S0001-600220020003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022002000300001 Colecistectomía laparoscópica Salazar-Vargas Carlos ,CCSS Hospital Calderón Guardia 09 2002 2002 44 103 104
S0001-600220020003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022002000300002 La sedación con la técnica de la triple sinergia: un método seguro en manos experimentadas y con normas claras Abed Raduan Mohammad Hasan ,Universidad de Costa Rica 09 2002 2002 44 105 106
S0001-600220020003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022002000300003 Malaria: una actualización Castro-Sancho José Ignacio Munguía-Ramírez María del Rocio Ávila-Agüero María Luisa ,CCSS Hospital Nacional de Niños ,Intituto Nacional de Seguros 09 2002 2002 44 107 112 Diagnóstico Prevención Plasmodium falciparum Plasmodium vivax Plasmodiun ovale Tratamiento Resistencia medicamentosa Nuevos antimaláricos Protocolos de vigilancia epidemiológica Protocolos de vigilancia epidemiológica 1998 San José Yang H M Malaria transmission model for different levels of acquired immunity and temperature-dependent parameters (vector) Rev Saúde Pública 2000 34 Chandar V Mehta S R Sharma P D Sarkar P K Falciparum malaria Indian J Pediatr 1989 56 Croft A Malaria: prevention in travellers BJM 2000 321 WHO Expert Committee on Malaria: twentieth report WHO Expert Committee on Malaria: twentieth report 2000 World Health Organ Flessa S Decision support for malaria-control programmes: a system dynamics model Health Care Manag Sci 1999 2 Wickramasinghe S N Abdalla S H Blood and bone marrow changes in malaria Bailliere’s Clinical Haematology 2000 13 Sharma A Mishra N C. Inhibition of a protein tyrosine kinase activity in P. falciparum by chloroquine Indian J Biochem Biophys 1999 36 Malaria: waiver by Uganda of taxes and tariffs on insecticide-treated nets Wkly Epidemiol Rec 2000 75 Graves P Gelband H Vaccines for preventing malaria review Cochrane Database Syst Rev 2000 World malaria situation in 1994 Wkly Epidemiol Rec 1997 69 Plebanski M Hill AV S The immunology of malaria infection Curr Opin Immunol 2000 12 Nosten F van Vugt M Price R Luxemburger C Thway K L Brockman A Effects of artesunate-mefloquine combination on incidence of P. falciparum malaria and mefloquine resistance in western Thailand: a prospective study Lancet 2000 356 Baird J K Resurgent malaria at the millenium: control strategies in crisis Drugs 2000 59 Hastings I M D’Alessandro U Modelling a predictable disaster: the rise and spread of drug-resistance malaria Parasitology Today 2000 16 Kulkarni A V Kasturi L Amin A Mashankar V Therapy and drug resistance in malaria Indian J Pediatr 2000 67 Normas Técnicas para el Control de la Malaria Normas Técnicas para el Control de la Malaria 1997 San José Memoria Anual 99: País sano con un sistema de salud avanzado Memoria Anual 99: País sano con un sistema de salud avanzado 1999 San José Krudsood S Wilairatana P Mason D P Treeprasertsuk S Singhasivanon P Looareesuwan S Hidden P falciparum infections Southeast Asian J of Trop Med Public Health 1999 30 Cahill J D Malaria with a positive "monospot" test J R Soc Med 2000 93 Agarwal V K Agarwal S Pathak T Splenic infarct in falciparum malaria Indian Pediatr 1997 34 Krogstad D J Cecil Malaria Tratado de medicina interna Tratado de medicina interna 1994 Interamericana-McGraw Hill Gbadoé A D À propos des céphalées dans le paludisme Arch Pediatr 2000 7 Warrell D A Looareesuwan S Warrell M J Kasemsarn P Intaraprasert R Bunnag D Dexamethasone proves deleterious in cerebral malaria. A