Uso de "Cell-Saver" En Cirugía Resectiva Hepática

Intraoperative Blood Salvage During Liver Resection: A Randomized Controlled Trial.
Annals of Surgery. 245(5):686-691, May 2007.
Hashimoto, Takuya; Kokudo, Norihiro; Orii, Ryo; Seyama, Yasuji; Sano, Keiji; Imamura, Hiroshi; Sugawara, Yasuhiko; Hasegawa, Kiyoshi; Makuuchi, Masatoshi

Abstract: Objective: A randomized controlled trial was conducted to clarify the effectiveness of intraoperative blood salvage in reducing blood loss.
Background: Although reduction of central venous pressure (CVP) is thought to decrease blood loss during liver resection, no consistently effective and safe method for obtaining the desired reduction of CVP has been established.
Methods: Living liver donors scheduled to undergo liver graft procurement were randomly assigned to a blood salvage group, in which a blood volume equal to approximately 0.7% of the patient's body weight was collected before the liver transection, or a control group. The surgeons were blinded to the randomization results. The primary outcome measure was blood loss during liver parenchymal division. A multivariate analysis was also performed.
Results: Seventy-nine donors were allocated intraoperatively to the blood salvage group (n = 40) or the control group (n = 39). The amount of blood loss during liver transection was significantly smaller in the blood salvage group than in the control group (median loss during transection, 140 mL vs. 230 mL, P = 0.034). The CVP at the beginning of the liver parenchymal division was significantly lower in the blood salvage group than in the control group (median, 5 cm H2O vs. 6 cm H2O, P = 0.005). The results of a multivariate analysis revealed that intraoperative blood salvage offered the advantage of reduced blood loss during liver parenchymal division (adjusted OR, 0.31; 95% CI, 0.11-0.85, P = 0.025).

Conclusion: Modest intraoperative blood salvage significantly and safely reduced blood loss during hepatic parenchymal transection.

Profilaxis Antibiotica en Pancreatitis Aguda Severa: Un Estudio Randomizado

Early Antibiotic Treatment for Severe Acute Necrotizing Pancreatitis: A Randomized, Double-Blind, Placebo-Controlled Study.
Annals of Surgery. 245(5):674-683, May 2007.
Dellinger, E Patchen; Tellado, Jose M.; Soto, Norberto E.; Ashley, Stanley W; Barie, Philip S.; Dugernier, Thierry; Imrie, Clement W; Johnson, Colin D. MChir; Knaebel, Hanns-Peter; Laterre, Pierre-Francois; Maravi-Poma, Enrique; Kissler, Jorge J. Olsina; Sanchez-Garcia, Miguel; Utzolino, Stefan

Background & Aims: In patients with severe, necrotizing pancreatitis, it is common to administer early, broad-spectrum antibiotics, often a carbapenem, in the hope of reducing the incidence of pancreatic and peripancreatic infections, although the benefits of doing so have not been proved.

Methods: A multicenter, prospective, double-blind, placebo-controlled randomized study set in 32 centers within North America and Europe. Participants: One hundred patients with clinically severe, confirmed necrotizing pancreatitis: 50 received meropenem and 50 received placebo.

Interventions: Meropenem (1 g intravenously every 8 hours) or placebo within 5 days of the onset of symptoms for 7 to 21 days. Main Outcome Measures: Primary endpoint: development of pancreatic or peripancreatic infection within 42 days following randomization. Other endpoints: time between onset of pancreatitis and the development of pancreatic or peripancreatic infection; all-cause mortality; requirement for surgical intervention; development of nonpancreatic infections within 42 days following randomization.

Results: Pancreatic or peripancreatic infections developed in 18% (9 of 50) of patients in the meropenem group compared with 12% (6 of 50) in the placebo group (P = 0.401). Overall mortality rate was 20% (10 of 50) in the meropenem group and 18% (9 of 50) in the placebo group (P = 0.799). Surgical intervention was required in 26% (13 of 50) and 20% (10 of 50) of the meropenem and placebo groups, respectively (P = 0.476).

