Sexual satisfaction in women with spinal cord injuries.

STUDY DESIGN: Structured interview based on a predesigned survey. OBJECTIVE: To examine the factors that affect the degree of sexual satisfaction in a sample of women with spinal cord injury (SCI). SETTING: The study participants were women with SCIs, from the area of the SCI Unit of A Coruña, a reference unit for the Community of Galicia in the northwest of Spain. All study participants were selected consecutively in the outpatient clinic in 2013. METHODS: The study included women with the American Spinal Injury Association (ASIA) A-D spinal injuries, between the ages of 18 and 65 years, who completed rehabilitation therapy and live in the community. A total of 32 women formed the final study group. RESULTS: When comparing the group of women who were sexually active with those who were not, variables such as age, neurological level, time since the SCI, ASIA or Spinal Cord Independence Measure score, urinary incontinence, chronic pain and spasticity were not related to sexual activity. The only factors that we found to be related to sexual activity were not having a stable partner (P=0.017) and a lack of sensation in the genital area (P=0.039). CONCLUSION: The only variables related to sexual activity were not having a partner and a lack of sensation in the genital area. Improving sexual satisfaction, information and specific programs during rehabilitation can help women with SCI explore and investigate new erotic possibilities, thereby improving their self-esteem and social relationships.

[Thermal radiofrequency of the medial genicular nerves in chronic pain related to degenerative meniscopathy. A clinical case]. / Radiofrecuencia térmica de las ramas geniculares mediales para dolor crónico en contexto de meniscopatía degenerativa. A propósito de un caso.

Persistent knee pain in patients around the fifth decade of life is a frequent cause of attention in rehabilitation consultations. The most common cause of diagnosis is knee osteoarthritis, considering the existence of different degrees seen in simple radiographies. The advanced degrees present joint space reduction, osteophytosis and subchondral sclerosis; however, in the initial degrees, the findings are more subtle and sometimes nonexistent for conventional radiology. Clinical ultrasound has partly come to fill this «diagnostic gap¼, making it possible to detect meniscal extrusions and small osteophytes as signs of incipient osteoarthritis and to relate them as triggers of pain. In clinical practice we find a group of patients who, with little or no radiological alterations, present persistent and severe pain with medial predominance in most cases. These, until the appearance of the current evidence, were subsidiaries of meniscectomies. At this moment, when meniscectomies are not recommended, it is necessary to find a treatment for those cases in which conservative and non-ablative interventional treatment has failed. In this context, the possibility of using radiofrequency arises. Its use is widespread in the case of tricompartmental and advanced osteoarthritis. However, little data is available on its usefulness in cases of medial meniscal extrusion. It seems that thermal radiofrequency has greater effects than pulsed radiofrequency. We present a clinical case where thermal radiofrequency of the medial genicular nerves of the knee is proposed as a therapeutic alternative for chronic pain secondary to medial meniscal extrusion associated with incipient knee osteoarthritis, with the result of a decrease in pain (VAS 8 before treatment, VAS 1 after one year), subjective improvement of 80% and gait capacity.

[Thermal radiofrequency as an alternative in the treatment of persistent localized neuropathic pain due to entrapment of a collateral nerve of the hand]. / Radiofrecuencia térmica como alternativa en el tratamiento del dolor neuropático localizado persistente por atrapamiento de un nervio colateral de la mano.

Localized neuropathic pain (LNP) is a relatively common cause of musculoskeletal pain, which can be present in up to 60% of neuropathic pain conditions. Its appearance can be associated with numerous pathologies (herpes, diabetes, etc.). A less common cause would be the direct compression of a peripheral nerve branch. Its diagnosis is usually clinical since complementary tests such as neurophysiological tests do not provide definitive data. As therapeutic measures we have oral analgesics, anticonvulsants, analgesic skin patches and interventional actions, including radiofrequency (RF). Thermal RF consists in the transmission of an electric impulse through a needle reaching a controlled increase in temperature with which a nerve ablative injury is achieved. We present a clinical case where thermal RF of the collateral nerve of the hand is proposed as a therapeutic alternative, whose entrapment is the cause of pain, obtaining a satisfactory clinical improvement.