double-blind trial in 100 comatose patients N Eng J Med 1982 306 Looareesuwan S Warrell D A White N J Sutharasamai P Chanthavanich P Sundaravej K Do patients with cerebral malaria have cerebral oedema? A computed tomography study Lancet 1983 1 Philips R E Warrell D A White N J Looareesuwan S Karbwang J Intravenous quinidina for the treatment of severe falciparum malaria. Clinical and pharmacokinetic studies N Eng J Med 1985 12 White N J Looareesuwan S Warrell D A Warrell M J Bunnag D Harinasuta T Quinine pharmacokinetics and toxicity in cerebral and uncomplicated falciparum malaria Am J Med 1982 73 Valecha N Srivastava A Sharma V P Rational approach to the treatment of malaria Natl Med J India 1994 7 Warrell D A Cerebral malaria: clinical features, pathophysiology and treatment Ann Trop Med Parasitol 1997 91 Duffy P E Fried M Malaria during pregnancy: parasites, antibodies and chondroitin sulphate A Biochem Soc Trans 1999 27 McKenzie F E Bossert W H Mixed-species Plasmodium infections of humans Am J Trop Med Hyg 1999 61 Vythilingam I Nitiavathy K Yi P Hugo B Singh B Wirtz R A A Highly sensitive, nested polymerase chain reaction based method using simple DNA extraction to detect malaria sporozoites in mosquitos Southeast Asian J Trop Med Public Health 1999 30 Delves C J Goman M Ridley R G Identification of Plasmodium falciparum infected mosquitos using a probe containing repetitive DNA Mol Biochem Parasitol 1989 32 Zabala F Gwards R W Collins F H Nussenzweig R S Nussenzweig V Monoclonal antibodies to circumsporozoite proteins identify the species of malaria parasite in infected mosquitos Nature 1982 299 Burkot T R Williams J L Schneider I Identification of Plasmodium falciparum infected mosquitos by a double antibody enzyme-linked immunosorbent assay Am J Trop Med Hyg 1984 33 Beier J C Perkin PV Wirtz RA Whirtmire RE Magumbi M Hochmeyer M Field W T Evaluation of an enzymes linked immunosorbent assay (ELISA) for Plasmodium falciparum detection in anopheline mosquitos from Kenya Am J Trop Med Hyg 1987 17 Stephens J K Phanart K Rooney W Barnish G A comparison of three malaria diagnostic tests, under field conditions in northwest Thailand Southeast Asian J Trop Med Public Health 1999 30 Manson-Bahr P Bell D R Manson's Tropical Diseases Manson's Tropical Diseases 1987 19 th McIntosh H M Olliaro P Artemisinin derivates for treating severe malaria Cochrane Database Syst Rev 2000 McIntosh H M Olliaro P Artemisinin derivates for treating uncomplicated malaria Cochrane Database Syst Rev 2000 McIntosh H M Chloroquine or amodiaquine combined with sulfadoxina-pyrimethamine for treating uncomplicated malaria Cochrane Database Syst Rev 2000 Lacy CF Armstrong L L Goldman M P Lance LL Drug Information Handbook: Pocket 1999-2000 Drug Information Handbook: Pocket 1999-2000 1999 Lexi-Comp, Inc Nosten F Luxemburger C ter Kuile F Treatment of multidrug-resistance Plasmodium falciparum malaria with 3-day artesunate-mefloquine combination J Infect Dis 1994 170 Wernsdorfer W H Epidemiology of drug resistance in malaria Acta Tropica 1994 56 Pinn G Malaria treatment in Queensland Med J Aust 2000 172 White N J Drug resistance in malaria Br Med Bull 1998 54 Hien T White N J Qinghaosu Lancet 1993 341 Brewer T G Peggins J O Grate S J Petras J M Levine B S Weina P J Neurotoxicity in animals due to arteether and artemether Trans R Soc Trop Med Hyg 1994 88 Wongsrichanalai C Thimasarn K Sirichaisinthop J Antimalarial drug combination policy: a caveat Lancet 2000 355 White N J Nosten F Looareesuwan S Averting a