Conclusions: This study demonstrated no statistically significant difference between the treatment groups for pancreatic or peripancreatic infection, mortality, or requirement for surgical intervention, and did not support early prophylactic antimicrobial use in patients with severe acute necrotizing pancreatitis.

Cuando un Derrame Pericardico Equivale a un Taponamiento

Does This Patient With a Pericardial Effusion Have Cardiac Tamponade?
Christopher L. Roy; Melissa A. Minor; M. Alan Brookhart; Niteesh K. Choudhry
JAMA. 2007;297:1810-1818.

Context Cardiac tamponade is a state of hemodynamic compromise resulting from cardiac compression by fluid trapped in the pericardial space. The clinical examination may assist in the decision to perform pericardiocentesis in patients with cardiac tamponade diagnosed by echocardiography.

Objective To systematically review the accuracy of the history, physical examination, and basic diagnostic tests for the diagnosis of cardiac tamponade.

Data Sources MEDLINE search of English-language articles published between 1966 and 2006, reference lists of these articles, and reference lists of relevant textbooks.

Study Selection We included articles that compared aspects of the clinical examination to a reference standard for the diagnosis of cardiac tamponade. We excluded studies with fewer than 15 patients. Of 787 studies identified by our search strategy, 8 were included in our final analysis.

Data Extraction Two authors independently reviewed articles for study results and quality. A third reviewer resolved disagreements.
Data Synthesis All studies evaluated patients with known tamponade or those referred for pericardiocentesis with known effusion. Five features occur in the majority of patients with tamponade: dyspnea (sensitivity range, 87%-89%), tachycardia (pooled sensitivity, 77%; 95% confidence interval [CI], 69%-85%), pulsus paradoxus (pooled sensitivity, 82%; 95% CI, 72%-92%), elevated jugular venous pressure (pooled sensitivity, 76%; 95% CI, 62%-90%), and cardiomegaly on chest radiograph (pooled sensitivity, 89%; 95% CI, 73%-100%). Based on 1 study, the presence of pulsus paradoxus greater than 10 mm Hg in a patient with a pericardial effusion increases the likelihood of tamponade (likelihood ratio, 3.3; 95% CI, 1.8-6.3), while a pulsus paradoxus of 10 mm Hg or less greatly lowers the likelihood (likelihood ratio, 0.03; 95% CI, 0.01-0.24).

Conclusions Among patients with cardiac tamponade, a minority will not have dyspnea, tachycardia, elevated jugular venous pressure, or cardiomegaly on chest radiograph. A pulsus paradoxus greater than 10 mm Hg among patients with a pericardial effusion helps distinguish those with cardiac tamponade from those without. Diagnostic certainty of the presence of tamponade requires additional testing.

¿Alta Ingesta de Carbohidratos Favorece la Formación de Cristales Biliares?

High dietary carbohydrates decrease gallbladder volume and enhance cholesterol crystal formation
Surgery 2007 141; (5) : 654-659
Abhishek Mathur MD, Marine Megan B, Hayder H. Al-Azzawi MD, Debao Lu MD, Deborah A. Swartz-Basile PhD, Attila Nakeeb MD and Henry A. Pitt MD, Department of Surgery, Indiana University School of Medicine.

Background
Animal and human data suggest that a diet high in refined carbohydrates leads to gallstone formation. However, no data are available on the role of dietary carbohydrates on gallbladder volume or on cholesterol crystal formation. Therefore, we tested the hypothesis that a high carbohydrate diet would alter gallbladder volume and enhance cholesterol crystal formation.

Methods
At 8 weeks of age, 60 lean and 36 obese leptin-deficient female mice were fed a 45% carbohydrate diet while an equal number of lean and obese mice were fed a 75% carbohydrate diet for 4 weeks. All animals then underwent cholecystectomy, and gallbladder bile volume was recorded. Bile was pooled, filtered, and maintained in a water bath at 37°C for 14 days. Birefringent cholesterol crystals in bile were counted daily; crystal observation time and crystal mass were determined.