[Ultrasound-guided radiofrequency ablation of the sural nerve for chronic ankle pain: A case report]. / Técnica de radiofrecuencia ablativa ecoguiada del nervio sural para el dolor crónico de tobillo. A propósito de un caso.

Chronic lateral ankle pain related to sural neuralgia is a rare pathology. The sural nerve innervates the sensitivity of the posterolateral border of the leg, as well as the dorsolateral border of the foot. On occasions, sural neuralgia is resistant to conservative treatment and can affect the patient's psycho-emotional and social sphere. We describe the case of a 54-year-old patient with neuropathic pain in the sural territory and a history of several ankle surgeries. After unsuccessful conservative treatment, ultrasound-guided ablative radiofrequency is performed in the sural nerve with subsequent complete cessation of pain without side effects. We propose to give importance to ecopalpation in the consultation of a rehabilitation physician, as well as to describe ultrasound-guided ablative radiofrequency as a safe and effective technique for sural neuralgia that does not respond to conservative treatment. However, more quality studies are needed to corroborate these results.

[Radial nerve entrapment in the spiral groove. Nerve block as a diagnostic and therapeutic tool]. / Atrapamiento del nervio radial a nivel del canal de torsión humeral. Bloqueos nerviosos como arma diagnóstica y terapéutica.

The radial nerve has a long and sinuous course in the upper limb from the axilla to the hand and fingers. There are several possible areas of compression along this trajectory, the most frequent being on the Arcade of Frohse, with entrapment of its terminal nerve, the posterior interosseous nerve. We report the case of a patient with radial nerve entrapment in the spiral groove and describe how ultrasound and nerve blocks could be useful in diagnosis and treatment. In our patient, nerve block at the main radial nerve in the spiral groove was insufficient. A second nerve block was needed in the inferior lateral cutaneous nerve of the arm to achieve an optimal clinical result.

[Proposal for approach to selective tibial nerve block in spastic patient. A propos of a case]. / Propuesta de abordaje para bloqueo selectivo del nervio tibial en paciente espástico. A propósito de un caso.

The most frequent pattern of spasticity in the lower limb is equinovarus foot. Patients with central nervous system injury and severe spasticity, conservative treatment and botulinum toxin type A often have a limited effect. In these cases, nerve blocks can be very useful in deciding our therapeutic action. We present a clinical case as an example of a new ultrasound-guided approach to tibial nerve block, as this is the main nerve involved in equinovarus foot pattern, specific for spastic patients and its usefulness for the clinical management of spasticity.

Addressing the role of the extrusion pump-bearing pGRT1 plasmid in toluene biodegradation by Pseudomonas putida DOT-T1E under real case scenarios.

The role of both the plasmid pGRT1 and the solvent extrusion pump ttgGHI during toluene biodegradation in Pseudomonas putida DOT-T1E cultures was investigated in a sterile suspended growth bioreactor operated as chemostat and inoculated independently with a wild type strain, a mutant lacking the pGRT1 plasmid (P. putida DOT-TIE-100), and a mutant with a modified pGRT1 plasmid lacking the genes encoding the ttgGHI solvent efflux pump (P. putida DOT-TIE-28). A similar process performance was recorded in all tested strains at 4 g tol m(-3) and dilution rates (D) of 0.1 h(-1). However, operation at 10 g tol m(-3) and D of 0.2 h(-1) revealed a much lower toluene EC (285 g m(-3) h(-1)) in P. putida DOT-T1E-100 cultures when compared to wild type and P. putida DOT-T1E-28 cultures (483-498 g m(-3) h(-1)), which suggests that other mechanisms rather than solvent extrusion by the ttgGHI efflux pump supported this superior process performance. Finally, the plasmid pGRT1 analysed exhibited a remarkable stability towards toluene harmful mediated effects, regardless the strain or toluene loading tested.

