Quoi de neuf en hyperthermie maligne en 2012 ?

Malignant hyperthermia (MH) is a pharmacogenetic disorder of anesthesia. Recent advances dealing with epidemiology of MH and the safe anesthetic course of MH susceptible patients are shortly presented here with a special insight into the preparation of modern anesthesia workstations, which they will share in operating room.     

Adenocarcinoma de células en anillo de sello en colocistoplastia

We report a case of signet ring-cell adenocarcinoma in augmentation colocystoplasty. We review the current litterature about tumours developping in augmentation bladder     

20 años de experiencia en trasplante renal en bloque de donantes pediátricos en receptores adultos

BackgroundEn bloc kidney transplantation from pediatric donors into adult recipients increases the donor pool. However, this surgical procedure is not widely performed in many transplant centers. To evaluate the long-term outcomes of bloc kidney transplantation from pediatric donors into adult recipients in a single center.Material and methodsRetrospective analysis of 42 patients who received pediatric cadaveric bloc kidney transplantation in our center since 1999. Median follow-up period was 73 months (5-233) in which renal function tests were taken and complications registered.ResultsWe have performed 42 bloc kidney transplantation from pediatric donors into adult recipients in our center. The recipients’ age was 44.1 ± 11.8 years. Pediatric donors were 22.4 ± 14.7 months old and weighted 11.3 ± 3.6 kg. Cold ischemia time was 15.7 ± 4.5 hours. During a median follow-up of 73 months, 35 patients (83.3%) had graft survival with excellent function (first-year serum creatinine levels of 0.99 ± 0.25 mg/dl). There were 7 graft losses (16.7%) in the immediate postoperative period (4 cases of vascular thrombosis, one anastomosis dehiscence and 2 cortical necrosis).ConclusionsThe pediatric en bloc renal graft transplantation into adults is a safe technique with excellent medium- to long-term functional performance. The vast majority of significant complications leading to graft loss were reported in the immediate postoperative period. A good selection of donors and recipients as well as an adequate surgical technique are essential to minimize the occurrence of adverse events.     

Cooperación en cirugía en el siglo XXI

The need for healthcare cooperation in low- and middle-income countries is known and is implemented day by day. However, the surgical sanitary assistance in these countries in the 21^st century is very controversial, as it is still below desirable levels and entails complex solutions. On the other hand, the number of surgeons seeking to get involved is increasing progressively. We analyze the causes of the low levels of medical assistance, such as the lack of qualified personnel, the brain drain of surgeons, healthcare costs or the lack of quantified needs. Opportunities for improvement, such as institutional twinning, short-term surgical missions or activities aimed at education, evaluation, evidence and training, are some of the possibilities proposed.     

Nuklearmedizinische Bildgebung an Herz und großen Gefäßen

Using various nuclear medicine diagnostic methods, cardiothoracic surgeons can obtain essential information which cannot be provided by other diagnostic disciplines. Therefore, they are an essential element in treatment planning and follow-up of most cardiac surgery interventions on the heart and the large vessels. The present article summarizes the use of various acquisition techniques, radiopharmaceuticals, and examination protocols in cardiovascular nuclear medicine imaging and their value in the diagnosis of ischemia, myocardial viability, cardiac tumors, inflammation as well as indications for bypass operations, heart transplantations (pre- and postoperative monitoring), the use of pacemakers/defibrillators, and valve operations. In addition, the authors comment on possible future developments: new and promising combined imaging techniques in clinical medicine will advance the evaluation of functional and morphological information and, thus, deliver more overall information than the sum of the information obtained from the individual methods. In the future, molecular imaging with the help of new radiochemical tracers will facilitate the prospective evaluation of the formation of cardiovascular problems and help clarify questions concerning plaque formation and programmed cell death.     

Craneotomía en el paciente consciente. Consideraciones en situaciones especiales

Awake craniotomy was the earliest surgical procedure known, and it has become fashionable again. In the past it was used for the surgical management of intractable epilepsy, but nowadays, its indications are increasing, and it is a widely recognized technique for the resection of mass lesions involving the eloquent cortex, and for deep brain stimulation. The procedure is safe, provides excellent results, and saves money and resources.The anesthesiologist should know the principles underlying neuroanesthesia, the technique of scalp blockade, and the sedation protocols, as well as feeling comfortable with advanced airway management. The main anesthetic aim is to keep patients cooperating when required (analgesia-based anesthesia).This review attempts to summarize the most recent evidence from the clinical literature, a long as the number of patients undergoing craniotomies in the awake state are increasing, specifically in the pediatric population.     

