Low-concentration distal nerve blocks with 0.125% levobupivacaine versus systemic analgesia for ambulatory trapeziectomy performed under axillary block: a randomized controlled trial.

BACKGROUND: Trapeziectomy is one of the most painful procedures in ambulatory surgery. This prospective randomized trial aimed to compare postoperative pain control using distal peripheral nerve blocks (dPNB) with a low concentration of a long-acting local anesthetic versus conventional systemic analgesia. METHODS: Fifty-two patients undergoing trapeziectomy were randomized to receive levobupivacaine 0.125% 5 mL on radial and median nerves at the elbow (dNB group), or not to receive these blocks (control group). In both groups, surgery was performed under axillary block (mepivacaine 1% 20 mL) and the same analgesic regimen was prescribed at discharge. The primary outcome was postoperative pain at 24 and 48 hours after surgery and maximum pain score on the first and second postoperative day. Secondary outcomes were duration of dPNB, rescue analgesia requirements, opioid-related side effects, consumption and effectiveness of antiemetic therapy, and upper limb motor block. RESULTS: Fifty patients were analyzed. Maximum pain intensity was moderate to severe (dPNB vs. control) in 33.3% vs. 92.3% (P=0.002) on the first day after surgery and 20.8% vs. 80.8% (P<0.001) on the second day. The average duration of analgesia after dPNB was 10 hours and no patient reported motor block. dPNB reduced rescue analgesia requirements and the incidence of postoperative nausea and vomiting (PONV). CONCLUSIONS: dPNB on target nerves provided better analgesia than systemic analgesia after trapeziectomy performed under axillary block. Opioid consumption and the incidence of PONV were lower in the dPNB group.

Impact of ventilator-associated pneumonia on mortality and epidemiological features of patients with secondary peritonitis.

BACKGROUND: Despite the significant impact of nosocomial infections on the morbidity and mortality of patients staying in the intensive care unit (ICU), no study over the past 20 years has focused specifically on VAP following secondary peritonitis. The objective of the present study was to determine in-hospital mortality and epidemiological features attributed to ventilator-associated pneumonia (VAP) following secondary peritonitis. METHODS: Prospective observational study involved 418 consecutive patients admitted in the ICU. Univariate and multivariate analyses were performed to identify risk factors associated with mortality and development of VAP. RESULTS: The incidence of VAP following secondary peritonitis was 9.6 %. Risk factors associated with the development of VAP were hospital-acquired peritonitis, requiring >48 h of mechanical ventilation, and SOFA score. The onset of VAP was late in majority of patients. VAP was developed about 16.8 days after the initiation of the peritonitis. Etiological microorganisms responsible for the peritonitis were different than for VAP. The 90-day in-hospital mortality rate was 47.5 % of VAP patients. Independent factors associated with 30- to 90-day in-hospital mortality were VAP and SOFA. CONCLUSIONS: In light of the impact on morbidity and mortality in the ICU, more attention should be given to the concurrent features among VAP and secondary peritonitis.

Pulmonary small cell carcinoma metastatic to the ovary: a clinicopathologic study of one case with emphasis on the importance of p53 analysis in diagnosis.

BACKGROUND: Small cell carcinoma of the lung (SCCL) is rarely associated with ovarian metastases. Only occasional cases have been reported so far. Since SCCL is increasing in women because of smoking, the frequency of ovarian metastases from SCCL may increase in the near future. CASE: A 54-year-old woman with SCCL presented with a left ovarian mass, 4.8 cm in diameter. The microscopic appearance of the ovarian tumor was identical to that of the previous bronchoscopic biopsy. Molecular analysis of p53 demonstrated an identical point mutation (S215) in both tumor sites. Moreover, a p53 DNA polymorphism (P52R) was identified in normal tissue, but present in homozygosity in both tumor sites. CONCLUSION: In this article, we report a new example of SCCL metastatic to the ovary, and we discuss the main features for differential diagnosis with primary ovarian small cell carcinoma, pulmonary type, with emphasis on the value of p53 analysis.

Analytical solution of the Pennes equation for burn-depth determination from infrared thermographs.

A serious problem in emergency medicine is the correct evaluation of skin burn depth to make the appropriate choice of treatment. In clinical practice, there is no difficulty in classifying first- and third-degree burns correctly. However, differentiation between the IIa (superficial dermal) and IIb (deep dermal) wounds is problematic even for experienced practitioners. In this work, the use of surface skin temperature for the determination of the depth of second-degree burns is explored. An analytical solution of the 3D Pennes steady-state equation is obtained assuming that the ratio between burn depth and the burn size is small. The inverse problem is posed in a search space consisting of geometrical parameters associated with the burned region. This space is searched to minimize the error between the analytical and experimental skin surface temperatures. The technique is greatly improved by using local one-dimensionality to provide the shape of the burned region. The feasibility of using this technique and thermography to determine skin burn depth is discussed.

