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BACKGROUND: Elevated preoperative lactate levels have been reported in patients admitted for resection of brain tumors. As histologic type and tumor grade have also been linked to lactate concentration, we hypothesized that preoperative lactate concentration in patients with brain tumors may be associated with tumor proliferation. We describe the relationship between preoperative plasma lactate levels, and the cell proliferation marker Ki-67 in brain tumor surgery. METHODS: In this cross-sectional study, records of patients who underwent craniotomy between June 2017 and February 2018 at our Hospital were reviewed to select glioma and meningioma cases in which lactate concentrations in plasma and degree of cell proliferation were registered. Bivariable and linear regression analyses were used to assess the association between lactate concentrations and the Ki-67 Index. RESULTS: Lactate concentrations in plasma and Ki-67 Index were available in 55 patients. Meningioma cases had a mean concentration of 1.2 (0.1) mmol/L compared to diffuse astrocytic and oligodendroglial tumors cases with 1.7 (0.1) mmol/L (P<0.01). Both variables had a low positive correlation in meningiomas (Spearman's r, 0.29; 95% CI, -0.10-0.61; P=0.13) and a high correlation in gliomas (Spearman's r, 0.64; 95% CI, 0.33-0.82; P<0.01). The pooled analysis showed a high correlation index (Spearman's r, 0.61; 95% CI, 0.40-0.76; P<0.01). A linear regression model showed that the Ki-67 Index explained 43% of the variation in lactate (P<0.01). CONCLUSIONS: Brain tumors with higher rates of cell proliferation have higher plasma lactate levels. In this scenario, lactate concentrations may not only reflect systemic perfusion.

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BACKGROUND: We aimed to assess the feasibility of using supraglottic devices as an alternative to orotracheal intubation for airway management during anesthesia for endovascular treatment of unruptured intracranial aneurisms in our department over a nine-year period. METHODS: Retrospective single center analysis of cases (2010-2018). Primary outcomes: airway management (supraglottic device repositioning, need for switch to orotracheal intubation, airway complications). SECONDARY OUTCOMES: aneurysm complexity, history of subarachnoid hemorrhage, hemodynamic monitoring, and perioperative complications. RESULTS: We included 187 patients in two groups: supraglottic device 130 (69.5%) and orotracheal intubation 57 (30.5%). No adverse incidents were recorded in 97% of the cases. Three supraglottic device patients required supraglottic device repositioning and 1 supraglottic device patient required orotracheal intubation due to inadequate ventilation. Three orotracheal intubation patients had a bronchospasm or laryngospasm during awakening. Forty-five patients (24.1%) had complex aneurysms or a history of subarachnoid hemorrhage. Thirty-three of them (73.3%) required orotracheal intubation compared to 24 of the 142 (16.9%) with non-complex aneurysms. Two patients in each group died during early postoperative recovery. Two in each group also had intraoperative bleeding. A post-hoc analysis showed that orotracheal intubation was used in 55 patients (44%) in 2010 through 2014 and 2 (3.2%) in 2015 through 2018, parallel to a trend toward less invasive blood pressure monitoring from the earlier to the later period from 34 (27.2%) cases to 5 (8.2%). CONCLUSION: Supraglottic device, like other less invasiveness protocols, can be considered a feasible alternative airway management approach in selected patients proposed for endovascular treatment of unruptured intracranial aneurisms.

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Asthma is a common cause of emergency care attendance in low- and middle-income countries (LMICs). While few prospective studies of predictors for emergency care attendance have been undertaken in high-income countries, none have been performed in a LMIC.We followed a cohort of 5-15-year-old children treated for asthma attacks in emergency rooms of public health facilities in Esmeraldas City, Ecuador. We collected blood and nasal wash samples, and performed spirometry and exhaled nitric oxide fraction measurements. We explored potential predictors for recurrence of severe asthma attacks requiring emergency care over 6 months' follow-up.We recruited 283 children of whom 264 (93%) were followed-up for ≥6 months or until their next asthma attack. Almost half (46%) had a subsequent severe asthma attack requiring emergency care. Predictors of recurrence in adjusted analyses were (adjusted OR, 95% CI) younger age (0.87, 0.79-0.96 per year), previous asthma diagnosis (2.2, 1.2-3.9), number of parenteral corticosteroid courses in previous year (1.3, 1.1-1.5), food triggers (2.0, 1.1-3.6) and eczema diagnosis (4.2, 1.02-17.6). A parsimonious Cox regression model included the first three predictors plus urban residence as a protective factor (adjusted hazard ratio 0.69, 95% CI 0.50-0.95). Laboratory and lung function tests did not predict recurrence.Factors independently associated with recurrent emergency attendance for asthma attacks were identified in a low-resource LMIC setting. This study suggests that a simple risk-assessment tool could potentially be created for emergency rooms in similar settings to identify higher-risk children on whom limited resources might be better focused.

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Resumen ANTECEDENTES El divertículo uretral es la formación de un saco entre la uretra y la vagina. El tratamiento, dependiente de los síntomas, puede ser conservador o quirúrgico. El primero consiste en la descompresión por aspiración, antibióticos profilácticos y dilatadores uretrales. Para el tratamiento quirúrgico existen diversas técnicas, su elección dependerá de la ubicación del divertículo. OBJETIVO Reportar el caso clínico de un padecimiento infrecuente y describir cómo se trató. CASO CLÍNICO Paciente de 59 años que acudió a consulta debido a una disuria severa de varios meses de evolución, asociada con aumento del volumen de la uretra distal, goteo postmiccional y dolor severo en la región vaginal. Se estableció el diagnóstico de divertículo uretral, se efectuó la escisión de la lesión y la evolución fue favorable. CONCLUSIONES El divertículo uretral es un diagnóstico poco frecuente y sospechado, por lo que debe haber un alto grado de sospecha en los cirujanos que intervienen esta área para evitar diagnósticos erróneos, reoperaciones innecesarias y complicaciones. Los tratamientos son variados según el tipo, lugar anatómico y síntomas de la lesión.