Complicaciones urológicas en el trasplante renal. Estudio en 250 casos

ObjectiveThe aim of this study is to value the incidence of urological complications (fistulae and estenosis) in our serie of renal transplant, to analyze the variables that can influence in their appearance and the treatments used. Likewise, to value the follow-up of theses patients and the survival of the renal graft and of the patientMaterial and methods250 renal transplants are carried out between july of 1985 and october of 1998. The relationship among the variables you makes by means of the test χ2 of Pearson and the test of Fisher; the contrasts of stockings with the t of Student; the survival of the organ and of the patient, by means of the analysis of curved of survival according to the method of Kaplan and Meier; and the comparison among curved of survival was carried out with the test of Cloth and CoxResultsOf the 250 transplants, 46 patients suffered for complications, 29 urinary fistulae (11,6%) and 21 estenosis (8,4%). The most frequent localization in both complications was the union uretero-vesical. The presence of urinary fistulae didn’t influence negatively in a significant way nor over the survival of the implant (p < 0,211), neither over the patient’s survival. The estenosis appearance was related in a significant way with the donor’s age (p < 0,02). The estenosis presence was not related in a significant way neither with the survival of the implant neither with that of the receiverConclusionsThe incidence of urological complications was of 18,4% (11,6% estenosis and 8,4% fistulae). The most frequent localization was the union uretero-vesical. The presence of estenosis correlated with the increase of the age of the donors. The technique of reimplante ureteral didn’t influence in the results in a significanty way. We don’t find any relationship between the appearance of urological complications and the patient’s survival     

Le thorax en entonnoir : quelle prise en charge en chirurgie plastique ? À propos de 10 cas

Subject

Several controversial issues concern pectus excavatum (funnel chest), the most common chest wall deformity. The pathogenesis of this deformity is uncertain, and there is no agreement as to its psychological, cardiac and pulmonary effects. An even more debatable point is the choice of surgical treatment among the more or less radical proposals made by different teams. No consensus exists concerning the indications for surgery, the technique to be used, or the suitable age of the patient.

Materials and methods

This retrospective study concerns 10 patients with funnel chest who underwent reconstruction surgery in our unit between 1989 and 2002. Nine patients received a silicone chest implant made to measure, and one a single breast implant. Each patient was interviewed and examined to obtain information and provide a basis for evaluation. The effects of possible associated abnormalities were evidenced by complementary cardiopulmonary examinations, and the severity of funnel chest was evaluated according to the Haller pectus index.

Results

The mean period after surgery was 5 years. The effects of funnel chest deformity were essentially psychological, relating to aesthetic disgrace. Although two-thirds of the deformities were considered severe, cardiopulmonary repercussions were minor. All 10 patients were satisfied with the repair performed, and this judgment was independent of surgical assessment. Acute complications concerned 5 seromas and one minimal scar separation.

Discussion

The indications for surgery and the means of surgical treatment for funnel chest are considered after comparison of our results with those in the literature and a survey of the different existing possibilities for treatment (implant, chondrosternoplasty, fat transplant).     

Angiographie der Gliedmaßen

Ohne ZusammenfassungMit 32 Textabbildungen.     

Caractéristiques cliniques et indicateurs de prise en charge des patients en dialyse

This chapter provides a set of indicators on patients treated by dialysis at December the 31th 2011. Even if ESRD is found in all classes of age, elders account for the great majority of the patients undergoing dialysis (median age: 70.4 years). These patients present a high rate of comorbidity especially diabetes (37% of patients) and cardiovascular comorbidities (59% of patients) that increases with the patient's age. Considering indicators of care, the main dialysis technique was hemodialysis (93.3% of patients). Even if an important inter-region variability remains considering the choices of treatment, more than 50% of the patients are undergoing hemodialysis in a hospital-based in-center unit, and we noticed an increase in hemodialysis in a medical satellite unit with time whereas the rate of self-care hemodialysis decreases. The rate of peritoneal dialysis remains stable. When comparing guidelines to real-life treatments, 77.5% of patients receive adequate dose of treatment (12 H/week, KT/V>1.2), the rate of patients with a hemoglobin blood-level lower than 10 g/dl and without erythropoietin treatment is 1.3%, which confirmed a good management of anemia. On the contrary, 34% of patients have a BMI lower than 23 kg/m² and only 23% have an albumin blood-level over 40 g/l, which underlines that nutritional management of ESRD patients can be improved.     

Aspergillose invasive en réanimation

Invasive pulmonary aspergilloses occur in patients with antineoplasic chemotherapy, mainly when associated with a prolonged neutropenia, in transplanted patients with continuous corticotherapy and less frequently in immunocompetent surgical patients. The clinical features are those of an acute infective pneumonia, not responding to antibiotherapy. Radiologie signs are often non specifie. Diagnosls is obtained with bronchoalveolar lavage in which Aspergillus is found both at direct examination and in culture. Serological tests are of little interest for the diagnosis of invasive asperglllosis. Extrapulmonary locations such as sinusitis, cutaneous or brain abscesses occur in 20 % of cases. The gold standard of treatment is intravenous amphoteridn B which elicits an acute reaction often followed by a nephrotoxic effect which can be decreased by Ouid loading with saline. Oral itraconazole administration can follow the initial treatment with amphotericin B. The mortality rate remains high and an early diagnosis and an appropriate treatment are essential.