TAC cerebral. Resultados. En 5 de los 21 pacientes (23,8%) se detectaron metástasis cerebrales, siendo correctamente diagnosticados mediante 18F-FDG-PET/TAC 3 de ellos. En uno de ellos la realización del estudio cerebral incrementó el estadio. Sólo uno de los pacientes mostró hipermetabolismo en la imagen PET en relación con las lesiones cerebrales evidenciadas en la imagen TAC. Se obtuvieron valores de sensibilidad, especificidad, valores predictivos positivo y negativo del 60, 100, 100 y 88,89%, respectivamente. Conclusión. Las áreas hipometabólicas en el parénquima cerebral con frecuencia se asocian a lesiones metastásicas en pacientes con cáncer microcítico de pulmón. La realización de un estudio selectivo cerebral PET/TAC en estos pacientes permite una correcta estadificación y el tratamiento precoz de las metástasis no sospechadas(AU)

Aim. To evaluate the diagnostic yield of a selective brain 18F-FDG PET/CT in neurologically asymptomatic patients with small cell lung cancer. Material and methods. Twenty-one neurologically asymptomatic patients referred to our service between July 2008 and December 2009 for staging of small cell lung cancer were included in the study. All underwent a standard 18F-FDG PET/CT study followed by a selective brain PET/CT. The neurological findings were confirmed by CT scan with intravenous contrast, MRI or minimum clinical follow-up of 6 months. The brain PET/CT was considered positive if any alteration was observed in the FDG distribution that was not related with previously known benign lesion in the CT image. Results. Brain metastases were detected in 5 of the 21 patients (23.8%), these being correctly classified in 3 of them by the selective brain PET/CT. The stage was upgraded in one of them with the selective brain study. Only one patient showed a hypermetabolic lesion in the PET images in relationship to the lesions observed in the CT images. Sensibility, specificity, positive predictive value and negative predictive value were 60, 100, 100 and 88.89%, respectively. Conclusion. Hypometabolic areas in the cerebral parenchyma are frequently associated to metastatic lesions in patients with small cell lung cancer. The selective brain PET/CT in these patients allows correct staging and early treatment of unsuspected metastasis(AU)

[Relationship between clinical results and sagittal profile in adult scoliosis. Value of the spinal-sacral angle and the spinal inclination angle]. / Correlación de resultados clínicos y perfil sagital en escoliosis del adulto. Valor del ángulo espinosacro y del ángulo de inclinación del raquis.

OBJECTIVES: To assess the clinical validity of two new recently described parameters (spinal-sacral angle (SSA) and spinal inclination angle (SIA) in adult scoliosis (AS) for evaluating the spinal-pelvic sagittal profile, as well as their still undefined role in AS. MATERIAL AND METHOD: A non-concurrent prospective radiographic and clinical study was conducted on 59 primary surgeries of AS (Cobb>40°), with a minimum of 2 years follow-up. The available X-rays and health questionnaires of 49 patients were used in the study. The changes in X-ray parameters after surgery were evaluated (Wilcoxon test), as well as the correlations as regards the clinical-radiography-age parameters (Spearman test and multiple linear regression). RESULTS: The median post-surgical follow-up was 8.5 years, and the median age of the patients was 49.5 years. There was a statistically significant change with the surgery in the SSA and SIA (less than 5° in both), thoracic kyphosis, lumbar lordosis (LL), pelvic rotation, sagittal balance (SB) and frontal Cobb. There was no correlation between pain and SSA-ST. There was a significant relationship between activity and SSA, ST, LL, SB, and age. After the multivariate analysis only age (not SSA or SIA) remained as a possible predictor of lower activity. DISCUSSION: When frontal deformity predominates, the sagittal radiographic parameters, including the newest angles, although they have an influence patient activity when analysed individually, they lose this influence when they are analysed together and with other clinical parameters. CONCLUSIONS: The SSA and SIA hardly change with surgery. They only correlate with activity, but cannot be considered predictors of this. Thus they do seem to be useful measurements in AS.

Is a selective brain (18)F-FDG PET/CT study profitable in patients with small cell lung cancer?

