Profilaxis antibiótica en amigdalectomías y su relación con la morbilidad postoperatoria / Antibiotic prophylaxis in tonsillectomy and its relationship with postoperative morbidity

Introducción y objetivos: El dolor postoperatorio en amigdalectomía es el síntoma principal y el más incapacitante. La prescripción de antibióticos es una práctica común para disminuir el dolor postoperatorio. El objetivo del estudio fue comparar la eficacia del control de la morbilidad postoperatoria de un esquema de profilaxis antibiótica intravenoso dosis única preoperatorio contra un antibiótico vía oral postoperatorio en pacientes pediátricos sometidos a amigdalectomía. Métodos: Ensayo clínico controlado aleatorizado abierto, realizado a pacientes de 4-15 años sometidos a amigdalectomía. Grupo experimental: cefalotina iv dosis única; grupo control: cefalotina iv dosis única más amoxicilina/ácido clavulánico durante 7 días. Se comparó la presencia e intensidad del dolor, tolerancia a vía oral, limitación de actividades, halitosis, otalgia y náuseas en los primeros 7 días del postoperatorio mediante la escala visual analógica del dolor de Wong-Baker y un cuestionario contestado por los padres. Resultados: Ciento dos pacientes sometidos a amigdalectomía, 51 por grupo. No hubo diferencia en la presencia ni intensidad del dolor postoperatorio entre ambos grupos (p > 0,05). No se encontró diferencia en los días para la reincorporación a las actividades habituales, dieta normal, días con halitosis, otalgia o náuseas. Solo se presentó un caso de sangrado postoperatorio en el grupo control. No ocurrieron complicaciones infecciosas. Conclusiones: El uso de cefalotina iv dosis única en el preoperatorio tiene la misma eficacia que el uso de amoxicilina/ácido clavulánico por vía oral durante 7 días para el control de la morbilidad en los pacientes pediátricos operados de amigdalectomía y ofrece una profilaxis antimicrobiana segura, por lo que el uso rutinario de antibióticos vía oral debe ser evitado (AU)

Introduction and objectives: Postoperative pain is the main symptom and the most incapacitating one in tonsillectomy, and prescribing oral antibiotics to reduce postoperative pain is common. The objective of this study was to evaluate the efficacy of 2 different prophylactic antibiotic schemes to reduce postoperative morbidity in paediatric patients undergoing tonsillectomy. One scheme consisted of a single-dose preoperative cephalothin, while the second was an oral antibiotic. Methods: This was an open randomized trial on patients aged 4-15 years undergoing tonsillectomy. The experimental group received single-dose intravenous cephalothin, while the control group received single-dose intravenous cephalothin plus oral suspension of amoxicillin/clavulanate for 7 days. We compared the presence and intensity of pain, limitations to normal diet, habitual activities, halitosis, otalgia and nausea within 7 days after surgery using the Wong-Baker FACES Pain Scale and a questionnaire for the parents. Results: For the 102 patients that underwent tonsillectomy (51 per group), there was no difference in the presence and severity of postoperative pain between the 2 groups (P>0.05). Neither was there any difference in the days needed to return to normal activities, normal diet, and duration of days with halitosis, otalgia or nausea. Just 1 patient from the control group had postoperative bleeding. There were no infectious complications. Conclusions: The use of single-dose preoperative intravenous cephalothin has the same efficacy as the use of oral amoxicillin/clavulanate for 7 days in reducing morbidity in paediatric patients undergoing tonsillectomy and offers safe antimicrobial prophylaxis. Consequently, the routine use of oral antibiotics should be avoided (AU)

Antibiotic prophylaxis in tonsillectomy and its relationship with postoperative morbidity.

