Confirmatory study of the usefulness of quantum molecular resonance and microdissectomy for the treatment of lumbar radiculopathy in a prospective cohort at 6 months follow-up.

OBJECTIVES: Low back pain is a common musculoskeletal complaint and while prognosis is usually favorable, some patients experience persistent pain despite conservative treatment and invasive treatment to target the root cause of the pain may be necessary. The aim of this study is to evaluate patient outcomes after treatment of lumbar radiculopathy (LR) with quantum molecular resonance radiofrequency coblation disc decompression and percutaneous microdiscectomy with grasper forceps (QMRG). METHODS: This prospective cohort study was carried out in two Spanish hospitals on 58 patients with LR secondary to a contained hydrated lumbar disc hernia or lumbar disc protrusion of more than 6 months of evolution, which persisted despite conservative treatment with analgesia, rehabilitation, and physiotherapy, and/or epidural block, in the previous 2 years. Patients were treated with QMRG and the outcomes were measured mainly using the Douleur Neuropathique en 4 Questions, Numeric Rating Scale, Oswestry Disability Index, SF12: Short Form 12 Health Survey, Patient Global Impression of Improvement, Clinical Global Impression of Improvement, and Medical Outcomes Study Sleep Scale. RESULTS: Patients who received QMRG showed significant improvement in their baseline scores at 6 months post-treatment. The minimal clinically important difference (MCID) threshold was met by 26-98% of patients, depending on the outcome measure, for non-sleep-related outcomes, and between 17 and 62% for sleep-related outcome measures. Of the 14 outcome measures studied, at least 50% of the patients met the MCID threshold in 8 of them. CONCLUSION: Treatment of LR with QMRG appears to be effective at 6 months post-intervention.

Incidence of opioid-induced esophageal dysfunction.

BACKGROUND: Retrospective studies have suggested that long-term use of opioids can cause esophageal motility dysfunction. A recent clinical entity known as opioid-induced esophageal dysfunction (OIED) has been postulated. There is no data from prospective studies assessing the incidence of opioid-induced effects on the esophagus. AIM: Evaluate the incidence of OIED during chronic opioid therapy. METHODS: From February 2017 to August 2018, all patients seen in the Pain Unit of the hospital, who started opioid treatment for chronic non-neoplastic pain and who did not present esophageal symptoms previously, were included. The presence of esophageal symptoms was assessed using the Eckardt score after 3 months and 1 year since the start of the study. In February 2021, the clinical records of all included patients were reviewed to assess whether esophageal symptoms were present and whether opioid therapy was continued. In patients presenting with esophageal symptoms, an endoscopy was performed and, if normal, a high-resolution esophageal manometry was performed. For a confidence level of 95%, a 4% margin of error and an estimated prevalence of 4%, a sample size of 92 patients was calculated. RESULTS: 100 patients were included and followed while taking opioids, for a median of 31 months with a range between 4 and 48 months. Three women presented with dysphagia during the first 3 months of treatment, being diagnosed with esophagogastric junction outflow obstruction; type II and type III achalasia. The cumulative incidence of OIED was 3%; 95%-CI: 0-6%. CONCLUSIONS: Chronic opioid therapy in patients with chronic non-neoplastic pain is associated with symptomatic esophageal dysfunction.

Quantum Molecular Resonance Radiofrequency Disc Decompression and Percutaneous Microdiscectomy for Lumbar Radiculopathy.

Within the practice of pain management, one of the most commonly encountered events is low back pain. Lumbar radiculopathy (LR) is a pain syndrome caused by the compression or irritation of the nerve roots in the lower back due to lumbar disc herniation, vertebra degeneration, or foramen narrowing. Symptoms of LR include low back pain that propagates toward the legs, numbness, weakness, and loss of reflexes. The aim of this study is to assess the long-term effectiveness of quantum molecular resonance disc decompression and its combination with a percutaneous microdiscectomy using Grasper© forceps (QMRG) in patients with persistent lumbar radiculopathy (LR) in relation to patient physical stress status. The main outcome measures of this prospective observational study were DN4, NRS, ODI, SF12, PGI, CGI, and MOS Sleep Scale. An improvement 12 months post-intervention was observed in patients without physical stress, presenting better overall results. The mean change was over the minimal clinically important difference in 64.3% of outcome measures studied for the whole sample. QMRG appears to be an effective treatment option for LR, but a reduction in physical stress is needed to ensure long-term effectiveness.

Preliminary evaluation of the efficacy of quantum molecular resonance coablative radiofrequency and microdiscectomy.