Problemas laborales en pacientes dependientesdel alcohol: Evolución en un año de tratamiento / Work–related problems among alcohol–dependent patients: Development a year of alcohol treatment

Objetivo: El objetivo de este estudio es analizar la prevalencia de problemas laborales debidos al consumode alcohol en una muestra de dependientes del alcohol y su evolución durante un año de tratamiento.Material y Método: Se realizó un estudio prospectivo de una cohorte de 93 pacientes, que realizarontratamiento durante un año, diagnosticados de dependencia del alcohol según criterios DSM–IV. Se obtuvoinformación de los siguientes problemas laborales debidos al consumo de alcohol: absentismo, llamadas deatención, sanciones, accidentes laborales, despidos, desempleo o paro, ocurridos en tres momentos: durantetoda la vida, el año anterior al inicio del tratamiento y durante un año de tratamiento.Resultados: El 57% tuvieron problemas laborales a lo largo de su vida, el 35,5% el año anterior al iniciodel tratamiento, y el 23,7% durante el año de tratamiento. Los problemas mas frecuentes fueron el absentismoy el desempleo. Los problemas laborales disminuyeron (p<0,05) durante el año de tratamiento respecto alaño anterior al inicio del tratamiento.Discusión: Este estudio indica que los problemas laborales son frecuentes entre los dependientes delalcohol, y que estos disminuyen con el tratamiento de la dependencia del alcohol (AU)

Objetive: The aim of this study is to analyse the prevalence of work–related problems due to the consumptionof alcohol in a sample of alcohol–dependent patients and their evolution over twelve months of treatment.Method: A prospective study was carried out on a cohort of 93 patients diagnosed as alcohol–dependentaccording to DSM–IV criteria, who underwent treatment over a 12 month period. Information concerning thefollowing work–related problems due to the consumption of alcohol was obtained: absenteeism, warnings,sanctions, accidents at work, dismissals and unemployment, that occurred within three different time scales: thepatient’s lifetime, the 12 months prior to the start of the treatment and during the 12 months of the treatment.Results: 57% had had work–related problems during their lifetime, 35.5% in the 12 months prior tostarting treatment and 23,7% during the year of treatment. The most frequent problems during the year oftreatment were absenteeism and unemployment. Work–related problems decreased (p < 0.05) during thetreatment with respect to the year prior to the start of the treatment.Conclusion: This study indicates that work–related problems are frequent among alcohol–dependentpatients, but that such problems decrease when the dependency is treated (AU)

Alcohol y prevención de los problemas relacionados con el consumo de alcohol en el ámbito laboral / No disponible

La importancia del alcohol en el medio laboral es indiscutible ya que el alcohol es la droga más consumida entre los trabajadores. Los problemas detectados más frecuentemente en el trabajo por consumo de alcohol han sido: absentismo, incremento de las bajas laborales, mayor accidentabilidad, disminución del rendimiento, mayor conflictividad, incumplimiento de la jornada laboral, comisión de más errores, aumento de expedientes disciplinarios, aumento de despidos y como consecuencia más paro. Se ha relacionado el tener problemas con el alcohol con el tipo de de trabajo y con el incremento de la oferta/disponibilidad de bebidas alcohólicas. Los costes económicos que producen a las empresas y a los países los consumidores de alcohol son importantes, en España los costes debidos a bajas laborales por consumo de alcohol ascienden a 72.854 millones de €/año. Algunas empresas además de las normas sobre consumo proporcionan ayuda a los empleados que tienen problemas con la bebida, realizando programas de prevención primaria (información), prevención secundaria (tratamiento), prevención terciaria (reinserción laboral). Son necesarias políticas de prevención relacionadas con el consumo de alcohol en la empresa ya que se ha demostrado que los servicios de prevención producen más ahorro que coste requiere el programa y es menos costoso que el tratamiento de los trabajadores con adicción al alcohol

The importance of alcohol at work is undeniable as it is the drug most commonly consumed by workers. The most frequently detected problems in the labor field due to the consumption of alcohol are: absenteeism, an increase in absense due to illness, a greater number of accidents, lower performance levels, higher levels of conflict, not complying with the required number of work hours, a higher percentage of errors, an increase in disciplinary proceedings, an increase in the number of workers fired and consequently higher unemployment. Having problems with alcohol has been related to certain types of work and to the increase in the supply/availability of alcoholic beverages. The economic costs caused by consumers of alcohol that companies and countries have to face are sizeable. In Spain, the costs from loss of working days due to the consumption of alcohol has reached 72.854 million €/year. Apart from rules concerning consumption of alcohol, some companies provide assistance for employees who have problems with alcohol, carrying out primary prevention programs (information), secondary prevention (treatment), and tertiary prevention (work rehabilitation). Preventive policies concerning the consumption of alcohol at work are necessary as it has been proved that prevention services save more money than the cost of the programs themselves, and that it is less costly than the treatment of alcohol dependent workers