INTRODUCTION AND OBJECTIVES: Postoperative pain is the main symptom and the most incapacitating one in tonsillectomy, and prescribing oral antibiotics to reduce postoperative pain is common. The objective of this study was to evaluate the efficacy of 2 different prophylactic antibiotic schemes to reduce postoperative morbidity in paediatric patients undergoing tonsillectomy. One scheme consisted of a single-dose preoperative cephalothin, while the second was an oral antibiotic. METHODS: This was an open randomized trial on patients aged 4-15 years undergoing tonsillectomy. The experimental group received single-dose intravenous cephalothin, while the control group received single-dose intravenous cephalothin plus oral suspension of amoxicillin/clavulanate for 7 days. We compared the presence and intensity of pain, limitations to normal diet, habitual activities, halitosis, otalgia and nausea within 7 days after surgery using the Wong-Baker FACES Pain Scale and a questionnaire for the parents. RESULTS: For the 102 patients that underwent tonsillectomy (51 per group), there was no difference in the presence and severity of postoperative pain between the 2 groups (P>.05). Neither was there any difference in the days needed to return to normal activities, normal diet, and duration of days with halitosis, otalgia or nausea. Just 1 patient from the control group had postoperative bleeding. There were no infectious complications. CONCLUSIONS: The use of single-dose preoperative intravenous cephalothin has the same efficacy as the use of oral amoxicillin/clavulanate for 7 days in reducing morbidity in paediatric patients undergoing tonsillectomy and offers safe antimicrobial prophylaxis. Consequently, the routine use of oral antibiotics should be avoided.

Robot-assisted vaginal hysterectomy: two cases.

Hysterectomy remains the most frequent surgical gynaecological procedure. We report two cases of robot-assisted vaginal hysterectomy and show its feasibility. Robotic assistance in vaginal hysterectomy could combine both the advantage of the vaginal route (reducing surgical length, blood loss, hospitalisation and recovery), and the advantage of the robot assistance (3D endoscopic vision, easier instrumental handling, surgical ergonomics) especially when the hysterectomy is difficult. It could be used in other pathologies that are already treated by vaginal route.

Photodiagnosis and photodynamic therapy of peritoneal metastasis of ovarian cancer.

Ovarian cancer is among the deadliest in women. Current treatment strategies fail to cure many patients owing to the difficulties of eradicating peritoneal implants frequently associated with this pathology. Photodynamic therapy represents a promising treatment as it offers many advantages over alternative strategies: diagnostic properties, specific targeting of abnormal cells, possibility to be combined with other therapies.

Continuous or fractionated photodynamic therapy? Comparison of three PDT schemes for ovarian peritoneal micrometastasis treatment in a rat model.

OBJECTIVE: This experimental study aimed to compare three illumination schemes to optimize hexaminolaevulinate (HAL)-PDT in a rat tumor model with advanced ovarian cancer. MATERIALS AND METHODS: Peritoneal carcinomatosis was induced by intraperitoneal 5×10(6)NuTu-19 cells injection in 60 female rats Fisher 344. Carcinomatosis was obtained 50 days post-tumor induction. Four hours post-intraperitoneal HAL (Photocure ASA, Oslo, Norway) injection, three different schemes of PDT were performed during 25 min on a 1cm(2) area. (A) Fractionated illumination (n=20) with an on-off cycle ("on": 2 min and "off": 1 min) at 30mW cm(-2) until a fluence of 30J cm(-2), (B) continuous illumination (n=20) at 30mW cm(-2) with a fluence of (45J cm(-2)C) continuous illumination (n=20) at 20mW cm(-2) with a fluence of 30J cm(-2). Laser light was generated using a 532nm KTP laser (Laser Quantum, Stockport, UK). Biopsies were taken 24h after treatment. Quantitative histology was performed. Necrosis value was determined: 0-no necrosis to 4-full necrosis. Depth of necrosis was then measured for each sample and correlated to Necrosis value. RESULTS: HAL-PDT was efficient in producing necrosis irrespective of the scheme. Tumor destruction was superior with fractionated illumination compared to both continuous illumination schemes regarding to the depth of necrosis (213±113µm vs 154±133µm vs 171±155µm) (p<0.05) or to the full necrosis rate (50% vs 30% vs 10%) (p<0.0001). CONCLUSION: Fractionated illumination during photodynamic therapy (PDT) was shown to improve tumor response. Fractionated illumination with short intervals should be considered for an effective PDT of advanced ovarian cancer.