[Bromocriptine in disorders of consciouness due to traumatic brain injury]. / Uso de bromocriptina en pacientes con alteración de conciencia secundaria a traumatismo craneoencefálico.

INTRODUCTION: The aim of this study was to assess the results and adverse effects of bromocriptine in patients with traumatic brain injury-vegetative state (TBI-VS) or traumatic brain injury-minimally conscious state (TBI-MCS). METHODS: We conducted a retrospective review of 10 patients, six with TBI-VS and four with TBI-MCS. All patients received bromocriptine at a starting dose of 2.5mg twice daily. Bromocriptine was titrated up to 7.5 or 12.5mg twice daily according to response and was maintained for at least 4 weeks. Various assessment scales were used in the following stages: before bromocriptine administration, at 4 weeks post bromocriptine prescription, and at hospital discharge. The assessment scales used were the Coma Recovery Scale-Revised (CRS-R), Disability Rating Scale, Glasgow Coma Scale, Barthel Scale, and Marshall Scale. RESULTS: Of the 10 patients, four with TBI-MCS and four with TBI-VS achieved a score of 23 points at discharge in the CRS-R, thus emerging from VS or MCS and regaining functional status. There were only two patients who emerged from VS but remained in MCS (8 to 11 and 5 to 10 points in CRS-R). CONCLUSIONS: Considering the poor prognosis for recovery in these patients, bromocriptine use has a positive risk-benefit ratio at a dosage of at least 7.5mg twice daily for 4 weeks.

Modeling photosynthetically oxygenated biodegradation processes using artificial neural networks.

The complexity of the mechanisms underlying organic matter mineralization and nutrient removal in algal-bacterial photobioreactors during the treatment of residual wastewaters has severely hindered the development of mechanistic models able to accurately describe these processes. Artificial neural networks (ANNs) are capable of inferring the complex relationships existing between input and output process variables without a detailed description of the mechanisms governing the process, and should therefore be more suitable for the modeling of photosynthetically oxygenated systems. Thus, a neural network consisting of a single hidden layer with four neurons accurately predicted the steady-state operation of a continuous stirred tank photobioreactor during salicylate biodegradation by an algal-bacterial consortium. Despite its simplicity and the low number of data sets for ANN training (23), this network topology exhibited a satisfactory fit for both training and testing data with correlation coefficients of 99%. Although the use of ANNs for modeling conventional wastewater treatment systems is not novel, this work constitutes, to the best of our knowledge, the first reported application of ANNs to photosynthetically oxygenated systems and one of the few models for microalgae-based treatment processes. This modeling approach is therefore expected to contribute to improve the understanding of the complex relationships between light, temperature, hydraulic retention time, pollutant concentration and process removal efficiency, which would eventually promote the development of algal-bacterial processes as a cost effective alternative for the treatment of industrial wastewaters.

Efficient nutrient removal from swine manure in a tubular biofilm photo-bioreactor using algae-bacteria consortia.