Results
The crystal observation time was significantly shortened in both lean and obese mice on the 75% diet compared with their counterparts on the 45% diet. The crystal mass was significantly increased in the lean mice on the 75% diet compared with the 45% diet. Gallbladder volumes were significantly reduced in both lean and obese mice on the 75% diet compared with their counterparts on the 45% diet.

Conclusions
These data suggest that a high carbohydrate diet decreases gallbladder volume, shortens cholesterol crystal observation time, and increases crystal mass. We conclude that dietary carbohydrates may play a role in cholesterol gallstone formation by altering biliary motility and by enhancing crystal formation.

¿Profilaxis Antibiótica en Heridas Simples de las Manos?

The Role of Antibiotic Prophylaxis for Prevention of Infection in Patients With Simple Hand Lacerations
Annals of Emergency Medicine 2007; 49(5):682-689.e1
Shahriar Zehtabchi MD

Study objective
The use of prophylactic antibiotics in patients with simple hand lacerations is controversial. This evidence-based emergency medicine review evaluates the existing evidence about the utility of prophylactic systemic antibiotics for prevention of infection in patients with simple hand lacerations.

Methods
MEDLINE, EMBASE, the Cochrane Library, and other databases were searched. Studies were selected for possible inclusion in the review if the authors stated that they had randomly assigned patients to an antibiotic treatment group or a control group and if they followed them up for the occurrence of infection. They also had to describe a reasonable method of wound cleaning for all subjects, repair the wounds, and exclude hand lacerations that involved special tissues such as bone, tendons, nerves, or large vessels. Standard criteria to appraise the quality of published trials were used.

Results
Four randomized trials met the inclusion criteria, of which 3 met minimally acceptable quality standards. Relative risks of infection after antibiotic use were 1.05 (95% confidence interval [CI] 0.09 to 11.38), 0.73 (95% CI 0.37 to 1.46), and 1.07 (95% CI 0.07 to 16.80) for the 3 included studies. In these trials, the differences in infection rates between antibiotic and control groups failed to reach statistical significance.

Conclusion
No convincing trend toward either benefit or harm from administration of antibiotics for uncomplicated hand lacerations is apparent. Clinical judgment based on individual cases should be used in such settings.

Glicemia al Ingreso en Primer Episodio de Infarto Agudo al Miocardio

Initial Serum Glucose Level as a Prognostic Factor in the First Acute Myocardial Infarction
Annals of Emergency Medicine 2007; 49(5) :618-626
Chin-Wang Hsu MD, MS, Hsiu Hsi Chen MD, PhD, Wayne H.-H. Sheu MD, PHD, Shi-Jye Chu MD, Ying-Sheng Shen MD, Chin-Pyng Wu MD, PHD and Kuo-Liong Chien MD, PhD

Study objective
We assess the prognostic role of initial glucose levels in patients with a first acute myocardial infarction in the emergency department (ED).

Methods
We conducted a 3-year retrospective cohort study. Patients with a first acute myocardial infarction were recruited from the ED of a tertiary hospital from January 1, 2001, to December 31, 2003. Initial glucose levels in the ED were stratified into 3 levels (normal <140 mg/dL; intermediate 140 to 200 mg/dL; and high ≥200 mg/dL). Logistic and Cox regression models were applied to estimate the 1-month short-term and 1-year long-term adverse prognoses, respectively.

Results
A total of 198 eligible subjects (159 men and 39 women; mean age 63.1±14.2 years) were recruited. The estimated survival curves among the 3 initial glucose levels were significantly different (P=.0002). After adjustment for sex, age, diabetic status, reperfusion therapy, and infarct subtype, the adjusted odds ratio for short-term prognosis progressed with higher levels when compared with the normal level (intermediate level: odds ratio 3.87; 95% confidence interval [CI] 1.71 to 8.78; high level: odds ratio 5.16; 95% CI 1.97 to 13.51). High initial glucose level was an important risk factor for long-term adverse prognosis (hazard ratio 3.08; 95% CI 1.59 to 5.98).

