RESUMEN
BACKGROUND: There is growing evidence for the effectiveness of mirror therapy (MT) on pain reduction in patients with type I complex regional pain syndrome (CRPS I). AIM: To evaluate the efficacy of MT on pain reduction and hand function in subjects with unilateral upper extremity CRPS I. DESIGN: Randomized controlled trial with control group cross-over (half cross-over design). SETTING: Subjects with CRPS I were outpatients of a university hospital and cooperating centers. All patients carried out the daily exercise at home. POPULATION: Subjects with unilateral upper extremity CRPS I meeting the Budapest diagnostic criteria. METHODS: Subjects were randomly divided into two groups. Group A (N.=13) carried out a ten-minute MT exercise daily, for a total duration of six weeks. Group B (N.=14) acted as a control group for six weeks followed by six weeks of MT with the same characteristics as Group A. Upper extremity active range of motion, strength, dexterity, limb volume, affected-to-unaffected hand temperature difference, and health-related quality of life were evaluated before and after each period. Daily records on the visual analogue scale were used for pain evaluation. Effectiveness was calculated using mixed-effects modelling for between-group comparisons and within-group variability, and identification of significant predictors. RESULTS: Twenty-three females and four males with an average age of 56.1±9.6 years completed the study. Except for the affected-to-unaffected hand temperature difference, both groups consistently demonstrated significant or near-significant improvements in measured parameters after MT period. The improvements were evident upon an intergroup comparison of Group A and the control period of Group B as well as longitudinally within Group B. No significant improvement was found during the control period. CONCLUSIONS: Principles focused on mirror visual feedback to the central nervous system can sustain promising therapeutic potential as part of the treatment for pain reduction and hand function in CRPS I patients. CLINICAL REHABILITATION IMPACT: MT can be considered as part of the therapeutic regimen employed for the treatment of CRPS I.
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Síndromes de Dolor Regional Complejo , Distrofia Simpática Refleja , Masculino , Femenino , Humanos , Persona de Mediana Edad , Anciano , Distrofia Simpática Refleja/terapia , Calidad de Vida , Retroalimentación Sensorial , Resultado del Tratamiento , Extremidad Superior , Síndromes de Dolor Regional Complejo/terapia , DolorAsunto(s)
Neurilemoma/diagnóstico , Neoplasias del Sistema Nervioso Periférico/diagnóstico , Neuropatía Ciática/diagnóstico , Ciática/diagnóstico , Adulto , Nalgas/inervación , Diagnóstico Diferencial , Femenino , Humanos , Neurilemoma/patología , Neoplasias del Sistema Nervioso Periférico/patología , Nervio Ciático/patología , Neuropatía Ciática/patologíaRESUMEN
OBJECTIVES: Respiratory complications are most common cause of morbidity/mortality in patients with cervical spinal cord injury (cSCI) due to respiratory muscle weakness and lower diaphragm position resulting in limited availability of inspiration, reduced thorax mobility and limited forced expiration. Differences in respiratory dysfunctions (RDs) in patients with motor complete versus incomplete cSCI were assessed. DESIGN: Prospective longitudinal study, serial measurement. SETTING: University hospital and ambulatory departments. METHODS: Twenty two patients with acute cSCI were recruited. Neurological level of injury and severity according to ISNCSCI were used as criteria for recruitment. Patients were divided into two groups - motor complete and incomplete. Standardized pulmonary function tests (PFT) were used - spirometry and respiratory muscle strength (RMS) measurement. Motor score of key muscles assessments for upper (UEMS) and lower (LEMS) limbs were used. Tests were performed in 5 measurement sessions starting on (medians) 14.5 days (M1), then 6.7 weeks, 3.2 months, 6.3 months and 1.0 year (M5). RESULTS: Significant differences in measurement sessions M2-M5 between groups in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), expiratory reserve volume (ERV), maximal static inspiratory/expiratory pressures (MIP, MEP) and UEMS were proved. Consequently, prominent differences in courses of particular parameters were found. No intergroup changes in UEMS were found during study. CONCLUSIONS: Obvious differences in parameters of spirometry, respiratory muscles and limb muscles strength between motor complete and incomplete group were found. Carefull monitoring of RDs by functional assessments (i.e., PFT and UEMS/LEMS tests) within one year after SCI seems to be clinically important.
