Bloqueo erector de la espina y sedación con dexmedetomidina en nivats (non intubated video-assisted thoracoscopic surgery) / Erector spinae block and sedation with dexmedetomidine in nivats (non intubated video-assisted thoracoscopic surgery)

La vía aérea difícil (VAD) es una de las principales causas de morbimortalidad en anestesia. La posibilidad de realizar una cirugía toracoscopica en ventilación espontánea con el uso de fármacos como la dexmedetomidina y remifentanilo, proporcionandoademás, analgesia con un bloqueo ecoguiado del erector de la espina han facilitado y/o posibilitado la realización de cirugía toracoscopica sin necesidad de intubación endotraqueal disminuyendo por tanto la necesidad de manipular la vía aérea, siendo una gran alternativa ante una VAD. (AU)

Difficult airway (DAV) is one of the main causes of morbidity and mortality in anesthesia. The possibility of performing spontaneously ventilated thoracoscopic surgery with the use of drugs such as dexmedetomidine and remifentanil, also providing analgesiawith an ultrasound-guided erector spinae block, has favoured and / or made possible thoracoscopic surgery without the need forendotracheal intubation, thus reducing the need to manipulate the airway, being a great alternative to VAD. (AU)

Experiences of a general practitioner in the daily practice about Digital Health Literacy. The real needs.

Digital Health Literacy (DHL) is a key element to promote patient empowerment. This position paper presents the lessons learnt from the daily activities of a General Practitioner interacting with patients. General Practitioners have a main role in each stage on individual digital health literacy process. They are the first meeting point between patients and the medical knowledge; in the search phase, they are who can prescribe and validate health information; in the comprehension phase, they lead to a full understanding; and in the adoption phase, they assist in the own personal application. Major conclusions are that General Practitioners need a set of tools, organizational resources and knowledge to acquire Digital Health Literacy skills to help patients on their way from the information to the empowerment. Some of these tools and knowledge are identified to draw the future roadmap to get people with Digital Health Literacy skills.

Solución del caso 37. Rabdomiólisis por cocaína / Solution to case 37. Cocaine-induced rhabdomyolysis

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Delayed adverse vascular events after splenectomy in hereditary spherocytosis.

BACKGROUND: It is probable that the variety and frequency of delayed adverse vascular events after splenectomy are underappreciated. Splenectomy is performed for a wide variety of conditions, and delayed postsplenectomy hazards are not often studied. OBJECTIVE: To estimate the relative risk of adverse vascular events in members of hereditary spherocytosis families who have or have not had a splenectomy. METHODS: Members of families in which hereditary spherocytosis exists were systematically questioned about adverse vascular events. RESULTS: The cumulative incidence of arterial and venous events at age 70 years was greater in persons who had undergone a splenectomy for spherocytosis (arterial, 22% females, 32% males; venous, 20% females, 19% males) than in affected persons who did not undergo splenectomy (arterial, 3% females, 2% males; venous, 6% females, 4% males) or non-affected family members (arterial, 10% females, 17% males; venous, 4% females, 12% males). Affected subjects who undergo splenectomy are at greatly increased risk of arterial events as compared to affected subjects who do not undergo splenectomy [arterial, hazard ratio (HR) 7.2, 95% confidence interval (CI) 2.8-17.2; venous, HR 3.3, 95% CI 1.1-9.8]. CONCLUSION: There is a significant, long-lasting, increased risk of adverse arterial and venous thromboembolic events after splenectomy performed for hereditary spherocytosis. A review of the literature indicates that this is also true when splenectomy is performed for several other indications.

DNA analysis in a paternity case involving a triploid fetus.

BACKGROUND: A parentage testing laboratory was asked to perform testing in a case of sexual assault that resulted in the conception of a child. Samples submitted to the laboratory included blood from the mother, the alleged father, and the fetus. CASE REPORT: DNA typing was used to determine if the suspect in this sexual assault was the father of the expected child. DNA extracted from these samples was subjected to both restriction fragment length polymorphism and polymerase chain reaction/short-tandem repeat analysis at a total of 13 genetic loci. Examination of DNA profiles for selected markers suggested that the fetus was triploid. Triploidy was confirmed through the use of fluorescent in situ hybridization of chromosomes, employing three chromosome-specific alpha satellite probes and fetal trophoblast nuclei. Statistical interpretation of the test results required identifying a method for calculation that would consider two transmitted paternal genes. Attempts to modify the standard method of calculating a paternity index were unsuccessful, because it was not possible to distinguish between dispermy and diandry as the mechanism of conception. Therefore, the likelihood ratio was calculated as the reciprocal of the random men not excluded value or the proportion of the population that possesses all of the paternal markers observed in the triploid fetus. CONCLUSION: Calculation of a likelihood ratio employing the exclusionary power of a collection of DNA markers appears to be the only method suitable for assigning weight to the significance of DNA matches between an alleged father and a child who is triploid.

Determination of sibship in any two persons.