Conclusion
A high initial glucose level in the ED is an important and independent predictor of short- and long-term adverse prognoses in patients with first acute myocardial infarction.

Valor de Ileostomía de Derivación en Anastomosis Colonica y Rectal de Alto Riesgo

The value of diverting loop ileostomy on the high-risk colon and rectal anastomosis
The American Journal of Surgery 2007;193(5): 585-588
Timothy W. Bax and M. Shane McNevin M.D.

Introduction
The need for diverting loop ileostomies to protect high-risk anastomoses has been questioned recently by several authors. This study was designed to evaluate the potential benefits and complications of diverting loop ileostomies in a high-risk anastomosis population.
Methods
Ninety-four consecutive patients undergoing diverting loop ileostomy were evaluated from a prospective database between 2003 and 2006. Criteria for diversion were: anastomosis less than 5 cm from the anal verge, previous pelvic radiation therapy, obstruction, and infection. Data regarding patient demographics, underlying pathology, anastomotic problems, and ileostomy-related problems were gathered.
Results
Indications for surgery were malignancy (n = 40), ulcerative colitis (n = 37), acute diverticulitis (n = 12), perirectal fistulas (n = 3), and familial polyposis (n = 2). There were 5 anastomotic complications. One required permanent stoma and 4 required delay in diverting ileostomy closure but no other intervention. Ileostomy-related problems were limited to minor stoma and pouch complaints requiring stoma nurse evaluation (n = 23), dehydration requiring outpatient (n = 8) or inpatient (n = 4) intravenous fluids, stricture at stoma closure site (n = 2), and bleeding at stoma closure site (n = 1). Four stoma site hernias (4.3%) have been identified to date.
Conclusion
The use of diverting loop ileostomy in patients undergoing colon and rectal surgery with high-risk anastomoses is beneficial. Their selected use has resulted in a 1% anastomotic loss rate with an acceptably low rate of complications related to the ileostomy.

Omeprazol Pre-Endoscopia Alta en Hemorragia Digestiva Alta

Omeprazole before Endoscopy in Patients with Gastrointestinal Bleeding
N Engl J Med 2007; 356(16):1631-40.
James Y. Lau, M.D., Wai K. Leung, M.D., Justin C.Y. Wu, M.D., Francis K.L. Chan, M.D., Vincent W.S. Wong, M.D., Philip W.Y. Chiu, M.D., Vivian W.Y. Lee, Ph.D., Kenneth K.C. Lee, Ph.D., Frances K.Y. Cheung, M.B., Ch.B., Priscilla Siu, B.Sc., Enders K.W. Ng, M.D., and Joseph J.Y. Sung, M.D.

Background A neutral gastric pH is critical for the stability of clots over bleeding arteries. We investigated the effect of preemptive infusion of omeprazole before endoscopy on the need for endoscopic therapy.

Methods Consecutive patients admitted with upper gastrointestinal bleeding underwent stabilization and were then randomly assigned to receive either omeprazole or placebo (each as an 80-mg intravenous bolus followed by an 8-mg infusion per hour) before endoscopy the next morning.

Results Over a 17-month period, 638 patients were enrolled and randomly assigned to omeprazole or placebo (319 in each group). The need for endoscopic treatment was lower in the omeprazole group than in the placebo group (60 of the 314 patients included in the analysis [19.1%] vs. 90 of 317 patients [28.4%], P=0.007). There were no significant differences between the omeprazole group and the placebo group in the mean amount of blood transfused (1.54 and 1.88 units, respectively; P=0.12) or the number of patients who had recurrent bleeding (11 and 8, P=0.49), who underwent emergency surgery (3 and 4, P=1.00), or who died within 30 days (8 and 7, P=0.78). The hospital stay was less than 3 days in 60.5% of patients in the omeprazole group, as compared with 49.2% in the placebo group (P=0.005). On endoscopy, fewer patients in the omeprazole group had actively bleeding ulcers (12 of 187, vs. 28 of 190 in the placebo group; P=0.01) and more omeprazole-treated patients had ulcers with clean bases (120 vs. 90, P=0.001).