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Médula Cervical/lesiones , Enfermedades Pulmonares/etiología , Traumatismos de la Médula Espinal/complicaciones , Adulto , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Fuerza Muscular , Estudios Prospectivos , Cuadriplejía/etiología , Pruebas de Función Respiratoria , Músculos Respiratorios/fisiopatología , EspirometríaRESUMEN
Pain-related fear may pose a serious barrier in the management of patients with chronic musculoskeletal pain, resulting in severe functional impairment in many cases. The paper describes the cognitive-behavioural therapy of a patient with a specific phobia (fear of pain and movement). The principal objective of the therapy was to educate the patient in strategies and skills to manage his fear and to verify the effect of the therapy. Both group and individual therapy was used. Group multimodal therapy of pain was provided by an interdisciplinary team of health care providers, specialising in pain management (psychotherapist, doctors and physiotherapists). The programme was based on operant therapy principles and included pacing and graded exercising and walking, relaxation, group education about ergonomics, and fear and pain relapse prevention. Reduction in the fear of pain and movement was achieved, and social bonds and physical and social activities improved after the psychotherapy, while the results were stable for two years.
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Dolor Crónico/psicología , Dolor Crónico/terapia , Terapia Cognitivo-Conductual , Miedo/psicología , Dolor Musculoesquelético/psicología , Dolor Musculoesquelético/terapia , Adulto , Humanos , Masculino , Manejo del Dolor/métodos , Conducta Social , Resultado del TratamientoRESUMEN
OBJECTIVES AND METHODS: Excitability changes in the primary motor cortex in 17 spinal-cord injured (SCI) patients and 10 controls were studied with paired-pulse transcranial magnetic stimulation. The paired pulses were applied at inter-stimulus intervals (ISI) of 2 ms and 15 ms while motor evoked potentials (MEP) were recorded in the biceps brachii (Bic), the abductor pollicis brevis (APB) and the tibialis anterior (TA) muscles. RESULTS: The study revealed a significant decrease in cortical motor excitability in the first weeks after SCI concerning the representation of both the affected muscles innervated from spinal segments below the lesion, and the spared muscles rostral to the lesion. In the patients with motor-incomplete injury, but not in those with motor-complete injury, the initial cortical inhibition of affected muscles was temporarily reduced 2-3 months following injury. The degree of inhibition in cortical areas representing the spared muscles was observed to be smaller in patients with no voluntary TA activity compared to patients with some activity remaining in the TA. Surprisingly, motor-cortical inhibition was observed not only at ISI 2 ms but also at ISI 15 ms. The inhibition persisted in patients who returned for a follow-up measurement 2-3 years later. CONCLUSION: The present data showed different evaluation of cortical excitability between patients with complete and incomplete spinal cord lesion. Our results provide more insight into the pathophysiology of SCI and contribute to the ongoing discussion about the recovery process and therapy of SCI patients.
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Vías Eferentes/fisiología , Potenciales Evocados Motores/fisiología , Corteza Motora/fisiología , Inhibición Neural/fisiología , Traumatismos de la Médula Espinal/fisiopatología , Adolescente , Adulto , Análisis de Varianza , Estudios de Casos y Controles , Vías Eferentes/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Músculo Esquelético/inervación , Músculo Esquelético/fisiología , Neuronas Eferentes/fisiología , Valores de Referencia , Factores de Tiempo , Estimulación Magnética Transcraneal , Adulto JovenRESUMEN
AIM: To compare the quality of magnetic resonance angiographies (MRAs) performed with different contrast agents and to evaluate the effect of body mass index (BMI) and ejection fraction (EF) on the quality of these MRAs. MATERIALS AND METHODS: 120 patients between the age of 43 and 86 years were subjected to MRAs with different contrast agents (Gadobutrolum, Dimeglumini gadobenas, Gadofosveset trisodium). Each patient's BMI was calculated, and EF was established using MR examination of the heart. Objective evaluations of the quality of the MRAs were done using abdominal fat-to-aorta enhancement ratio (FAR) comparisons. This ratio was then correlated with the patient's BMI and EF. Subjective evaluations of the quality of the MRAs were done by 5 blinded evaluators. Correlation analysis and analysis of variance were used for statistical assessement. RESULTS: There was no statistically significant difference in FAR for any of the contrast agent groups. There was a mesoscale correlation between a patient's BMI and FAR. However, no correlation was found between the EF and FAR for any of the contrast agent groups. The results of the subjective evaluation showed that there was no statistical difference in the quality of MRAs regardless of the contrast agent used. CONCLUSION: Subjectively there was no statistically significant difference in the quality of the MRAs. Irrespective of the type of contrast used or the patient's EF, the lower the BMI of a patient the higher the signal enhancement and hence the better the quality of the MRA produced in that patient.