AIM: To evaluate the diagnostic yield of a selective brain (18)F-FDG PET/CT in neurologically asymptomatic patients with small cell lung cancer. MATERIAL AND METHODS: Twenty-one neurologically asymptomatic patients referred to our service between July 2008 and December 2009 for staging of small cell lung cancer were included in the study. All underwent a standard (18)F-FDG PET/CT study followed by a selective brain PET/CT. The neurological findings were confirmed by CT scan with intravenous contrast, MRI or minimum clinical follow-up of 6 months. The brain PET/CT was considered positive if any alteration was observed in the FDG distribution that was not related with previously known benign lesion in the CT image. RESULTS: Brain metastases were detected in 5 of the 21 patients (23.8%), these being correctly classified in 3 of them by the selective brain PET/CT. The stage was upgraded in one of them with the selective brain study. Only one patient showed a hypermetabolic lesion in the PET images in relationship to the lesions observed in the CT images. Sensibility, specificity, positive predictive value and negative predictive value were 60, 100, 100 and 88.89%, respectively. CONCLUSION: Hypometabolic areas in the cerebral parenchyma are frequently associated to metastatic lesions in patients with small cell lung cancer. The selective brain PET/CT in these patients allows correct staging and early treatment of unsuspected metastasis.

PET-TAC con 18F-FDG tras llenado retrógrado vesical en el estudio de patología pélvica maligna / 18F-FDG PET/CT with retrograde filling of the urinary bladder in the assessment of malignant pelvic disease

Objetivo. Determinar el papel de la PET-TAC con llenado retrógrado vesical (LLRV) en la valoración de patología pélvica maligna en pacientes con tumores de origen urotelial o ginecológico. Material y métodos. Se realizó un análisis retrospectivo longitudinal de 62 estudios PET-TAC pertenecientes a 52 pacientes. Todos tenían antecedentes de neoplasia pélvica (29 urotelial y 23 ginecológica), 42 habían sido sometidos a tratamientos previos. Material y métodos. Se realizó a todos los pacientes una PET-TAC según protocolo estándar. Los criterios de inclusión para la adquisición posterior de una PET-TAC tras LLRV fueron la sospecha radiológica de malignidad pélvica o el incremento de actividad urinaria vesical de 18F-FDG que dificultaba la valoración de órganos pélvicos. Material y métodos. Se analizaron los hallazgos patológicos a nivel pélvico junto con el valor añadido de la imagen de LLRV. Material y métodos. Las lesiones fueron confirmadas histológicamente o por seguimiento clínico-radiológico durante un mínimo de 12 meses. Resultados. Se confirmó malignidad pélvica en 33 casos, 16 de origen urotelial. Resultados. Treinta y cinco de los sesenta y dos estudios mostraron malignidad pélvica por PET/TAC, 4 de ellos fueron falsos positivos y 2 falsos negativos. En 19 casos se detectó malignidad en la pared vesical, 16 fueron verdaderos positivos. Resultados. Con respecto a la imagen estándar, el LLRV ayudó a confirmar/descartar enfermedad vesical y/o ginecológica en 54 casos. Conclusión. El LLRV es una técnica altamente recomendable en la valoración de patología neoplásica pélvica, especialmente de origen vesical(AU)

Aim. To assess the role of PET/CT with retrograde filling of urinary bladder (RFUB) in the assessment of pelvic malignancy in patients with urothelial or gynecological tumors. Material and methods. A retrospective longitudinal analysis based on 62 studies belonging to 52 patients was performed. All of them had a history of pelvic malignancy (29 urothelial and 23 gynecological) and 42 had undergone previous treatments. All patients underwent a standard PET/CT protocol. Inclusion criteria were radiological alterations in pelvic organs or increased urinary activity of 18F-FDG that hindered evaluation of the pelvic structures. Pathological pelvic locations were assessed as the additional value of PET/CT with RFUB. The pathologic lesions were histologically or clinically evaluated with a minimum follow-up of 12 months. Results. Pelvic malignancy was confirmed in 33 cases, 16 of which were of urothelial origin. A total of 35/62 studies showed a pathologic PET/CT in pelvis, 4 of them were false positive and 2 false negative. In 19 cases, malignancy was detected in the bladder wall, 16 of which were true positive. No false negative was detected. Regarding standard imaging acquisition, RFUB helped to confirm or rule out bladder and/or gynecological disease in 54 cases. Conclusion. Retrograde bladder filling is a highly recommended technique in the assessment of malignant pelvic disease, especially of bladder origin(AU)

[18F-FDG PET/CT with retrograde filling of the urinary bladder in the assessment of malignant pelvic disease]. / PET-TAC con (18)F-FDG tras llenado retrógrado vesical en el estudio de patología pélvica maligna.

