ABSTRACT
The introduction of video-assisted thoracoscopic (VATS) techniques has led to a new approach in thoracic surgery. VATS is performed by inserting a thoracoscope through a small incisions in the chest wall, thus maximizing the preservation of muscle and tissue. Because of its low rate of morbidity and mortality, VATS is currently the technique of choice in most thoracic procedures. Lung resection by VATS reduces prolonged air leaks, arrhythmia, pneumonia, postoperative pain and inflammatory markers. This reduction in postoperative complications shortens hospital length of stay, and is particularly beneficial in high-risk patients with low tolerance to thoracotomy. Compared with conventional thoracotomy, the oncological results of VATS surgery are similar or even superior to those of open surgery. This aim of this multidisciplinary position statement produced by the thoracic surgery working group of the Spanish Society of Anesthesiology and Reanimation (SEDAR), the Spanish Society of Thoracic Surgery (SECT), and the Spanish Association of Physiotherapy (AEF) is to standardize and disseminate a series of perioperative anaesthesia management guidelines for patients undergoing VATS lung resection surgery. Each recommendation is based on an in-depth review of the available literature by the authors. In this document, the care of patients undergoing VATS surgery is organized in sections, starting with the surgical approach, and followed by the three pillars of anaesthesia management: preoperative, intraoperative, and postoperative anaesthesia.
Subject(s)
Anesthesia , Anesthesiology , Thoracic Surgery , Humans , Lung , Physical Therapy Modalities , Pneumonectomy/adverse effects , Thoracic Surgery, Video-Assisted/adverse effects , Thoracic Surgery, Video-Assisted/methodsABSTRACT
La introducción de técnicas toracoscópicas asistidas por video en cirugía torácica (VATS) ha permitido realizar un nuevo enfoque en la cirugía torácica. El acceso videotoracoscópico se realiza con pequeñas incisiones, preservando al máximo los músculos y los tejidos. En la actualidad, la VATS se considera de elección en la mayoría de los procedimientos torácicos, principalmente debido a la menor morbimortalidad asociada. La resección pulmonar por VATS presenta reducción de las fugas de aire prolongadas, arritmias, neumonía, dolor postoperatorio y una disminución de los marcadores inflamatorios. Esta reducción de las complicaciones postoperatorias está vinculada a una reducción de la estancia hospitalaria, siendo los pacientes de alto riesgo y con poca tolerancia a la toracotomía los principales beneficiarios de esta técnica.En comparación con la toracotomía convencional, los?resultados?oncológicos de la cirugía VATS son similares o incluso superiores a los de la cirugía abierta.Este documento, de redacción multidisciplinar, consensuado por el grupo de trabajo de cirugía torácica de la Sociedad Española de Anestesiología y Reanimación (SEDAR), de la Sociedad Española de Cirugía Torácica (SECT) y la Asociación Española de Fisioterapia (AEF), pretende estandarizar y difundir, con base en la bibliografía más actual, las mejores pautas de manejo clínico perioperatorio de los pacientes que se someten a una cirugía de resección pulmonar por VATS. Cada recomendación parte de una revisión de la literatura disponible y analizada en profundidad por los autores.Con el objetivo de dirigir el curso asistencial que seguirá el paciente que se somete a una cirugía pulmonar por VATS, esta guía se organiza inicialmente en el enfoque quirúrgico, seguido de los tres puntos clásicos del proceso anestésico. Estos puntos son preoperatorio, intraoperatorio y postoperatorio.(AU)
