Outcomes in patients managed with endovascular stent for malignant superior vena cava syndrome.

Background: Malignant Superior Vena Cava Syndrome (SVCS) corresponds to the clinical manifestations due to the restriction of venous return to the right atrium secondary to obstruction of the superior vena cava and/or its main tributaries for a tumor. Endovascular management has proven to be safe, effective and cause a fast symptomatic relief in patients with SVCS. There is limited evidence in factors associated with outcomes in malignant setting for this procedure. Materials and methods: An analytical retrospective study was conducted and included patients that underwent endovascular management for malignant SVCS at the National Cancer Institute of Colombia between May 2016 and May 2021. Clinical and technical variables were analyzed to found associations with outcomes in these patients. Results: 54 patients were analyzed. Successful procedure rate was 94.4 %. At 10 months, the OS of the entire cohort of patients was 25 %. Patients with breast or lung cancer (P = 0.031), unsuccessful procedure (P = 0.011), and also with short time of symptoms to the date of the endovascular procedure (P = 0.027) had worse OS. Multivariate analysis showed that lung cancer [HR = 2.55, 95%IC:(1.21-5.36)] and left internal jugular vein or left Innominate vein distal stent attachment [HR = 3.27, 95%IC:(1.31-8.15)] were independent factors for worst OS. Conclusions: Based in the high success rate of the endovascular management and the better outcome in patients with early and successful procedure, this procedure should be considered as part of the multimodal treatment in patients with SVCS independent of the clinical scenario and the oncological diagnosis.

Optimización de procesos relacionados con la gestión del inventario de una farmacia hospitalaria mediante el uso de la metodología Lean Six Sigma / Optimization of processes related to the inventory management of a hospital pharmacy using the Lean Six Sigma methodology

Introducción: La gestión eficiente del inventario es un desafío para los Servicios de Farmacia Hospitalaria (SFH). Se han reportado resultados favorables en la mejora de procesos hospitalarios utilizando la metodología Lean Six Sigma (LSS). Este trabajo tiene como objetivo implementar la metodología LSS para mejorar el desempeño de tres procesos que influyen en el inventario del SFH en un 70% y alcanzar un mínimo del 90% de stocks correctos.Métodos: El estudio se desarrolló en el SFH del Instituto Modelo de Cardiología Privado S.R.L. Se aplicó metodología DMAIC (definir, medir, analizar, implementar mejoras, controlar) en el proceso de recepción (PR), proceso de dispensación por dosis diaria unitaria (PDDU) y proceso de distribución de insumos a servicios (PDS). Se definieron tres períodos: inicial (08/18-09/18) para calcular el desempeño base medido en número de errores/ciclo, implementación (10/18-12/18) para aplicar mejoras, y consolidación (01/19-03/19) para evaluar consistencia en el tiempo. Se controló mensualmente el inventario del SFH y mediante control estadístico se monitoreó estabilidad y capacidad. Resultados: Comparando el período inicial vs. consolidación los errores disminuyeron: PR de 0,135 errores/recepción a 0,033 errores/recepción, PDDU de 0,064 errores/paciente a 0,008 errores/paciente y PDS de 1,294 errores/pedido a 0,044 errores/pedido respectivamente. En el período de consolidación el 95,95% de stocks fueron correctos vs. el 63,42% del período diagnóstico.Conclusión: La implementación de LSS en un SFH eficientizó la gestión del stock y disminuyó los errores en los procesos de PR, PDDU y PDS, demostrando ser una herramienta muy útil para las organizaciones de salud. (AU)

Introduction: Efficient inventory management is a challenge for Hospital Pharmacy Services (HPS). Positive results have been reported in the improvement of hospital processes using the Lean Six Sigma (LSS) methodology. This work aims to implement the LSS methodology to improve the performance of three processes that influence the inventory of the HPS by 70% and reach a minimum of 90% of correct stocks.Methods: The study was carried out at the HPS of the Instituto Modelo de Cardiología Privado S.R.L. DMAIC methodology (define, measure, analyse, improve, control) was applied in the receiving process (RP), the unit dose daily drug distribution system (UDDDDS) and the supply distribution to hospital services process (SDHSP). Three periods were defined: initial (08/18-09/18) to calculate the base performance measured in number of defects/cycle, implementation (10/18-12/18) to apply improvements, and consolidation (01/19-03/19) to evaluate consistency over time. The inventory of the SPH was checked monthly and the stability and capacity of each process was monitored with statistical control techniques.Results: Comparing the initial period vs. consolidation the defects decreased: RP from 0.135 defects/reception to 0.033 defects/reception, UDDDDS from 0.064 defects/patient to 0.008 defects/patient and SDHSP from 1.294 defects/order to 0.044 defects/order respectively. In the consolidation period 95.95% of stocks were correct vs. 63.42% of the diagnostic period.Conclusion: The implementation of LSS in an HPS efficient the stock management and reduced errors in the processes of RP, UDDDDS and SDHSP, proving to be a very useful tool for health care organizations. (AU)