AIM: To assess the role of PET/CT with retrograde filling of urinary bladder (RFUB) in the assessment of pelvic malignancy in patients with urothelial or gynecological tumors. MATERIAL AND METHODS: A retrospective longitudinal analysis based on 62 studies belonging to 52 patients was performed. All of them had a history of pelvic malignancy (29 urothelial and 23 gynecological) and 42 had undergone previous treatments. All patients underwent a standard PET/CT protocol. Inclusion criteria were radiological alterations in pelvic organs or increased urinary activity of (18)F-FDG that hindered evaluation of the pelvic structures. Pathological pelvic locations were assessed as the additional value of PET/CT with RFUB. The pathologic lesions were histologically or clinically evaluated with a minimum follow-up of 12 months. RESULTS: Pelvic malignancy was confirmed in 33 cases, 16 of which were of urothelial origin. A total of 35/62 studies showed a pathologic PET/CT in pelvis, 4 of them were false positive and 2 false negative. In 19 cases, malignancy was detected in the bladder wall, 16 of which were true positive. No false negative was detected. Regarding standard imaging acquisition, RFUB helped to confirm or rule out bladder and/or gynecological disease in 54 cases. CONCLUSION: Retrograde bladder filling is a highly recommended technique in the assessment of malignant pelvic disease, especially of bladder origin.

Caracterización ayurvedica de estudiantes de primer año De la ELAM / First years students ELAM characterization

Se realiza un estudio analítico en 260 estudiantes de primer año de la Escuela Latinoamericana de Medicina del curso 2005-2006 en el período de enero a marzo de 2006, con la finalidad de caracterizarlos desde el punto de vista ayurvédico. Los estudiantes fueron seleccionados a través de un muestreo aleatorio simple utilizando una lista de aleatorización. A cada estudiante se le realiza examen físico y se le aplica un formulario-encuesta para identificar las variables objeto de estudio: edad, sexo, peso corporal, talla, antecedentes patológicos personales, número de comidas al día, número de horas diarias dedicadas al sueño y tipo constitucional metabólico. Con la información obtenida se conforma una base de datos. Se utiliza el porcentaje como medida de resumen de las variables cualitativas. Predominaron los estudiantes del sexo femenino (52.7 por ciento), con menos de 20 años de edad (43.8 por ciento) y del tipo constitucional metabólico Vatta (68.8 por ciento). Las afecciones alérgicas fueron el antecedente patológico personal más referido y la mayoría de los estudiantes refirieron tener entre 3 y 6 comidas al día y dedicar menos de 6 horas diarias al sueño (AU)

[Cost-effectiveness analysis of patient-controlled analgesia compared to continuous elastomeric pump infusion of tramadol and metamizole]. / Análisis coste-efectividad de la PCA postoperatoria frente a la infusión continua elastomérica de tramadol y metamizol.

OBJECTIVES: Little information is available on the cost-effectiveness of postoperative patient-controlled analgesia (PCA). The present study compared PCA to continuous infusion by elastomeric pump. MATERIAL AND METHODS: Fifty ASA 1 or 2 patients undergoing major gynecologic surgery were enrolled for a randomized controlled trial to evaluate the effectiveness and costs derived from intravenous PCA with metamizole and tramadol compared to continuous infusion of the same analgesic solution by elastomeric pump in the 48 hours following surgery. Patient satisfaction and side effects were also recorded. RESULTS: The analgesic effectiveness and side effects of the 2 regimens were similar, although 61% of patients in the elastomeric pump group needed morphine for rescue analgesia compared to 33% in the PCA group (P < .05). In the PCA group, 81% of the patients said they would repeat the analgesic treatment compared to only 56% in the elastomeric pump group (P = .05). The mean number of nursing interventions was 16 for the PCA group and 19 for the elastomeric pump group. The mean cost of the treatment (not including the PCA pump, provided by the manufacturer) was Euros 41.35 for the PCA group and Euros 56.22 for the elastomeric pump group. CONCLUSIONS: The analgesic efficacy of the 2 regimens was similar. However, patient satisfaction was greater with PCA and use of an elastomeric pump was more expensive. In the setting of the present study, postoperative PCA proved to be more advantageous than continuous elastomeric pump infusion.

