[Complications of the cannulation of a central venous line]. / Complicaciones de la canalización de una vía venosa central.

Central venous catheters are essential in modern-day medical practice, particularly in intensive care units. Although such catheters provide necessary vascular access, their use puts patients at risk of mechanical and infectious complications. Unfortunately, these complications are associated with an increase of the morbidity-mortality, lengthen hospitalization and raise medical costs. Strategies should be implemented to reduce the incidence of these complications to improve clinical outcome and reduce health-care costs.

[Use of antiepileptic drugs in bipolar disorder]. / Utilización de los antiepilépticos en el trastorno bipolar.

OBJECTIVE: Bipolar disorder is a chronic disease difficult to treat that generates a high degree of incapacity. Although lithium remains the first choice drug, some patients do not respond and others show adverse reactions. One alternative to lithium is the use of certain antiepileptic drugs. Data on the efficacy of old and new antiepileptic drugs in bipolar disorder obtained in controlled clinical trials are reviewed. DEVELOPMENT: Results in many clinical trial support the use of some old antiepileptic drugs such as carbamazepine and sodium valproate in monotherapy in the acute treatment of severe, mixed or mild manic episodes as well as in the management treatment of bipolar disorder. Overall, new antiepileptic drugs show a better profile of adverse reactions with fewer interactions than lithium, but data on their efficacy in bipolar disorder remain scarce. Oxcarbazepine efficacy in mania is similar to that of the carbamazepine. Lamotrigine is becoming the best alternative to lithium in depressive episodes. Topiramate does not appear to be effective in acute treatment of manic episodes. Levetiracetam seems to produce some benefits, but controlled, randomized and double blind clinical trials are not yet available. Data on gabapentin efficacy are controversial. CONCLUSIONS: Although lithium is still the first choice for the treatment of bipolar disorder, carbamazepine and valproate are also first choice drugs. Oxcarbazepine and lamotrigine may be a good option in some patients. Other new antiepileptic drugs may also be effective in bipolar disorder but more solid evidence of their efficacy is needed.

High initial blood levels of tacrolimus in overweight renal transplant recipients.

For the purpose of both efficacy and safety, exposure to tacrolimus and other immunosuppressive drugs must be monitored, since initial levels influence the development of acute rejection episodes, nephrotoxicity, and posttransplantation diabetes mellitus. The aim of this study was to identify risk factors for developing high initial tacrolimus blood levels. We analyzed clinical and biochemical parameters of 85 renal transplant recipients receiving tacrolimus-based immunosuppressive therapy by stratifying into subgroups of patients who displayed first tacrolimus concentrations higher and lower than 15 ng/mL. Patients with a first level of tacrolimus higher than 15 ng/mL were older (52 +/- 13 vs 40 +/- 12 years, P < .05) and had a larger body mass index (27 +/- 4 vs 23 +/- 3 kg/m2, P < .05) than patients with lower levels, despite receiving a lower weight-adjusted cumulative steroid dose (8.2 +/- 2.2 vs 9.3 +/- 2.5 mg/kg, P < .05). Upon logistic regression, age (RR 1.047, 95% CI 1.007 to 1.08, P = .021) and body mass index (RR 1.176, 95% CI 1.009 to 1.371, P = .036) remained significant risk factors for high initial blood levels of tacrolimus. As these subgroups of patients are most prone to develop posttransplantation glycemic disorders, attention must be paid to avoid high tacrolimus blood levels by diminishing initial tacrolimus doses or estimating them from ideal body weight.