BACKGROUND: Parentage testing laboratories may be asked to provide genetic evidence that two persons are or are not related, when no other relatives are available for study. Simple methods using autosomal, codominant, unlinked genetic systems can determine if two people are blood relatives (e.g., siblings). STUDY DESIGN AND METHODS: The odds ratios (full sibship index) of true sibling pairs were determined from two-child paternity cases and compared with regionally and racially matched control pairs of unrelated children. The sharing of two, one, or no alleles was observed in pairs of children at three independent, polymorphic VNTR (variable number of tandem repeat) sequences loci. The sibship index was calculated as (the chance that an observation would occur if two children were siblings) divided by (the chance that it would occur if the two were unrelated). Sibship indices and the frequencies of shared alleles were determined for 20 sibling pairs and 20 control pairs. RESULTS: Sibship index values were less than 1 in all 20 pairs of unrelated children. Sibship index values were greater than 100 in nine pairs of siblings (45%), between 10 and 100 in five pairs (25%), between 1 and 10 in four pairs (20%), and less than 1 in two pairs (10%). Siblings shared two alleles in 17 of 60 observations (28.3%); controls shared two alleles in 0 of 60 observations (0%). CONCLUSION: The sharing of one allele and the sharing of no alleles at a polymorphic locus of high heterozygosity provide limited information for and against sibship, respectively. The sharing of two alleles produces strong evidence favoring sibship. In a given case, the study of more than three polymorphic loci of high heterozygosity may be needed to develop the evidence that two people are siblings. The general logic and methods used for siblings apply to kinship analyses of other two-person pedigrees.

[Fibro-epithelial polyps of the urinary tract. Apropos of 2 new cases (of the ureter and bladder)]. / Pólipos fibro-epiteliales del tracto urinario. A propósito de dos nuevos casos (ureteral y vesical).

Fibroepithelial polyps are benign mesodermal tumors that may be localized at any level of the urinary tract. However, the ureter and urethra are uncommon sites and these are rarely found in the bladder. Two cases are described involving the middle ureteral third and the bladder. We discuss the different hypotheses regarding its etiology and describe the clinical features, diagnostic methods and treatment. We underscore its benign natural history, treatment by conservative surgery and non-recurrence.

A comparison of the predictive value and diagnostic efficiency of FHAP and CEA as cancer markers.

Previous studies have shown that fast homoarginine-sensitive alkaline phosphatase (FHAP) is roughly equivalent to CEA (Roche) as a marker in colon cancer. The present study compares FHAP with CEA-EIA (Abbott) as a marker in cancer of the colon, breast, lung, ovary, uterus, skin, and lymph nodes. Comparison is made with regard to sensitivity, specificity, predictive value of a positive test, and diagnostic efficiency. It was determined that FHAP and CEA-EIA were comparable as markers for cancers of the colon, breast, and lung. FHAP was more sensitive and specific and had a higher predictive value and diagnostic efficiency for cancers of the ovary, uterus, skin, and lymph nodes.

Interrelationships among human chorionic gonadotropin (hCG), 17 beta-estradiol, progesterone, and estriol in maternal serum: evidence for an inhibitory effect of the fetal adrenal on secretion of hCG.

In normal pregnancy, maternal serum hCG reaches a maximum concentration about 8-10 weeks after the last menstrual period and then decreases. To investigate the possibility that this decrease in hCG is produced by an inhibitory effect of steroids originating in the feto-placental unit, hCG, progesterone, 17 beta-estradiol, and estriol were determined by specific RIAs in 341 serum specimens obtained from 229 different pregnancies. Expressions for predicted hCG as a function of estimated trophoblastic mass and percent predicted hCG were determined to correct for the increase in hCG with increasing trophoblastic mass. The relationships between hCG and progesterone, 17 beta-estradiol, estriol, or estimated trophoblastic mass were not linear. Expression of the hCG data as percent predicted hCG produced linear relationships between hCG and each of the above steroids. Both hCG itself and percent predicted hCG were shown to have a negative regression on estriol (P less than 0.001) and a positive regression on progesterone (P less than 0.001), but not on 17 beta-estradiol (P greater than 0.05), in a multiple linear regression on all three steroids. These data suggest that hCG production is inhibited by a steroid originating in the fetal adrenal. This inhibitory effect plateaus in late pregnancy, allowing a minor late increase in hCG due to increasing trophoblastic mass.

Test-retest reliabilities of State-Trait Anxiety Inventory in a stressful social analogue situation.

The State-Trait Anxiety Inventory asserts that state anxiety varies with situational stress and that trait anxiety is related to relatively stable individual differences in proneness to anxiety. This study investigated test-retest reliabilities related to an anxiety-provoking social analogue involving a female confederate. The results, obtained from the perspective of a nonacademic anxiety situation, supported the state and trait concepts.

A computer-based record system for a hospital transfusion service.

An on-line, real-time system for recording transfusion service activities was added to an existing LABCOM general laboratory computing system. The new programs monitor the blood inventory, crossmatches performed, units issued and final disposition of all units of blood. The computer prints the final patient record of units crossmatched and transfused, generates the patient bill, and tallies the workload. The system has reduced the manual clerical operations from 12 to 14 man-hours per day to eight or less. Acceptance by the medical technologists has been excellent.