The introduction of video-assisted thoracoscopic (VATS) techniques has led to a new approach in thoracic surgery. VATS is performed by inserting a thoracoscope through a small incisions in the chest wall, thus maximizing the preservation of muscle and tissue. Because of its low rate of morbidity and mortality, VATS is currently the technique of choice in most thoracic procedures. Lung resection by VATS reduces prolonged air leaks, arrhythmia, pneumonia, postoperative pain and inflammatory markers. This reduction in postoperative complications shortens hospital length of stay, and is particularly beneficial in high-risk patients with low tolerance to thoracotomy.Compared with conventional thoracotomy, the oncological results of VATS surgery are similar or even superior to those of open surgery.This aim of this multidisciplinary position statement produced by the thoracic surgery working group of the Spanish Society of Anesthesiology and Reanimation (SEDAR), the Spanish Society of Thoracic Surgery (SECT), and the Spanish Association of Physiotherapy (AEF) is to standardize and disseminate a series of perioperative anaesthesia management guidelines for patients undergoing VATS lung resection surgery. Each recommendation is based on an in-depth review of the available literature by the authors.In this document, the care of patients undergoing VATS surgery is organized in sections, starting with the surgical approach, and followed by the three pillars of anaesthesia management: preoperative, intraoperative, and postoperative anaesthesia.(AU)
Subject(s)
Perioperative Period , Lung/surgery , Thoracoscopy , Anesthesia, Cardiac Procedures , Thoracic Surgery , One-Lung Ventilation , Pain, Postoperative , Anesthesiology , Spain , Pain ManagementABSTRACT
The introduction of video-assisted thoracoscopic (VATS) techniques has led to a new approach in thoracic surgery. VATS is performed by inserting a thoracoscope through a small incisions in the chest wall, thus maximizing the preservation of muscle and tissue. Because of its low rate of morbidity and mortality, VATS is currently the technique of choice in most thoracic procedures. Lung resection by VATS reduces prolonged air leaks, arrhythmia, pneumonia, postoperative pain and inflammatory markers. This reduction in postoperative complications shortens hospital length of stay, and is particularly beneficial in high-risk patients with low tolerance to thoracotomy. Compared with conventional thoracotomy, the oncological results of VATS surgery are similar or even superior to those of open surgery. This aim of this multidisciplinary position statement produced by the thoracic surgery working group of the Spanish Society of Anesthesiology and Reanimation (SEDAR), the Spanish Society of Thoracic Surgery (SECT), and the Spanish Association of Physiotherapy (AEF) is to standardize and disseminate a series of perioperative anaesthesia management guidelines for patients undergoing VATS lung resection surgery. Each recommendation is based on an in-depth review of the available literature by the authors. In this document, the care of patients undergoing VATS surgery is organized in sections, starting with the surgical approach, and followed by the three pillars of anaesthesia management: preoperative, intraoperative, and postoperative anaesthesia.
ABSTRACT
Since July 2009, there has been a community outbreak of leishmaniasis in the south-west area of the Madrid autonomous community, Spain, affecting residents from four towns that are geographically close together and share extensive park areas. As of December 2012, 446 cases were reported (6 in 2009, 97 in 2010, 196 in 2011 and 147 in 2012), a mean incidence rate of 22.2 per 100,000 inhabitants during July 2009 and December 2012. The mean age was 44 years (range: 2 months to 95 years); 61.0% were male. A total of 68 (15.2%) had immunosuppressive conditions; 160 (35.9%) had visceral leishmaniasis and 286 (64.1%) cutaneous. A total of 421 (94.4%) cases were confirmed. Leishmania infantum was identified as the agent. Monitoring revealed high densities of the vector Phlebotomus perniciosus. The surveillance system for canine leishmaniasis did not detect any increase in prevalence during the period. Environmental control measures have been taken, such as improvements in sanitation and disinsection in the risk areas and control of the overpopulation of Leporidae, as xenodiagnosis studies have shown that hares play a role as active reservoirs. This is the largest reported community outbreak of leishmaniasis in Europe. The discovery of the new reservoir stands out in the multifactorial aetiology of the outbreak. Epidemiological research and environmental intervention measures are continuing.
