Pain management in cervical cancer.

Cervical cancer (CC) occupies the second place in incidence and mortality among women in México. Despite this, Cervical Cancer continues to have a late diagnosis which leads to a high rate of complications. Pain represents the most feared and disabling symptom, being present in up to 86% of patients with advanced disease. The approach to managing pain in this population has not been studied and described to a full extent. In addition, there is a pressing need to provide concise recommendations to promote adequate pain control. We performed a review of the literature in CC and had experts in the field of pain management evaluate the evidence found. We then issued relevant recommendations on pharmacology and interventional pain management. Thus, the approach to pain management must be comprehensive and individualized, considering the timely and appropriate use of pharmacologic treatment as well as interventional procedures.

Learning from the pulmonary veins.

The purpose of this article is to review the basic embryology and anatomy of the pulmonary veins and the various imaging techniques used to evaluate the pulmonary veins, as well as the radiologic findings in diseases affecting these structures. Specific cases highlight the clinical importance of the imaging features, particularly the findings obtained with multidetector computed tomography (CT). Pulmonary vein disease can be broadly classified into congenital or acquired conditions. Congenital disease, which often goes unnoticed until patients are adults, mainly includes (a) anomalies in the number or diameter of the vessels and (b) abnormal drainage or connection with the pulmonary arterial tree. Acquired disease can be grouped into (a) stenosis and obstruction, (b) hypertension, (c) thrombosis, (d) calcifications, and (e) collateral circulation. Pulmonary vein stenosis or obstruction, which often has important clinical repercussions, is frequently a result of radiofrequency ablation complications, neoplastic infiltration, or fibrosing mediastinitis. The most common cause of pulmonary venous hypertension is chronic left ventricular failure. This condition is difficult to differentiate from veno-occlusive pulmonary disease, which requires a completely different treatment. Pulmonary vein thrombosis is a rare, potentially severe condition that can have a local or distant cause. Calcifications have been described in rheumatic mitral valve disease and chronic renal failure. Finally, the pulmonary veins can act as conduits for collateral circulation in cases of obstruction of the superior vena cava. Multidetector CT is an excellent modality for imaging evaluation of the pulmonary veins, even when the examination is not specifically tailored for their assessment.

[National consensus of diagnosis and treatment of non-small cell lung cancer]. / Consenso nacional de diagnóstico y tratamiento del cáncer de pulmón de células no pequeñas.

Mexican specialists in oncology, oncologic surgery, thoracic surgery, pneumology, pathology, molecular biology, anesthesiology, algology, psychology, nutrition, and rehabilitation (all of them experts in lung cancer treatment) in order to develop the National Consensus on Lung Cancer. The consensus has been developed as an answer to the need of updated Mexican guidelines for the optimal treatment of the disease, as well as to the requirements that such guidelines be established by multidisciplinary panel, depicting the current attention given to cancer lung cases in Mexico. Thus, this paper analyses the epidemiological review, screening, diagnosis, staging, pathology, translational medicine, and the suitable therapies for early, locally advanced, and metastatic disease in the first, second, and third lines of management, as well as rehabilitation and palliative measures.

El epidurograma: un método de verificación del espacio epidural en un modelo animal / The epidurogram: a method of validation of epidural space an animal model

El cada vez más frecuente abordaje del espacio epidural o intratecal con fines diagnósticos, pronósticos y/o terapéuticos, que permitan la invasión de éstos en forma aguda o crónica obligan a identificar la ubicación de los catéteres instalados y la posible distribución de los agentes depositados a través de ellos; por lo que nos propusimos evaluar experimentalmente si el epidurograma cumple esta función, además de conocer algunas particularidades de la vía espinal. Con base a este objetivo se implantan 64 ratas Wistar con catéteres epidurales por microcirugía, administrando material radiopaco, efectuando estudio radiológico y evaluación neuroconductal (tiempo de retiro de las patas y cola) al frió y calor, encontrando hallasgos radiológicos que se corroboraron con el estudio necrológico, y a su vez correlacionando resultados con las estimaciones neurofuncionales, lo que sugiere que la epidurografía es un método consistente y confiable; resultando una herramienta eficaz para la exploración del espacio epidural

Infusión epidural continua con una mezcla de bupivacaina 0.1 y meperidina para analgesia post-operatoria / Epidural infusion of a mixture of bupivaine and mepridine for postoperative analgesia

Estudiamos la seguridad y la eficacia de la analgesia epidural por infusión continua con una mezcla de meperidina-bupivacaína. Métodos: los catéteres epidurales se colocaron desde el preoperatorio y fueron utilizados para anestesia (epidural o epidural más general ligera). La infusión epidural se preparó con sol. salina 250 ml, meperidina 200 mg y bupivacaína 0.1 por ciento y se inició al llegar el paciente a la sala de recuperación a una velocidad de 10 ml/hora. Los pacientes fueron evaluados a intervalos de 4 - 6 horas y se valoraron dolor en reposo y con la inspiración (EVA 0 - 10), sedación (0 - 3) y aparición de efectos indeseables y complicaciones. Resultados: el estudio incluyó a 110 pacientes sometidos a cirugía abdominal mayor (47), ortopédica (21), urológica (17), ginecológica (17) y vascular (8). Los catéteres epidurales fueron usados por 1 (16 por ciento), 2 (32 por ciento) ó 3 (52 por ciento) días. Un 26 por ciento de los casos necesitaron algún AINE durante el primer día. La calidad de la analgesia fue muy buena en todos los casos con una EVA promedio menor a 3 desde las 6 horas del postoperatorio. La incidencia de efectos indeseable fue baja y no hubo ningún caso de depresión respiratoria. Conclusión: la infusión epidural continua de una mezcla de meperidina-bupivacaína 0.1 por ciento es segura y eficaz, pudiendo emplearse en salas generales de hospitalización