Direct effects of fermented cow's milk product with Lactobacillus paracasei CBA L74 on human enterocytes.

Cow's milk fermented with Lactobacillus paracasei CBA L74 (FM-CBAL74) exerts a preventive effect against infectious diseases in children. We evaluated if this effect is at least in part related to a direct modulation of non-immune and immune defence mechanisms in human enterocytes. Human enterocytes (Caco-2) were stimulated for 48 h with FM-CBAL74 at different concentrations. Cell growth was assessed by colorimetric assay; cell differentiation (assessed by lactase expression), tight junction proteins (zonula occludens1 and occludin), mucin 2, and toll-like receptor (TRL) pathways were analysed by real-time PCR; innate immunity peptide synthesis, beta-defensin-2 (HBD-2) and cathelicidin (LL-37) were evaluated by ELISA. Mucus layer thickness was analysed by histochemistry. FMCBA L74 stimulated cell growth and differentiation, tight junction proteins and mucin 2 expression, and mucus layer thickness in a dose-dependent fashion. A significant stimulation of HBD-2 and LL-37 synthesis, associated with a modulation of TLR pathway, was also observed. FM-CBAL74 regulates non-immune and immune defence mechanisms through a direct interaction with the enterocytes. These effects could be involved in the preventive action against infectious diseases demonstrated by this fermented product in children.

Sistemas psicológicos como epistemología de la psicología: insumos técnicos y bases conceptuales para la formación universitaria / Systems of psychology as epistemology of psychology: technical supplies and conceptual bases for psychology education

Recuperando el marco esbozado en un análisis anterior, el presente trabajo describe una propuesta de enseñanza de sistemas psicológicos a partir de parámetros de análisis meta-teórico y de modelos meta-científicos concretos, con el objeto de resituar los cursos de sistemas psicológicos en la sistematología como parte del subsistema de la epistemología de la psicología. Se describen tres cuestiones centrales para la sistematología en la formación de psicólogos: la importancia del trabajo sobre fuentes primarias a partir de recursos pedagógicos específicos para el desarrollo de competencias y actitudes científicas, la necesidad de disponer de uno (o varios) conjuntos de parámetros fijos para analizar comparativamente los sistemas teóricos, y los problemas, criterios y opciones al momento de contextualizar dicho análisis meta-teórico comparativo en modelos meta-científicos comprehensivos pertenecientes a la filosofía de la ciencia y de la psicología. Se concluye sobre la necesidad de trascender la enseñanza de la sistematología como una enunciación de conceptos de 'grandes autores', y se caracterizan ciertos riesgos y limitaciones de la enseñanza de la sistematología como ejercicio epistemológico de la psicología.

Resuming the framework outlined in a previous analysis, the present work describes a proposal for teaching systems of psychology based on parameters of meta-theoretical analysis and specific meta-scientific models, with the aim of relocating psychological systems' courses in systematology of psychology as a component of the epistemology of psychology. Three central issues for systematology in psychologists' education are described: the importance of working with primary sources through specific pedagogical resources with the aim of developing scientific competences and attitudes, the need to have one (or several) sets of fixed parameters to comparatively analyze theoretical systems, and the problems, criteria and options available when contextualizing such comparative meta-theoretical analysis in comprehensive meta-scientific models which belong to the philosophy of science and of psychology. We conclude on the need to transcend the teaching of systematology as a verbal enunciation of concepts proposed by 'great authors', and on certain risks and limitations regarding the teaching of psychological systems conceived as an epistemological exercise.

A pentacoordinated norbornenyl-acyl-rhodium(iii) complex as a likely intermediate in the catalytic hydroacylation of norbornadiene.