Subject(s)
Communicable Diseases, Emerging/epidemiology , Disease Outbreaks , Leishmaniasis/epidemiology , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Animals , Child , Child, Preschool , Dogs , Female , Humans , Incidence , Infant , Leishmania infantum/isolation & purification , Leishmaniasis/prevention & control , Male , Middle Aged , Risk Factors , Sex Distribution , Socioeconomic Factors , Spain/epidemiology , Urban Population , Young AdultABSTRACT
Los profesionales deben desarrollar una serie de competencias genéricas encesarias para el correctod esempeño de su trabajo, de enre la cuales destanca auellas relacionadas con la autorregulación emocional y el afrontameitno de situaciones de riesgo psicosocial en el enrono laboral. En el prsente estudio se analiza el papel de la autoeficacia percibida ante el aforntameitno de resgos laborales psicosociales como variable moduladora del burnout. Se encontró n efecto dierencial moderador d ela auoeficacia sobere el burnut en fucnión de ls condiciones de trabajo pesentes. De manera que ante algna de ellas (como en caso de sobrecarga) protégé del cansancio emocional y frente a otras (como es el casod e la ambigüdad del rol) incrementa la probabiidad de padecer el síndrome de quemarse(AU)
Perceived self-efficacy for occupational coping as modulating variable of burnout.Professionals must develop a series of necessary generic competence for the correct perfomance of their work, where those related to eotional elf-regulation and coping with occupationl psychosocial risk factors stand out. The present study examines the rol of perceived occupational coping self-efficacy as a modulating variable of burnout. We have found a diferntial modulator effcet of self-efficacy on burnout in terms of working conditions; So that under some of tat conditions (i.e. oerload) self-efciacy protects against emotional exhaustion and under others (ie. Role ambiguity) self efficacy can increase the probaility of burnout occurrence(AU)
Subject(s)
Humans , Male , Female , Adult , Job Satisfaction , Burnout, Professional/epidemiology , Burnout, Professional/psychology , Self Efficacy , Social Welfare/psychology , 16360 , Employee Discipline , Risk Factors , Social Support , Psychosocial ImpactABSTRACT
CASE REPORTS: We report the cases of four males from four different families, who presented paroxysmal episodes from the 1st 2nd year. These episodes were characterised by asymmetrical bilateral dystonia of the upper limbs, predominantly in both hands, and were associated with orofacial dyskinesias, stereotipies (jumping, arm flapping, etc.), facial tics and, occasionally, phonic tics. Consciousness is not affected in any of the cases. These movements are triggered in situations where the patient is relaxed or excited. They occur daily and last from a few seconds to 30 minutes. Between the bouts, they remain asymptomatic. Family cases suggest it is inherited by autosomal dominant transmission, perhaps linked to the X chromosome; in addition, two cases are sporadic. In the only adult, the movements progress to a series of rhythmic bilateral dystonic myoclonias and facial tics dyskinesias. All the studies carried out, EEG, hemogram, biochemical analysis, neuroimaging, copper and ceruloplasmin levels, were normal. CONCLUSIONS: 1. We report a non epileptic paroxysmal disorder originating in the extrapyramidal tracts with its own characteristics, with onset during early childhood, which is associated with stereotipies, tics and dystonia; 2. It occurs predominantly in males; 3. It is inherited by autosomal dominant transmission, or perhaps sex linked autosomal dominant inheritance, and there are also sporadic cases; 4. The range of clinical features is very wide and includes cases in which there are few symptoms to others where the extent and gravity of the disorder is very significant.