Protoporphyrin IX fluorescence photobleaching is a useful tool to predict the response of rat ovarian cancer following hexaminolevulinate photodynamic therapy.

OBJECTIVE: Accurate dosimetry was shown to be critical to achieve effective photodynamic therapy (PDT). This study aimed to assess the reliability of in vivo protoporphyrin IX (PpIX) fluorescence photobleaching as a predictive tool of the hexaminolevulinate PDT (HAL-PDT) response in a rat model of advanced ovarian cancer. MATERIALS AND METHODS: Intraperitoneal 10(6) NuTu 19 cells were injected in 26 female rats Fisher 344. Peritoneal carcinomatosis was obtained 26 days post-tumor induction. Four hours post-intraperitoneal HAL (Photocure ASA, Oslo, Norway) injection, a laparoscopic procedure (D-light AutoFluorescence system, Karl Storz endoscope, Tuttlingen, Germany) and a fluorescence examination were made for 22 rats. The first group (LASER group, n=26) was illuminated with laser light using a 532 nm KTP laser (Laser Quantum, Stockport, UK) on 1 cm(2) surface at 45 J/cm(2). The second group (NO LASER group, n=26) served as controls. Biopsies were taken 24 hours after PDT. Semi-quantitative histology was performed and necrosis value was determined: 0--no necrosis to 4--full necrosis. Fluorescence was monitored before and after illumination on complete responders (NV=3-4; n=20) and non-responders (NV=0-2; n=6). RESULTS: High PpIX photobleaching corresponded with complete responders whereas low photobleaching corresponded with non-responders (P<0.05). A direct linear correlation was shown between photobleaching and necrosis (R(2)=0.89). CONCLUSION: In vivo PpIX fluorescence photobleaching is useful to predict the tissue response to HAL-PDT.

Comparison of continuous and fractionated illumination during hexaminolaevulinate-photodynamic therapy.

OBJECTIVE: This experimental study aimed to compare continuous and fractionated illumination to optimize hexaminolaevulinate (HAL)-photodynamic therapy (PDT) in a rat tumour model with advanced ovarian cancer. MATERIALS AND METHODS: Intraperitoneal 10(6) Nu Tu-19 cells were injected in 36 female rats Fisher 344. Peritoneal carcinomatosis was obtained 26 days post-tumour induction. Four hours post-intraperitoneal HAL (Photocure ASA, Oslo, Norway) injection, two schemes of PDT were performed at 30 mW cm(-2) on a 1cm(2) area: fractionated illumination (n=16) with a on-off cycle ("on": 2 min and "off": 1 min) until a fluence of 30 J cm(-2) was delivered, and continuous illumination (n=20) with a fluence of 45 J cm(-2). Laser light was generated using a 532 nm KTP laser (Laser Quantum, Stockport, UK). Biopsies were taken 24h after treatment. Semi-quantitative histology was performed. Necrosis value was determined-0: no necrosis to 4: full necrosis. RESULTS: HAL-PDT was efficient in producing necrosis irrespective of the scheme (NV=3.34+/-0.91). Tumour destruction was superior with fractionated illumination compared to continuous illumination (3.67+/-0.70 vs. 3.10+/-0.94) (p<0.05). CONCLUSION: Fractionated illumination during photodynamic therapy was shown to improve tumour response. Fractionated illumination with short intervals should be considered for an effective PDT of advanced ovarian cancer.

Evaluation of ALA-PDT of ovarian cancer in the Fisher 344 rat tumor model.