Abstract BACKGROUND The urethral diverticulum is the formation of a sac between the urethra and the vagina. The treatment, dependent on the symptoms, can be conservative or surgical. The first consists of aspiration decompression, prophylactic antibiotics and urethral dilators. For surgical treatment there are several techniques, their choice will depend on the location of the diverticulum. OBJECTIVE To report the clinical case of an infrequent condition that generates ignorance of the health professional to detect, treat and refer this type of patients. DESCRIBE The management of an uncommon case, reporting a favorable mediate and long-term postoperative evolution. CLINICAL CASE A 59-year-old patient attended the clinic due to a severe dysuria lasting several months, associated with an increase in the volume of the distal urethra, post-voiding drip, and severe pain in the vaginal region. Diagnosis of urethral diverticulum was made, and excision of the lesion was performed with favorable evolution. CONCLUSIONS The urethral diverticulum is a rare and suspected diagnosis, so there should be a high degree of suspicion in surgeons who address this area to avoid poor diagnosis, unnecessary reoperations and complications. The treatments are varied according to the type, anatomical location and symptomatology of the lesion.

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Introduction: Advances in imaging, computing and optics have encouraged the application of minimally invasive surgical approach to a variety of neurosurgical procedures. The advantages include accurate localization of lesions usually inaccessible to conventional surgery, less trauma to healthy brain, blood vessels and nerves, shorter operating time, reduced blood loss, and early recovery and discharge. Nevertheless minimally invasive neurosurgical (MIN) procedures still have potential intra-and post-operative complications that can cause morbidity and mortality. Objectives: The aim of this study was to review and analyze published literature describing experiences in the anesthetic management of the most commonly performed MIN procedures. Materials and methods: Neurosurgical and neuroanesthesia literature (1990-2013) was reviewed and description of anesthetic technique/management and perioperative morbidity/mortality was reported. We also compared the different authors' experience with MIN procedures. Results: The neurosurgical literature dealing with MIN has expanded, but there are few references in relation to anesthetic management. Anesthesia goals remain the same: careful pre-operative assessment and planning, and meticulous cerebral hemodynamic control to ensure adequate cerebral perfusion pressure. The degree of postoperative care depends on local practice, patient factors and postoperative brain imaging.

Introducción: Los avances en la formación de imágenes, la computación y la óptica han alentado la aplicación del enfoque quirúrgico mínimamente invasivo a una variedad de procedimientos neuroquirúrgicos. Las ventajas incluyen la localización exacta de las lesiones generalmente inaccesibles a la cirugía convencional, menos trauma al cerebro sano, vasos sanguíneos y nervios, más corto el tiempo de funcionamiento, la reducción de la pérdida de sangre, la recuperación temprana y el alta. Sin embargo los procedimientos neuroquirúrgicos mínimamente invasivos (NMI) todavía tienen potencial complicaciones intra y post-operatorias que pueden causar morbilidad y mortalidad. Objetivos: El objetivo de este estudio fue revisar y analizar la literatura publicada que describe las experiencias en el manejo anestésico de los procedimientos más comúnmente realizados en NMI. Materiales y métodos: Literatura sobre neurocirugía y neuroanestesia (1990-2013). Revisión y descripción de la técnica anestésica/gestión y morbilidad perioperatoria/mortalidad notificada. Comparación de la experiencia de los diferentes autores en procedimientos de NMI. Resultados: La literatura sobre NMI se ha expandido, pero hay pocas referencias en relación con el manejo anestésico. Las metas anestésicas siguen siendo las mismas: la evaluación preoperatoria cuidadosa y la planificación, el meticuloso control de hemodinámica cerebral para asegurar la presión de perfusión cerebral adecuada. El grado de cuidado postoperatorio depende de la práctica local, factores del paciente y de imagen cerebral postoperatoria.

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AIM: The objective of this study was to evaluate the frequency of periodontopathic and other subgingival anaerobic and facultative bacteria in the bloodstream following scaling and root planing (SRP). MATERIAL AND METHODS: Forty-two patients with severe generalized chronic periodontitis (GChP) and generalized aggressive periodontitis (GAgP) were included in the study. Four samples of peripheric blood were drawn from the cubital vein at different times: Pre-treatment: immediately before the SRP procedure (T1), immediately after treatment (T2), 15 min. post-treatment (T3) and 30 min. post-treatment (T4). In order to identify the presence of microorganisms in blood, subcultures were conducted under anaerobic conditions. RESULTS: 80.9% of the patients presented positive cultures after SRP and it occurred more frequently immediately after treatment; however, 19% of the patients still had microorganisms in the bloodstream 30 min. after the procedure. The periodontopathic microorganisms more frequently identified were Porphyromonas gingivalis and Micromonas micros. Campylobacter spp., Eikenella corrodens, Tannerella forsythensis, Fusobacterium spp. and Prevotella intermedia were isolated less often. Actinomyces spp. were also found frequently during bacteraemia after SRP. CONCLUSIONS: SRP induced bacteraemia associated with anaerobic bacteria, especially in patients with periodontal disease.

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