Subject(s)
Dyskinesias/physiopathology , Dystonic Disorders/physiopathology , Stereotypic Movement Disorder/physiopathology , Tic Disorders/physiopathology , Adult , Child , Child, Preschool , Diagnosis, Differential , Dyskinesias/genetics , Dystonic Disorders/genetics , Humans , Infant , Male , Stereotypic Movement Disorder/genetics , Tic Disorders/geneticsABSTRACT
Casos clínicos. Presentamos cuatro varones, pertenecientes a cuatro familias diferentes, que presentan, a partir del 1.er-2.º año, unos episodios de presentación paroxística, que se caracterizan por distonía bilateral asimétrica de los miembros superiores, que predominan en ambas manos y que se asocian a discinesias orofaciales, estereotipias (saltos, aleteo, etc.), tics faciales y, a veces, tics fónicos. En ningún caso hay compromiso de la conciencia. Estos movimientos se desencadenan en situaciones de relajación o excitación. Son de frecuencia diaria y duran de segundos a 30 minutos. Entre los episodios permanecen asintomáticos. Los casos familiares sugieren herencia autosómica dominante o, quizás, ligada al cromosoma X; además, dos casos son esporádicos. En el único adulto, los movimientos evolucionaron a una serie de mioclonías distónicas bilaterales rítmicas y tics (discinesias faciales). Todos los estudios realizados -EEG, hemograma, bioquímica, neuroimagen, cupremia y ceruloplasmina- fueron normales. Conclusiones. 1. Presentamos un trastorno paroxístico no epiléptico de origen extrapiramidal con características propias, de inicio en la infancia, que asocia estereotipias, tics y distonía; 2. Predominio en varones;3. Su herencia es autosómica dominante o, quizás, herencia ligada al sexo, y también hay casos esporádicos; 4. El espectro clínico del cuadro es muy amplio, y abarca desde casos poco sintomáticos hasta otros con una importante afectación (AU)
Case reports. We report the cases of four males from four different families, who presented paroxysmal episodes from the 1st-2nd year. These episodes were characterised by asymmetrical bilateral dystonia of the upper limbs, predominantly in both hands, and were associated with orofacial dyskinesias, stereotipies (jumping, arm-flapping, etc.), facial tics and, occasionally, phonic tics. Consciousness is not affected in any of the cases. These movements are triggered in situations where the patient is relaxed or excited. They occur daily and last from a few seconds to 30 minutes. Between the bouts, they remain asymptomatic. Family cases suggest it is inherited by autosomal dominant transmission, perhaps linked to the X chromosome; in addition, two cases are sporadic. In the only adult, the movements progress to a series of rhythmic bilateral dystonic myoclonias and facial tics-dyskinesias. All the studies carried out, EEG, hemogram, biochemical analysis, neuroimaging, copper and ceruloplasmin levels, were normal. Conclusions. 1. We report a non-epileptic paroxysmal disorder originating in the extrapyramidal tracts with its own characteristics, with onset during early childhood, which is associated with stereotipies, tics and dystonia; 2. It occurs predominantly in males; 3. It is inherited by autosomal dominant transmission, or perhaps sex-linked autosomal dominant inheritance, and there are also sporadic cases; 4. The range of clinical features is very wide and includes cases in which there are few symptoms to others where the extent and gravity of the disorder is very significant (AU)
Subject(s)
Child , Child, Preschool , Adult , Male , Infant , Humans , Tic Disorders , Stereotypic Movement Disorder , Dystonic Disorders , Dyskinesias , Diagnosis, DifferentialABSTRACT
Presentamos un paciente masculino, blanco, de 53 años, conocido diabético. Consultó a nuestro hospital por anemia, ictericia, hepato-esplenomegalia y pérdida de 10 kgrs. en los últimos 2 meses. Las radiografías de tórax mostraron una masa en mediastino anterior e inferior de 8x11 cms. Las pruebas de laboratorio rebelaron reticulocitosis, elevada sedimentación globular, hiperbilirrubinemia indirecta, Coombs fuertemente positivo, complemento C3 y C4 normales y ANA negativo. El tratamiento inicial con prednisona mejoró sus cifras hematológicas y se practicó toracotomía. Después de la remoción del tumor que resultó ser un timoma lifo-epitelial, el paciente se recuperó totalmente desde el punto de vista hematológico, con negativización del Coombs. Hacemos enfásis en la rara asociación de timoma con anemia hemolítica, (menos del 1// en las grandes series) y que el tratamiento definitivo de esta condición es la cirugía
Subject(s)
Middle Aged , Humans , Male , Thymoma/diagnosis , Thymoma/complications , Thymoma/surgeryABSTRACT
The articles includes eight cases of congenital atresia of the vagina seen and studied at the Pediatric Surgery Department. All cases were congenital five of them corresponded to the Mayer-Rokitansky-Kuster-Hauser Syndrome an the remaining three to congenital adrenal hyperplasia. No other malformations were associated to any of the cases. The karyotype, hormones and secondary sexual characteristics were normal in those cases of Mayer-Rokitansky-Kuster-Hauser Syndrome. In the other three cases of congenital adrenal hyperplasia the karyotype was found to be 46XX, the 17-ketosteroids and pregnanediol were high and the patients were found to have hirsutism and were virilized. The ultrasonography, CAT and magnetic resonance scans showed excellent anatomical information on the congenital vaginal atresia and the intrapelvic organs. No other invasive study was needed to confirm its existence. Six of the patients were operated using the McIndoe and Bannister technique while on the other two the Tobin and Day technique was used. Post-surgical complications included vaginal stenosis in two cases within the first three months. The article includes an analysis of the complications and both the anatomical and functional results obtained.