Análisis coste-efectividad de la PCA postoperatoria frente a la infusión continua elastomérica de tramadol y metamizol / Cost-effectiveness of patient-controlled analgesia compared to continuous elastomeric pump infusion of tramadol and metamizole

OBJETIVOS: Existen pocos datos relativos al coste-efectividad de los sistemas de analgesia controlada por el paciente (PCA) en el postoperatorio. El presente estudio compara desde esta perspectiva la PCA con una infusión elastomérica continua. MATERIAL Y MÉTODO: Estudio prospectivo, controlado y aleatorizado en 50 pacientes ASA I o II sometidas a cirugía mayor ginecológica, que evalúa durante las primeras 48 horas de postoperatorio la efectividad, los efectos secundarios, la satisfacción y los costes derivados de la administración de una pauta PCA i.v de metamizol y tramadol (Grupo PCA), frente a la infusión elastomérica continua de la misma solución analgésica (Grupo Elastómero). RESULTADOS: La efectividad analgésica y los efectos secundarios de las pautas fueron similares, aunque más pacientes del Grupo Elastómero precisaron rescates analgésicos con morfina (61% frente al 33% del grupo PCA; p < 0,05). El 81% de las pacientes del Grupo PCA repetirían el tratamiento analgésico frente a sólo el 56% del grupo Elastómero -p = 0,05-). El número medio de intervenciones de enfermería fue de 16 y 19 para los grupos PCA y Elastómero respectivamente. Los gastos medios de los tratamientos (no incluida la bomba PCA facilitada por la industria) ascendieron en el grupo PCA a 41,35 euros frente a los 56,22 euros del grupo Elastómero. CONCLUSIONES: Ambas pautas presentaron una eficacia analgésica parecida aunque la PCA resultó más satisfactoria, a la vez que el elastómero fue más caro. En las condiciones particulares de nuestro estudio la PCA postoperatoria resultó más ventajosa que la infusión continua elastomérica (AU)

OBJECTIVES: Little information is available on the cost-effectiveness of postoperative patient-controlled analgesia (PCA). The present study compared PCA to continuous infusion by elastomeric pump. MATERIAL AND METHODS: Fifty ASA 1 or 2 patients undergoing major gynecologic surgery were enrolled for a randomized controlled trial to evaluate the effectiveness and costs derived from intravenous PCA with metamizole and tramadol compared to continuous infusion of the same analgesic solution by elastomeric pump in the 48 hours following surgery. Patient satisfaction and side effects were also recorded. RESULTS: The analgesic effectiveness and side effects of the 2 regimens were similar, although 61% of patients in the elastomeric pump group needed morphine for rescue analgesia compared to 33% in the PCA group (P<.05). In the PCA group, 81% of the patients said they would repeat the analgesic treatment compared to only 56% in the elastomeric pump group (P=.05). The mean number of nursing interventions was 16 for the PCA group and 19 for the elastomeric pump group. The mean cost of the treatment (not including the PCA pump, provided by the manufacturer) was €41.35 for the PCA group and €56.22 for the elastomeric pump group. CONCLUSIONS: The analgesic efficacy of the 2 regimens was similar. However, patient satisfaction was greater with PCA and use of an elastomeric pump was more expensive. In the setting of the present study, postoperative PCA proved to be more advantageous than continuous elastomeric pump infusion (AU)

Valoración de la actividad de una Unidad de Dolor Agudo Postoperatorio por los cuidadores del paciente quirúrgico / Assessment of the activity of an Acute Postoperative Pain Unit by the staff taking care of surgical patients