Conclusions Infusion of high-dose omeprazole before endoscopy accelerated the resolution of signs of bleeding in ulcers and reduced the need for endoscopic therapy.

Escala Universal Para Evaluar las Destrezas Técnicas en Pabellón

A universal global rating scale for the evaluation of technical skills in the operating room
The American Journal of Surgery Volume 193, Issue 5, May 2007, Pages 551-555
Jeffrey D. Doyle M.D., Eric M. Webber M.D. and Ravi S. Sidhu M.D. Department of Surgery, Faculty of Medicine, University of British Columbia,

Abstract
Background
The ideal assessment of technical skills should be defensible and practical. The purpose of this study was to evaluate the utility of a Global Rating Scale (GRS) Assessment tool of resident operating room performance.
Methods
Residents were assessed in the operating room on multiple occasions during a 6-month study period using a 9-item GRS. Data were analyzed to assess scale reliability and sensitivity to year of training. Feasibility was evaluated with a post-study questionnaire.
Results
Seven residents had a total of 32 procedures assessed. One-way analysis of variance (ANOVA) showed that scores increased with year of training (P = .009). Reliability was excellent. (Cronbach’s α .91). The post-study survey identified feedback and faculty interaction as strengths of this tool, but time constraint was a barrier.
Conclusions
The GRS tool is a valid and reliable method that has the potential to be a practical, useful assessment tool of resident operating room performance.

Congreso American College of Surgeons Capítulo Chileno Mayo 2007

Esta pronto a realizarse el congreso 2007 del Capítulo Chileno del ACS.

Para más información hacer click en el título de este "entry".

Tratamiento "Hibrido" del Aneurisma Toracoabdominal

Tratamiento "híbrido" del aneurisma tóraco-abdominal: revascularización visceral extraanatómica e inserción de endoprótesis
Rev Méd Chile 2007; 135: 153-159
Renato Mertens M, Francisco Valdés E, Albrecht Krämer Sch, Leopoldo Mariné M, Michel Bergoeing R, Rodrigo Sagües C, Alvaro Huete G, Jeannette Vergara G, Magaly Valdebenito G.

La historia natural del aneurisma de la aorta tóraco-abdominal es hacia la ruptura y muerte por hemorragia, dependiendo del diámetro de la lesión1,2.
El tratamiento quirúrgico convencional de estas lesiones implica un extenso abordaje quirúrgico y detener el flujo sanguíneo hacia el sector visceral abdominal por un tiempo variable. Esto conlleva una alta morbimortalidad, donde destaca una alta incidencia de paraplejia definitiva por isquemia medular3-5.
En los últimos años, el desarrollo de técnicas endovasculares mínimamente invasivas para el tratamiento de las enfermedades de la aorta ha abierto una opción menos agresiva para el manejo de estos pacientes6.Las endoprótesis comercialmente disponibles en la actualidad son dispositivos tubulares relativamente simples, su aplicación aislada en esta situación llevaría a cubrir el origen de los vasos viscerales y renales provocando isquemia. Con el fin de hacer técnicamente posible el procedimiento endovascular en este tipo de pacientes, hemos realizado primero revascularización quirúrgica extraanatómica de estos vasos, previo a la inserción de la endoprótesis.
A continuación reportamos nuestra experiencia acumulada en la aplicación de esta técnica en esta grave condición.

http://www.scielo.cl/pdf/rmc/v135n2/art02.pdf

Neumonia Asociada a Ventilación Mecánica

Does This Patient Have Ventilator-Associated Pneumonia?
Michael Klompas, MD
JAMA. 2007;297:1583-1593.

