Efectos de la técnica de arcos botantes para la abertura de la sutura occipitomastoidea en la cervicalgia mecánica / Effects of flying buttresses for the opening of the occipitomastoid suture in mechanical neck pain

Introducción: La cervicalgia mecánica (CM) podría considerarse un problema de salud pública, ya que afecta a casi la mitad de la población en algún momento de su vida. En el 14% de la población, tiene una duración de 6 meses o más, provocando limitaciones laborales, en las actividades de la vida diaria así y de ocio. Objetivo: Analizar los efectos inmediatos de la técnica con arcos botantes (TAB) para la abertura de la sutura occipitomastoidea (OM), realizada bilateralmente, sobre la amplitud articular cervical, el umbral de dolor a la presión (UDP) y la intensidad del dolor. Material y Métodos: Estudio experimental, controlado, aleatorizado, doble ciego. Treinta (n=30) sujetos con CM, distribuidos aleatoriamente en dos grupos, Grupo Experimental (GE)(n=15) que recibió la TAB bilateralmente, y Grupo Control (GC) (n=15) que no recibió ninguna intervención. En ambos grupos se evaluaron (antes y después), la amplitud articular cervical, el UDP, los Puntos gatillo de Trapecios superiores y Escalenos anteriores (algómetría), y la intensidad del dolor en reposo y con cada movimiento cervical mediante una escala numérica del dolor (END). Resultados: El GE presenta mejoras estadísticamente significativas para las variables algométricas del trapecio superior derecho(p=0,033),trapecio superior izquierdo(p=0,03), la OM izquierda(p=0,003), el escaleno izquierdo(p=0,043), la amplitud de movimiento en rotación izquierda(p=0,04) y la intensidad del dolor a la rotación izquierda (p=0,013). Observamos tendencia a la significación estadística de la amplitud del movimiento de lateroflexión izquierda (p=0,056). Conclusiones: La técnica con arcos botantes para la abertura de la OM, aplicada en pacientes con CMC, aumenta el UDP en los músculol s trapecios, escaleno izquierdo y la sutura OM izquierda, la amplitud de movilidad y disminuye el dolor, durante la rotación cervical izquierda (AU)

Introduction: Mechanical neck pain (CM) could be considered a public health problem, affecting almost half of the population at some point in their lives. In 14% of the population, it has a duration of 6 months or more, causing labor limitations in activities of daily life and leisure. Objective: To analyze the immediate effects of the technique with flying buttresses (TFB) for the opening of the occipitomastoid (OM) suture, conducted bilaterally on the cervical joint extent, the pain pressure threshold (UDP) and the pain intensity. Material and methods: Experimental study, controlled, randomized, double-blind. Thirty (n = 30) subjects with CM, randomized into two groups: Experimental Group (GE) (n = 15) bilaterally received the TAB and Control Group (CG) (n = 15) that did not receive any intervention. In both groups, the cervical joint amplitude were evaluated (before and after), as well as the UDP, the trigger points of the higher trapezoids and anterior scalenes (algometry) and pain intensity at rest and with each cervical movement using a numerical pain scale (END). Results: The GE introduces significant improvements for algometrical variables of the right upper trapezius (p = 0.033), left upper trapezius (p = 0.03), the left OM (p = 0.003), the left scalene (p = 0.043), the range of motion in left rotation (p = 0.04) and pain intensity in left rotation (p = 0.013). We observed a trend towards statistical significance of the range of left sidebending (p = 0.056). Conclusions: The flying buttress technique for the opening of OM, applied in patients with CMC, increases the UDP in the trapezius muscles, left scalene and left OM suture, range of motion and decreases pain during left cervical rotation (AU)

Usefulness of paced activation sequence mapping in catheter ablation of accessory pathways.

INTRODUCTION: Radiofrequency (RF) ablation of accessory pathways (APs) is often a time-consuming procedure, mainly because conventional criteria have modest accuracy. Thus, additional mapping criteria are desirable. Our hypothesis was that comparison of paced atrial activation sequences with that obtained during orthodromic AV reentrant tachycardia might be useful for locating the atrial insertion of single APs. METHODS AND RESULTS: The study included 15 patients with a single AP referred for ablation. Analysis of the atrial activation sequence was simplified by measuring the activation time (AT) that elapsed between two atrial reference points placed next to the AV annulus on either side of the area containing the AP. Ablation was guided by conventional criteria. Before each RF delivery, a short pacing train was delivered from the ablation catheter and, after verification of atrial capture, the AT was compared with the AT obtained during orthodromic tachycardia. Fifty sites of RF delivery were appropriate for analysis. The multivariate model with the highest predictive power included a deviation of AT between pacing and tachycardia < or = 5 msec (P < 0.001), a local AV ratio > or = 1 (P = 0.04), and stability of the local electrogram (P = 0.05). The combination of all these criteria predicted a successful application with high sensitivity, specificity, and positive predictive value (92%, 86%, and 71% respectively). To validate the method prospectively, 10 additional consecutive patients underwent an AP ablation procedure guided by these criteria. CONCLUSION: This technique seems to be highly accurate in selecting the atrial site for RF ablation of single APs.

Radiofrequency ablation of atrioventricular accessory pathways associated with discordant atrioventricular connections.

Discordant atrioventricular connections associated with Wolff-Parkinson-White syndrome increase the challenge of radiofrequency ablation. We report the results and techniques of radiofrequency ablation in three patients with discordant atrioventricular connections, including one patient having double outlet right ventricle with atrioventricular reentry tachycardias. There were two males and one female, aged 14 and 22 years old. We found four accessory pathways during our electrophysiological studies, with two of them manifest on the electrocardiogram, corresponding to left paraseptal and right midseptal regions. The electrophysiological study confirmed this localization, and showed two concealed accessory pathways in the right and left paraseptal regions. Radiofrequency ablation was successful in all cases without recurrence at a mean follow-up of 18.6 months. No complications were observed during the procedures. We conclude that radiofrequency ablation is feasible and effective in the ablation of accessory pathways in patients with discordant atrioventricular connections.

Management of the neck in thyroid cancer.

The incidence of nodal metastasis in differentiated thyroid cancer ranges between 40% to 75%. Elective neck dissection is generally not advised in patients with differentiated thyroid cancer; however, if clinically apparent nodal disease is noted in the tracheoesophageal groove during surgery, central compartment clearance is advised. If clinically apparent nodal disease is present in the lateral compartment of the neck, modified neck dissection preserving the sternomastoid, accessory nerve, and jugular vein is advised. The "berry picking procedure" is generally not recommended because of the higher incidence of regional recurrence. Due consideration should be given for parathyroidal transplantation if the blood supply to the parathyroids is damaged during central compartment clearance. The incidence of lymph node metastasis is highest in young patients, however, lymph node metastasis has no bearing on long-term survival. There seems to be a higher incidence of regional recurrence in elderly individuals. If patients present with bulky nodal disease, consideration may be given for postoperative radioactive iodine dosimetry and ablation if necessary. Differentiated thyroid cancer represents a unique disease in the human body, where lymph node metastasis has no prognostic implication. Aggressive surgical clearance is advised in patients with medullary thyroid cancer in the central compartment and the jugular chain lymph nodes.