ABSTRACT
Background: Bilateral superficial cervical plexus block is a simple non-invasive technique that can be used as preventive analgesia in the perioperative period of thyroidectomy. Aim: to assess the analgesic effects of the technique during the postoperative period of thyroidectomy. Material and Methods: Patients with indication of total thyroidectomy, with a low operative risk according to the American Society of Anesthesiology, were studied. All were operated with general anesthesia using Fentanyl, Propofol, Vecuronium and Isoflurane. Patients were randomly and blindly assigned to superficial cervical plexus block using Bupivacaine 0.25% or to a placebo injection. Postoperative pain, need for analgesics and patient satisfaction were assessed...
Introducción: La cirugía de la glándula tiroides es reconocida como un procedimiento que produce un dolor leve a moderado. El bloqueo bilateral de plexo cervical superficial es una técnica simple, poco invasiva, que pudiera ser beneficioso en estos pacientes como modelo de analgesia preventiva. Objetivos: Evaluar la calidad de la analgesia del postoperatorio de la cirugía de tiroides, con el uso de bloqueo bilateral del plexo cervical superficial. Material y Métodos: Se estudiaron pacientes ASA I y II propuestos para cirugía de tiroides bajo anestesia general. En todos los pacientes se hizo anestesia general balanceada con Fentanyl, Propofol, Vecuronio e Isoflurano. En forma aleatoria y ciega se asignaron los pacientes en 2 grupos: grupo A, Bupivacaína 0,25% 20 ml y grupo B placebo. Se evaluó características demográficas, dolor postoperatorio, necesidad de analgésicos de rescate, náuseas, vómitos y satisfacción del paciente...
Subject(s)
Humans , Male , Adult , Female , Middle Aged , Anesthesia/methods , Pain, Postoperative/prevention & control , Morphine/administration & dosage , Thyroidectomy/methods , Cervical Plexus , Patient Satisfaction , Preoperative CareSubject(s)
Ambulatory Care/legislation & jurisprudence , Career Choice , Internal Medicine/legislation & jurisprudence , Job Satisfaction , Medical Staff, Hospital/legislation & jurisprudence , National Health Programs/legislation & jurisprudence , Physician-Patient Relations , Contract Services/legislation & jurisprudence , Education, Medical, Continuing/legislation & jurisprudence , Education, Medical, Graduate/legislation & jurisprudence , Germany , Humans , Internal Medicine/education , Medical Staff, Hospital/education , Medical Staff, Hospital/supply & distribution , Reimbursement Mechanisms/legislation & jurisprudence , Work Schedule Tolerance , WorkforceABSTRACT
Background: Diastolic function can be evaluated intraoperatively using transesoptiageal echocardiography. Aim: To study if intraoperative diastolic dysfunction is associated to a greater number of hemodynamic events during surgery and during the postoperative period. Material and methods: Patients with indication of intraoperative transesophageal echocardiography due to cardiovascular diseases were included in the study. Diastolic function was assessed measuring transmitral intraventricular filling delay and pulmonary vein now. Patients were divided, according to diastolic dysfunction, in those with derangements in relaxation, pseudonormalization and restrictive patterns. Hypertension, hypotension, ST segment depression, alterations in myocardial contractility, pulmonary congestion and postoperative oliguria were recorded. Results: Fifty eight patients aged 68± 12 years (39 males), were studied. Forty four had diastolic dysfunction. Intraoperative hypotension occurred in 82 percent of patients with diastolic dysfunction and 16 percent of patients without it. Likewise, hypotension and oliguria during the postoperative period were more common in patients with diastolic dysfunction. Conclusions: In this group of patients with cardiovascular disease, intraoperative diastolic dysfunction is a risk factor for hemodynamic instability.
Subject(s)
Aged , Female , Humans , Male , Echocardiography, Transesophageal , Intraoperative Care/methods , Intraoperative Complications , Surgical Procedures, Operative/adverse effects , Ventricular Dysfunction, Left , Hypertension/physiopathology , Hypertension , Hypotension/physiopathology , Hypotension , Intraoperative Complications/physiopathology , Oliguria/physiopathology , Oliguria , Predictive Value of Tests , Risk Factors , Ventricular Dysfunction, Left/physiopathologyABSTRACT
BACKGROUND: Diastolic function can be evaluated intraoperatively using transesoptiageal echocardiography. AIM: To study if intraoperative diastolic dysfunction is associated to a greater number of hemodynamic events during surgery and during the postoperative period. MATERIAL AND METHODS: Patients with indication of intraoperative transesophageal echocardiography due to cardiovascular diseases were included in the study. Diastolic function was assessed measuring transmitral intraventricular filling delay and pulmonary vein now. Patients were divided, according to diastolic dysfunction, in those with derangements in relaxation, pseudonormalization and restrictive patterns. Hypertension, hypotension, ST segment depression, alterations in myocardial contractility, pulmonary congestion and postoperative oliguria were recorded. RESULTS: Fifty eight patients aged 68+/- 12 years (39 males), were studied. Forty four had diastolic dysfunction. Intraoperative hypotension occurred in 82% of patients with diastolic dysfunction and 16% of patients without it. Likewise, hypotension and oliguria during the postoperative period were more common in patients with diastolic dysfunction. CONCLUSIONS: In this group of patients with cardiovascular disease, intraoperative diastolic dysfunction is a risk factor for hemodynamic instability.
