Charcot-MArie-tooth y analgesia epidural obstétrica, una opción segura / No disponible

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Microbial inactivation and shelf life comparison of 'cold' hurdle processing with pulsed electric fields and microfiltration, and conventional thermal pasteurisation in skim milk.

Thermal pasteurisation (TP) is the established food technology for commercial processing of milk. However, degradation of valuable nutrients in milk and its sensory characteristics occurs during TP due to substantial heat exposure. Pulsed electric fields (PEF) and microfiltration (MF) both represent emerging food processing technologies allowing gentle milk preservation at lower temperatures and shorter treatment times for similar, or better, microbial inactivation and shelf stability when applied in a hurdle approach compared to TP. Incubated raw milk was used as an inoculum for the enrichment of skim milk with native microorganisms before PEF, MF, and TP processing. Inoculated milk was PEF-processed at electric field strengths between 16 and 42 kV/cm for treatment times from 612 to 2105 µs; accounting for energy densities between 407 and 815 kJ/L, while MF was applied with a transmembrane flux of 660 L/h m². Milk was TP-treated at 75°C for 24 s. Comparing PEF, MF, and TP for the reduction of the native microbial load in milk led to a 4.6 log10 CFU/mL reduction in count for TP, which was similar to 3.7 log10 CFU/mL obtained by MF (P≥0.05), and more effective than the 2.5 log10 CFU/mL inactivation achieved by PEF inactivation (at 815 kJ/L (P<0.05)). Combined processing with MF followed by PEF (MF/PEF) produced a 4.1 (at 407 and 632 kJ/L), 4.4 (at 668 kJ/L) and 4.8 (at 815 kJ/L) log10 CFU/mL reduction in count of the milk microorganisms, which was comparable to that of TP (P≥0.05). Reversed processing (PEF/MF) achieved comparable reductions of 4.9, 5.3 and 5.7 log10 CFU/mL (at 407, 632 and 668 kJ/L, respectively (P≥0.05)) and a higher inactivation of 7.1 log10 (at 815 kJ/mL (P<0.05)) in milk than for TP. Microbial shelf life of PEF/MF-treated (815 kJ/L) and TP-treated milk stored at 4°C was analysed over 35 days for total aerobic; enterobacteria; yeasts and moulds; lactobacilli; psychrotroph; thermoduric psychrotroph, mesophilic, and thermophilic; and staphylococci counts. For both PEF/MF and TP-treated milk an overall shelf stability of 7 days was observed based on total aerobic counts (P≥0.05). Milk hurdle processing with PEF/MF at its most effective treatment parameters produced greater microbial inactivation and overall similar shelf stability at lower processing temperatures compared to TP. With higher field strength, shorter treatment time, larger energy density, and rising temperature the efficacy of PEF/MF increased contrary to MF/PEF. Thus, PEF/MF represents a potential alternative for 'cold' pasteurisation of milk with improved quality.

[Esmolol to control hemodynamic response during removal of a bilateral pheochromocytoma from a 10-year-old girl]. / Manejo hemodinámico intraoperatorio con esmolol durante la extirpación de un feocromocitoma bilateral en una paciente de 10 años.

Pheochromocytomas, which derive from chromaffin cells, can secrete catecholamines in large amounts. The incidence of these tumors is low at 2 to 8 cases per million population and only 10% of cases occur in children. A thorough understanding of the pathophysiology of these tumors and the consequent effect of drugs will be necessary for treating these patients during the perioperative period. A great deal has been published on drugs that can be used in this setting, but only a small portion of the information is relevant to children. Esmolol, a short-action beta-blocker, figures among the drugs that have been developed in recent years. We report a case in which esmolol was used during surgery in a 10-year-old girl undergoing scheduled removal of a bilateral pheochromocytoma.

Manejo hemodinámico intraoperatorio con esmolol durante la extirpación de un feocromocitoma bilateral en una paciente de 10 años / Esmolol to control hemodynamic response during removal of a bilateral pheochromocytoma from a 10-year-old girl

Los feocromocitomas son tumores derivados de lascélulas cromafines, que pueden secretar grandes cantidadesde catecolaminas. Su incidencia es baja, 2-8 casospor millón de habitantes, solamente un 10% de éstos sedan en edad infantil. Para el tratamiento perioperatoriocorrecto se requiere un conocimiento profundo desu fisiopatología, y de la farmacología implicada. Haygran cantidad de información publicada sobre fármacosque pueden utilizarse pero no tan extensa en niños.En los últimos años se han ido desarrollando nuevosfármacos entre los que se encuentran el esmolol, unbeta bloqueante de acción corta. Presentamos un casode tratamiento intraoperatorio con esmolol en unapaciente de 10 años programada para la extirpación deun feocromocitoma bilateral(AU)

