RESUMEN
BACKGROUND AND OBJECTIVES: Wound infiltration with available local anesthetics generally provides analgesia for less than 8 hrs. The site 1 sodium-channel toxin neosaxitoxin (neoSTX) produced analgesia for over 24 hrs in animals and human volunteers. In this randomized, double-blind trial, we examined the postoperative course of patients undergoing laparoscopic cholecystectomy under a standardized general anesthesia with wound infiltration using either neoSTX or bupivacaine. We hypothesized that neoSTX would reduce pain compared with bupivacaine at 12 hrs postoperatively. METHODS: Patients received preincisional infiltration of laparoscope entry sites with 20 mL containing either neoSTX (total dose, 100 µg) or bupivacaine 0.25% (total dose, 50 mg). The primary outcome measure was the visual analog pain score at 12 hrs postoperatively. Secondary outcomes included repeated pain scores at rest and with movement,analgesic use, functional recovery, and adverse effects. Groups were compared using Mann-Whitney U tests for pain scores, Fisher exact test for proportions of patients with severe pain and complete analgesia, and Kaplan-Meier curves for time to full recovery. RESULTS: Among 137 subjects, 69 were randomized to neoSTX and 68 to bupivacaine. Median pain scores at rest and with movement 12 hrs postoperatively were lower in the neoSTX group compared with the bupivacaine group (P<0.01). Additional pain measures and recovery parameters also favored neoSTX. No serious adverse events occurred,and no adverse events were more frequent in the neoSTX group. CONCLUSIONS: NeoSTX shows promise as a long-acting local anesthetic. Future studies will examine dose response, combination formulations, and safety with dose escalation.
Asunto(s)
Analgesia , Anestesia Local , Bupivacaína/administración & dosificación , Colecistectomía Laparoscópica , Dolor Postoperatorio/prevención & control , Saxitoxina/análogos & derivados , Adulto , Analgesia/métodos , Anestesia Local/métodos , Bupivacaína/farmacocinética , Colecistectomía Laparoscópica/efectos adversos , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor/efectos de los fármacos , Dimensión del Dolor/métodos , Dolor Postoperatorio/etiología , Dolor Postoperatorio/metabolismo , Saxitoxina/administración & dosificación , Saxitoxina/farmacocinéticaRESUMEN
BACKGROUND: Bariatric surgery is increasingly being performed and sleeve gastrectomy (SG) has proved to be effective and safe. Among its complications, leaks are the most serious and life threatening. METHODS: The focus of the study is nine patients who underwent a SG and developed a gastric leak after surgery. Our data were obtained from the clinical charts of the patients and through interviews with the surgeon who performed the index surgery. RESULTS: Eight patients underwent SG at outside institutions while one was operated at Clinica Alemana. Three patients developed symptoms within 5 days after surgery, while the rest were diagnosed after 10 days from the surgery. A CT scan was the method used to confirm the diagnosis in all patients. The three patients who had a leak detected during the immediate postoperative period underwent laparoscopic reoperation. Among the rest of the patients, percutaneous drainage was employed in one patient as the primary procedure while the other underwent surgical drainage. An esophageal endoluminal stent was employed in four patients. The leak closed in all patients with the healing time ranging from 21 to 240 days. CONCLUSIONS: Diagnosis of a leak after a SG required a greater index of suspicion in order to perform an early diagnosis. Sepsis control and nutritional support are the cornerstones of this treatment. Evolution is characterized by longer periods of time that are necessary in order to wait until the leak closes. Management must be tailored to each patient.
Asunto(s)
Fuga Anastomótica/terapia , Gastrectomía , Obesidad Mórbida/cirugía , Adulto , Fuga Anastomótica/diagnóstico por imagen , Fuga Anastomótica/cirugía , Drenaje/instrumentación , Drenaje/métodos , Nutrición Enteral , Femenino , Gastrectomía/métodos , Humanos , Laparoscopía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Reoperación , Stents , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
Los tumores del estroma gastrointestinal (GIST) son neoplasias de baja frecuencia que presentan menos del 1 por ciento de todos los tumores del tracto digestivo. Inicialmente se clasificaban dentro del grupo de los sarcomas pero actualmente se consideran como una entidad clínico patológica diferente. Comprometen con mayor frecuencia el estómago pero se pueden presentar en cualquier otra ubicación del tracto digestivo donde exista músculo liso. Su diagnóstico es histológico. El 80 por ciento de estos tumores expresa CD 117 y el 20 por ciento restante tiene mutaciones en un receptor de Tirosina-Kinasa (TK) relacionado con PDGFRa (platelet-derived growth factor receptor alpha). El tratamiento se basa en cirugía y administración de inhibidores de Tirosina-Kinasa. En este trabajo se presentan tres casos clínicos de GIST del aparato digestivo. CD 117 positivos. Se revisan los aspectos fisiopatológicos, clínicos, diagnóstico y terapéuticos de este tipo especial de tumores.
Asunto(s)
Masculino , Femenino , Persona de Mediana Edad , Humanos , Tumores del Estroma Gastrointestinal/diagnóstico , Diagnóstico Diferencial , Tumores del Estroma Gastrointestinal/fisiopatología , Tumores del Estroma Gastrointestinal/terapiaRESUMEN
Se presenta un trabajo prospectivo de los casos de esófago de Barrett, encontrándose que un termino medio de índice de reflujo de 16,661, (p = 0003) en relación al grupo control, al igual que un índice de DeMeester de 60,015, (p = 0,0002) así como también un largo abdominal del esfínter de 0,641 (p = 0,002) a la manometría, son hechos estadísticamente significativo en la existencia de un esófago de Barrett, en los pacientes con reflujo gastroesofágico. Se encontró, además, la desaparición del 25,4 por ciento y una disminución del 30,3 por ciento de los esófagos de Barrett después de la cirugía, al cabo de tres años de observación. A medida que pasan los años de evaluación, estas cifras van aumentando, razón por la cual se postula efectuar una vagotomía supraselectiva con una fundoplicatura geométricamente simétrica, como tratamiento de los reflujos con esófago Barrett.
Asunto(s)
Masculino , Adolescente , Adulto , Humanos , Femenino , Persona de Mediana Edad , Esófago de Barrett/etiología , Esófago de Barrett/terapia , Reflujo Gastroesofágico/cirugía , Estudios Prospectivos , Resultado del Tratamiento , VagotomíaRESUMEN
A clinical and entomological trial was carried out in 88 head louse (pediculus humanus capitis) infested children treated with a single dose of 1 percent permethrin shampoo or lotion. The sex distribution was 47 males and 41 females with ages ranging between 5 and 14 years old. In order to assess the efficiency of treatments, search for adult forms, nymphs and eggs (nits) of the parasite was performed in each of the children, before and after treatment (30 minutes, 7 days and 21 days). The entomological evaluations consisted in stereoscopic and microscopic examination of a mean of 12 hair samples taken from the retroauricular and occipital regions of each of the children, the biological condition of eggs, viable (inmature, mature), dead ans empty, was recorded. The cure rates, both clinical and entomological, obtained were 91,5 percent for shampoo and 95.2 percent for lotion. No adverse reactions with the 2 formulations used were reported. In conclusion, 1 percent permethrin shampoo or lotion is an effective and safe treatment for pediculosis capitis