{"id":3146,"date":"2008-06-28T03:59:28","date_gmt":"2008-06-28T07:59:28","guid":{"rendered":"http:\/\/piel-l.org\/blog\/?p=3146"},"modified":"2008-06-28T03:59:28","modified_gmt":"2008-06-28T07:59:28","slug":"articulos-cientificos-201","status":"publish","type":"post","link":"https:\/\/piel-l.org\/blog\/3146","title":{"rendered":"Art\u00edculos cient\u00edficos 201"},"content":{"rendered":"

LA ANESTESIA LOCAL COMBINADA CON EPINEFRINA EN DEDOS Y MANOS ES SEGURA<\/strong>
Estudio multic\u00e9ntrico con 3 110 casos
Low-dose paclitaxel effective for aggressive classic Kaposi's sarcoma<\/strong>
13 June 2008
Br J Dermatol 2008; 158: 1339-1344<\/p>\n

<\/p>\n

LA ANESTESIA LOCAL COMBINADA CON EPINEFRINA EN DEDOS Y MANOS ES SEGURA<\/strong>
Estudio multic\u00e9ntrico con 3 110 casos<\/p>\n

Saint John, Canad\u00e1:
La incidencia de isquemia digital debido al bloqueo por la anestesia asociada con epinefrina en dedos y manos es extremadamente baja, lo que posibilita la realizaci\u00f3n de cirug\u00edas complejas sin necesidad del uso de torniquetes o anestesia general.<\/p>\n

[Journal of Hand Surgery 30(5):1061-1067 Sep, 2005] – aSNC <\/p>\n

En la pr\u00e1ctica cotidiana existe la percepci\u00f3n, muy arraigada por cierto, de que las infiltraciones con epinefrina est\u00e1n contraindicadas en dedos debido a la posibilidad de que la vasoconstricci\u00f3n que provoca tenga como desenlace la isquemia digital. Para los autores de esta investigaci\u00f3n sin embargo, la incidencia de infarto en dedos por inyecciones de lidoca\u00edna asociada con dosis bajas de epinefrina, es extremadamente baja, en especial si el cirujano se halla familiarizado con el rescate con fentolamina. Adicionalmente presenta la ventaja de prescindir de torniquetes o anestesia general para realizar cirug\u00edas complejas de los dedos.Llegan a esta conclusi\u00f3n por los resultados observados en 3 110 casos de cirug\u00edas de mano y dedos efectuadas por 9 cirujanos en 6 ciudades de Norteam\u00e9rica. Los cirujanos inyectaron electivamente en 1 340 dedos y 1 770 manos que requer\u00edan tratamiento quir\u00fargico, bupivaca\u00edna o lidoca\u00edna con una concentraci\u00f3n de 1 en 100 000 o menos de epinefrina. Por cierto, todos estaban preparados para utilizar fentolamina de surgir complicaciones, tal cual lo suger\u00edan investigaciones anteriores.Las causas de cirug\u00eda en dedos incluyeron 428 dedos en gatillo, 203 enfermedades de Dupuytren, 100 amputaciones y 99 reparaciones de tendones flexores, entre otros. Por su parte, las cirug\u00edas de mano se debieron principalmente a s\u00edndrome de t\u00fanel carpiano, fracturas metacarpianas y gangliones. Afortunadamente, en ning\u00fan caso se constataron signos de isquemia digital y no hubo necesidad de utilizar el m\u00e9todo de rescate.En cuanto a la t\u00e9cnica, la mayor\u00eda de los autores emplearon el bloqueo del paquete v\u00e1sculo nervioso por abordaje dorsal, mientras que algunos de estos, reforzaron la anestesia con infiltraciones de la regi\u00f3n subcut\u00e1nea palmar. Las dosis de anestesia fueron concordantes con aquellas sin epinefrina utilizadas habitualmente. En esencia, los autores demostraron que las infiltraciones de anestesia con epinefrina son posibles en dedos y manos bien vascularizadas, de tal modo que contradicen la creencia arraigada sobre el riesgo de isquemia digital que provoca este procedimiento. No obstante, se avienen a aclarar que no est\u00e1n propiciando el empleo indiscriminado de inyecciones de anestesia asociada con bajas dosis de epinefrina. En ese sentido, aunque las contraindicaciones no est\u00e1n a\u00fan establecidas, no recomiendan su utilizaci\u00f3n en pacientes con antecedentes de insuficiencia vascular, enfermedad de Buerger o con cirug\u00edas previas de reimplante digital. Tomado de InSIIC<\/p>\n

