Model selection of chaotic systems from data with hidden variables using sparse data assimilation.

Many natural systems exhibit chaotic behavior, including the weather, hydrology, neuroscience, and population dynamics. Although many chaotic systems can be described by relatively simple dynamical equations, characterizing these systems can be challenging due to sensitivity to initial conditions and difficulties in differentiating chaotic behavior from noise. Ideally, one wishes to find a parsimonious set of equations that describe a dynamical system. However, model selection is more challenging when only a subset of the variables are experimentally accessible. Manifold learning methods using time-delay embeddings can successfully reconstruct the underlying structure of the system from data with hidden variables, but not the equations. Recent work in sparse-optimization based model selection has enabled model discovery given a library of possible terms, but regression-based methods require measurements of all state variables. We present a method combining variational annealing-a technique previously used for parameter estimation in chaotic systems with hidden variables-with sparse-optimization methods to perform model identification for chaotic systems with unmeasured variables. We applied the method to ground-truth time-series simulated from the classic Lorenz system and experimental data from an electrical circuit with Lorenz-system like behavior. In both cases, we successfully recover the expected equations with two measured and one hidden variable. Application to simulated data from the Colpitts oscillator demonstrates successful model selection of terms within nonlinear functions. We discuss the robustness of our method to varying noise.

¿Influye la anestesia en los resultados de la cirugía oncológica? / Does the anesthesia have any influence on surgical outcome?

Los criterios de calidad en la cirugía oncológica radical se basan en la extirpación completa del tumor, con márgenes libres, sin enfermedad macroscópica residual, en una linfadenectomía adecuada y en la mínima manipulación tumoral posible. A pesar de conseguir estos objetivos, tras la extirpación puede quedar enfermedad residual no visible o micrometástasis, con potencial de crecimiento y diseminación, dependiendo de la capacidad tumoral y de las defensas del huésped. Tres factores perioperatorios pueden desplazar potencialmente el equilibrio hacia la progresión de la enfermedad residual mínima: a) la cirugía, por la manipulación, libera células tumorales a la circulación, deprime la inmunidad celular (IC), incluyendo la actividad citotóxica de las células Th1 (T helper) y las NK (natural killer), reduce los factores anti-angiogénicos e incrementa los pro-angiogénicos; b) los anestésicos generales, excepto el propofol, disminuyen la IC; y c) los opioides inhiben la IC y humoral y promueven el crecimiento tumoral. La anestesia y la analgesia regional bloquean las aferencias nociceptivas intraoperatorias y disminuyen o eliminan el dolor agudo postoperatorio. Combinada con la anestesia general, disminuiría el consumo de anestésicos volátiles, potencialmente inmunosupresores. Estas acciones preservan la inmunidad al disminuir la respuesta neuroendocrina e inflamatoria al estrés y el consumo de opioides. Los estudios experimentales apoyan esta hipótesis. Los estudios clínicos presentan resultados contradictorios. Desde el año 2000, se han realizado 21 estudios en cáncer de mama, próstata, colon y recto, pulmón, hígado y melanoma. Dieciséis son retrospectivos, 5 muestran resultados positivos en cuanto a la asociación de la analgesia epidural y la disminución de la recurrencia oncológica. Otros 5 muestran resultados parciales, y 6 estudios no mostraron ninguna asociación. Los 5 estudios prospectivos también muestran resultados variables. Los diferentes resultados clínicos pueden deberse a múltiples factores de confusión, como distintos grados histológicos, radioterapia y quimioterapia previas, diversos grados de dificultad y de radicalidad quirúrgica, la presencia de anemia previa, sangrado, transfusión o hipotermia. También pueden existir diferencias entre las técnicas anestésicas y el uso o no de la analgesia epidural en el intraoperatorio. La administración de fármacos potencialmente inmunoprotectores, como AINE, tramadol, β-bloqueantes y estatinas, pueden contribuir a enmascarar los resultados. Existen además problemas metodológicos, como tamaños de muestra pequeños para un potencial efecto positivo inferior al 30 %, mezclas heterogéneas de pacientes, de procedimientos quirúrgicos y de series antiguas y finalmente la dificultad de aislar un efecto dentro del entorno perioperatorio complejo y multifactorial. Quedan muchas preguntas pendientes, a la espera de ensayos prospectivos que acabarán dentro de 3 a 7 años. Los nuevos abordajes laparoscópicos, la cirugía mínimamente invasiva y la neoadyuvancia, han cambiado radicalmente el grado de agresión quirúrgica y probablemente también el impacto de las técnicas anestésicas inmunoprotectoras en la recurrencia quirúrgica. En la actualidad no hay evidencia que apoye una técnica anestésica sobre otra en la supervivencia oncológica