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Índice de Masa Corporal , Medios de Contraste , Gadolinio , Pierna/irrigación sanguínea , Angiografía por Resonancia Magnética , Imagen por Resonancia Cinemagnética , Compuestos Organometálicos , Enfermedad Arterial Periférica/diagnóstico , Volumen Sistólico , Adulto , Anciano , Anciano de 80 o más Años , Aorta Abdominal/patología , Corazón , Humanos , Meglumina/análogos & derivados , Persona de Mediana Edad , Enfermedad Arterial Periférica/fisiopatologíaRESUMEN
OBJECTIVES: Balance and motor disturbances are significant symptoms commonly associated with hereditary motor and sensory neuropathy (HMSN), also known as Charcot-Marie-Tooth disease (CMT). Although CMT is a progressive neurological disease, comprehensive physiotherapeutic strategies may improve balance and motor patterns, and, therefore, enhance the quality of life (ADL). CASE PRESENTATION: A 55-year-old HMSN patient with confirmed CMT X phenotype was evaluated for locomotor stability on a stabilometric platform. Stability tests were repeated after a 3-week, intensive in-patient rehabilitation program and the results were compared. CONCLUSIONS: Improvements in "modified clinical testing of sensory interaction on balance", "limits of stability" and "forward lunge" tests were observed. Subjectively, the patient noted a significant improvement in both balance and gait.
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Enfermedad de Charcot-Marie-Tooth , Calidad de Vida , Humanos , FenotipoRESUMEN
BACKGROUND/AIMS: To assess the biliary manometric perfusion test (BMPT) for evaluating success in treating benign biliary strictures. METHODOLOGY: During 2003 to 2010, 29 patients were subjected to BMPT after percutaneous balloon dilatation treatment. Intrabiliary pressure less than 20cm of water was considered the success threshold. Results of BMPT evaluation were retrospectively compared with a similar group where the standard clinical test was used for evaluating treatment success. The clinical test group included 21 patients treated for biliary strictures from 1994 to 2006. RESULTS: The two groups were statistically similar by age and gender. The BMPT group was tested without complications and pressure inside the biliary tree was less than 20cm of water in 27 of 29 patients. Subsequently, catheters were removed from all 27. Three patients required re-interventions 13 days, 11 months and 32 months later. Kaplan-Meier survival analysis showed that the probability of biliary patency at 3 year was 82.2%. There was no significant difference between groups by this measure (log rank test, p=0.624). CONCLUSIONS: The manometric test is an alternative for evaluating success in treating benign biliary strictures. It is simple, less time-consuming, economical, safe, effective and more comfortable for patients than the clinical test.
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Sistema Biliar/fisiopatología , Colestasis/fisiopatología , Colestasis/terapia , Adulto , Anciano , Sistema Biliar/diagnóstico por imagen , Cateterismo , Catéteres de Permanencia , Colangiografía , Colestasis/diagnóstico por imagen , Constricción Patológica/diagnóstico por imagen , Constricción Patológica/fisiopatología , Constricción Patológica/terapia , Medios de Contraste , Drenaje , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Manometría , Persona de Mediana Edad , Presión , Recurrencia , Estudios Retrospectivos , Adulto JovenRESUMEN
Peripheral nerve stimulation (PNS) is a neurostimulation analgesic technique. PNS is utilized to treat peripheral neuropathic pain. It is highly sophisticated and a specialized technique used where other forms of treatment have failed. This paper describes the PNS procedure, its therapeutic principles, indications, and the comprehensive care for patients after the PNS implant. First, we summarize our experience using this type of invasive treatment. In the second part, a case of intractable neuropathic pain following repeated surgery to the ulnar nerve is reported. Prior to PNS, the patient underwent multiple types of antineuralgic treatment with no significant result. Only after the PNS application, was a significant analgesic effect achieved.