Pheochromocytomas, which derive from chromaffincells, can secrete catecholamines in large amounts. Theincidence of these tumors is low at 2 to 8 cases permillion population and only 10% of cases occur inchildren. A thorough understanding of thepathophysiology of these tumors and the consequenteffect of drugs will be necessary for treating thesepatients during the perioperative period. A great dealhas been published on drugs that can be used in thissetting, but only a small portion of the information isrelevant to children. Esmolol, a short-action -blocker,figures among the drugs that have been developed inrecent years. We report a case in which esmolol was usedduring surgery in a 10-year-old girl undergoingscheduled removal of a bilateral pheochromocytoma(AU)

Meningioma intrapulmonar. Descripción de un caso y breve revisión de la literatura / Intrapulmonary meningioma

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Crosectomía y escleroterapia con espuma frente a safenectomía como tratamiento de las varices producto de reflujo en la unión safenofemoral / Crossectomy and foam sclerotherapy versus saphenectomy as treatment for varicose veins produced by reflux at the saphenofemoral

Introducción. El tratamiento de la enfermedad varicosa producto del reflujo de la unión safenofemoral ha variadoen los últimos años con el advenimiento de novedosas técnicas menos traumáticas. En el presente estudio se describeuna técnica y se describen sus ventajas en relación con otros procedimientos actuales. Pacientes y métodos. Se tratade un estudio prospectivo, comparativo, de una muestra seleccionada de 36 casos. Se realizó una crosectomía y unaescleroterapia con espuma de etoxiesclerol en 18 casos y una safenectomía convencional en los restantes. Resultados.Para la técnica descrita, el tiempo quirúrgico promedio fue de 30 minutos. El tiempo promedio de hospitalización fue deun día, con un reintegro a las actividades cotidianas en la segunda semana en todos los casos y una elevada tasa de satisfacción(94,4%). En el seguimiento durante un período de 3 a 12 meses no se encontraron recurrencias. Se describióun caso de hiperpigmentación como única complicación postoperatoria asociada con el procedimiento. Se demostró unbeneficio con respecto a la safenectomía convencional en cuanto a tasa de complicaciones menores postoperatorias (5,5frente a 33,3%, p < 0,05). Conclusión. La escleroterapia con espuma en el tratamiento de la insuficiencia venosa superficiales una técnica que ha demostrado su eficacia. La técnica propuesta, es decir, la crosectomía y la esclerosis con espumaes una técnica factible, con una tasa de éxito comparable a la safenectomía, que ofrece las ventajas del tratamientomínimamente invasivo sin la necesidad de requerir en el área quirúrgica equipos de alto coste, lo cual la hace más accesiblepara centros no especializados

Introduction. Treatment of varicose vein disease resulting from reflux in the saphenofemoral junction haschanged in recent years with the advent of novel, less traumatic techniques. In this study we outline one such technique anddescribe its advantages compared to other procedures currently in use. Patients and methods. We conducted a prospective,comparative study of a selected sample of 36 cases. Crossectomy and ethoxysclerol foam sclerotherapy were performed in18 cases and the others were treated by means of a conventional saphenectomy. Results. For the technique reported here,average surgery time was 30 minutes. Average hospitalisation time was one day, with return to daily activities during thesecond week in all cases and a high rate of satisfaction (94.4%). No relapses were found during the 3 to 12-month followupperiod. One case of hyperpigmentation was reported as the only post-operative complication associated to theprocedure. The benefits of this procedure over those obtained using conventional saphenectomy were proved by the lowerrate of post-operative complications (5.5 versus 33.3%, p < 0.05). Conclusions. Foam sclerotherapy in the treatment ofsuperficial venous insufficiency is a technique that has been shown to be effective. The technique proposed here, that is tosay, crossectomy and foam sclerosis is a feasible technique, with a success rate comparable to that of saphenectomy. Thefact that it offers the advantages of minimally invasive treatment without requiring high-cost equipment in the surgicalarea makes it more readily available for use in non-specialised centres

Complicaciones por implantación de marcapaso electrónico (método endocavitario) / Complications from the implantation of an electronic pacemaker (intracavitary method)

Se presentan las complicaciones de 511 pacientes a quienes ha sido necesaria la implantación de marcapaso electrónico por método endocavitario, en un período de 7 años y 4 meses. Se encontraron 251 complicaciones; las más frecuentes fueron el desplazamiento del electrodo, seguido de la necrosis séptica y aséptica de la piel; las demás se presentaron en un número menor. Hubo pacientes con más de una complicación(AU)

Parietografía de la vejiga

Se describe la técnica de la parietografía vesical. debe tenerse en cuenta como un medio diagnóstico más en las neoplasias vesicales. Se presenta una casuística donde se corroboran las ventajas señaladas(AU)