malaria disaster Lancet 1999 353 Prasad K Garner P Steroids for treating cerebral malaria Cochrane Database Syst Rev 2000 Snow R W Craig M Deichmann U Marsh K Estimating mortality, morbidity and disability due to malaria among Africa’s non-pregnant population Bull World Health Organ 1999 77 van Vugt M White N J The treatment of chloroquine-resistant malaria Trop Doct 1999 29 Croft A M J Garner P Mefloquine for preventing malaria in non-immune adult travelers Cochrane Database Syst Rev 2000 Coates C J A mosquito transformed Nature 2000 405 Birmingham K Industry outlines its perspective on new third-world vaccine development Nat Med 2000 6 Dame J B Williams J L McCutchan T F Weber J L Wirtz R A Hockmeyer W T Structure of the gene encoding the immunodominant surface antigen on the sporozoite of the human malaria parasite Plasmodium falciparum Science 1984 225 Enea V Arnot D Schmidt E C Cochrane A Gwadz R Nussenzweig R S Circumsporozoite gene of Plasmodium cynomolgi: cDNA cloning and expression of the repetitive circumsporozoite epitope Proc Natl Acad Sci 1984 81 Robson K J May J R Jennings M W Harris T H Marsh K Newbold C I A highly conserved amino-acid sequence in thrombospondin, properdin, and in proteins from sporozoites and blood stages of a human malaria parasite Nature 1988 335 Fidock D A Sallenave-Sales S Sherwood J A Gachihi G S De Fatima Ferreira-Da-Cruz M Thomas A W Conservation of the Plasmodium falciparum sporozoite surface protein gene, STARP, in field isolates and distinct species of Plasmodium Mol Biochem Parasitol 1994 67 Ménard R The journey of the malaria sporozoite through its host: two parasite proteins lead the way Microbes Infec 2000 2 Lengeler C Insecticide treated bednets and curtains for preventing malaria Cochrane Database Syst Rev 2000 Roberts D R Manguin S Mouchet J DDT house spraying and re-emerging malaria Lancet 2000 356
S0001-600220020003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022002000300004 Colecistectomía abierta versus laparoscópica: experiencia en el Hospital San Juan de Dios Zúñiga-Vargas Juan José Vargas-Carranza Julia ,CCSS Hospital San Juan de Dios San José Costa Rica 09 2002 2002 44 113 116

La cirugía laparoscópica es una técnica mínimamente invasiva de uso cotidiano en el ámbito mundial. Desde hace quince años, la colecistectomía laparoscópica es un procedimiento seguro y muy valioso a disposición del cirujano. Este estudio tiene como fin comparar los resultados de la colecistectomía laparoscópica en el Hospital San Juan de Dios con la técnica de la colecistectomía abierta ó tradicional. Métodos: Se realizó un estudio retrospectivo de todos los pacientes colecistectomizados desde julio de 1996 a junio de 1999, en el Hospital San Juan de Dios en Costa Rica. Al comparar las dos técnicas quirúrgicas (clásica y laparoscópica), se consideró la evolución posoperatoria y las posibles complicaciones que aparecen posteriores al acto quirúrgico. Además se buscaron las contraindicaciones que dicha técnica pudiese tener. Resultados : Fueron revisados un total de 3193 pacientes colecistectomizados, de los cuales 476 fueron operados por laparoscopia. Se tuvo en éstas menos complicaciones posquirúrgicas y menor estancia posoperatoria que en las colecistectomías abiertas. También se notó una disminución paulatina del tiempo quirúrgico en los actos por laparoscopia. Conclusión: Se comprueban las ventajas de la cirugía invasiva mínima y se documenta que este tipo de abordaje es más seguro y beneficioso para el paciente y para el médico mismo.

