Two probable anaphylactic events during consecutive cranial surgeries: case report / Dos probables eventos de anafilaxia durante cirugías craneales consecutivas. Reporte de caso

Abstract Perioperative anaphylaxis represents a complex diagnosis due to the varying intensity of the symptoms which are also shared with other pathologies. This article discusses a case of a patient that sustained 2 probable anaphylactic reactions during consecutive cranial surgeries under general anesthesia; the causal agent could not be confirmed. Investigating these reactions is essential for identifying the causal agents and preventing increasingly severe reactions in future exposures.

Resumen La anafilaxia perioperatoria representa un diagnóstico problemático porque posee manifestaciones clínicas de distinta intensidad y comunes a otras patologías. Reportamos el caso de un paciente que presentó dos probables eventos de anafilaxia durante cirugías craneales consecutivas bajo anestesia general, cuyo agente causal no pudo ser confirmado. La investigación de estas reacciones es crucial para identificar los agentes causales y evitar reacciones de mayor severidad en futuras exposiciones.

Physiological differences between various types of Eisenmenger syndrome and relation to outcome.

BACKGROUND: Eisenmenger syndrome (ES) is the most advanced form of pulmonary arterial hypertension (PAH) related to congenital heart disease. Several studies have suggested that the presence and location of the shunt defines the natural history of these patients by influencing right ventricular adaptation to PAH. We aimed to echocardiographically assess differences in cardiac physiology and outcome between various types of ES. METHODS AND RESULTS: In this longitudinal cohort study, 191 patients with ES and non-complex congenital heart disease were recruited, 36 with pre-tricuspid and 155 with post-tricuspid shunts. Patients with pre-tricuspid shunts were older, had higher BNP concentrations and lower exercise tolerance compared to patients with post-tricuspid shunts. Right ventricular (RV) function was impaired in patients with atrial septal defects, with larger right ventricles, impaired systolic function and adaptation. The left ventricular eccentricity index was significantly higher in pre-tricuspid defects. Within post-tricuspid shunts, patients with atrio-ventricular septal defects had better right ventricular function compared to ventricular septal defects, while in those with a patent ductus arteriosus this was worse. There was a trend towards lower mortality in patients with post versus pre-tricuspid shunts, which was significant for patients above the age of 48 years. CONCLUSION: The presence of a post-tricuspid shunt appears to carry physiological and possibly prognostic benefits in ES compared to patients with pre-tricuspid shunts. This should be borne in mind when management decisions and advanced therapies are considered.

Analysis of extinction in ultraviolet and visible spectra of water bodies of the Paraguay and Brazil wetlands.

The extinction spectra in ultraviolet and visible radiation were analyzed using filtered and unfiltered water samples obtained in 11 open water bodies in the Neembucù (Paraguay) and Pantanal (Brazil) wetlands. The role of dissolved and suspended matter in the total extinction was analyzed between 260 nm and 700 nm. The chromophoric dissolved organic matter (CDOM) was the major component in extinction of considered ultraviolet radiation (260-400 nm). The differences in CDOM concentrations explained the main pattern of extinction of the ultraviolet radiation in the samples. Nevertheless, differences between the studied water bodies were found also to depend on the rate of photodegradation and photobleaching. The methodology developed in the present study was to distinguish "humic optic waters" according to quantity and quality of dissolved and suspended matter present. In the "humic optic water", the penetration of 10% of incident UV radiation and the photoactive layer are estimated. The influence of particulate matter increases in the total extinction of the wavelengths higher than 400 nm. The integral of the extinction curve of suspended matter in the visible wavelengths (400-700 nm) was found to relate with the total suspended solids and chlorophyll concentrations.

Valoración de la seguridad y eficacia del Desflurano en anestesia general en adultos / Evaluation of safety and effectiveness of Desfluorane in adults undergoing general anesthesia

Se practicó un estudio prospectivo, lineal, no comparativo y abierto en 20 pacientes sometidos a cirugía general ASA I, II, entre 18 y 50 años, con selección de hombres y mujeres no embarazadas, para valorar la seguridad y eficacia del desflurano, teniendo como meta valorar estabilidad hemodinámica, observar efectos colaterales y cuantificar el tiempo de recuperación total postoperatoria. Se administró narcosis basal con fentanyl 2 µg/kg.; inducción con propofol 3 - 5 mg/kg., relajación muscular con atracurio 300 µg/kg., mantenimiento anestésico O2-N2O al 50 por ciento y desflurano a concentración de 6-12 por ciento. Los resultados mostraron que no hubo cambios hemodinámicos significativos en los diferentes estadios de la anestesia, manteniéndose la frecuencia cardiaca y presión sanguínea dentro de 20 por ciento de valores preoperatorios, SaO2, PaCO2 y gases anestésicos se mantuvieron sin cambios. El tiempo de recuperación postoperatoria total con respuesta a preguntas fue de 6.57 ñ 1.6 min. En este estudio se concluye que desflurano es un agente anestésico seguro, con estabilidad hemodinámica y de rápida recuperación

Respuesta hemodinámica a medios de contraste en pacientes sometidos a cateterismo cardíaco con pobre función ventricular

Realizamos en el Hospital Militar Central de Bogotá una observación prospectiva en pacientes con pobre función ventricular, donde comparamos el comportamiento hemodinámico y clínico luego de la administración de una dosis usual de medio de contraste iónico y no iónico, durante un cateterismo cardíaco diagnóstico. Estudiamos 60 pacientes, 37 recibieron diatrizoato de metilglucamina y 23 lopamidol. No encontramos diferencias significativas en la tolerancia clínica (náuseas, vómito y reacciones alérgicas) ni en los parámetros hemodinámicos (frecuencia cardíaca, presión de fin de diástole del ventriculo izquierdo, presión aórtica y presión pulmonar) en los pacientes sometidos a medios de contraste iónico y no iónico. realizamos una revisión de la literartura y damos pautas para el uso de los medios de contraste en catetrismos cardíacos