The following quality criteria management is considered in radical surgery for cancer, complete eradication of the tumor with negative surgical margins and without macroscopic residual tumor, adequate removal of lymph nodes and minimal manipulation of the tumor. Despite getting all these objectives, residual non-visible tumor or micrometastasis may persist after tumor resection therefore cancer cells can growth and disseminate depending on the aggressiveness of the tumor and host defenses. Three perioperative factors can contribute to cancer advance: a) Surgical manipulation that releases cancer cells to the bloodstream, diminishes cellular immunity, including T helper 1 (TH1) and natural killer (NK) cell activity, decreases anti-angiogenic factors and increases pro-angiogenic factors; b) general anaesthetics, except propofol, diminish cellular immunity; and c) opioids inhibit cellular and humoral immunity and promote cancer cell growth. Regional anaesthesia and analgesia block nociceptive afferents and decrease or eliminate acute postoperative pain. Combined with general anaesthesia would reduce the consumption of volatile anesthetics, potentially immunosuppressive. These actions preserve immunity due to the decrease of neuroendocrine and inflammatory response to stress and the consumption of opioids. Experimental studies support this hypothesis. Clinical studies show contradictory results. Since the year 2000, twenty one cancer studies for many types of cancer (breast, prostate, colon and rectum, lung, liver and melanoma) have been published. Sixteen studies are retrospective, 5 studies show positive correlation between epidural analgesia and decrease of cancer recurrence risk. Five studies show partial results and 6 studies did not show any association. Data from 5 prospective studies also show variable results. Differences in clinical studies results may be due to several confounding factors like different histological grading, radiotherapy and chemotherapy used previously, different technical difficulty and radical surgery grade, perioperative anaemia, bled, transfusion or hypothermia. Other causes of conflicting results are related to anaesthetic technique and the use or not of intraoperative epidural analgesia. The administration of drugs with potential immunosuppressive effects like non-steroidal anti-inflammatory drugs, tramadol, beta blockers and statins can also mask the results. There exist moreover methodological problems like small sample size to get a potential positive effect less than 30 %, patients, surgical procedures and old series heterogeneity and finally difficulty to isolate an effect from the complex and multifactorial perioperative environment. Many outstanding questions are waiting for prospective trials that end within 3 to 7 years. The new laparoscopic approaches, minimally invasive surgery and neoadjuvancy have radically changed the degree of surgical aggression and probably also the impact of the immunoprotective anesthetic techniques on surgical recurrence. Currently there is no evidence that supports one anesthetic technique over another in cancer survival (AU)

¿Influyen las técnicas anestésicas en los resultados postoperatorios? Parte II / Do anesthetic techniques influence postoperative outcomes? Part II

Conocer hasta qué punto nuestras técnicas anestésicas pueden modificar los resultados postoperatorios ha abierto en los últimos años un gran campo de investigación. En esta segunda parte, revisamos las principales controversias que plantea la literatura sobre el impacto de las técnicas anestésicas en los resultados postoperatorios, en 6 áreas principales: disfunción cognitiva postoperatoria, dolor crónico postoperatorio, recurrencia oncológica, náuseas/vómitos postoperatorios, resultados quirúrgicos y consumo de recursos. El desarrollo de estrategias anestésicas protectoras y preventivas frente a complicaciones postoperatorias a corto y largo plazo ocupará probablemente un papel importante en nuestra práctica anestésica diaria. El control del dolor dinámico postoperatorio es uno de los requisitos básicos de los programas de recuperación postoperatoria acelerada (cirugía fast-track). Además es un factor preventivo del desarrollo de dolor crónico postoperatorio. El peso de la técnica anestésica en la inmunosupresión postoperatoria está pendiente de definir. La posibilidad de que la anestesia influya en la recurrencia oncológica, es un área de investigación muy controvertida. Las pautas clásicas de fluidoterapia pueden incrementar las complicaciones postoperatorias. Por otro lado, el mantenimiento de la normoglucemia y de la normotermia se relaciona con una disminución de la morbilidad postoperatoria. El gran volumen de intervenciones quirúrgicas hace que la adecuación de los recursos humanos, organizativos y tecnológicos tenga un gran impacto en los costes totales(AU)