[RhCl(NCO)(nbyl)(PR3)] (nbyl = σ-norbornenyl; NCO = quinoline-8-acyl; R = p-F-C6H4) (1) has been synthesized by the reaction of [Rh(nbd)Cl]2 (nbd = norbornadiene) with 2 equivalents of NCHO (quinoline-8-carbaldehyde) and 2 equivalents of PR3. Compound 1 has been fully characterized in solution and also in the solid state by X-ray diffraction. Compound 1 shows low stability in solution and undergoes slow ring closure isomerization to [RhCl(NCO)(ntyl)(PR3)] (ntyl = σ-nortricyclyl) (2) after 12 hours. Reaction of 1 with an extra equivalent of aldehyde (NCHO) and PR3 led to the formation of [RhCl(H)(NCO)(PR3)2] (3) and an equivalent of ketone, which is a hydroacylation product. The catalytic activity of 3 in the hydroacylation of nbd with NCHO is reported as well as the catalytic activity of compound 1. Compounds 1 and 3 are proposed as intermediate species in the catalytic hydroacylation of norbornadiene with NCHO.

[The effect of corifollitropin alfa on in vitro fertilization-ICSI patients with previous failure with an FSH/HMG protocol: Preliminary report in Mexico]. / Efecto de la corifolitropina alfa en pacientes de fertilización in vitro-ICSI con falla previa en un protocolo de FSH/HMG: experiencia preliminar en México.

BACKGROUND: The daily application of drugs, often in high doses, is a factor of stress for the infertile couple. During the last decade corifollitropin alpha has allowed a friendlier scheme comparable to traditional protocols (rFSH-HMG) results. OBJECTIVE: To compare the results of corifollitropin alpha in patients with a previous cycle of IVF-ICSI with traditional scheme ovarian stimulation. MATERIALS AND METHODS: Observational, retrospective cohort study type that infertile couples were included. RESULTS: No significant differences in the dose used HFRS (2023U/ total ± 712 vs 636 U/total ± 307) and serum estradiol day shooting HGCr (1972 pg/dL vs 1107 ± 1152 pg/dL ± 775). A higher pregnancy rate was found corifollitropin alpha perhaps because it was a second attempt at in vitro fertilization. CONCLUSIONS: Reproductive outcomes in a cycle of ovarian stimulation with corifollitropin are comparable with the results of a traditional ovarian stimulation cycle. It is important to broaden the experience of the drug indication in Mexican patients.

Stability evaluation of 7 % chloral hydrate syrup contained in mono and multi-dose bottles under room and refrigeration conditions.

PURPOSE: To evaluate the stability of an extemporaneously prepared 7% chloral hydrate syrup under different conditions of storage and dispensing. METHODS: Three batches of 7% chloral hydrate syrup were prepared. Each batch was stored in 50 light-resistant glass containers of 60 mL with child-resistant caps and in two bottles of 1000 mL to simulate two forms of dispensing, mono and multi-dose, respectively. Twenty five mono-dose bottles and a multi-dose bottle of each batch were stored under room conditions (20 ± 1 °C) and the rest of the samples were stored in the fridge (5 ± 2 °C). The physical, chemical and microbiological stability was evaluated for 180 days. Stability was defined as retention of at least 95% of the initial concentration of chloral hydrate, the absence of both visible particulate matter, or color and/or odor changes and the compliance with microbiological attributes of non-sterile pharmaceutical products. RESULTS: At least 98% of the initial chloral hydrate concentration remained throughout the 180-day study period. There were no detectable changes in color, odor, specific gravity and pH and no visible microbial growth. These results were not affected by storage, room or refrigeration conditions or by the frequent opening or closing of the multi-dose containers. CONCLUSIONS: Extemporaneously compounded 7% chloral hydrate syrup was stable for at least 180 days when stored in mono or multi-dose light-resistant glass containers at room temperature and under refrigeration.