Context Ventilator-associated pneumonia (VAP) is a common and serious nosocomial infection. Accurate, timely diagnosis enables affected patients to receive appropriate therapy and avoids mistreatment of patients having other conditions.

Objective To review the published medical literature describing the precision and accuracy of clinical, radiographic, and laboratory data to diagnose bacterial VAP relative to a histological gold standard.

Data Sources English-language articles identified by a structured search strategy using MEDLINE (January 1966-October 31, 2006) and Google Scholar. Additional articles were identified through the reference lists of studies and review papers identified by the search strategy.

Study Selection Included studies described clinical findings associated with VAP in 25 or more patients receiving mechanical ventilation who subsequently underwent pulmonary biopsy or autopsy. Fourteen studies describing clinical findings in 655 patients met inclusion criteria.

Data Extraction Data were abstracted onto a structured form, allowing calculation of the likelihood ratios (LRs) for each sign or combination of findings.
Data Synthesis The presence or absence of fever, abnormal white blood cell count, or purulent pulmonary secretions do not substantively alter the probability of VAP. However, the combination of a new radiographic infiltrate with at least 2 of fever, leukocytosis, or purulent sputum increases the likelihood of VAP (summary LR, 2.8; 95% confidence interval, 0.97-7.9). The absence of a new infiltrate on a plain chest radiograph lowers the likelihood of VAP (summary LR, 0.35; 95% confidence interval, 0.14-0.87). Fewer than 50% neutrophils on cell count analysis of lower pulmonary secretions makes VAP unlikely (LR range, 0.05-0.10).

Conclusions Routine bedside evaluation coupled with radiographic information provides suggestive but not definitive evidence that VAP is present or absent. Given the severity of VAP and the frequency of serious conditions that can mimic VAP, clinicians should be ready to consider additional tests that provide further evidence for VAP or that establish another diagnosis.

Estado Actual del Trasplante de Islotes Pancreáticos

Estado actual del trasplante de islotes pancreáticos
Revista Española de Cirugía Abril 2007;81(4):177-91
José María Balibrea del Castillo, Elena Vara Ameigeiras, Javier Arias-Díaz, M Cruz García Martín, Juan Carlos García-Pérez, José Luis Balibrea Canteroe. Departamento de Cirugía. Facultad de Medicina. Universidad Complutense de Madrid

El trasplante de islotes pancreáticos mejora día a día sus resultados clínicos gracias a numerosas mejoras en el proceso desarrolladas en los últimos años. Tanto los nuevos protocolos de inmunosupresión como la selección de los donantes y receptores, así como un especial cuidado en la obtención, preservación y procesamiento de los páncreas, han hecho posible conseguir controles glucémicos prolongados. Uno de los objetivos principales de esta revisión es presentar la evolución de los resultados en humanos a medida que estos cambios han ido introduciéndose. Asimismo, se revisa el empleo de nuevas fuentes de islotes, como son el donante vivo y el donante a corazón parado, junto con los nuevos hallazgos en el conocimiento de los mecanismos de rechazo y las nuevas opciones terapéuticas desarrolladas para prevenirlo.

Para acceder al texto completo en PDF hacer click en título de este entry.

Manejo de Lesiones de Vena Mesenterica Superior

Superior Mesenteric Venous Injuries: To Ligate or to Repair Remains the Question.
Journal of Trauma-Injury Infection & Critical Care. 62(3):668-675, March 2007.
Asensio, Juan A. MD, FACS; Petrone, Patrizio MD; Garcia-Nunez, Luis MD; Healy, Matthew BS; Martin, Matthew MD; Kuncir, Eric MD, FACS

Background: Superior mesenteric vein injuries are rare and incur high mortality. Given their low incidence, little data exist delineating indications for when to institute primary repair versus ligation. The purposes of this study are to review our institutional experience, to determine the additive effect on mortality of associated vascular injuries, to correlate mortality with the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) for abdominal vascular injury and to examine and define the indications and outcomes for primary repair versus ligation.