The knowledge of the influence of anesthetic techniques in postoperative outcomes has opened a large field of research in recent years. In this second part, we review some of the major controversies arising from the literature on the impact of anesthetic techniques on postoperative outcomes in 6 areas: postoperative cognitive dysfunction, chronic postoperative pain, cancer recurrence, postoperative nausea/vomiting, surgical outcomes, and resources utilization. The development of protective and preventive anesthetic strategies against short and long-term postoperative complications will probably occupy an important role in our daily anesthetic practice. Dynamic postoperative pain control has been confirmed as one of the basic requirements of accelerated postoperative recovery programs («fast-track surgery»), and it is also a preventive factor for development of chronic postoperative pain. The weight of anesthetic technique on postoperative immunosuppression is to be defined. The potential influence of anesthesia on cancer recurrence, is a highly controversial area of research. The classic pattern of perioperative fluid therapy may increase postoperative complications. On the other hand, the maintenance of normoglycemia and normothermia was associated with a decreased postoperative morbidity. The high volume of surgical procedures means that the adequacy of human, organizational and technological resources have a major impact on overall costs(AU)

¿Influyen las técnicas anestésicas en los resultados postoperatorios? Parte I / Do anesthetic techniques influence postoperative outcomes? Part I

La pregunta sobre si nuestras técnicas anestésicas pueden modificar los resultados postoperatorios ha abierto en los últimos años un gran campo de investigación. Los pacientes con riesgo sometidos a cirugía no cardíaca son los que presentan mayor incidencia de complicaciones postoperatorias y de mortalidad. Definir adecuadamente este grupo de pacientes permitiría concentrar esfuerzos y recursos para mejorar los resultados. La disminución progresiva de la mortalidad y de las complicaciones en los últimos 20 años está modificando el enfoque de la investigación en el área perioperatoria. La evaluación de los resultados intermedios postoperatorios probablemente discrimine mejor las diferencias de efectividad de las distintas modalidades anestésicas. Revisamos las principales controversias que plantea la literatura sobre el impacto de las técnicas anestésicas en los resultados postoperatorios. Para ello hemos definido 9 áreas principales en el campo de la investigación de resultados postoperatorios: mortalidad, complicaciones cardiovasculares, complicaciones respiratorias, disfunción cognitiva postoperatoria, dolor crónico postoperatorio, recurrencia oncológica, náuseas/vómitos postoperatorios, resultados quirúrgicos y consumo de recursos. En esta primera parte de la revisión, abordamos las bases de la investigación de resultados postoperatorios, la mortalidad, las complicaciones cardiovasculares y las respiratorias (AU)

The influence of anesthetic technique on postoperative outcomes has opened a wide field of research in recent years. High-risk patients undergoing non-cardiac surgery are those who have higher incidence of postoperative complications and mortality. A proper definition of this group of patients should focus maximal efforts and resources to improve the results. In view of the significant reduction in postoperative mortality and morbidity in last 20 years, perioperative research should take into account new indicators to investigate the role of anesthetic techniques on postoperative outcomes. Studies focused on the evaluation of intermediate outcomes would probably discriminate better effectiveness differences between anesthetic techniques. We review some of the major controversies arising in the literature about the impact of anesthetic techniques on postoperative outcomes. We have grouped the impact of these techniques into 9 major investigation areas: mortality, cardiovascular complications, respiratory complications, postoperative cognitive dysfunction, chronic postoperative pain, cancer recurrence, postoperative nausea/vomiting, surgical outcomes and resources utilization. In this first part of the review, we discuss the basis on postoperative outcomes research, mortality, cardiovascular and respiratory complications (AU)

[Do anesthetic techniques influence postoperative outcomes? Part II]. / ¿Influyen las técnicas anestésicas en los resultados postoperatorios? Parte II.