Justification: Today, laparoscopic surgery as a least invasive technique is widely used in the world. Laparoscopic cholecystectomy is a valuable and safe technique and is has been available to the general surgeon for the last 15 years. In Costa Rica it has become a pretty common procedure with great results but they have not been well studied and documented. This study aims to expose part of the work that takes place at the Hospital San Juan de Dios with laparoscopic cholecystectomy and highlights the results in contrast with those of traditional cholecystectomy. Methodology: Aretrospective study was conducted of all the cholecystectomies performed at the Hospital San Juan de Dios in Costa Rica from July 1996 to June 1999. A comparative analysis between the classic and the laparoscopic approach was completed considering post-operative evolution and postoperative complications. Results: A total of 3193 cholecystectomies, were reviewed, 476 were laparoscopic cholecystectomies, they had less post-operative complications and less post-operative recovery time as opposed to the open cholecystectomies. The study showed further a progressive diminution of the operative time in the laparoscopic group. Conclusions : Laparoscopic cholecystectomy is a safe procedure and it carries several advantages both for thepatient and the surgeon.

 colecistectomía abierta colecistectomía laparoscópica abordaje quirúrgico colelitiasis colédoco litiasis contraindicaciones complicaciones tiempo quirúrgico pre y pos-operatorio síndrome Mirizzi Asbun H Rossi R Techniques of Laparoscopic Cholecystectomy: The Difficult Operation Surg. Clin. N. A 1994 74 Lujan J Parrilla P Robles R Marin P Torralba J Garcia-Ayllon J Laparoscopic Cholecystectomy vs. Open Cholecystectomy in the treatment of Acute Cholecystitis Arch. Surg 1998 133 Horvath K Strategies for the Prevention of Laparoscopic Common Bile Duct Injuries Surg. Endosc 1993 7 Deziel D Complications of Cholecystectomy Surg. Clin. N. A. 1994 74 Baev S Pzarliev Todorov G Laparoscopic Cholecystectomy: 700 Consecutive Cases Int. Surg 1995 80 Dadidoff A Pappas T Mechanisms of Mayor Biliary Injury during Laparoscopic Cholecystectomy Ann. of Surg 1992 215 Asbun H Rossi R Bile Duct Injury during Laparoscopic Cholecystectomy, Mechanism of Injury, Prevention and Management World J. Surg 1993 17 Kuster G Domagk D Laparoscopic Cholecystectomy with delayed Cholecystectomy as an alternative to convert to open procedure Surg. Endosc 1996 10 Martin R Rossi R Spectrum, Mechanisms of Injury and their Prevention Surg.Clin.N.A 1994 74 Branum G Schamitt C Baillie j Management of Major Biliary Complications after Laparoscopic Cholecystectomy Ann. of Surg 1993 217 Gerhard R Jatzko Lisborg P Perti A Stettner H Multivariate Comparison of Complications after Laparoscopic Cholecystectomy and Open Cholecystectomy Ann. of Surg 1995 211 Horvath K Strategies for the Prevention of Laparoscopic Common Bile Duct Injuries Surg. Endosc 1993 7 Morgenstern L Berci G Pasternak E Bile Leakage after Cholecystectomy: a Laparoscopic Perspective Surg. Endosc 1993 7 Rossi Laparoscopic Bile Duct Injuries. Risk Factors, Recognition and repair Arch. Surg 1992 127 Sandberg A Aliender G Accidental Lesion of the common Bile Duct at Cholecystectomy: Pre and Perioperative Factor of Importance Ann. Surg 1985 201 Cuschieri A Cirugía Biliar Laparoscópica Cirugía Biliar Laparoscópica 1994 Segunda edición Blackwell Scientific Publications Cuschieri A The European Experience with Laparoscopic Cholecystectomy Am. J. Surg 1991 161
S0001-600220020003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022002000300005 Diagnóstico tardío de displasia evolutiva de cadera en la población infantil costarricense en el periodo 1996-2000 Monge-Bonilla Cecilia Sánchez-Ramírez Adriana Morales-Alpízar Catalina Serrano-Aybar Pablo López-Ruiz Róger ,CCSS Hospital Nacional de Niños Servicio de Ortopedia San José Costa Rica 09 2002 2002 44 117 120