Aims: The aim of this study was to determine whether there exists a difference in efficacy in the treatment of lumbar radiculopathy with quantum molecular resonance coablative radiofrequency and quantum molecular resonance coablative radiofrequency and percutaneous microdiscectomy with grasper forceps (QMRG). Patients & methods: A total of 28 patients from La Fe University and Polytechnic Hospital in Valencia were enrolled in a retrospective cohort. Results: Treatment with QMRG significantly improved non-sleep-related and sleep-related outcome measures. At 6 months post-intervention, treatment with QMRG resulted in significantly better scores in numeric rating scale, Oswestry Disability Index, Short Form 12 Health Survey Physical and Total, Patient Global Impression of Improvement, sleep disturbance and the two sleep problems indexes. Conclusion: Treatment of lumbar radiculopathy with QMRG appears to be more effective at 6 months post-intervention.

Randomized Prospective Study in Patients With Complex Regional Pain Syndrome of the Upper Limb With High-Frequency Spinal Cord Stimulation (10-kHz) and Low-Frequency Spinal Cord Stimulation.

OBJECTIVE: The objective of this prospective randomized study of cases and controls was to evaluate the efficacy of treatment with low-frequency spinal cord stimulation (LF-SCS) and 10 kHz spinal cord stimulation (10-kHz SCS) in patients diagnosed with complex regional pain syndrome type I (CRPS) with upper limb involvement. MATERIALS AND METHODS: Fifty patients were randomized to receive conventional treatment or SCS with a commercially available low-frequency or 10-kHz system. Patients were assessed at 1, 3, 6, and 12 months. The primary endpoint was at 12-months post permanent implantation of the SCS devices. Outcome measures assessed included: Numerical Rating Scale (NRS), 12-Item Short-Format Health Survey (SF-12), Oswestry Disability Index (ODI), Study Sleep Scale medical outcomes (MOS-SS), Douleur Neuropathique 4 questions pain questionnaire (DN4), Patient Global Impression Scale on the impact of treatment improvement (PGI-I), Clinician Global Impression Scale on the impact of improving the patient (CGI-I). RESULTS: Forty-one patients were finally included in the analysis, 19 patients in the conventional treatment group, 12 in the LF-SCS group, and 10 in the 10-kHz SCS group. At the primary endpoint, patients treated with LF-SCS presented improvements in the NRS and DN4 outcomes around 2.4 and 1.5 times above the minimal clinically important difference (MCID) thresholds. At the primary endpoint, patients treated with 10-kHz SCS presented improvements in the NRS and DN4 outcomes around 2 and 1.4 times above the MCID thresholds. CONCLUSIONS: Patients experienced considerable improvement after SCS. The results show that LF-SCS has very good results when compared with conventional treatment. The results obtained with 10-kHz SCS are encouraging, with the advantages of the absence of paresthesia making it an alternative in the treatment of CRPS.

[Evaluation of the lower urinary tract function in pediatric patients with primary vesicoureteral reflux]. / Valoración de la función del tracto urinario inferior en el paciente pediátrico portador de reflujo vesicoureteral primario.

OBJECTIVES: To present a methodology of perioperative evaluation of lower urinary tract function in patients with primary VUR. To describe the most frequent urodynamic patterns in patients with primary VUR and their treatment. To show the results of a lower urinary tract evaluation in a prospective study in a pediatric population of 63 patients, with persistent primary VUR, with the aim to help to a better understanding of the natural history of VUR. METHODS: The study includes a pediatric population of 63 patients with primary grade II-V VUR, 28 girls and 35 boys, with ages between six months and 15 years (mean age 5.9 yr.). In the study protocol for the systematic study of primary vesicoureteral reflux we perform a non invasive screening for lower urinary tract dysfunction, which select patients that will benefit from a complete cystomanometry. STUDY VARIABLES: age, gender, VUR side and grade, and renal function, in relation with the lower urinary tract function at the time of recruitment. The results of urodynamics have been evaluated in relation to urinary symptoms and history of lower urinary tract infection. RESULTS: Differential characteristics of the study population: high mean age (overall 5.9 yr.; 7.7 in girls), high percentage of high grade VUR (59%), renal damage (52%) and lower urinary tract dysfunction (86%) without significant differences between boys and girls. Statistically significant associations between: VUR grade and renal damage; presence of lower urinary tract dysfunction and bilateral VUR; female gender and lower urinary tract dysfunction; and normal lower urinary tract function and absence of renal damage. The voiding dysfunction pattern was predominant in females and bladder hyperactivity in males. Urinary symptoms did not differ between the various patterns of urodynamic abnormalities. The incidence of UTI shows significant differences between the various urodynamic patterns, being more frequent in girls with type 4 urodynamic pattern (dysfunctional voiding). CONCLUSIONS: The performance of a non invasive screening of lower urinary tract function by medical history, urine analysis, ultrasound and post void residual ultrasound evaluation enabled the selection of patients who would benefit from a complete urodynamic study. If there are symptoms or signs of lower urinary tract dysfunction it is recommended to perform a complete urodynamic study. Pediatric cystomanometry provides precise data about bladder filling and voiding phases, facilitating the specific treatment of the lower urinary tract dysfunction. The urodynamic study has a special significance in the prognosis of the urological malformation associated in children with VUR. With this systematic study of the lower urinary tract function early diagnosis and treatment of patients in risk may be achieved, as well as adequate selection of patients that will benefit from pharmacotherapy and/or urotherapy, with the aim to prevent renal damage progression and to potentiate definitive cure of VUR.