Material: Retrospective 156 months study (January 1992 through December 2004) in a large Level I urban trauma center of all patients admitted with superior mesenteric vein injuries. Patients were stratified, according to surgical technique employed to deal with their injuries, into those undergoing primary repair versus ligation to determine outcomes and define the surgical indications of these methods. The main outcome measure was overall survival. Cases of survival were stratified according to surgical method: primary repair versus ligation.

Results: There were 51 patients with a mean Injury Severity Score of 25 +/- 12. Mechanism of injury was penetrating for 38 (76%), blunt for 13 (24%), and patients undergoing emergency department thoracotomy for 4 (8%). Surgical management was ligation for 30 (59%), primary repair for 16 (31%), and 5 (10%) patients were exsanguinated before repair. The overall survival rate was 24/50 (47%). The survival rate excluding patients undergoing emergency department thoracotomy was 51%. The survival rate excluding patients that sustained greater than 3 to 4 associated vessels injured was 65%. The survival rates of patients with superior mesenteric vein and superior mesenteric artery was 55% and superior mesenteric vein and portal vein (PV) was 40%. The survival rate of patients with isolated superior mesenteric vein injuries was 55%. Mortality stratified to AAST-OIS grade III, 44%; grade IV, 42%; and grade V, 42%. Survival rates stratified to method of management consisted of primary repair (60%) versus ligation (40%).

Conclusions: SMV injuries are highly lethal. Multiple associated vessel injuries increase mortality. Mortality correlates well with the American Association for the Surgery of Trauma-Organ Injury Scale for abdominal vascular injuries. Patients undergoing primary repair have higher survival rates (63%) and lesser numbers of associated vascular and nonvascular injuries; whereas those undergoing ligation have a smaller survival rate (40%) and higher number of associated vascular and nonvascular injuries. Ligation appears to be safe and should be selected for hemodynamically unstable patients with a large number of associated injuries.

Advertencia Respecto al Antibiótico LINEZOLID

La FDA emitió el 16 de marzo de este año un advertencia sobre el uso de Linezolid. Se ha publicado evidencia de aumento de mortalidad en pacientes tratados con este antibiótico en sepsis por cateter causado por bacterias gram negativas solas o combinadas con gram positivas.
Esta información esta disponible en www.fda.org.

A continuación pueden ver la advertencia publicada:

Zyvox (Linezolid)
Audience: Infectious disease specialists, other healthcare professionals[Posted 03/16/2007] FDA notified healthcare professionals of new emerging safety concerns about Zyvox (linezolid) from a recent clinical study. This open-label, randomized trial compared linezolid to vancomycin, oxacillin, or dicloxacillin in the treatment of seriously ill patients with intravascular catheter-related bloodstream infections including those with catheter-site infections. Patients treated with linezolid had a higher chance of death than did patients treated with any comparator antibiotic, and the chance of death was related to the type of organism causing the infection. Patients with Gram positive infections had no difference in mortality according to their antibiotic treatment. In contrast, mortality was higher in patients treated with linezolid who were infected with Gram negative organisms alone, with both Gram positive and Gram negative organisms, or who had no infection when they entered the study.

Linezolid is not approved for the treatment of catheter-related bloodstream infections, catheter-site infections, or for the treatment of infections caused by Gram negative bacteria. If infection with Gram negative bacteria is known or suspected, appropriate therapy should be started immediately

Nuevas Técnicas en el Tratamiento de la Pancreatitis Crónica

El número de abril de Contemporary Surgery tiene un resúmen sobre algunas técnicas quirúrgicas que se se pueden utilizar para el tratamiento de la pancreatitis crónica. El siguiente link permite el ingreso a la versión completa en PDF.

http://www.contemporarysurgery.com/pdf/6304/6304CS_Review.pdf

What’s new in treating chronic pancreatitisMartin A. Makary, MD, MPH; Dana K. Andersen, MD
Contemporary Surgery april 2007 vol 63 Nº4

Hybrid operations outperform traditional procedures.

Puestow procedure
Examining the evidence
Beger and Frey procedures