Concentrated animals feeding operations (CAFOs) often pose a negative environmental impact due to the uncontrolled spreading of manure into soils that ends up in the release of organic matter and nutrients into water bodies. Conventional aerobic methods treating CAFOs wastewater require intensive oxygenation, which significantly increases the operational costs. The alternative proposed in this research is the application of micro-algae based systems by taking advantage of the cost-effective in situ oxygenation via photosynthesis. A 4.9 L enclosed tubular biofilm photo-bioreactor was inoculated with an algal-bacterial consortium formed by the micro-algae Chlorella sorokiniana and a mixed bacterial culture from an activated sludge process. C. sorokiniana delivers the O(2) necessary to accomplish both organic matter and ammonium oxidation. The reactor was fed with diluted swine wastewater containing 180, 15 and 2,000 mg/L of NH(4) (+)-N, soluble P and total COD, respectively. The photo-bioreactor exhibited good and sustained nutrient removal efficiencies (up to 99% and 86% for NH(4) (+) and PO(4) (3-), respectively) while total COD was removed up to 75% when the biofilm was properly established. Liquid superficial velocities up to 0.4 m/s (achieved by culture broth recirculation) hindered the formation of a stable biofilm, while operation at velocities lower than 0.1 m/s supported stable process performance. The high shear stress imposed by the centrifugal recirculation pump disintegrated the large aggregates detached from the biofilm, which resulted in a poor settling performance and therefore poor COD removal efficiencies. Enclosed biofilm photo-bioreactors therefore offer a potentially more economical alternative to conventional tertiary treatments process.

Sulfide removal by moderate oxygenation of anaerobic sludge environments.

Introduction of a limited amount of oxygen to anaerobic bioreactors is proposed as a simple technique to lower the level of sulfide in the biogas. This paper presents the results of a bioreactor study and of batch experiments that were performed to obtain better insight into the fate of sulfur compounds and oxygen during micro-aerobic sulfide oxidation. Introduction of a low airflow (0.7-0.9 m(3)m(-3)d(-1), corresponding to an O(2)/S molar ratio of 8-10) to a fluidized bed reactor fed with low-sulfate vinasse was sufficient to reduce the biogas H(2)S-content to an undetectable level. Sulfide was initially oxidized to elemental sulfur, thiosulfate and - most probably - polysulfide. Significant sulfate production did not occur. Bioreactor sludge sampled from the reactor after three weeks' micro-aerobic operation was much faster in oxidizing sulfur than bioreactor sludge sampled during fully anaerobic reactor operation. The reaction proceeded faster with increasing O(2)/sulfide ratios.

Inhibitory effects of catechol accumulation on benzene biodegradation in Pseudomonas putida F1 cultures.

The influence of benzene concentration on the specific growth rate (mu), CO(2) and metabolite production, and cellular energetic content (i.e., ATP content), during benzene biodegradation by Pseudomonas putida F1 was investigated. Within the concentration range tested (5-130mg benzene l(-1)) the mu, the specific CO(2) production, and the ATP content remained constant at 0.42-0.48h(-1), 1.86+/-0.21g CO(2) g(-1) biomass, and 5.3+/-0.4x10(-6)mol ATP g(-1) biomass, respectively. Catechol accumulated during process start-up at all tested concentrations. Catechol specific production increased with increasing benzene inlet concentrations. This confirms that the transformation of this intermediate was the limiting step during benzene degradation. It was shown that catechol inhibited both the conversion of benzene to catechol and its further transformation. In addition, catechol concentrations higher than 10mgl(-1) significantly decreased both benzene and catechol associated respiration, confirming the highly inhibitory effect of this intermediate. This inhibitory threshold concentration was approximately two orders of magnitude lower than the concentrations present in the culture medium during process start-up, suggesting that cellular activity was always far below its maximum. Thus, due to its toxic and inhibitory nature and its tendency to accumulate at high benzene loading, catechol must be carefully monitored during process operation.

Nutrients removal in hybrid fluidised bed bioreactors operated with aeration cycles.