OBJECTIVE: This study aimed to evaluate aminolevulinic acid-photodynamic therapy (ALA-PDT) in an experimental tumor model to expand the use of PDT in the treatment of ovarian cancer with peritoneal carcinosis. MATERIALS AND METHODS: 5-Aminolevulinic acid (ALA) (Photocure ASA, Norway) 60mg/kg was injected in the peritoneum cavity of 45 female rats Fisher with induced peritoneal metastases of ovarian cancer. ALA-PDT was performed 4h later with two different lasers: (1) laser diode (Diomed, Cambridge, UK), at 630nm, 100mW/cm(2), or (2) KTP laser (Laser Quantum, Stockport, UK), 532nm, 30mW/cm(2). The animals were divided into five groups: LASER ALONE group, CTRL group (no cancer), NO LASER group, 1 DOSE group (PDT during 1s) and 1.5 DOSE group (PDT during 1.5s). Biopsies were taken 24h after treatment. A semi-quantitative score called necrosis value (NV) was assigned to each sample that reflected the depth of the peritoneal necrosis. RESULTS: In the first two groups, the peritoneum remained intact irrespective of the wavelength. In the 1 DOSE group, necrosis was observed for 532nm and 630nm. In the 1.5 DOSE group, necrosis was observed for 532nm (NV: 3.22±0.83) and 630nm (NV: 2.67±1.00) (p<0.05). The mesothelium strongly thinned out in the diffuse shape of the tumor. CONCLUSION: Only ALA-PDT induces tumor necrosis with either 532nm and 630nm and should be considered an effective therapy for micrometastasis of ovarian cancer. This preliminary study deserves further experiments.

Exenatide: uso en humanos / Exenatide: use in humans

El exenatide es el primer agonista sintético del receptor de GLP-1 (glucagon-like peptide 1) aprobado para el tratamiento de pacientes con diabetes tipo 2. La multiplicidad de efectos que produce sobre el metabolismo de la glucosa, el apetito y el peso corporal, así como su capacidad potencial para mantener la masa de células β, lo convierten en una alternativa terapéutica atractiva. El presente artículo pretende revisar la información existente sobre la farmacocinética, farmacodinamia, efectividad y seguridad del exenatide en humanos, derivada de los primeros estudios de fase I y II y de los ensayos clínicos controlados que condujeron a la aprobación de su uso clínico como terapia de combinación con sulfonilureas y metformina.

Exenatide is the first synthetic agonist of the GLP-1 (glucagon-like peptide 1) receptor approved for clinical use in patients with type 2 diabetes. The multiplicity of its effects over glucose metabolism, appetite, body weight and its potential capacity to preserve the ?cell mass, makes it an attractive therapeutic alternative. This article attempts to review the current literature on pharmacokinetics, pharmacodynamics, efficacy, and safety of exenatide in humans, derived from the early phase I and II studies, and from the clinical controlled trials that led to its approval for clinical use as a combination therapy with sulphonylureas and metformin.

[Exenatide: use in humans]. / Exenatide: uso en humanos.

Exenatide is the first synthetic agonist of the GLP-1 (glucagon-like peptide 1) receptor approved for clinical use in patients with type 2 diabetes. The multiplicity of its effects over glucose metabolism, appetite, body weight and its potential capacity to preserve the ?cell mass, makes it an attractive therapeutic alternative. This article attempts to review the current literature on pharmacokinetics, pharmacodynamics, efficacy, and safety of exenatide in humans, derived from the early phase I and II studies, and from the clinical controlled trials that led to its approval for clinical use as a combination therapy with sulphonylureas and metformin.

[Colonic stenosis secondary to non-steroid anti-inflammatory agents as a cause of anemia and chronic diarrhea]. / Estenosis colónica secundaria a antiinflamatorios no esteroideos como causa de anemia y diarrea crónica.

Gastroduodenal mucosal injury is a widely recognized side effect of non-steroidal antiinflammatory agents (NSAID). Distal small bowel and colon are additional organs of the gastrointestinal tract exposed to deleterious effects of these drugs. Inflammation and ulceration have been described as pathologic damage associated with NSAID. Strictures of colon induced by NSAID are a new entity characterized by diaphragm-like strictures. Most patients present with anemia, obstructive symptoms, diarrhea, or weight loss. Endoscopic dilation, surgical resection, symptomatic treatment, and interruption of NSAID ingestion are treatment of choice. Only 23 cases of NSAID-related, colonic, diaphragm-like strictures have been reported. Here we describe a case of concentric colonic stricture related to naproxen and clinical features of this entity are discussed.