Multicentre, prospective, randomized control non-inferiority trial of bladder catheter management in colon surgery.

AIM: Perioperative bladder catheterization is a controversial issue. Most current recommendations are based on data from open surgery extrapolated to enhanced recovery after surgery or fast-track programmes ranging between 24 and 48 h. The aim of this study is to provide a rationale for reducing catheterization time while at the same time avoiding acute urine retention (AUR), in patients undergoing scheduled laparoscopic colon surgery. METHOD: This is a multicentre, prospective, controlled, randomized non-inferiority study of bladder catheter management in patients undergoing scheduled laparoscopic colon surgery, randomized into two groups: experimental (with catheter removal immediately after surgery) and control (with catheter removal 24 h post-surgery). The main outcome will be the development of AUR, and secondary outcomes the development of urinary infection within the first 30 days and hospital stay. Demographic, surgical and pathological variables will also be evaluated, especially the development of adverse effects assessed according to the Clavien scale and the Comprehensive Complication Index. Following the literature, we assume an incidence of AUR of 11% and a margin of non-inferiority (delta) of 8% and estimate that a sample size of 208 patients per group will be required (with an estimated 10% of losses per group). CONCLUSIONS: In this study we try to demonstrate that the bladder catheter can be removed immediately after scheduled laparoscopic colon surgery, without increasing acute urine retention. This measure would offers the benefits of earlier mobilization and reduces catheter-related morbidity.

Origen de la hemorragia en pacientes politraumatizados con fractura de pelvis e inestabilidad hemodinámica / Source of bleeding in trauma patients with pelvic fracture and haemodynamic instability

INTRODUCCIÓN: La principal causa de mortalidad en los politraumatizados con fracturas pélvicas es el shock hipovolémico. Analizamos la asociación entre el origen de la hemorragia, mecanismo de acción y tipo de fractura. MÉTODOS: Estudio descriptivo y prospectivo que incluye a pacientes politraumatizados mayores de 16 años, ingresados en el área de críticos o que han fallecido antes de su ingreso, con fractura pélvica e inestabilidad hemodinámica. Se define inestabilidad hemodinámica como PAS < 90 o FC > 100 latidos/min. La fractura pélvica se define según la clasificación de Tile. RESULTADOS: Un total de 157 de 1.088 politraumatizados tenían fractura pélvica. Se ha incluido a 63 pacientes, todos hemodinámicamente inestables. En el 85% de los pacientes precipitados la hemorragia procedía de la propia fractura pélvica, comparado con solo el 44% de las víctimas que sufrieron un (choque). El 65% de los pacientes con fractura de pelvis estable sangraban de lesiones asociadas; el 70% de los pacientes con fractura inestable sangraban de la propia fractura. Existe una interacción entre el mecanismo de acción y el tipo de fractura. La probabilidad de sangrar de la pelvis es mayor en los precipitados (>80%), independientemente del tipo de fractura. La hemorragia de las lesiones asociadas es mayor en un impacto, duplicándose cuando la fractura es estable (91%). CONCLUSIONES: El mecanismo de acción es un factor clave para determinar el origen de la hemorragia en pacientes con fractura de pelvis. Los pacientes precipitados sangran de la propia fractura, mientras que los pacientes con un impacto (choque) pueden sangrar tanto de la propia fractura como de las lesiones asociadas, dependiendo del tipo de fractura

INTRODUCTION: The main cause of mortality in trauma patients with pelvic fractures is hypovolemic shock. We analyzed the association between the source of bleeding, mechanism of action and type of fracture. METHODS: Prospective descriptive study involving trauma patients older than 16 years old, admitted to the intensive care unit or dead before admission, with pelvic fractures and hemodynamic instability. Hemodynamic instability was defined as SBP <90 and/or HR> 100 beats/min. Pelvic fracture was defined by the Tile classification. RESULTS: A total of 157 of 1088 trauma patients had pelvic fracture. We included 63 patients, all hemodynamically unstable. A total of 85% of pelvic fractures after falls from great heights bled from the fracture itself, compared to only 44% of victims of impact (hit). A total of 65% of patients with stable pelvic fracture bled from associated lesions; 70% of patients with unstable fracture bled from the fracture itself. There is an interaction between the mechanism of action and type of fracture. The probability of pelvic bleeding is higher in the precipitated patient (> 80%) regardless of the type of fracture. Bleeding from associated injuries is greater in impact victims, doubling when the fracture is stable (91%). CONCLUSIONS: Mechanism of action is a key to determine the source of bleeding in patients with pelvic fracture. After falls patients bleed from the fracture itself, while patients with an impact (hit) can bleed both from the fracture and associated injuries, depending on the type of fracture

Source of bleeding in trauma patients with pelvic fracture and haemodynamic instability.

INTRODUCTION: The main cause of mortality in trauma patients with pelvic fractures is hypovolemic shock. We analyzed the association between the source of bleeding, mechanism of action and type of fracture. METHODS: Prospective descriptive study involving trauma patients older than 16 years old, admitted to the intensive care unit or dead before admission, with pelvic fractures and hemodynamic instability. Hemodynamic instability was defined as SBP <90 and/or HR> 100 beats/min. Pelvic fracture was defined by the Tile classification. RESULTS: A total of 157 of 1088 trauma patients had pelvic fracture. We included 63 patients, all hemodynamically unstable. A total of 85% of pelvic fractures after falls from great heights bled from the fracture itself, compared to only 44% of victims of impact (hit). A total of 65% of patients with stable pelvic fracture bled from associated lesions; 70% of patients with unstable fracture bled from the fracture itself. There is an interaction between the mechanism of action and type of fracture. The probability of pelvic bleeding is higher in the precipitated patient (> 80%) regardless of the type of fracture. Bleeding from associated injuries is greater in impact victims, doubling when the fracture is stable (91%). CONCLUSIONS: Mechanism of action is a key to determine the source of bleeding in patients with pelvic fracture. After falls patients bleed from the fracture itself, while patients with an impact (hit) can bleed both from the fracture and associated injuries, depending on the type of fracture.

A comprehensive study of reaction parameters in the enzymatic production of novel biofuels integrating glycerol into their composition.

A comprehensive study of critical parameters in the pig pancreatic lipase (PPL) catalysed transesterification of sunflower oil to novel biofuels integrating glycerol into their composition is reported. The influence of oil/alcohol ratio, temperature, quantity of enzyme and water added and pH have been investigated. The enzymatic activity of PPL was found to be greatly influenced by the pH, reaching notable activities at high pH values (10-12), in contrast to other lipases. The addition of small quantities of NaOH (up to 0.1 mL) as coadjuvant in the transesterification reaction enhances the activity of the enzymes. This remarkable behaviour, reported for the first time, may pave the way for the utilisation of these relatively cheap enzymes in large scale commercial biodiesel production. Besides, a novel biofuels containing glycerol into their composition as mono- and diglycerides using PPL as biocatalyst has been developed.