Abstract Two hybrid fluidised bed reactors filled with sepiolite and granular activated carbon (GAC) were operated with short cycled aeration for removing organic matter, total nitrogen and phosphorous, respectively. Both reactors were continuously operated with synthetic and/or industrial wastewater containing 350-500 mg COD/L, 110-130 mg NKT/L, 90-100 mg NH3-N/L and 12-15 mg P/L for 8 months. The reactor filled with sepiolite, treating only synthetic wastewater, removed COD, ammonia, total nitrogen and phosphorous up to 88, 91, 55 and 80% with a hydraulic retention time (HRT) of 10 h, respectively. These efficiencies correspond to removal rates of 0.95 kgCODm(-3)d(-1) and 0.16 kg total N m(-3)d(-1). The reactor filled with GAC was operated for 4 months with synthetic wastewater and 4 months with industrial wastewater, removing 98% of COD, 96% of ammonia, and 66% of total nitrogen, with an HRT of 13.6 h. No significant phosphorous removing activity was observed in this reactor. Microbial communities growing with both reactors were followed using polymerase chain reaction (PCR) and denaturing gradient gel electrophoresis (DGGE) techniques. The microbial fingerprints, i.e. DGGE profiles, indicated that biological communities in both reactors were stable along the operational period even when the operating conditions were changed.

Neuropatía peronea secundaria a ganglión extraneural: revisión de literatura y propuesta de tratamiento. Caso no positivo / Peroneal neuropathy caused by an extraneural ganglion: literary review and treatment proposal. A non-positive case

La discopatía lumbar con afectación de raíces lumbares L4 o L5 es una causa frecuente de consulta y, en casos severos, puede ser el origen de dolor neuropático en el miembro inferior y/o de un pie equino por compromiso de la musculatura dorsiflexora del pie. Sin embargo, la causa de esta clínica no siempre está en relación con la patología lumbar ni el sistema nervioso central, siendo vital su correcto diagnóstico diferencial. Este artículo presenta el caso de un paciente de 69 años con una neuropatía compresiva peronea secun­daria a un ganglión, inicialmente interpretada como una radicu­lopatía L5. Este incorrecto enfoque supuso la sobremedicación del paciente, un mal control algésico, la realización de una discectomía L4-L5 innecesaria y una pobre evolución neurológica. Un enfoque diagnóstico correcto y un abordaje tera­péutico precoz habrían supuesto una mayor mejoría clínica e incluso una recuperación neurológica completa del paciente. Por ello, este caso sirve para resaltar: a) el va­lor de la ecografía en neuropatías periféricas como herramienta diagnóstica y pronóstica y el de la ecografía en gangliones como arma diagnóstico-­terapéutica; b) el uso de las pruebas diagnósticas como apoyo a una exploración física exhaustiva, y no como diagnóstico en sí mismas, y c) la importancia de la publicación de casos no positivos para optimizar recursos, evitar repetir errores, reducir el sesgo de publicación y facilitar el inicio de proyectos de investigación.(AU)

Lumbar disc disease with L4 or L5 lumbar root involvement is a common cause of medical attendance. In severe circumstances it can lead to neuropathic pain, weakness and foot drop. However, this clinical presentation is not always related with lumbar or central nervous system pathology, being the differential diagnosis of great importance. It is reported a case of 69-year-old patient with a peroneal nerve entrapment caused by an extraneural ganglion, misdiagnosed as a L5 radiculopathy. This incorrect approach entailed patient overmedication, poor pain control, an unnecessary L4-L5 discectomy, and a poor neurological outcome. In this case, an early diagnosis and therapeutic approach would have meant not only a greater clinical improvement and even a complete neurological recovery. Moreover, this case highlights: a) the value of ecography in periphe­ral neuropathies as a diagnostic and prognostic tool and ultrasounds in ganglions cyst as a diagnostic and therapeutic weapon; b) the use of diagnostic tests to support a thorough physical examination, not as a diagnosis themselves; and c) the importance of non-positive cases publication to optimize resources, avoid repeating mistakes, reduce publication bias and facilitate the start of research projects.(AU)

New process for simultaneous removal of nitrogen and sulphur under anaerobic conditions.

