2/7/10
TVP: Terapia endovenosa
Endovenous therapy for deep venous thrombosis: The TORPEDO trial
Conclusions. In patients with symptomatic proximal DVT, PEVI plus anticoagulation may be superior to anticoagulation-alone in the reduction of VTE and PTS at 6 months. (c) 2010 Wiley-Liss, Inc.
http://tinyurl.com/26yu53t
24/6/10
GPC
Da gusto saber que en el Perú ya estamos creando Guías de Práctica Clínica.
¿Alguien conoce otras guías peruanas aparte de las dos de Neumonía Adquirida en la Comunidad en Adultos y Niños?
27/1/10
¿Que es una Web Médica Acreditada?
Es una web médica acreditada (WMA) por el Colegio Oficial de Médicos de Barcelona quienes acreditan la calidad de los contenidos médicos que se difunden a través de la red.
Actualmente los médicos podemos realizar búsquedas en estas web mediante el motor de búsqueda personalizado WMA Google Search
"Por qué es necesario el Programa de Acreditación de Web Mèdica Acreditada?"
- Web Mèdica Acreditada. Presentacin. (ver en Google Sidewiki)
20/1/10
Estrategias para prevenir daño púlmonar duarnte CEC
Strategies to prevent intraoperative lung injury during cardiopulmonary bypass
Using medication such as corticosteroids and aprotinin, which protect the lungs during CPB, and leukocyte depletion filters for operations expected to exceed 90 minutes in CPB-time appear to be protective against the toxic impact of CPB in the lungs. The newer methods of ultrafiltration used to scavenge pro-inflammatory factors seem to be protective for the lung function. In a similar way, reducing the use of cardiotomy suction device, as well as the contact-time between free blood and pericardium, it is expected that the postoperative lung function will be improved.
Using medication such as corticosteroids and aprotinin, which protect the lungs during CPB, and leukocyte depletion filters for operations expected to exceed 90 minutes in CPB-time appear to be protective against the toxic impact of CPB in the lungs. The newer methods of ultrafiltration used to scavenge pro-inflammatory factors seem to be protective for the lung function. In a similar way, reducing the use of cardiotomy suction device, as well as the contact-time between free blood and pericardium, it is expected that the postoperative lung function will be improved.
9/1/10
Pyogenic Vertebral Osteomyelitis after Surgery for Rupture of the Aortic Arch
Pyogenic Vertebral Osteomyelitis after Surgery for Rupture of the Aortic Arch
Vertebral osteomyelitis is a very rare and intractable complication after vascular surgery.
We describe a case of pyogenic vertebral osteomyelitis induced by methicillin-resistant
Staphylococcus Aureus sepsis following surgery for traumatic rupture of the aortic
arch, successfully managed with long-term antibiotic therapy for 75 weeks.
(Asian Cardiovasc Thorac Ann 2008;16:e23–4)
Vertebral osteomyelitis is a very rare and intractable complication after vascular surgery.
We describe a case of pyogenic vertebral osteomyelitis induced by methicillin-resistant
Staphylococcus Aureus sepsis following surgery for traumatic rupture of the aortic
arch, successfully managed with long-term antibiotic therapy for 75 weeks.
(Asian Cardiovasc Thorac Ann 2008;16:e23–4)
26/12/09
Cambiar el servidor de salida en Microsoft Outlook
Para poder configurar la cuenta de hotmail ó msn.com en Microsoft Outlook 2007 hay que cambiar el código 25 por 587. Funcionó muy bien
con referencia a: Configurar cuentas Hotmail como POP3 desde cualquier cliente de correo totalmente gratis (Outlook, Thunderbird, etc) : Soft Zone : Blog sobre Software con tutoriales de ayuda y noticias (ver en Google Sidewiki)2/7/09
Placas de esternón para mejorar la estabilidad
Sternal plating for primary and secondary sternal closure; can it improve sternal stability?: "Transverse sternal plating with 1 or 4 plates significantly improves sternal stability closure in human cadaver model. Adding a single sternal plate to primary closure improves the strength of sternal closure with traditional wiring potentially reducing the risk of sternal dehiscence and could be considered in high risk patients."