[Renal biopsy through a retroperitoneoscopic approach: our experience in 53 pediatric patients]. / Biopsia renal por abordaje retroperitoneoscópico: nuestra experiencia en 53 pacientes pediátricos.

OBJECTIVES: The retroperitoneoscopic approach enables adequate vision of the renal fossa and retroperitoneal structures. Our objective is to support the performance of renal biopsies through a retroperitoneoscopic approach in those pediatric surgery departments still doing open biopsies. METHODS: We performed 53 renal biopsies through a retroperitoneoscopic approach. Twenty-eight patients were males and 25 females, with ages between 13 months and 19 years (mean age range 4 years). The biopsies were indicated after the following diagnosis: nephrotic syndrome (n = 20), hemolytic-uremic syndrome (n = 3), hematuria (n = 15), idiopathic purpura (n = 2), proteinuria (n = 13). Ten patients were in renal failure. We performed our technique of retroperitoneoscopic approach in all cases. RESULTS: Adequate exposure of the kidney was achieved in all cases, and the biopsy sample gave a pathologic diagnosis after immunohistochemical and morphologic studies. One case was converted to open surgery due to bleeding from the kidney. In 51 cases the estimated blood loss was lower than 20 cc. No drainage was necessary after surgery. Mean hospital stay was 48 hours for the first 20 cases and between 24-36 hours for the remainder. CONCLUSIONS: The Retroperitoneoscopic renal biopsy is an adequate procedure for the pediatric patients and represents a real alternative to open biopsy, and in cases of contraindication for ultrasound guided percutaneous biopsy, because: 1. It offers an excellent exposure of the kidney. 2. It obtains a kidney sample enough for the study. 3. The morbidity associated with the procedure is minimal. 4. Diminishes the hospital stay and shortens the time to return back to normal life.

[Laparoscopy in pediatric urology]. / Laparoscopia en urología pediátrica.

OBJECTIVES: To establish urological pathologies in which video-assisted laparoscopy would be indicated as an alternative to conventional surgery. METHODS: From 1995 to December 2000 we performed 106 urological laparoscopic procedures in 99 children six months to 16 years old (mean age of 7 years). The indications for laparoscopy were: a) Diagnostic indications in 60 patients (n)/65 procedures (p) including intrabdominal testis (n = 28, p = 33) and renal biopsy (n = 32, p = 32); b) Therapeutical indications in 33 patients (n)/34 procedures (p) consisted of varicocelectomy (n = 5, p = 7), orchiectomy (n = 1, p = 1), closure of patent processus vaginalis (n = 2, p = 4), retroperitoneoscopic nephrectomy (n = 16, p = 18), renal cyst excision (n = 2, p = 2), marsupialization of symptomatic giant lymphocele after renal transplantation (n = 2, p = 4), and c) Retroperitoneoscopic approach before open access in 6 patients/7 procedures. RESULTS: The laparoscopic approach was effective in 100% and 94.2% of diagnostic and therapeutic procedures, respectively. Conversion to an open approach was required in two procedures because of peritoneal perforation during retroperitoneoscopic nephrectomy in one case and bleeding after retroperineoscopic renal biopsy in the other. Previous retroperitoneal surgery is not a contraindication for retroperitoneoscopy. There were no postoperative complications with intraoperative morbidity of 2.8%. Overall average hospital stay was 1.4 days. CONCLUSIONS: Minimally invasive surgery plays an important role in management of pediatric urology patients. Nowadays, there are procedures in pediatric urology that can be considered established indications for laparoscopic or retroperitoneoscopic approaches.

Frecuencia y sintomatología de las disfunciones temporomandibulares / Frecuency and symptoms of temporomandibular dysfunctions

Se estudiaron 204 pacientes de la consulta de Otorrinolaringología del Hospital Docente Clinicoquirúrgico "Calixto García" comprendidos entre los 15 y 64 años de edad, 109 del sexo femenino y 95 del sexo masculino. Se encontró que de la totalidad de los pacientes estudiados, 81 (39,7 por ciento) presentaron el síndrome dolor disfunción, con mayor frecuencia en el sexo femenino. Se halló asociación entre las sintomatologías auditivas y el síndrome dolor disfunción, además se observó que el cansansio muscular y el dolor a la palpación del músculo Pterigoideo medial es muy frecuente en los pacientes con sintomatologías auditivas