Objetivo:Implantada en nuestra institución desde el año 2000una Unidad de Dolor Agudo Postoperatorio (UDAP) basada en enfermería y supervisada por el Servicio de Anestesiología,pretendemos evaluar cómo es percibida su actividadpor los cuidadores del paciente quirúrgico.Material y método:El Servicio de Anestesiología y Reanimación con la Unidadde Recuperación Postanestésica (URPA) mantienenuna UDAP basada en enfermería que trata de forma planificaday protocolizada el dolor postoperatorio de más de1.000 pacientes/año que reciben las cirugías más agresivasy dolorosas en un hospital de segundo nivel. De formaanónima y voluntaria se les solicitó a la enfermería y los facultativosresponsables de los pacientes que respondieran aun cuestionario escrito de 15 preguntas (12 de respuestacerrada agrupada en 4 categorías y 3 de respuesta abierta)en el que valorar diferentes aspectos de su actividad.Resultados:De 168 encuestas distribuidas se valoraron 87 cuestionariosdevueltos (52%), 48 de facultativos y 39 de enfermería.El papel de UDAP resultó bien o muy bien comprendidopor el 97% de los respondedores y su actividadfue percibida con bastante unanimidad como útil, efectiva ynecesaria por el 98, el 93 y el 97%, respectivamente. Lasindicaciones del tratamiento fueron consideradas apropiadaso muy apropiadas por el 87%, la actitud de su personalante las consultas fue considerada satisfactoria o muy satisfactoriapor el 90% y las técnicas analgésicas eran suficientementecomprendidas por el 89%. El 67% consideraronque los pacientes estaban bien o muy bien informados. Facultativosy enfermería discreparon en la percepción delgrado de complementación de la actividad de la UDAP conla del resto de los cuidadores (poco o muy poco para el51% de la enfermería frente a sólo el 19% de los facultativos;p = 0,001) y en la fluidez de la comunicación con supersonal (poca o muy poca para el 41% de la enfermeríafrente al 19% de los facultativos; p=0,01). El aspecto mejorvalorado de la UDAP fue la mejora en el control del dolorpostoperatorio; el peor, la comunicación entre los profesionalesy, la sugerencia más referida, la de intentarmejorarla.Conclusiones:El papel de la UDAP es muy bien comprendido en nuestrohospital por los cuidadores del paciente quirúrgico yaunque su actividad es unánimemente percibida como útil ynecesaria, existen problemas de integración y comunicación,especialmente con la enfermería de planta. La identificaciónde situaciones como esta mediante estudios deopinión sobre su actividad, puede ser útil para dirigir mejorasen el funcionamiento de las Unidades de Dolor Agudocon modelos organizativos similares al nuestro

Objective:An Acute Postoperative Pain Unit (APPU) staffed bynurses and supervised by the Service of Anesthesiologywas created in our center in 2.000. The aim of this studywas to assess how the staff taking care of surgical patientsperceive its activity.Material and method:The Service of Anesthesiology and Resuscitation andthe Post-Anesthetic Recovery Unit (PARU) maintain anAPPU staffed by nurses that provides planned and protocolizedmanagement of postoperative pain to more than1.000 patients/year undergoing the most aggressive andpainful surgical procedures in a second-level hospital. Nursesand doctors taking care of the patients were requestedto anonymously and voluntarily answer a written questionnairewith 15 questions (12 close-ended questions groupedin 4 categories and 3 open-ended questions) that assessedseveral aspects of their activity.Results:Out of 168 questionnaires handed out, 87 questionnairesreturned were considered (52%), 48 from doctors and39 from nurses. The role of the APPU was well or verywell understood by 97% of the responders and its activitywas perceived rather unanimously as useful, effective andnecessary by 98, 93 and 97%, respectively. Treatment indicationswere considered appropriate or very appropriateby 87%, staff attitude towards consultation was consideredsatisfactory or very satisfactory by 90% and analgesic techniqueswere sufficiently understood by 89%. A 67% consideredthat patients were well or very well informed. Doctorsand nurses disagreed in their perception of the degreeto which the APPU activity complemented that of otherhealth care staff (low or very low for 51% of nurses versus19% of doctors; p=0.001) and in the fluency of communicationwith the staff (little or very little for 41% of nursesversus 19% of doctors; p=0.01). The most valued aspectof the UPPA was the management of postoperative pain;the least valued aspect was the communication betweenprofessionals and the most frequent suggestion: attempt toimprove such communication.Conclusions:The role of the UPPA is very well understood in our hospitalby the staff taking care of surgical patients and while itsactivity is unanimously perceived as useful and necessary,there are integration and communication problems, speciallywith the general nursing staff. The identification of this typeof situations through opinion polls about its activity can beuseful in order to improve the operation of acute pain unitswith organizational models similar to ours

