Experiencia en la implementación de un protocolo de verificación de la tasa de Kerma de referencia en aire de semillas de125I

This paper presents the experience in the use of a validation protocol for the¹²⁵I seeds reference air Kerma rate used in prostate treatments before being implanted. The method used employs a well-type ionization chamber that has been calibrated against an international standard at an accredited dosimetry calibration laboratory (ADCL), this is a direct traceability system. Then, as a quality control check on the well-chamber’s response, the calibration factors are assayed on an ADCL calibrated¹²⁵I seed, secondary traceability system. Before each assay procedure a long-lived source, which dosimetric characteristics are well known, is placed in the well-chamber as a redundancy program to verify that our dosimetry system has not changed with time. Finally the results of verifications over a 2-year period are discussed.     

Effects of isoflurane, sevoflurane and propofol anaesthesia on jugular venous oxygen saturation in patients undergoing coronary artery bypass surgery

We investigated the effect of sevoflurane, isoflurane and propofolon jugular venous bulb oxygen saturation (Sj_O2) in 21 patientsundergoing coronary artery bypass graft surgery (CABG) duringand after normothermic cardiopulmonary bypass (CPB). Patientsreceived a standardized anaesthetic consisting of fentanyl,midazolam and were then randomly allocated to receive eitherisoflurane, sevoflurane or propofol for maintenance. Sj_O2 valueswere significantly lower than baseline 1 h after CPB in thepropofol but not the isoflurane or the sevoflurane groups. Furthermore,Sj_O2 values were significantly higher during CPB in the isofluranegroup (P=0.0081) and significantly lower 6 h after CPB in thesevoflurane group (P=0.0447) when compared to the propofol group.We conclude that jugular venous desaturation during and afternormothermic CPB is more likely during propofol anaesthesia.     

Parent-Reported Problem Behavior Among Children With Sensory Disabilities Attending Elementary Regular Schools

Parent-reported problem behaviors of 94 children with visual and auditory disabilities, attending elementary regular schools, were compared with problems reported in a general population sample of nondisabled children. Both samples were matched by means of a pairwise matching procedure, taking into account age and sex. Problem behavior was measured by Achenbachs (1991) CBCL (Achenbach, T. M. (1991). Manual for the Child Behavior Checklist/4-18 and 1991 Profile, University of Vermont, Department of Psychiatry, Burlington, VT). No significant main effects of type, degree, and nature of disability were found on the CBCL Total Problems scale, nor on the syndrome scales. In general, children with sensory disabilities attending elementary regular schools did not show more problems in comparison to nondisabled children. Merely on the Social Problems scale there was a significant difference between both samples, the children with sensory disabilities getting higher scores than their nondisabled peers. Further, children with sensory disabilities ran considerable risks of developing deviant scores on the Social Problems and the Thought Problems syndromes, the odds being respectively 3.2 and 5.2 times higher than in the general population sample. To optimize the benefits from placement in integrated classrooms for children with sensory disabilities, school counselors and teachers should not only focus on the academic achievements of these children, but also on their social skills and peer sociometric status.     

Lost gallstones: a relaparoscopic solution to laparoscopic pollution

This case report describes the treatment by radiological intervention combined with therapeutic relaparoscopy of a patient with a gluteolumbar fistula due to lost gallstones 5 years after laparoscopic cholecystectomy.     

Allogenic blood transfusion does not predispose to infection after cardiac surgery

Background

Many retrospective studies report increased postoperative infection after allogenic blood transfusion. To investigate this phenomenon, we prospectively studied 232 patients undergoing cardiac surgery.

Methods

Patients were screened daily for evidence of culture positive infections. Wounds were examined daily and defined on the ASEPSIS score. Chest radiographs and white cell counts and differentials were recorded on days 1, 2, and 4. The use of blood products was monitored blindly and independently. Patients were grouped according to transfusion status and compared using χ² or Fisher's test. Logistic regression analyses were performed to identify predictors of transfusion and infection.

Results

Of 232 patients, 116 (50%) received blood product transfusion. Patients receiving blood had lower preoperative hemoglobin, were older, with a greater proportion of urgent/emergency or revision surgery, and were higher risk. Despite this, there were no differences in the frequency of chest infection (20% versus 15%, p = 0.38), urinary infection (3.5% versus 5.3%, p = 0 0.75), wound infection (3.5% versus 8.0%, p = 0.16), or overall infection (28% versus 30%, p = 0.89) comparing the transfused versus untransfused groups. There was no evidence to suggest that administration of blood products was associated with infection (odds ratio 0.92, p = 0.77).

Conclusions

The administration of blood per se did not lead to increased postoperative infection. Clinicians should reconsider withholding blood transfusion in patients solely owing to concerns of predisposition to infection.