A granular activated carbon (GAC) anaerobic fluidised-bed reactor treating vinasse from an ethanol distillery of sugar beet molasses was operated for 90 days, the first 40 days of start-up followed by 50 days of operation at constant organic loading rate of 1.7g COD/Ld. The reactor showed good performance in terms of organic matter removal but an anomalous behaviour in terms of unusual high concentrations of molecular nitrogen in the biogas. The analysis of the different nitrogenous and sulphur compounds and the mass balances of these compounds in the liquid and gas phases clearly indicated an uncommon evolution of nitrogen and sulphur in the reactor. About 50% of the nitrogen entering the reactor as total Kjeldahl nitrogen (TKN) was removed from the liquid phase appearing as N2 in the gas phase. Simultaneously, only 20% of the S-SO4(2-) initially present in the influent appears as S-S2- in the effluent or S-H2S in the biogas, indicating that 80% of the sulphur is removed. This behaviour has not been reported previously in the literature. These observations may suggest a new anaerobic removal process of ammonia and sulphate according to an uncommon mechanism involving simultaneous anaerobic ammonium oxidation and sulphate reduction.

Simultaneous organic nitrogen and sulfate removal in an anaerobic GAC fluidised bed reactor.

A granular activated carbon (GAC) anaerobic fluidised bed reactor treating vinasse from an ethanol distillery of sugar beet molasses was operated for 250 days under three different organic loading rates. The reactor showed good performance in terms of organic matter removal and methane production but an anomalous behaviour in terms of unusual high concentrations of molecular nitrogen and low concentration of hydrogen sulphide in the biogas. The analysis of the different nitrogenous and sulphur compounds and the mass balances of these species in the liquid and gas phases clearly indicated an uncommon evolution of nitrogen and sulphur in the reactor. Up to 55% of the TKN and up to 80% of the sulphur disappear in the liquid phase. This is the opposite to any previously reported results in the bibliography. The new postulated anaerobic process of ammonia and sulphate removal seems to follow the mechanism: SO4 = +2 NH4+-->S + N2 + 4H2O (delta G degree = -47.8 kJ/mol).

Combined anaerobic/aerobic (UASB + UBAF) system for organic matter and nitrogen removal from a high strength industrial wastewater.

The paper presents the experimental results collected from seven months of operation of a combined anaerobic/aerobic system treating an industrial effluent with averaged content of organic matter and nitrogen of 10.4 g COD/L and 790 mg NKT/L, respectively. The system was formed by an upflow anaerobic sludge blanket (UASB) and an upflow biological aerated filter (UBAF) connected in series, with a recycling line of the UBAF effluent into the UASB for its denitrification. The best results were obtained when operating the two reactors, UASB and UBAF, with hydraulic retention times (HRT) of 3.3 and 1.3 days, respectively, and a recycling ratio of 6.7. Under these conditions the system removed 98% of the organic matter and ammonia and 91% of the total nitrogen entering the system. The activity of the different microorganisms was followed through activity assays consisting of measuring the consumption or production rate of any specific substrate or metabolism product. Thus when operating the system under the aforementioned conditions the reported values for the specific activity of methanogenic microorganisms and denitrifiers coexisting in the UASB were 1.05 g COD/g VS d and 32.08 mg NO3-N/g VS d, respectively. While the activity of ammonia and nitrite oxidizers within the UBAF were 47.65 and 4.36 mg O2/g VS h, respectively.

Nitrification-denitrification of UASB effluents highly loaded with nitrogen in an activated sludge reactor operated with short cycled aeration.

A conventional activated sludge reactor operated with short cycled aeration was used for total nitrogen removal of UASB anaerobic reactor effluent containing nitrogen (up to 1,200 mg NKT/L) and organic matter (up to 2,000 mg COD/L). Initially the reactor was fed with synthetic water to progressively introduce the UASB effluent. This favored the acclimation of the microorganisms to the real environment. The results obtained throughout this study showed that initially the tested technology is feasible and can report significant cuts on operation and maintenance when compared to conventional activated sludge processes. Total nitrogen removal up to 66% was attained treating the effluent of an UASB process designed for treating the wastewater of a potato starch factory. Total nitrogen removal capacities ranging between 0.1 and 0.58 kg of nitrogen per cubic metre per day are reported. Short-cycled aeration allowed for a more efficient use of the oxygen supply for nitrification and the organic carbon content present in the wastewater for denitrification. This operating protocol has demonstrated serious advantages in terms of operation costs and simplicity when total nitrogen removal is wanted. Most of the existing activated sludge processes, i.e. single continuous flow reactors, can be updated for total nitrogen removal essentially at no cost, the inversion (aeration control system) is rapidly returned as reduction in energy expenditure.