Influencia de la monitorización BIS en los requerimientos de analgesia postoperatoria / Influence of BIS monitoring on the need of postoperative analgesia

Objetivos: La monitorización del indice biespectral (BIS) durante la anestesia total intravenosa (ATIV) suele conllevar una disminución de la administración dé propofol cuando se compara con la dosificación estándar. Este hecho puede asociarse con el incremento de las necesidades intraoperatorias de opioides. El objetivo de este estudio es determinar si estas circunstancias pueden influir, y en qué medida, sobre los requerimientos de analgesia postoperatoria. Material y métodos: Ensayo controlado, aleatorizado y parcialmente doble ciego en 40 pacientes ASA I y II sometidas a cirugía mayor ginecológica bajo ATIV. En el grupo BIS la administración de propofol fue dirigida por las variaciones de este indice, mientras que en el grupo control se realizó según una dosificación estándar. En ambos grupos el fentanilo se administró según las respuestas hemodinámicas. La analgesia postoperatoria consistió en tramado! y metamizol i.v. mediante PCA, con morfina de rescate. Los dos grupos de tratamiento se compararon en cuanto a vaviables relativas a la analgesia y el dolor postoperatorio de las primeras 24 horas. Resultados: Una paciente fue excluida. El grupo BIS (n=17) recibió menos propofol y más fentanilo que el grupo control (n=22) (429 mg frente 630 mg y 620 microg frente a 544 microg, respectivamente; p<0,0001) y también recuperó antes la ,consciencia (7,5 min frente a 10,5 min, p<0,003). No se observaron diferencias significativas en cuanto al inicio de la analgesia postoperatoria, el consumo de fármacos ni los efectos secundarios. La valoración del dolor y la satisfacción con su tratamiento fue similar en ambos grupos de pacientes. Las pacientes del grupo control, no obstante, fueron más precozmente dadas de alta de la URPA (115 min frente a 159 min, p=0,04).Conclusiones: En las condiciones referidas en este estudio la monitorización BIS durante la anestesia, y con ella las variaciones inducidas` en la administración de propofol y fentanilo, no influyeron significativamente sobre la analgesia postoperatoria (AU)

Thromboangiitis obliterans (Buerger's disease) with intestinal involvement--a case report.

Thromboangiitis obliterans (TAO) or Buerger's disease is a nonatherosclerotic vascular disease of unknown etiology that occurs almost exclusively in young male tobacco users. The involvement of the medium-sized and small arteries and veins leads to ischemic complaints and trophic changes in the limbs. The authors report a case of Buerger's disease in a 29-year-old man, a heavy smoker, affecting the lower limbs and mesenteric vessels.

[Jugular thrombosis and adenocarcinoma of the prostate: a state of hypercoagulability?]. / Trombosis yugular y adenocarcinoma de próstata: estado de hipercoagulabilidad?

The association between cancer and hypercoagulability states is well known. It usually presents as a complication of gastrointestinal tract adenocarcinomas. We present the case of patient diagnosed of prostatic adenocarcinoma who was admitted because of pain and inflammation in the left side of the neck. The ultrasound study showed a jugular vein thrombosis. In the bibliographic review (MEDLINE 1990-1995), we have not found any similar reports Jugular vein thrombosis is a rare complication and usually is secondary to central vein catheter insertion, although it has been also described with ovarian hyperstimulation syndrome, infections, head and neck tumors and rarely in other neoplastic diseases. The physiopathologic process is not well known, although it is known that neoplastic cells interact with the thrombin and plasmin generating systems and that there is also a decrease in coagulation inhibitors, all of which leads to prothrombin activation in the absence of the corresponding increases in thrombin inhibitor complexes.