Stability evaluation of 7% chloral hydrate syrup contained in mono and multi-dose bottles under room and refrigeration conditions

Purpose: To evaluate the stability of an extemporaneously prepared 7% chloral hydrate syrup under different conditions of storage and dispensing. Methods: Three batches of 7% chloral hydrate syrup were prepared. Each batch was stored in 50 light-resistant glass containers of 60 mL with child-resistant caps and in two bottles of 1000 mL to simulate two forms of dispensing, mono and multi-dose, respectively. Twenty five mono-dose bottles and a multi-dose bottle of each batch were stored under room conditions (20 ± 1oC) and the rest of the samples were stored in the fridge (5 ± 2oC). The physical, chemical and microbiological stability was evaluated for 180 days. Stability was defined as retention of at least 95% of the initial concentration of chloral hydrate, the absence of both visible particulate matter, or color and/or odor changes and the compliance with microbiological attributes of non-sterile pharmaceutical products. Results: At least 98% of the initial chloral hydrate concentration remained throughout the 180-day study period. There were no detectable changes in color, odor, specific gravity and pH and no visible microbial growth. These results were not affected by storage, room or refrigeration conditions or by the frequent opening or closing of the multi-dose containers. Conclusions: Extemporaneously compounded 7% chloral hydrate syrup was stable for at least 180 days when stored in mono or multi-dose light-resistant glass containers at room temperature and under refrigeration (AU)

Objetivo: Evaluar la estabilidad de un jarabe extemporáneo de hidrato de cloral al 7% bajo diferentes condiciones de almacenamiento y dispensación. Métodos: Se prepararon tres lotes de hidrato de cloral. Cada lote se almacenó en 50 contenedores de vidrio resistentes a la luz de 60 ml con tapones de protección infantil y en dos botes de 1000 ml para simular dos formas de dispensación, mono y multidosis, respectivamente. Veinticinco envases monodosis y un envase multidosis de cada lote se almacenaron en condiciones ambiente (20 ± 1oC)y el resto de las muestras se almacenaron en el frigorífico (5 ± 2oC). Se evaluaron las estabilidades física, química y microbiológica durante 180 días. Se definió la estabilidad como la retención de al menos el 95% de la concentración inicial del hidrato de cloral, la ausencia de partículas visibles y de cambios en el color y/o el olor, así como el cumplimiento de los requisitos microbiológicos de los productos farmacéuticos no estériles. Resultados: Al menos el 98% de la concentración inicial de hidrato de cloral se mantuvo a lo largo de los 180 días del periodo de estudio. No se apreciaron cambios detectables en el olor, el color ni la densidad o el pH y tampoco se apreció crecimiento microbiológico. Estos resultados no se vieron influidos por las condiciones de almacenamiento, estar a temperatura ambiente o refrigerada ni por la frecuencia de apertura y cierre de los contenedores multidosis. Conclusiones: El compuesto de jarabe de hidrato de cloral extemporáneo al 7% fue estable durante al menos 180 días en envases de vidrio mono o multidosis, resistentes a la luz, a temperatura ambiente y con refrigeració (AU)

Nitrous oxide (N(2)O) reduces postoperative opioid-induced hyperalgesia after remifentanil-propofol anaesthesia in humans.

BACKGROUND: The aim of this study was to test if intraoperative administration of N(2)O during propofol-remifentanil anaesthesia prevented the onset of postoperative opioid-induced hyperalgesia (OIH). METHODS: Fifty adult ASA I-II patients undergoing elective open septorhinoplasty under general anaesthesia were studied. Anaesthesia was with propofol, adjusted to bispectral index (40-50), and remifentanil (0.30 µg kg(-1) min(-1)). Patients were assigned to one of the two groups: with N(2)O (70%) and without N(2)O (100% oxygen). Mechanical pain thresholds were measured before surgery and 2 and 12-18 h after surgery. Pain measurements were performed on the arm using hand-held von Frey filaments. A non-parametric analysis of variance was used in the von Frey data analysis. P<0.05 was considered statistically significant. RESULTS: Baseline pain thresholds to mechanical stimuli were similar in both groups, with mean values of 69 [95% confidence interval (CI): 50.2, 95.1] g in the group without N(2)O and 71 (95% CI: 45.7, 112.1) g in the group with N(2)O. Postoperative pain scores and cumulative morphine consumption were similar between the groups. The analysis revealed a decrease in the threshold value in both groups. However, post hoc comparisons showed that at 12-18 h after surgery, the decrease in mechanical threshold was greater in the group without N(2)O than the group with N(2)O (post hoc analysis with Bonferroni's correction, P<0.05). CONCLUSIONS: Intraoperative 70% N(2)O administration significantly reduced postoperative OIH in patients receiving propofol-remifentanil anaesthesia.