En este proyecto se plantea un problema de repercusión en la salud pública: el diagnóstico tardío de la DEC. El objetivo general del estudio es determinar los casos de DEC diagnosticados tardadamente en el periodo establecido, que fueron internados en el HNN, con el fin de concienciar a la comunidad médica sobre la magnitud del problema, sus complicaciones potencialmente irreversibles y enfatizar la importancia de la detección temprana. Métodos: Este es un estudio retrospectivo que analiza expedientes médicos de pacientes internados con el diagnóstico de DEC en el HNN, de 1996 a 2000. La muestra fue escogida de manera aleatoria. Los datos se organizaron en un instrumento de recolección y se analizaron de acuerdo con tasas, promedios, porcentajes y relaciones entre ellos. Resultados: La mayor incidencia de casos de DEC se da en San José, seguida por Cartago y en tercer lugar, Heredia. La mayoría de los pacientes fueron diagnosticados en el periodo comprendido entre el primero y los cinco años. La edad promedio de la muestra fue de 3 años y 4 meses, con una desviación estándar de 4.99. Se encontró que el 82% de los pacientes fueron del sexo femenino y el 18% del masculino. El tipo de luxación más frecuente fue la izquierda, en un 55.2% de los casos; la luxación derecha correspondió a un 24.8%, y la bilateral a un 20.0%. La relación entre izquierda y derecha fue de 2.2:1. Al nacer, presentación fetal más frecuente fue la cefálica, en un 62.9% de los pacientes. La presentación pélvica representó, un 26.7% y en un 10.5% de los afectados, no se indicó. En cuanto al tipo de parto, un 80% fue vaginal y un 19% por cesárea, en un 7%, no se indica. El porcentaje de niños nacidos de término fue de un 67.6% Conclusiones: Dentro de la población de estudio, la mayor parte de los pacientes fueron diagnosticados después del año, cuando el defecto se hizo evidente por el inicio de la bipedestación. De toda la población de estudio, el 98.5% fue sometida a algún tipo de tratamiento quirúrgico. La intervención quirúrgica, además de representar un alto costo institucional, constituye un trauma para el paciente, los resultados no siempre son óptimos y las complicaciones son diversas.

Late diagnosis of DDH is an important public health issue, the purpose of this project is to make the medical community aware of the problem and to emphasize on early detection. The aim is to analyze the cases of DDH with delayed diagnosis, seem at the National Children’s Hospital in San José, Costa Rica.This is a retrospective study that analyzes medical charts of patients with DDH whose diagnosis were reached late and that were hospitalized at the National Children’s Hospital between the years of 1996 and 2000. The sample was randomized. The information was organized in a data base designed for this purpose. The information was presented and analyzed by percentages, mean, standard deviation and the relationships between them. The great majority of cases of DDH were found in San José, followed by Cartago and in third place Heredia. Most of the patients were diagnosed between their first and fifth year of age. The mean age of diagnosis was 3 years and 4 months with a standard deviation of 4.99. From the total population, 82% of patients were female and 18% male. The most frequent type of dislocation site was left in 52% of the cases, right was found in 24.8% and bilateral in 20%. The ratio between left and right dislocation was 2.2:1. The most frequent presentation at birth was cephalic in 62.9% of the patients, 26.7% were pelvic and it was not indicated in 10.5% of cases. Concerning the type of birth, 80% were vaginal and 19% by cesarean section, 7% of the charts did not have this information. The percentage of children born at term was 67.6% The great majority of patients in this study were diagnosed after one year of age, when the defect became evident while walking. Of the total population, 98.5% had to be submitted to some kind of surgical treatment. Surgical intervention represents high costs for the institution, traumatic to the patient and the results are frequently not optimal with many possible complications.

