Bloqueo subdural como complicación de la anestesia epidural / Subdural block as a complication of epidural anesthesia

El bloqueo subdural involuntario es una rara pero conocida complicación. Describimos el caso de un bloqueo subdural ocurrido al intentar realizar una analgesia epidural para el parto. (AU)

Unintentional subdural block is a rare but known complication. We describe the case of unintentional subdural block while attempting to perform an epidural block for delivery. (AU)

Insuficiencia respiratoria aguda como forma de debut de una anomalía congénita (doble arco aórtico) / Acute respiratory failure as a form of debut of a congenital anomaly (double aortic arch)

El doble arco aórtico es una anomalía vascular poco frecuente que provoca compresión traqueal y esofágica, habitualmente en losprimeros meses de vida. La estenosis traqueal asociada con el doble arco aórtico conlleva un alto riesgo de morbilidad, mortalidady reestenosis. Presentamos el caso de un paciente en que su anomalía no fue diagnosticada, y permaneció en silencio hasta la edad adulta cuando comenzó a padecer clínica compresiva. (AU)

The double aortic arch is a rare vascular anomaly that usually causes tracheal and esophageal compression in the first months oflife. Tracheal stenosis associated with double aortic arch carries a high risk of morbidity, mortality, and restenosis. We present thecase of a patient in whom his anomaly was not diagnosed, and he remained silent until adulthood when he began to suffer from compression symptoms. (AU)

Aplicaciones de la dexmetomidina en anestesia y cirugía / Application of dexmedetomidina in anesthesia and surgery

La dexmedetomidina es un potente agonista de los a-2 adrenorreceptores con propiedades simpaticolíticas, sedantes, amnésicas yanalgésicas, que se ha descrito como un complemento útil y seguro en muchas aplicaciones clínicas, incluyendo sedación en Cuidados Intensivos, anestesia regional y general, sedación en proceso pediátricos e intubación con fibrobroncoscopio en el paciente despierto. Revisamos la aplicación de la dexmedetomidina en anestesia y cirugía. (AU)

Dexmetomidine is a potent and highly seletive a-2 adrenoceptor agonist with sympatholytic, sedative, amnestic, and analgesic properties, which has been described as a useful and safe adjunct in many clinical applications, including sedation at Intensive Care Unit, regional and general anesthesia, sedation for pediatric procedures, and awake fiber-optic intubation. We review theapplication of dexmedetomidina in anesthesia and surgery. (AU)

[Hypobaric spinal anesthesia in a large ventral hernia]. / Anestesia espinal hipobara en hernia supraumbilical de gran tamaño.

High abdominal wall surgery may require general anesthesia but, in patients with high risk of difficult airway and respiratory complications, local or regional anesthesia is the choice whenever possible. Spinal anesthesia usually used (both isobaric and hyperbaric) could compromise the respiratory function due to blockade of the T6 metamere or higher. Hypobaric spinal anesthesia (HSA) at low doses (3.6 cc of 0.1% hypobaric bupivacaine plus 0.2 cc of 0.005% fentanyl) achieves sufficient analgesia with minimal motor blockade. We present the case of a patient with a large supraumbilical hernia with high risk of difficult airway and respiratory complications, who went through HSA. The patient did not report pain or dyspnea during the surgical procedure thus, HSA at low doses is an option to be taken into account in high abdominal wall surgery despite not having been described for this use.

Implicaciones anestésicas en los pacientes portadores de la variante termolábil de la enzima metilén tetrahidrofólico reductasa (MTHFR) / Anesthetic implications for patients with the thermolabile variant of the methylenetetrahydrofolate reductase gene

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Asistolia asociada a la utilización de remifentanilo / Asystole as a consequence of remifentanil use

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Consideraciones sobre la nueva guía de fármacos inhibidores de la hemostasia y anestesia regional neuroaxial / On the new guidelines for inhibitors of hemostasis and regional neuraxial

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Treatment charts in radiation therapy. An analysis of European treatment records.

The radiotherapy treatment chart (dose prescription, set-up parameters, dose computation and daily dose recording form) represents an important working tool in radiotherapy, not only as a compilation of data, but also as a method of communication among physicians, physicists and technicians. In addition to administrative and medical data, physical and simulation data that are indispensable for the daily accurate reproduction of the therapy procedures should be recorded, as well as accurate daily entries of the fractional and cumulative absorbed doses. Moreover, any radiation therapy quality assurance programme must rely on the accessibility of the radiation treatment history and a correct record of the therapy protocol in order to be verifiable. We have analysed the treatment charts of 92 European Departments of Radiation Oncology, with the aim of identifying their salient characteristics and data recorded. The study shows strong differences among the charts analysed, not only in the amount of information recorded, but also in the kind of data and concepts used.

Dosimetry and use of an immobilization system for head and neck radiotherapy treatments.

The day-to-day reproducibility of planned radiotherapy treatment is an important precondition for achieving good clinical results and reducing toxic effects. This reproducibility is difficult to achieve in the irradiation of head and neck malignancies because of the mobility of this anatomical area. This paper presents a dosimetric study and analysis of the utility of a facial mask immobilization system prepared from an orthopedic glass-fiber bandage. The dosimetric study conducted on a lucite phantom shows that the interposition of one, two, or three layers of the bandage reduces the deep absorbed dose by about 1% at 0.5 cm2, while increasing the absorbed surface dose by 12% (for a field of 15 X 15 cm2 and one layer of bandage) to 46% (for a field of 5 X 5 cm and three layers of bandage). The dosimetric study conducted on a Rando Anderson manikin shows an average increase in the skin dose of about 8% and a maximum increase of about 20%. The good dosimetric results and the practicality of this system of immobilization have persuaded us to propose it as an alternative to the systems currently on the market, which, although rather more sophisticated, are also more expensive.

[Wilms' tumor: a series of 79 cases (author's transl)]. / Tumor de Wilms. Estudio de 79 casos.

79 cases of Wilms' tumor with age at diagnosis between 0 and eight years, are reported. 76 of them are evaluable for therapeutic results. 54 (71%) are alive and disease-free, with a mean survival of 53 months. Group A (35 patients) received pre-surgical treatment with radiotherapy and the survival rate is 77%. Group B (32 patients) were not treated before surgery and the survival rate is 84%. Both groups received post-surgical treatment with radiotherapy and chemotherapy (vincristine and actinomycin D). Patients in group C, chronologically the oldest, did not receive chemotherapy and its survival rate was 20%. Prognostical significance of age, sex, site, clinical stage and histology are examined. Classical concepts on histological classifications are revised and present criteria are shown, along with its' therapeutic and prognostic implications.