ABC de la nefropatía diabética: una guía práctica para el médico general / ABC of diabetic nephropathy: a practical guide for the general practitioner

La nefropatía diabética constituye una patología con elevada morbimortalidad y es la principal causa de ingreso a tratamiento de diálisis. Esta revisión tiene por objeto describir en forma concisa y práctica aquellos aspectos más relevantes en la evaluación y tratamiento de la nefropatía diabética, sin dejar de lado los aspectos preventivos cuyo respaldo de evidencia es robusto. Si bien está escrito desde la óptica del nefrólogo no debe perderse de vista una concepción y manejo integral del enfermo.

Diabetic nephropathy is the main cause of end stage renal failure. This review, intended to the general practitioner, aims to describe in a concise form the most relevant issues in the management of diabetic nephropathy. Although written from the stand point of view of the nephrologist, a multidisciplinary approach is warranted.

Características clínicas y diagnósticas en infarto renal agudo en una serie clínica / Clinical features and diagnosis in acute renal infarction in a clinical series

El infarto renal agudo constituye un diagnóstico infrecuente. Ello puede deberse a que sus síntomas son similares a los de los cálculos renales o la pielonefritis aguda. Por esa razón, el síntoma cardinal de dolor de flanco debe ser investigado en forma muy acabada. Esta serie clínica revisa seis casos de infarto renal agudo vistos en esta institución durante el año 2007.

Acute renal infarction represents an uncommon diagnosis. Its symptoms may overlap with other disorders such as renal stones or pyelonephritis. Therefore a thoroughly study of the patient with flank pain is mandatory. This clinical series assess the main diagnostic and etiologic features of patients diagnosed as acute kidney infarction.

Caso clínico-anatomopatológico: las diversas presentaciones de la nefropatía por IgA / Clinicopathological case: the various presentations of IgA nephropathy

Se trata de una paciente de 58 años, sexo femenino, que se presenta con hematuria, proteinuria severa y función renal normal. Pocas semanas después, ella desarrolla una trombosis de vena renal, embolia pulmonar secundaria y un episodio de insuficiencia renal aguda. Este caso clínico ilustra las distintas presentaciones clínicas de una nefropatía por IgA grave, incluyendo hematuria, síndrome nefrótico y trombosis de vena renal. Además muestra otras complicaciones serias, como embolia pulmonar y falla renal aguda. La paciente fue sometida a 2 biopsias renales, que permitieron una correlación adecuada entre las manifestaciones clínicas y la patología renal.

This is a female, 58 years old patient, who presented with hematuria, heavy proteinuria and normal kidney function. Few weeks later she developed a renal venous thrombosis, pulmonary embolism and acute kidney injury. This clinical case illustrates the variable presenting features of a severe IgA nephropathy including hematuria, nephrotic syndrome and renal venous thrombosis. Further it shows its possible severe complications such as lung embolism and acute renal failure. The patient was kidney biopsied in two opportunities, which allows assessing the correlation between the variable clinical characteristics and the renal pathology.

Monitoreo inmunológico: el comienzo de una nueva era en trasplantes / Inmune monitoring: the start of a new age in transplantation

La necesidad de ajustar la inmunosupresión en forma individualizada ha estimulado la emergencia de técnicas que permiten predecir eventos clínicos como rechazo agudo o tolerancia. Esta revisión analiza, considerando principalmente el trasplante renal, las limitantes actuales de la inmunosupresión para concluir que una terapia individualizada permitiría mejorar la sobrevida de pacientes y órganos trasplantados en el largo plazo. En segundo lugar describe los métodos diagnósticos que en forma más consistente han demostrado tener valor predictivo con importancia clínica. Entre ellos se cuentan ensayos funcionales, determinación de anticuerpos específicos y linfocitos reactivos contra el donante, así como el análisis de marcadores a nivel de proteínas o genómicos. Los avances logrados auguran el comienzo de una nueva eraen trasplantes.

Organ transplantation is often related to higher survival and lower morbidity than conservative treatments. Nevertheless, survival and morbidity could be optimized tailoring the immunosupression to the particular needs of each individual patient. The requirement to optimize immunosupression makes necessary to improve the immunologic assessment and therefore has promoted the development of new immunological diagnostic tools. This review addresses first the need to tailor immunosupression, and then focuses in the value of anti HLA antibodies, alloreactive T cells, phenotypic analysis of lymphocytes and cytokines, repertoire analysis and genetic approaches, as well as in vivo studies. Further validation and standardization of these tests are needed in order to enter the routine clinical practice. Accomplishment of these goals would signal the beginning of a new era in transplantation.