 Displasia evolutiva cadera diagnóstico Behrman M Kliegman Developmental dysplasia of the hip Developmental dysplasia of the hip 1994 W.B. Saunders Dysplasia of the Hip. Early Detection of Developmental Dysplasia of de Hip Pediatrics 2000 105 French L Dietz F Screening for Developmental Dysplasia of the Hip American Academy of family physicians 1999 1 Malformaciones Congénitas en Costa Rica, 1999 Malformaciones Congénitas en Costa Rica, 1999 2000 San José Prerregistro de Malformaciones Congénitas en Costa Rica, 2000 Prerregistro de Malformaciones Congénitas en Costa Rica, 2000 2001 San José Lehmann H Hinton R Morelo P Santoni J Developmental Dysplasia of the Hip Practice Guideline: Technical Report Pediatrics 2000 105 Lewis K Jones D Powel N Ultrasound and Neonatal Hip Screening: The Five-Year Results of a Prospective Study in High Risk Babies J Pediatr Orthop 1999 19 Ramírez L Luxación congénita de cadera de diagnóstico tardío, distribución regional en Costa Rica, 1986 a 1990 Luxación congénita de cadera de diagnóstico tardío, distribución regional en Costa Rica, 1986 a 1990 1992 Salter A Lange M Luxación y subluxación de la cadera Trastornos y lesiones del sistema musculoesquelético Trastornos y lesiones del sistema musculoesquelético 1969 Barcelona Editorial Jims Scott S AAP Develops Guidelines for Early Detection of Dislocated Hips Practice Guidelines 2001 1 Tachdjian M Ortopedia Pediátrica Ortopedia Pediátrica 1994 322 Buenos Aires Editorial Interamericana
S0001-600220020003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022002000300006 Triple sinergia: un método eficaz de sedoanalgesia para colonoscopías Jiménez-Trejos Gerardo Con-Chin Gil Reynaldo Con-Chin Vicky ,Centro Médico Internacional 09 2002 2002 44 121 125

Con el desarrollo de las nuevas tecnologías en el campo de diagnóstico, tanto radiológico como endoscópico, apareció un nuevo tipo de paciente, el cual se volvió un reto para el anestesiólogo, ya que por ser sometido a procedimientos invasivos y poco dolorosos, permitía el avance en las técnicas de sedación. Objetivos: A) Comprobar la eficacia del método de sedación con triple sinergia. B) Determinar el número de bolos de propofol necesarios para realizar el procedimiento. C) Evaluar las complicaciones asociadas a la técnica de sedación hipnótica. Materiales y método: Se estudió en forma prospectiva una muestra consecutiva de 1500 pacientes entre los años 1998 y 2000, de edades mayores de los 18 años, que fueron sometidos a colonoscopía, en el Centro Endoscópico Internacional, San José, Costa Rica. Se aplicó la sedación hipnótica con la técnica de la triple sinergia (midazolam/fentanil/propofol). Resultados: De los 1500 pacientes, un 57,8% fueron hombres y un 42,4%, mujeres. La mayoría fueron de la categoría ASA II (n = 725). Un total de 208 pacientes (13,8%) presentaron desaturación. La técnica de sedación fue placentera en el 94% de los pacientes. Un 1% presentó náusea y vómito. El 98% de los pacientes tuvieron amnesia del procedimiento. Solo el 2% de los casos sintió dolor. Conclusiones: La sedación hipnótica con la técnica de la triple sinergia es un método efectivo y seguro, tanto para el endoscopista como para el paciente. El costo es mínimo y la incidencia de efectos secundarios es baja. Todo lo anterior reduce de manera sensible el tiempo del procedimiento y la estancia del paciente. Dado a que la desaturación es un efecto relativamente frecuente, recomendamos colocar a todos los pacientes una cánula nasal con oxígeno profiláctico y monitorizarlos con pulsoximetría y electrocardiográficamente, en especial los casos de la categoría ASA III.