Aplicación local de Acido tranexámico para reducir sangrado en BPAC
Abstract | Can local application of Tranexamic acid reduce post- coronary bypass surgery blood loss? A randomized controlled trial.: "Topical application of tranexamic acid in patients undergoing primary coronary artery bypass grafting led to a significant reduction in postoperative blood loss without adding extra risk to the patient."
4/6/09
Rol de la Aspirina en la TVP
¿Tiene la Aspirina un rol en la Trombosis venosa profunda?
Does acetyl salicylic acid (ASA) have a role in the prevention of venous thromboembolism? Br J Haematol. 2009 May 9. [Epub ahead of print]
Karthikeyan G, Eikelboom JW, Turpie AG, Hirsh J.
All India Institute of Medical Sciences, New Delhi, India.
Summary Guidelines differ on whether acetyl salicylic acid (ASA, aspirin) should be used for prophylaxis in patients at high-risk of venous thromboembolism (VTE), principally because of differences in perceptions of its efficacy. ASA is an attractive therapeutic option because it is inexpensive, easy to administer and does not require monitoring. We critically reappraised the evidence from randomized controlled trials for the efficacy of ASA in VTE prevention. ASA is clearly efficacious in preventing VTE compared to placebo or no treatment, but appears to be less efficacious than the low molecular weight heparins in small trials. There is little data for ASA in comparison with unfractionated heparin and warfarin. A large randomized controlled trial is required to clarify the role of ASA compared to contemporary anticoagulant strategies for the prevention of VTE.
PMID: 19438502 [PubMed - as supplied by publisher]
Does acetyl salicylic acid (ASA) have a role in the prevention of venous thromboembolism? Br J Haematol. 2009 May 9. [Epub ahead of print]
Karthikeyan G, Eikelboom JW, Turpie AG, Hirsh J.
All India Institute of Medical Sciences, New Delhi, India.
Summary Guidelines differ on whether acetyl salicylic acid (ASA, aspirin) should be used for prophylaxis in patients at high-risk of venous thromboembolism (VTE), principally because of differences in perceptions of its efficacy. ASA is an attractive therapeutic option because it is inexpensive, easy to administer and does not require monitoring. We critically reappraised the evidence from randomized controlled trials for the efficacy of ASA in VTE prevention. ASA is clearly efficacious in preventing VTE compared to placebo or no treatment, but appears to be less efficacious than the low molecular weight heparins in small trials. There is little data for ASA in comparison with unfractionated heparin and warfarin. A large randomized controlled trial is required to clarify the role of ASA compared to contemporary anticoagulant strategies for the prevention of VTE.
PMID: 19438502 [PubMed - as supplied by publisher]
9/3/09
Bypass Ventrículo aórtico en estenosis aórticas críticas.
Treatment of aortic stenosis with aortic valve byp...[J Thorac Cardiovasc Surg. 2009] - PubMed Result: "CONCLUSIONS: An aortic valve bypass conduit as small as 10 mm results in excellent relief of left ventricular outflow tract obstruction in critical aortic valve stenosis. The presence of an aortic valve bypass conduit has no effect on cerebral blood flow. All blood flow to the brain occurs via antegrade flow across the native stenotic valve; this configuration may decrease the long-term risk of cerebral thromboembolism."
Insuficiencia Mitral en cambio aórtico
Management of moderate functional mitral regurgita...[J Thorac Cardiovasc Surg. 2009] - PubMed Result: "CONCLUSION: Moderate functional mitral regurgitation improved in most patients after aortic valve replacement. Residual mitral regurgitation did not affect survival independently of left ventricular function."
Abordaje de Válvula Mitral en aurículas pequeñas
The transseptal T-cut--what more can we see? [J Card Surg. 2008 Sep-Oct] - PubMed Result: "An optimal approach to the mitral valve for repair or replacement must provide adequate exposure even in a small left atrial and redo cases, without need for forceful retraction. This benefit of good exposure must not be at the cost of increased morbidity from increased postoperative bleeding, SA node, or atrioventricular node dysfunction. We describe a simple technique of transseptal T-cut for exposure of the mitral valve, which is without the attendant complications of the other techniques."