The knowledge of the influence of anesthetic techniques in postoperative outcomes has opened a large field of research in recent years. In this second part, we review some of the major controversies arising from the literature on the impact of anesthetic techniques on postoperative outcomes in 6 areas: postoperative cognitive dysfunction, chronic postoperative pain, cancer recurrence, postoperative nausea/vomiting, surgical outcomes, and resources utilization. The development of protective and preventive anesthetic strategies against short and long-term postoperative complications will probably occupy an important role in our daily anesthetic practice. Dynamic postoperative pain control has been confirmed as one of the basic requirements of accelerated postoperative recovery programs ("fast-track surgery"), and it is also a preventive factor for development of chronic postoperative pain. The weight of anesthetic technique on postoperative immunosuppression is to be defined. The potential influence of anesthesia on cancer recurrence, is a highly controversial area of research. The classic pattern of perioperative fluid therapy may increase postoperative complications. On the other hand, the maintenance of normoglycemia and normothermia was associated with a decreased postoperative morbidity. The high volume of surgical procedures means that the adequacy of human, organizational and technological resources have a major impact on overall costs.

[Do anesthetic techniques influence postoperative outcomes? Part I]. / ¿Influyen las técnicas anestésicas en los resultados postoperatorios? Parte I.

The influence of anesthetic technique on postoperative outcomes has opened a wide field of research in recent years. High-risk patients undergoing non-cardiac surgery are those who have higher incidence of postoperative complications and mortality. A proper definition of this group of patients should focus maximal efforts and resources to improve the results. In view of the significant reduction in postoperative mortality and morbidity in last 20 years, perioperative research should take into account new indicators to investigate the role of anesthetic techniques on postoperative outcomes. Studies focused on the evaluation of intermediate outcomes would probably discriminate better effectiveness differences between anesthetic techniques. We review some of the major controversies arising in the literature about the impact of anesthetic techniques on postoperative outcomes. We have grouped the impact of these techniques into 9 major investigation areas: mortality, cardiovascular complications, respiratory complications, postoperative cognitive dysfunction, chronic postoperative pain, cancer recurrence, postoperative nausea/vomiting, surgical outcomes and resources utilization. In this first part of the review, we discuss the basis on postoperative outcomes research, mortality, cardiovascular and respiratory complications.

La transición de dolor agudo postoperatorio a crónico: ¿qué sabemos? / No disponible

La transición del dolor agudo postoperatorio a crónico es un proceso complejo, poco conocido y de interés creciente en los últimos años. Los cuadros dolorosos crónicos derivados de determinados procedimientos quirúrgicos como la toracotomía, la mastectomía o la amputación se asocian a una elevada prevalencia. Sin embargo, han sido identificados una serie de factores pronósticos o predictivos relacionados con la aparición de dichos cuadros dolorosos. Su detección precoz permitiría iniciar tratamientos analgésicos preventivos con el objetivo de evitar dicha transición (AU)

The transition from acute to chronic postoperative pain is a complex process, little well known process and of increasing interest in the last years. Certain surgical procedures such as thoracotomy, mastectomy or amputation are associated to high prevalence of painfull chronic syndromes. Nevertheless, series of predictive factors have been identified in development of chronic postoperative pain. Its early detection would allow initiating analgesic preventive treatments with the aim of avoiding this transition (AU)

Atención del dolor agudo postoperatorio: evaluación de resultados en las salas de hospitalización quirúrgicas / Treating acute postoperative pain: evaluation of results on the surgical ward