Justification: With the development of the new technology in the radiological as well as in the endoscopic diagnosis field, a new type of patient has emerged and has become a challenge for the anesthesiologist. Endoscopic procedures are invasive, fast, and a little painful. This has made advances in sedation techniques very necessary. Objectives: The general objective of this study was to demonstrate that hypnotic sedation with the so called triple synergy (midazolam/fentanyl/propofol) is an effective, safe and efficient method for carrying out colosnoscopies. The specific objectives were: a) to determine the number of propofol boluses necessary to perform the procedure and b) to evaluate the complications associated with to the hypnotic sedation technique. Materials and methods: A consecutive cohort of 1500 patients, older than18 years of age that underwent colonoscopy at the Centro Endoscópico Internacional, San José, Costa Rica, was prospectively studied between 1998 and 2000. Hypnotic sedation with the technique of the triple synergy was applied (midazolam/fentanyl/propofol). Results: 57.8% were men and 42.4% were women. Most of the patients were ASA II (n = 725) category. A total of 208 patients (13.8%) who presented desaturation, were easily handled with the cervical hyperextension and supplementary oxygen. The sedation technique was pleasant for 94% of the patients. One percent presented nausea and vomiting. Ninety eight percent has amnesia of the procedure. Only 2% felt pain. Conclusions: Hypnotic sedation with the triple synergy technique is an effective and safe method to satisfy the needs of the endoscopist and the patient’s comfort during the colonoscopies. The cost is minimal and the side effects are relatively few. All this reduces the length of the procedure and the patients’ stay. Since desaturation is a relatively frequent effect, we recommend to use prophylactic oxygen with a nasal cannula to every patient and to monitor them with pulseoximeter and electrocardiograply, especially in those of the ASA III category.

 Sedación hipnótica triple sinergia colonoscopía Faymonville ME Mambourg PH Joris J Vrijens B Fissette J Albert A Lamy M Psychological approaches during conscious sedation: hypnosis versus stress reducing strategies - a prospective randomized study Pain 1997 73 Bell GD Charlton JE Colonoscopy: is sedation necessary and is there any role for intravenous propofol? Endoscopy 2000 32 Early DS Saifuddin T Johnson JC King PD Marshall JB Patient attitudes toward undergoing colonoscopy without sedation Am J Gastroenterol 1999 94 López-Andrade A Prieto-Cuéllar M García-Sánchez MJ Martín-Ruiz JL Sedación de pacientes en las técnicas dolorosas diagnósticas y terapéuticas: supuestos clínicos Rev Soc Esp Dolor 2001 8 Charlotte H Christensen M Effect of oxygen on tachycardia and arterial oxygen saturation during colonoscopy Eur J Surg 1999 165 Gilbertson LI Conscious sedation Internat Anesthesiology Clin 1999 37 Koshy G Nair S Norkus EP Hertan HI Pitchumoni CS Propofol versus midazolam and meperidine for conscious sedation in GI endoscopy Am J Gastroenterol 2000 95 Tzabar Y Brydon C Gillies GW Induction of anesthesia with midazolam and a target-controlled propofol infusion Anaesthesia 1996 51 Forbes GM Nitrous oxide for colonoscopy: a randomized controlled study Gastrointest Endosc 2000 51 Kostash M Johnston R Sedation for colonoscopy: a double-blind comparison of diazepam/meperidine, midazolam/fentanyl and propofol/fentanyl combinations Can J Gastroenterol 1994 8 Liou WC Lin TC Hsu H Selective use of midazolam for conscious sedation during colonoscopy J Surg Assoc China 1992 25 Buckley P Propofol in patients needing long-term sedation in intensive care: an assessment of the development of tolerance Intensive Care Med 1997 23 Gepts E Claeys F Infusion of propofol as sedative technique for colonoscopies Postg Med J 1985 61 ^s3 Church JA Stanton PD Kenny GNC Anderson JR Propofol for sedation during endoscopy: assessment of a computer-controlled infusion system Gastrointest Endosc 1991 37 Bryson HM Fulton BR Faulds D Propofol: an update of its use in anaesthesia and conscious sedation Drugs 1995 50 Fulton B Sorkin EM Propofol: an overview of its pharmacology and a review of its clinical efficacy in intensive care sedation Drugs 1995 50 Carrasco G Molina R Propofol versus