Combining the biological nitrogen and sulfur cycles in anaerobic conditions.

The biochemical processes involved in the anaerobic degradation of carbon, nitrogen and sulfur compounds can be represented by an oxidation-reduction or electron donor-acceptor scheme. The theoretic values of Gibbs free energy (deltaG0) calculated from thermodynamic data indicate the feasibility of the reactions. The interactions C-S and C-N are well known but there is a lack of information about the interaction N-S. The anaerobic transformation of nitrates using reduced sulfur compounds can be explained considering that nitrate acts as electron acceptor while reduced sulfur compounds are the electron donors. A new N-S interaction in anaerobic conditions (ORP = -425 mV) has been experimentally observed when treating industrial wastewater rich in organic nitrogen and sulfate. The mass balances of the different nitrogenous and sulfur compounds in the liquid and gas phases clearly indicated an uncommon evolution. An important percentage of the nitrogen entering the reactor as TKN was removed from the liquid phase appearing as N2 in the gas phase. Simultaneously, only part of the sulfate initially present in the influent appeared as sulfide in the effluent or as hydrogen sulfide in the gas. These experimental observations may suggest a new anaerobic N-S biological interaction involving simultaneous anaerobic ammonium oxidation and sulfate reduction, ammonium being the electron donor and sulfate the electron acceptor.

Técnica de radiofrecuencia ablativa ecoguiada del nervio sural para el dolor crónico de tobillo. A propósito de un caso / Ultrasound-guided radiofrequency ablation of the sural nerve for chronic ankle pain: A case report

El dolor crónico en la cara lateral del tobillo relacionado con la neuralgia sural es una patología poco frecuente. El nervio sural inerva la sensibilidad del borde posterolateral de la pierna, así como del borde dorsolateral del pie. En ocasiones la neuralgia sural es resistente al tratamiento conservador, pudiendo afectar a la esfera psicoemocional y social del paciente. Describimos el caso de un paciente de 54años con dolor neuropático en territorio del sural y con el antecedente de varias cirugías de tobillo. Tras tratamiento conservador sin éxito, se realiza radiofrecuencia ablativa ecoguiada en nervio sural con posterior cese completo del dolor sin efectos secundarios. Nos proponemos dar importancia a la ecopalpación en consulta de un médico rehabilitador, así como describir la radiofrecuencia ablativa ecoguiada como una técnica segura y eficaz para la neuralgia sural que no responde a tratamiento conservador. Sin embargo, se necesitan más estudios de calidad para corroborar estos resultados.(AU)

Chronic lateral ankle pain related to sural neuralgia is a rare pathology. The sural nerve innervates the sensitivity of the posterolateral border of the leg, as well as the dorsolateral border of the foot. On occasions, sural neuralgia is resistant to conservative treatment and can affect the patient's psycho-emotional and social sphere. We describe the case of a 54-year-old patient with neuropathic pain in the sural territory and a history of several ankle surgeries. After unsuccessful conservative treatment, ultrasound-guided ablative radiofrequency is performed in the sural nerve with subsequent complete cessation of pain without side effects. We propose to give importance to ecopalpation in the consultation of a rehabilitation physician, as well as to describe ultrasound-guided ablative radiofrequency as a safe and effective technique for sural neuralgia that does not respond to conservative treatment. However, more quality studies are needed to corroborate these results.(AU)