Objetivos: Describir el tratamiento global del dolor agudo postoperatorio en las salas de hospitalización quirúrgicas. Relacionar el grado de dolor con los distintos tipos de abordajes y procedimientos quirúrgicos. Por último, registrar el grado de información, las expectativas y la satisfacción de los pacientes con la atención recibida en el tratamiento del dolor postoperatorio. Pacientes y Métodos: Estudio observacional transversal mediante entrevista y revisión de historia clínica. Se evaluaron 234 pacientes, incluyendo todos los pacientes postoperados ingresados más de 24 horas a partir del día de la intervención quirúrgica, de cirugía programada o urgente. Los principales parámetros registrados fueron, la intensidad del dolor en reposo y en movimiento, el día del postoperatorio, el tipo de abordaje y el procedimiento quirúrgico. Resultados: El registro del dolor agudo postoperatorio en las salas quirúrgicas, mostró una prevalencia de dolor en reposo (valor en la escala numérica > 3) del 33% y en movimiento del 66%. El porcentaje de dolor intenso (valor en la escala numérica > 6) en reposo fue de 1,7% y en movimiento de 7,3%. Los factores que se relacionaron con la mayor intensidad del dolor fueron, el primer día del postoperatorio, en el que el 74,4% de los pacientes presentaron los valores máximos de dolor, el tipo de abordaje y procedimiento quirúrgico (p < 0,004), y finalmente las expectativas de sufrir dolor moderado o intenso (p < 0,001). Conclusiones: Registrar la prevalencia del dolor postoperatorio en las salas de hospitalización quirúrgicas nos permite conocer el estado actual del tratamiento del dolor agudo postoperatorio. El dolor al movimiento es uno de los principales indicadores para detectar grupos de pacientes en los que es posible mejorar las pautas analgésicas. El abordaje y el tipo de procedimiento quirúrgico es un factor básico a tener en cuenta para poder comparar resultados analgésicos(AU)

Objective: To describe management of acute postoperative pain on the surgical ward. To study the relationship between pain and a variety of surgical procedures and approaches. To determine the level of information patients received, their expectations, and their satisfaction with treatment of postoperative pain. Patients and methods: Cross-sectional observational study by survey and review of patient records. We studied 234 patients, including all who were hospitalized for more than 24 hours after scheduled or emergency operations. The main variables recorded were pain intensity at rest and during movement, including on the day after surgery, and the surgical procedure and approach. Results: The prevalence of pain (>3 on a numerical scale) on the surgical ward was 33% at rest and 66% during movement. The prevalence of intense pain (>6 on the numerical scale) was 1.7% at rest and 7.3% during movement. Factors related to greater pain intensity were timing, that is, the first day after surgery, when 74.4% of patients experienced their most intense pain; type of surgery and approach (P<.004); and expecting to experience moderate or intense pain (P<.001). Conclusions: Recording the prevalence of postoperative pain on a surgical ward provides information about the real situation of acute postoperative pain control. Pain on movement is a principal indicator for detecting groups of patients for whom analgesic protocols could be improved. Type of surgery and approach is a fundamental factor to consider when comparing the results of analgesic protocols(AU)

[Treating acute postoperative pain: evaluation of results on the surgical ward]. / Atencióón del dolor agudo postoperatorio: evaluación de resultados en las salas de hospitalizacidón quirúrgicas.

OBJECTIVE: To describe management of acute postoperative pain on the surgical ward. To study the relationship between pain and a variety of surgical procedures and approaches. To determine the level of information patients received, their expectations, and their satisfaction with treatment of postoperative pain. PATIENTS AND METHODS: Cross-sectional observational study by survey and review of patient records. We studied 234 patients, including all who were hospitalized for more than 24 hours after scheduled or emergency operations. The main variables recorded were pain intensity at rest and during movement, including on the day after surgery, and the surgical procedure and approach. RESULTS: The prevalence of pain (>3 on a numerical scale) on the surgical ward was 33% at rest and 66% during movement. The prevalence of intense pain (>6 on the numerical scale) was 1.7% at rest and 7.3% during movement. Factors related to greater pain intensity were timing, that is, the first day after surgery, when 74.4% of patients experienced their most intense pain; type of surgery and approach (P<.004); and expecting to experience moderate or intense pain (P<.001). CONCLUSIONS: Recording the prevalence of postoperative pain on a surgical ward provides information about the real situation of acute postoperative pain control. Pain on movement is a principal indicator for detecting groups of patients for whom analgesic protocols could be improved. Type of surgery and approach is a fundamental factor to consider when comparing the results of analgesic protocols.