midazolam en la sedación de duración corta, media y prolongada de pacientes críticos Chest 1993 103 Caba F Echeverría M Morales R Guerrero JA Rodríguez R Sinergismo de midazolam y propofol en la inducción de la anestesia Rev Esp Anestesiol Reanim 1993 40 Hernández C Parramon F Estudio comparativo de tres técnicas de anestesia total intravenosa: midazolam-ketamina, propofol-ketamina y propofol-fentanil Rev Esp Reanim Anest 1999 46 Nakagawa M Midazolam premedication reduces propofol requirement for sedation during regional anaesthesia Can J Anesth 1999 47 Oh J Monitoring during and after intravenous conscious sedation Internat Anesthesiology Clin 1999 37 Pacífico A Cedillo F Nadim N Conscious sedation with combined hipnotic agents for implantation of implantable cadioverter-defibrillators J Am Coll Cardiol 1997 30 Schneider TW Minto CF Shafer SL Gambus PL Andresen C Goodale DB The influence of age on propofol pharmacodynamics Anesthesiology 1999 90 Darvas K Tarjanyi M Molnar Z Borsodi M Eles Z Sedation for ambulatory endoscopy Acta Chirurgica Hungarica 1999 38 Barash PG Anestesia Clínica Anestesia Clínica 1999 3rd ^eMéxico D.F McGraw-Hill Interamericana Johansen JW Sebel PS Development and clinical application of electroencephalographic bispectrum monitoring Anesthesiology 2000 93 Bowe AL Ripepi A Dilger J Boparai N Brody FJ Ponsky JL Bispectral index monitoring of sedation during endoscopy Gastrointest Endosc 2000 52 Schraag S Bothner U Gajraj R Kenny GNC Georgieff M The performance of electroencephalogram bispectral index and auditory evoked potential index to predict loss of consciousness during propofol infusion Anesth Analg 1999 89 Külling Fantin AC Biro P Bauerfeind P Fried M Safer colonoscopy with patient-controlled analgesia and sedation with propofol and alfentanil Gastrointest Endosc 2001 54 Minolig G Quality assurance and colonoscopy Gastrointest Endosc 1999 31 Vascello LA Bowe EA A case for capnographic monitoring as a standard of care J Oral Maxillofac Surg 1999 57 Badrinath S Avramov MN Shadrick M Witt TR Ivankovich AD The use of a ketamine-propofol combination during monitored anesthesia care Anesth Analg 2000 90 Froehlich F Colonoscopy: antispasmodics not only for premedication, buy also during endoscope withdraw? Gastrointest Endosc 2000 51 Gempeler F Sedación en cuidados intensivos Rev Colomb Anest 1994 22 Gilberson LI Conscious sedation in special setting Internat Anesthesiology Clin 1999 37 Gillham MJ Hutchinson RC Carter R Kenny GNC Patient-maintained sedation for ERCP with a target-controlled infusion of propofol: a pilot study Gastrointest Endosc 2001 4 Witwam J. G Vinik F Spotlight 10 th European Congress of Anesthesiology (ECA) Spotlight 10 th European Congress of Anesthesiology (ECA) 1998 Frankfurt
S0001-600220020003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022002000300007 Meningitis por Kluyvera sp. en una paciente con una derivación lumbo-peritoneal: reporte de un caso Paredes-Rodríguez Danny Villalobos-Vindas Juan Avilés-Montoya Alvaro Alvarado-Cerdas Enrique ,CCSS Medicina Interna ,CCSS Hospital México Servicio de Infectología 09 2002 2002 44 126 127

Describimos el caso de una paciente portadora de una derivación lumbo- peritoneal, que desarrolló una meningitis bacteriana en la cual Kluyvera sp. se aisló del líquido cefalorraquídeo. En nuestro conocimiento este es el primer caso reportado de infección del SNC por este microorganismo. Esta bacteria era sensible a cefalosporinas de tercera generación y se logró la resolución con Cefotaxime. El Género Kluyvera comprende tres especies infrecuentemente aisladas de muestras clínicas. Se puede asociar a infecciones desde leves a severas y posiblemente se favorece en un huésped inmunocomprometido.

We describe the case of a female patient with a previous lumboperitoneal shunt, who developed bacterial meningitis Kluyvera sp. was isolated from the cerebrospinal fluid. To our knowledge this is the first case of CNS infection by this microorganism. This pathogen was very sensitive to third generation cephalosporins; and was treated succesfully with cefotaxime. The Kluyver genus comprises three species who are uncommonly isolated from clinical samples. It can be associated with mild to severe infections and is more common in inmunosuppressed hosts.

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