——————————————————————<\/p>\n

Low-dose paclitaxel effective for aggressive classic Kaposi's sarcoma<\/strong><\/p>\n

13 June 2008<\/p>\n

Br J Dermatol 2008; 158: 1339-1344<\/p>\n

MedWire News: Low-dose paclitaxel is effective and well tolerated in patients with aggressive, refractory classic Kaposi's sarcoma (cKS), study findings suggest.<\/p>\n

"Paclitaxel has proved to be highly effective in the treatment of severe AIDS-related KS, for which it is now considered as a second-line monotherapy," explain Monica Bellinvia (University of Milan, Italy) and colleagues.<\/p>\n

They evaluated the efficacy and tolerability of intravenous paclitaxel 100 mg weekly in 17 patients with advanced aggressive and refractory cKS. Response to treatment was evaluated after 12 weeks.<\/p>\n

Patients had long-lasting disease, with a mean duration of 10.9 years, and had previously received between one and eight chemotherapy regimens. The patients' stage of disease ranged from IIIBc to IVBcv, their mean age was 71.4 years, and all but one patient was male.<\/p>\n

In all, 14 of 17 patients achieved a partial (n=11) or complete (n=3) response after 12 cycles of paclitaxel. Treatment was discontinued in two patients because of a systemic allergic reaction after the second infusion, while another patient experienced disease progression despite initial improvement.<\/p>\n

Of the 14 responders at week 12, the three patients who achieved complete response discontinued therapy and the remaining 11 patients continued maintenance treatment with paclitaxel once every 2 weeks for an average of eight further cycles. Of these patients, seven went on to achieve complete response and four remained partial responders.<\/p>\n

Ten of the 14 responding patients relapsed, with a mean time to recurrence of 7.35 months from the 12th cycle and 4.50 months from the end of maintenance therapy.<\/p>\n

The researchers note that recurrence was mild and responsive to local treatment in four of the 10 patients who relapsed. The remaining six patients received further treatment with paclitaxel and five achieved an intermediate or good response.<\/p>\n

"Despite the usual although often milder recurrence, the therapy was very successful in slowing down disease progression in elderly patients with chronic disease where no other therapy proved to be effective, thus often permitting an easier management using local treatment," note Bellinvia and team.<\/p>\n

"In our experience, low-dose paclitaxel proved to be a useful drug, with low toxicity, that was extremely active in elderly patients affected by advanced and heavily pretreated cKS."<\/p>\n

Writing in the British Journal of Dermatology, the researchers conclude: "Considering the rapidity to induce response and the efficacy of paclitaxel used as third, fourth, or more line of therapy, in our opinion this drug should be assessed as second-line therapy for advanced and complicated cKS in controlled prospective clinical trials, just as was done in advanced HIV-associated KS." <\/p>\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

LA ANESTESIA LOCAL COMBINADA CON EPINEFRINA EN DEDOS Y MANOS ES SEGURA Estudio multic\u00e9ntrico con 3 110 casos Low-dose paclitaxel effective for aggressive classic Kaposi's sarcoma 13 June 2008 Br J Dermatol 2008; 158: 1339-1344<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8],"tags":[106],"class_list":["post-3146","post","type-post","status-publish","format-standard","","category-articulos-cientificos","tag-anestesia"],"_links":{"self":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/3146","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/users\/16"}],"replies":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/comments?post=3146"}],"version-history":[{"count":0,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/3146\/revisions"}],"wp:attachment":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media?parent=3146"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/categories?post=3146"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/tags?post=3146"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}