Atención del dolor agudo postoperatorio: evaluación de resultados en las salas de hospitalización quirúrgicas / Treating acute postoperative pain: evaluation of results on the surgical ward

Objetivos: Describir el tratamiento global del dolor agudo postoperatorio en las salas de hospitalización quirúrgicas. Relacionar el grado de dolor con los distintos tipos de abordajes y procedimientos quirúrgicos. Por último, registrar el grado de información, las expectativas y la satisfacción de los pacientes con la atención recibida en el tratamiento del dolor postoperatorio. Pacientes y Métodos: Estudio observacional transversal mediante entrevista y revisión de historia clínica. Se evaluaron 234 pacientes, incluyendo todos los pacientes postoperados ingresados más de 24 horas a partir del día de la intervención quirúrgica, de cirugía programada o urgente. Los principales parámetros registrados fueron, la intensidad del dolor en reposo y en movimiento, el día del postoperatorio, el tipo de abordaje y el procedimiento quirúrgico. Resultados: El registro del dolor agudo postoperatorio en las salas quirúrgicas, mostró una prevalencia de dolor en reposo (valor en la escala numérica > 3) del 33% y en movimiento del 66%. El porcentaje de dolor intenso (valor en la escala numérica > 6) en reposo fue de 1,7% y en movimiento de 7,3%. Los factores que se relacionaron con la mayor intensidad del dolor fueron, el primer día del postoperatorio, en el que el 74,4% de los pacientes presentaron los valores máximos de dolor, el tipo de abordaje y procedimiento quirúrgico (p < 0,004), y finalmente las expectativas de sufrir dolor moderado o intenso (p < 0,001). Conclusiones: Registrar la prevalencia del dolor postoperatorio en las salas de hospitalización quirúrgicas nos permite conocer el estado actual del tratamiento del dolor agudo postoperatorio. El dolor al movimiento es uno de los principales indicadores para detectar grupos de pacientes en los que es posible mejorar las pautas analgésicas. El abordaje y el tipo de procedimiento quirúrgico es un factor básico a tener en cuenta para poder comparar resultados analgésicos(AU)

Objective: To describe management of acute postoperative pain on the surgical ward. To study the relationship between pain and a variety of surgical procedures and approaches. To determine the level of information patients received, their expectations, and their satisfaction with treatment of postoperative pain. Patients and methods: Cross-sectional observational study by survey and review of patient records. We studied 234 patients, including all who were hospitalized for more than 24 hours after scheduled or emergency operations. The main variables recorded were pain intensity at rest and during movement, including on the day after surgery, and the surgical procedure and approach. Results: The prevalence of pain (>3 on a numerical scale) on the surgical ward was 33% at rest and 66% during movement. The prevalence of intense pain (>6 on the numerical scale) was 1.7% at rest and 7.3% during movement. Factors related to greater pain intensity were timing, that is, the first day after surgery, when 74.4% of patients experienced their most intense pain; type of surgery and approach (P<.004); and expecting to experience moderate or intense pain (P<.001). Conclusions: Recording the prevalence of postoperative pain on a surgical ward provides information about the real situation of acute postoperative pain control. Pain on movement is a principal indicator for detecting groups of patients for whom analgesic protocols could be improved. Type of surgery and approach is a fundamental factor to consider when comparing the results of analgesic protocols(AU)

Situación actual del dolor agudo postoperatorio en un hospital de la Comunidad de Baleares / No disponible

No disponible

Catéter intratecal con reservorio en el síndrome postlaminectomia vía clínica y protocolo / Intrathecal catheter with reservoir in pos-tlatninectotnp syndrome. Clinical guidelines and protocol

El síndrome de la espalda operada es una patología frecuente que cursa con lumbalgia y/o radiculalgia crónica tras la cirugía. Las recomendaciones para su manejo son variadas y controvertidas debido a su cronicidad y necesidad de tratamiento paliativo a largo plazo. La necesidad de nuevas técnicas terapéuticas nos hará reducir costes y mejorar la calidad de vida de los pacientes. Describimos la utilización, con éxito, de la implantación de un sistema intratecal con reservorio subcutáneo en un paciente con síndrome de espalda operada complicada como tratamiento de cuarto escalón según criterios de la OMS como modelo de protocolo de actuación en nuestro centro hospitalario (AU)