Subject(s)
Adrenal Hyperplasia, Congenital/pathology , Vagina/abnormalities , Adolescent , Adrenal Hyperplasia, Congenital/epidemiology , Adrenal Hyperplasia, Congenital/surgery , Child , Diagnostic Imaging , Female , Gonadal Steroid Hormones/blood , Humans , Incidence , Karyotyping , Reoperation , Surgery, Plastic/adverse effects , Surgery, Plastic/methods , Surgical Flaps , Syndrome , Vagina/surgeryABSTRACT
Un grupo de investigadores de la Universidad de Carabobo y Maravén, llevaron a cabo un experimento involucrando a los 350 pobladores del caserio Las Majadas en el control y prevención de la malaria mediante la educación sanitaria, organización comunal y uso del mosquitero impregnado con Permetrina. En mayo de 1986 con la ayuda de la comunidad, se impregnaron 33 de los 55 mosquiteros existentes. Seis meses más tarde, en octubre, el equipo volvio a la comunidad y entrevistaron a 21 de las 33 personas que habían contraido la malaria en al intervalo enero-octubre, 1986. Se encontro que hubo un brote serio en el mes de junio que solo produjo 22 casos. Catorce de las victimas dormian en sitios sin ninguna protección contra el mosquito..
Subject(s)
Humans , Male , Female , Malaria/prevention & control , Culicidae , Malaria/epidemiologyABSTRACT
Using the micronucleus test to evaluate the mutagenic effect of 5,5-diphenylhydantoin (DPH) on bone marrow polychromatic erythrocytes, male Balb-C mice were treated with the drug in single and multiple injection tests. A significant increase in the frequency of micronucleated polychromatic erythrocytes (MPE), P less than 0.05, was found when the mice received a single injection of DPH at doses of 0.5 and 1.0 mg/kg, and this frequency did not increase at higher doses. When mice were treated 3 times, at 24-h intervals, with 1.0 mg/kg of DPH, a significant increase in MPE was also observed (P less than 0.05) but this was lower than when they received a single injection of the same dose. A cytotoxic effect of NaOH, 0.1 N, which was used as solvent, was also observed either when alone or when DPH (1.0 mg/kg) was injected 3 times. This effect was comparable to the one produced by mitomycin C (MMC) at a dose of 0.5 mg/kg.
Subject(s)
Cell Nucleus/drug effects , Erythrocytes/drug effects , Mutagens , Phenytoin/pharmacology , Animals , Antibiotics, Antineoplastic/pharmacology , Bone Marrow/drug effects , Bone Marrow Cells , Erythrocytes/cytology , Male , Mice , Mice, Inbred BALB C , Mitomycin , Mitomycins/pharmacology , Mutagenicity TestsABSTRACT
PIP: 268 cases of septic abortion which occurred between 1964-72 in a large metropolitan hospital in Mexico were analyzed retrospecively. There cases represented 0.88% of all cases of abortion during the same time. Most patients were between 21-30, and 48% with parity 2-5; 63% were at their first abortion; only 16 patients declared to have attempted abortion, and most cases were first trimester abortion. Pre- and postoperative procedures and vital signs were carefully taken, and time elapsed from medical treatment to surgery was 4-12 hours. There were 237 curettages, and 28 hysterectomies. Complication from surgery were 4.1%; there were 19 deaths, i.e. 7.5% of patients, of which 10 only 24 hours after hospitalization. Protocol of treatment of septic abortion is discussed, and surgical treatment highly recommended.^ieng