Tto quirúrgico de la Endocarditis Bacteriana
Surgical therapy in patients with active infective...[Eur J Cardiothorac Surg. 2008] - PubMed Result: "CONCLUSIONS: The survival of patients differs significantly in dependence on their surgical urgency. Better outcome could have been achieved if patients had been referred earlier for surgery and operated upon before heart failure or septic shock developed. Long-term survival was better in patients without abscess formation. The low reinfection rate of Shelhigh bioprostheses in AIE is promising and the early and mid-term results achieved need to be verified in the long-term course."
Anticoagulación en prótesis cardiacas
Aniticoagulation in patients following prosthetic ...[Ann Thorac Cardiovasc Surg. 2009] - PubMed Result: "Conclusions: Anticoagulation for mechanical heart valve replacement can be managed with INR levels of 2-2.5 with acceptable hemorrhagic and thromboembolic events."
6/3/09
Neumotórax y Drenaje Torácico
Air Leaks, Pneumothorax, and Chest Drains: (Para leer el artículo completo se necesita una cuenta en MedScape. Es gratis)
Air leaks can be defined as any extrusion of air from normal gas-filled cavities including the upper airway, sinuses, tracheobronchial tree, and gastrointestinal (GI) tract. Clinical conditions of relevance in anaesthesia and critical care include pneumothorax, pneumomediastinum, pneumopericardium, pneumoperitoneum, and subcutaneous emphysema. This review will cover those related to the chest; of these, pneumothorax is the most common serious complication. In critically ill patients, the diagnosis of pneumothorax is often complicated by other disease processes and the limitations of bedside imaging.
Air leaks can be defined as any extrusion of air from normal gas-filled cavities including the upper airway, sinuses, tracheobronchial tree, and gastrointestinal (GI) tract. Clinical conditions of relevance in anaesthesia and critical care include pneumothorax, pneumomediastinum, pneumopericardium, pneumoperitoneum, and subcutaneous emphysema. This review will cover those related to the chest; of these, pneumothorax is the most common serious complication. In critically ill patients, the diagnosis of pneumothorax is often complicated by other disease processes and the limitations of bedside imaging.
24/1/09
Cambio aórtico por toracotomía izquierda después de una cirugía de esófago.
Aortic valve replacement through left thoracotomy ...[Ann Thorac Surg. 2008] - PubMed Result:
Paciente con cirugía de esófago 14 años atrás, con tubo gástrico subesternal. Se abordó la válvula aórtica por toracotomía izquierda.
A 67-year-old man was referred for aortic valve surgery due to aortic valve regurgitation. He underwent an aortic valve replacement through a left thoracotomy, since he had a history of esophageal surgery with substernal gastric tube reconstruction and lymph node dissection through a right thoracotomy 14 years ago. The aortic valve was successfully replaced with excellent visualization using vacuum-assisted venous drainage on a cardiopulmonary bypass. Although exposing the aortic valve through a left thoracotomy is difficult, the application of vacuum-assisted venous drainage helps visualize the aortic valve in this approach."
Paciente con cirugía de esófago 14 años atrás, con tubo gástrico subesternal. Se abordó la válvula aórtica por toracotomía izquierda.
A 67-year-old man was referred for aortic valve surgery due to aortic valve regurgitation. He underwent an aortic valve replacement through a left thoracotomy, since he had a history of esophageal surgery with substernal gastric tube reconstruction and lymph node dissection through a right thoracotomy 14 years ago. The aortic valve was successfully replaced with excellent visualization using vacuum-assisted venous drainage on a cardiopulmonary bypass. Although exposing the aortic valve through a left thoracotomy is difficult, the application of vacuum-assisted venous drainage helps visualize the aortic valve in this approach."
Mismatch aórtico de prótesis mecánica y stented bioprótesis
Validity of identifying patient-prosthesis mismatc...[J Artif Organs. 2008] - PubMed Result:
Pibarot and Dumesnil demostraron que el índice de área efectiva,IAE, ( indexed effective orifice area) de las prótesis mecánicas debe ser mayor a 0.85 - 0.90' cm2/m2 para prevenir un gradiente elevado después de la cirugía cardiaca.
Este IAE debe ser mayor de 1.25 cm2/m2 en las stented bioprótesis.