The operated back syndrome is a frequent pathology that presents chronic lumbalgia and/or radiculalgia after surgery. Its management recommendations are varied and controversial due to its chronicity and its need for palliative treatment in the long term. The new therapies will lead to a reduction in costs and to an improvement of the quality of life. We describe the successful use of an intrathecal system with subcutaneous reservoir in a patient with complicated operated back syndrome, as fourth level treatment according to WHO criteria. We use this case report as a means of presenting the treatment guideline in our hospital (AU)

Dolor de miembro fantasma tras hematoma de muñón postraumático 40 años después de la amputación: a propósito de un caso / Phantom limb pain secondary to post-trauma stump hematoma 40 years after amputation: description of one case

El dolor de miembro postamputación incluye dos síndromes, a veces difíciles de diferenciar entre sí: por un lado, el del dolor de miembro fantasma (DMF), que implica la percepción de sensaciones dolorosas desagradables en la distribución de una parte del cuerpo amputada y, por otro lado, el del dolor de muñón (DM) procedente de la parte residual del miembro amputado. Presentamos el caso de un paciente de 69 años con antecedentes de amputación supracondílea postraumática del miembro inferior derecho hace 40 años tras accidente de tráfico, que inició un cuadro de dolor agudo de características mixtas nociceptivas y neuropáticas en la zona de muñón amputado, coincidiendo con una caída accidental sobre el mismo. A la exploración física, destacaba una zona marginal tumefacta y dolorosa a la palpación que ecográficamente confirmó ser un hematoma de muñón desencadenante del cuadro. El tratamiento bidireccional del dolor de muñón, con descarga y crioterapia, y del dolor de miembro fantasma con antiinflamatorios no esteroideos, antidepresivos tricíclicos, anticonvulsivantes y neurolépticos permitió un buen control del síndrome doloroso. En nuestro paciente, el hecho de que hubieran transcurrido cuarenta años no impidió la aparición de un DMF por primera vez. El tratamiento precoz y desde un punto de vista etiopatogénico resultó ser fundamental para la resolución del cuadro (AU)

Risk of babesiosis and anaplasmosis in different ecological zones of Santa Cruz Department, Bolivia.

A cross-sectional study was done of seroprevalence of Babesia bigemina, B.bovis, and Anaplasma marginale in cattle from eastern Bolivia, to characterise the risk of tick-borne disease in three ecological zones. Nineteen farms were sampled in the subtropical humid zone, 13 in the dry subtropical zone and nine in the lower western valleys of the Andean massif. The enzyme-linked immunosorbent assay was used. All three pathogens were widespread. For B. bovis, seroprevalences were high (75-78%) in the two subtropical zones which thus had low risk of disease from this infection; but the western valleys were endemically unstable with higher risk. For B. bigemina, seroprevalences were lower (24-57%) in the two subtropical zones and thus these areas were endemically unstable for disease from this infection. However, the seroprevalence of B. bigemina in the western valleys was too low (13%) for risk of disease in susceptible cattle to be considered high. For A. marginale, the seroprevalences in the two subtropical zones were low (19-32%) and very low (6%) in the western valleys suggesting all these zones were endemically unstable for anaplasmosis. Data for individual farms were analysed for risk of both forms of babesiosis; this showed low risk of disease in the subtropical humid zone, higher risk in the dry subtropical zone and variable risk in the western valleys.

Mastitis control programme in the developing dairy industry of tropical lowland Bolivia.

Mastitis is an important disease in developing dairy industries. This paper describes a commercial mastitis control programme in Santa Cruz, Bolivia, based upon the five-point mastitis control plan and bulk tank somatic cell count (BTSCC) monitoring. Twelve farms which participated on the programme for 6 years are considered. Mean annual BTSCC fell steadily from 1,200,000 cells/ml to 461,000 cells/ml over this time. This progressive improvement was probably a result of increasing use of and attention to detail in mastitis control practices. The control of subclinical mastitis improved in both hand-milked and machine-milked herds, though hand-milked herds consistently produced milk of higher BTSCC. The mastitis programme did not appear to influence the incidence of clinical mastitis. The concludes that a simple mastitis programme based on the five-point plan and BTSCC monitoring can be commercially implemented and effectively control subclinical mastitis in a tropical, developing country.