Trasplante páncreas y riñón en Clínica Las Condes / Simultaneous kidney pancreas transplant, Clínica Las Condes experience

El trasplante combinado páncreas-riñón (TPR) para pacientes portadores de Diabetes Mellitus 1 con insuficiencia renal crónica terminal, ha demostrado ser la única terapia que permite alcanzar el estado de normoglicemia de manera estable, situación que lleva a una disminución de las complicaciones crónicas de la DM y mejora la expectativa y calidad de vida. En nuestro país la tasa de realización de este trasplante es aún muy baja, lo que se debe a factores asociados a la donación y a una insuficiente divulgación de los resultados nacionales. Objetivo: Describir los resultados obtenidos por el equipo de trasplante de Clínica Las Condes en TPR desde el inicio del programa, en marzo 1994 a marzo 2009. Método: Se recopiló la información de los 12 pacientes sometidos a TPR en nuestro centro entre 1994 y marzo 2009, analizando las variables con estadística descriptiva y la sobrevida con curvas de Kaplan-Meier. Resultados: La sobrevida actuarial de pacientes a 5 y 10 años fue de 75 por ciento. La sobrevida actuarial de páncreas fue 83 por ciento a los 5 y 10 años, y la de riñón 74 por ciento en los mismos periodos. Nueve pacientes presentan injertos funcionantes a marzo 2009, todos los cuales realizan una vida normal. Discusión: Estos resultados son comparables a los presentados por centros extranjeros de prestigio internacional y se deben principalmente a avances en las técnicas quirúrgicas y de inmunosupresión. La baja tasa de complicaciones y alta sobrevida presentada refuerzan la necesidad de potenciar esta terapia en nuestro país.

Combined kidney-pancreas transplant (KPT) for patients with type 1 Diabetes Mellitus complicated with end stage renal disease has shown to be the best treatment to achieve a stable metabolic condition, which may lead to a decrease in chronic diabetes complications and improves quality of life and patient survival. In our country, the rate of this transplant is still very low, associated with donation issues and little knowledge of the results achieved by Chilean experience. Objective: describe the results obtained by Clínica Las Condes transplant team in KPT, from the beginning of the program in March 1994 to March 2009. Methods: Information of 12 patients undergoing KPT in our center from 1994 to march 2009, was collected and analyzed through descriptive statistics. Actuarial survival was calculated with Kaplan Meier formula. Results: Patient survival was 75 percent at 5 and 10 years. Kidney transplant survival was 74 percent and pancreas survival was 83 percent in the same periods. Nine patients have functioning grafts, all of them living a normal life. Discussion: These results are similar to those reported by foreign centers of international status and are due to advances in surgical techniques and immunosuppressive treatment. The low rate of complications and excellent survival presented in this article enforces the need to potentates this therapy in our country.

Propofol consumption and recovery times after bispectral index or cerebral state index guidance of anaesthesia.

BACKGROUND: We compared the propofol requirements and recovery times when either the bispectral index (BIS) monitor or the cerebral state monitor (CSM) is used to guide propofol anaesthesia. METHODS: Forty patients undergoing laparoscopic cholecystectomy were studied. All patients were monitored with both monitors and were randomly allocated into two groups according to the monitor used to titrate propofol administration. Propofol was administered to maintain BIS or CSM within 40 and 60. Propofol consumption and clinical markers of recovery were assessed after surgery. RESULTS: In the CSM group, the values of cerebral state index (CSI) and BIS were 47 (5) and 38 (6), respectively (P=0.00054). In the BIS group, the values of CSI and BIS were 47 (5) and 45 (2), respectively (P=0.15). In the BIS group, the total amount of propofol used was lower [109 (20) microg kg(-1) min(-1)] than in the CSM group [130 (27) microg kg(-1) min(-1)] (P=0.018). The time to eye opening was lower in the BIS [7.2 (3.5) min] than in the CSM group [10.7 (6.6)] (P=0.038). There were no differences in fentanyl consumption, or in other clinical markers of recovery. CONCLUSIONS: Compared with BIS, propofol anaesthesia guided with CSI resulted in 20% higher propofol doses. This, however, does not lead to clinically relevant differences in recovery times.