The main problem that arises from patient-prosthesis mismatch after aortic valve replacement is a residual high transvalvular pressure gradient, resulting in left ventricular overload. It was demonstrated by Pibarot and Dumesnil that the indexed effective orifice area should be larger than 0.85-0.90 cm2/m2 to prevent any significant transvalvular pressure gradient after operation. However, we have encountered a higher residual transvalvular pressure gradient than expected in some patients with an aortic stented bioprosthesis with an indexed effective orifice area greater than 0.85 cm2/m2. Based on our data, an indexed effective orifice area of less than 1.25 cm2/m2 might be considered the threshold for patient-prosthesis mismatch in patients with a stented bioprosthesis because this indexed effective orifice area is associated with a low mean transvalvular pressure gradient (less than 10 mmHg). The practical implications include the necessity to consider the hemodynamic performance of each prosthesis type when seeking to define patient-prosthesis mismatch and abnormally or significant high postoperative gradients that lead to an increased left ventricular workload, so as to avoid residual significant transvalvular pressure gradients and higher rates of morbidity and mortality."
Pibarot and Dumesnil demostraron que el índice de área efectiva,IAE, ( indexed effective orifice area) de las prótesis mecánicas debe ser mayor a 0.85 - 0.90' cm2/m2 para prevenir un gradiente elevado después de la cirugía cardiaca.
Este IAE debe ser mayor de 1.25 cm2/m2 en las stented bioprótesis.
The main problem that arises from patient-prosthesis mismatch after aortic valve replacement is a residual high transvalvular pressure gradient, resulting in left ventricular overload. It was demonstrated by Pibarot and Dumesnil that the indexed effective orifice area should be larger than 0.85-0.90 cm2/m2 to prevent any significant transvalvular pressure gradient after operation. However, we have encountered a higher residual transvalvular pressure gradient than expected in some patients with an aortic stented bioprosthesis with an indexed effective orifice area greater than 0.85 cm2/m2. Based on our data, an indexed effective orifice area of less than 1.25 cm2/m2 might be considered the threshold for patient-prosthesis mismatch in patients with a stented bioprosthesis because this indexed effective orifice area is associated with a low mean transvalvular pressure gradient (less than 10 mmHg). The practical implications include the necessity to consider the hemodynamic performance of each prosthesis type when seeking to define patient-prosthesis mismatch and abnormally or significant high postoperative gradients that lead to an increased left ventricular workload, so as to avoid residual significant transvalvular pressure gradients and higher rates of morbidity and mortality."
Control de la anticoagulación en el perioperatorio de cirugía cardiaca
Perioperative coagulation management and blood con...[J Cardiothorac Vasc Anesth. 2008] - PubMed Result:
CONCLUSIONS: The majority of Canadian institutions do not use point-of-care tests other than ACT. Most institutions do not have algorithms for management of bleeding following cardiac surgery and at least 30% do not monitor their transfusion practice perioperatively. Cardiac surgery patients in Canada may benefit from a standardized approach to blood conservation in the perioperative period."
CONCLUSIONS: The majority of Canadian institutions do not use point-of-care tests other than ACT. Most institutions do not have algorithms for management of bleeding following cardiac surgery and at least 30% do not monitor their transfusion practice perioperatively. Cardiac surgery patients in Canada may benefit from a standardized approach to blood conservation in the perioperative period."
Uso del Cell Saver en la cirugía cardiaca
A randomized controlled trial of cell salvage in r...[Anesth Analg. 2008] - PubMed Result:
"CONCLUSION: In patients undergoing routine first-time cardiac surgery in an institution with a rigorous blood conservation program, the routine use of cell salvage does not further reduce the proportion of patients exposed to allogeneic blood transfusion. However, patients who do not have excessive bleeding after surgery receive significantly fewer units of blood with cell salvage. Although the use of cell savage may reduce the demand for blood products during cardiac surgery, this comes at an increased cost to the institution."
"CONCLUSION: In patients undergoing routine first-time cardiac surgery in an institution with a rigorous blood conservation program, the routine use of cell salvage does not further reduce the proportion of patients exposed to allogeneic blood transfusion. However, patients who do not have excessive bleeding after surgery receive significantly fewer units of blood with cell salvage. Although the use of cell savage may reduce the demand for blood products during cardiac surgery, this comes at an increased cost to the institution."
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