Subject(s)
Echocardiography, Transesophageal , Intraoperative Care/methods , Intraoperative Complications/diagnostic imaging , Surgical Procedures, Operative/adverse effects , Ventricular Dysfunction, Left/diagnostic imaging , Aged , Female , Humans , Hypertension/diagnostic imaging , Hypertension/physiopathology , Hypotension/diagnostic imaging , Hypotension/physiopathology , Intraoperative Complications/physiopathology , Male , Oliguria/diagnostic imaging , Oliguria/physiopathology , Predictive Value of Tests , Risk Factors , Ventricular Dysfunction, Left/physiopathologyABSTRACT
Introducción: La ecocardiografía transesofágica (ETE) puede ser de utilidad para monitorizar la hemodinamia intraoperatorio de pacientes con riesgo cardiovascular durante cirugía no cardíaca. Sin embargo sus indicaciones y utilidad clínica han sido poco estudiadas en nuestro medio. Objetivo: evaluar el uso de ETE intraoperatorio realizado por anestesiólogos durante cirugía no cardíaca. Métodos: Se monitorizó con un transductor transesofágico multiplanar a 218 pacientes (66 ± 8 años) con alto riesgo cardiovascular sometidos a cirugía no cardíaca; 61 por ciento fueron hombres. Se evaluó la utilidad de la monitorización hemodinámica con ETE en cada enfermo respecto de decidir cambios en el manejo perioperatorio dependientes de los hallazgos ecocardiográficos. Los pacientes fueron clasificados en 4 grupos: grupo 1= sin cambios en el manejo; grupo 2= cambio en manejo de volúmenes y drogas; grupo 3= cambios en el manejo postoperatorio y grupo 4= sustituto de catéter de arteria pulmonar. Resultados: En todos los casos se logró insertar el transductor y obtener visiones satisfactorias. En 96 casos (44 por ciento) hubo cambios en el aporte de volúmenes y fármacos guiados por ETE (grupo 2). En un 25 por ciento de los pacientes, por hallazgos ecocardiográficos hubo cambios postoperatorio (grupo 3). En 30 por ciento no se indicó Swan Ganz guiándose el manejo hemodinámico por la ETE (grupo 4). Conclusiones: La monitorización hemodinámica intraoperatoria con ETE realizada por anestesiólogos demostró alta utilidad, ya que implicó cambios de diagnóstico y conducta en la mayoría de pacientes monitorizados durante cirugía no cardíaca incluidos en esta serie.
Subject(s)
Male , Humans , Female , Middle Aged , Echocardiography, Transesophageal/methods , Monitoring, Intraoperative/instrumentation , Monitoring, Intraoperative/methods , Hemodynamics , Surgical Procedures, Operative , Anesthesiology/education , Anesthesiology/instrumentation , Clinical Competence , Prospective Studies , TransducersABSTRACT
Se analizan los embarazos y partos de adolescentes, menores de 19 años, atendidas en el Servicio de Obstetricia y Ginecología del Hospital del Salvador, entre los años 1994 y 2000. Destaca durante este período, la disminución en el número de embarazos, menor porcentaje de operación cesárea, y mayor porcentaje de recién nacido con peso insuficiente
Subject(s)
Humans , Adolescent , Female , Pregnancy , Labor, Obstetric , Parturition , Pregnancy in Adolescence , Adolescent Health Services , Infant, Newborn, Diseases/epidemiology , Obstetric Labor Complications , Pregnancy ComplicationsSubject(s)
Enteritis/chemically induced , Enteritis/drug therapy , Gold Sodium Thiomalate/adverse effects , Octreotide/therapeutic use , Adult , Arthritis, Psoriatic/drug therapy , Female , Follow-Up Studies , Gold Sodium Thiomalate/administration & dosage , Humans , Injections, Intramuscular , Injections, Subcutaneous , Octreotide/administration & dosageABSTRACT
A Swiss family with hereditary articular chondrocalcinosis is described. Chondrocalcinosis was found on x-rays of five cases in two generations. In four there were recurrent attacks of pseudogout; in all observations the first rheumatic symptoms started early in the fourth decade. There was no history of consanguinity and the mode of inheritance was autosomal dominant, in agreement with most of the other familial pedigrees reported in the literature.
Subject(s)
Chondrocalcinosis/genetics , Adult , Chondrocalcinosis/diagnostic imaging , Chromosome Aberrations/genetics , Chromosome Disorders , Female , Genes, Dominant , Humans , Male , Middle Aged , Pedigree , RadiographyABSTRACT
A case of acute myelo-monocytic leukemia (M4) in a 75 year old man with multiple osteosclerotic lesions is reported. Bone metastases were clinically and radiologically suspected. A surgical bone marrow biopsy at the iliac crest revealed a massive infiltrate of blasts with medullary fibrosis, large areas of osteosclerosis and foci of necrosis. Osteosclerosis is rarely observed during acute leukemias in adults. Differential diagnosis with acute myelofibrosis is discussed.
Subject(s)
Leukemia, Monocytic, Acute/complications , Leukemia, Myeloid, Acute/complications , Osteosclerosis/complications , Primary Myelofibrosis/complications , Aged , Collagen/metabolism , Diagnosis, Differential , Humans , Male , Osteosclerosis/pathologyABSTRACT
Selective cannulation and aspiration of bile prior to ERCP may be helpful in bacterial contamination (suppurative cholangitis), in patients with choledocholithiasis, to determine lithogenicity of bile, and in studies where antibiotic concentration of different substances are analyzed in correlation to hepato-biliary diseases. Results of appropriate examinations are presented.