Lipoestructura según técnica de Coleman. Experiencia personal / Lipostructure with Coleman technique. Personal experience

La lipoestructura está basada en la modificación tridimensional permanente de la anatomía, mediante el relleno con el propio tejido graso del paciente, previamente purificado. La importancia de la técnica consiste en rellenar el tejido desaparecido y atrófico y en que ofrece resultados predecibles, permanentes y seguros. Hay que familiarizarse con el procedimiento no sólo para aplicarlo a procedimientos de Cirugía Estética, sino por su utilidad en reconstrucciones dentro del capítulo de la Cirugía Reparadora. Empleamos la técnica desde el año 2000, con un seguimiento máximo de tres años. Durante este periodo hemos realizado seis lipoestructuras faciales; en dos ocasiones asociadas a estiramientos, con muy buenos resultados y gran satisfacción por parte de las pacientes; de igual modo, aplicándola técnica a problemas de reparación facial, hemos realizado dos procedimientos, en una paciente que presentaba atrofiahemifacial y en otra con un Síndrome de primer y segundo arco branquial, con muy buenos resultados a largo plazo. También hemos tratado problemas de reparación corporal en cinco pacientes con secuelas de poliomielitis, zonas deprimidas en glúteos, cicatrices en la cara, secuelas de liposucción en muslos y secuelas iatrogénicas de mastectomía en un paciente con ginecomastia. Los resultados nos han animado air ampliando las indicaciones (AU)

Lipostructure is a technique based on three-dimensional change of the anatomy, injecting fat autografting previously centrifugated. The innovation of this technique is refill atrophy and disappeared tissues with permanent, reliable and predictable results. Learn the correct technique is useful to correct as Aesthetic as Reconstructive defects. We have applied this procedure since 2000, with postoperative results to three years. In six face lipoinjections, two of them as adjunct procedure of lifting, very good aesthetic improvement for patient and surgeon was obtained. In the same way two patients with hemifacial atrophy and first and second arch brachial Syndrome have been benefited from fat autografting injections. Related to reconstructive problems we have repaired five patients with poliomyelitis sequelae, depressed gluteus tissues, midfacial scar, calf liposuction iatrognic sequelae, and mastectomy secuelae in a man with ginecomasty. Excellent results encourage us to increment indications (AU)

Embarazo, nefropatía e hipertensión arterial / Pregnancy, kidney diseases and arterial hypertension

La hipertensión arterial y la presencia de nefropatía durante el embarazo representan patologías frecuentes y de importancia en el curso de la gestación. Este artículo analiza sus principales causas, su diagnóstico y tratamiento. La preeclampsia representa una patología cuyas causas comienzan a develarse. Evidencias clínicas y experimentales apuntan a una isquemia útero-placentaria por defecto en la migración del trofoblasto.

Técnica personal para mamoplastia de reducción y mastopexia con cicatriz vertical / Personal technique in vertical reduction mammaplasty and mastopexy with vertical scar

La secuela que representa para la paciente la cicatriz resultante de una mamoplastia de reducción clásica en T invertida, nos animó a perfeccionar la técnica de cicatriz vertical, manteniendo una mama de aspecto natural y juvenil. Presentamos una nueva técnica válida para reducción y pexia mamaria, de cicatriz vertical sin despegamiento cutáneo, con pedículo superior para el complejo areola pezón (CAP) semicircunferencial de diá- metro en relación con el ascenso de dicho CAP, que es sencilla en su diseño y realización y aplicable a gigantomastias y ptosis grado III. Provee unos resultados estéticos a largo plazo muy buenos y presenta una baja incidencia de complicaciones intra y postoperatorias. Nuestra experiencia es de 152 pacientes en los últimos diez años, con reducciones entre 200 y 1750 gr. de tejido mamario, en pacientes con reducciones mamarias bilaterales y unilaterales para simetrización de reconstrucciones mamarias (AU)

Inverted T scar after classical reduction mammoplasty is an important sequela that incouraged us to improve breast reduction with vertical sear, trying to keep a youthful and natural breast. We present a new technique as much for breast reduction as for mastopexy, with a vertical scar, not undermining the skin and using a hemicircunferencial superior pedicle correlated to the movement of nipple areola complex. It is also easy to plan and perform, and indicated in very large breast and severe ptosis. Long-lasting aesthetic results are very good with low incidence of intra and postoperative complications. In a personal serie of 152 patients operated during last ten years, we got breast resections between 200 and 1750 gr in bilateral and unilateral procedures (AU)