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Terapia por Estimulación Eléctrica , Neuralgia/terapia , Nervios Periféricos/fisiología , Administración Cutánea , Adulto , Capsaicina/administración & dosificación , Capsaicina/uso terapéutico , Electrodos Implantados , Femenino , Humanos , Neuralgia/psicología , Examen Neurológico , Neurocirugia , Nervio Cubital/fisiología , Neuropatías Cubitales/terapiaRESUMEN
BACKGROUND: During the past nine years three cases of cystic adventitial disease of the popliteal artery have been diagnosed and treated in our medical institution. Different approaches were used in the treatment in all these cases. The purpose of this report is to summarise the current knowledge of the etiology, presentation, diagnostics and treatment of this condition, with the addition of new cases. METHODS: Information about three new cases is presented and discussed together with that from the relevant publications obtained from the Pubmed database. Results. In the first case resection with synthetic graft interposition was used. Nine years after the surgery the patient is without any signs of recurrence, but he experienced local thrombolysis of the occluded graft and repeated PTA of hemodynamically significant anastomotic stenoses. The second case treated with US-guided aspiration has demanded repeated reinterventions due to recurrence; nevertheless, the result is satisfactory. In the last instance, the cyst was evacuated and excised. Six months after the surgery the patient is symptom-free and without signs of recurrence. CONCLUSIONS: CAD of the popliteal artery is a rare vascular condition. However, it must be considered in the differential diagnosis, especially in middle-aged male patients without evidence of atherosclerotic disease in whom intermittent claudication has developed suddenly with a rapid progression or with fluctuation in severity. Duplex ultrasound and MRA are the the best diagnostic methods. Based on the existing knowledge, the treatment of choice is surgery (either evacuation with the removal of the cystic wall or resection and grafting).
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Arteriopatías Oclusivas/diagnóstico , Arteria Poplítea , Anciano , Arteriopatías Oclusivas/complicaciones , Arteriopatías Oclusivas/cirugía , Quistes/diagnóstico , Quistes/cirugía , Humanos , Claudicación Intermitente/etiología , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Ultrasonografía Doppler DúplexRESUMEN
STUDY DESIGN: A report on 3 patients undergoing total spondylectomy of the C2 vertebra for tumor and the technique for C1-3 reconstruction. OBJECTIVE: To illustrate the feasibility of complete resection of the C2 vertebra with preservation of the vertebral arteries and cervical nerve roots. BACKGROUND: Total spondylectomy provides improved progression free survival in many patients with locally aggressive spinal tumors. However, the perceived technical demands of effectively preserving both vertebral arteries, maintaining cervical nerve roots, and biomechanical reconstruction of the cranial-cervical junction often dissuades surgeons from carrying out total spondylectomy of the C2 vertebra. METHODS: A review of 3 patients undergoing total C2 spondylectomy for tumor (thyroid adenocarcinoma, chordoma, and solitary plasmocytoma) was done. The surgical procedure that was undertaken and the technique used are described. RESULTS: Postoperatively, all 3 patients had uneventful postoperative recovery with gradual improvement in their neurologic functions. CONCLUSION: Preservation of bilateral vertebral arteries and all cervical nerve roots is feasible when carrying out intralesional total spondylectomy in patients with C2 vertebral body tumors and should be considered in patients thought to benefit from total C2 vertebra excision. In an attempt to augment construct stability and provide anterior column load sharing, we have used mesh cage and iliac crest graft between C1 and C3 held in place with a short cervical plate without complications.
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Adenocarcinoma/cirugía , Vértebra Cervical Axis/cirugía , Cordoma/cirugía , Procedimientos Ortopédicos/métodos , Plasmacitoma/cirugía , Neoplasias de la Columna Vertebral/cirugía , Adenocarcinoma/patología , Adulto , Vértebra Cervical Axis/patología , Cordoma/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Plasmacitoma/patología , Neoplasias de la Columna Vertebral/patología , Resultado del TratamientoAsunto(s)
Endocarditis/etiología , Eosinófilos/fisiología , Corazón/fisiopatología , Síndrome Hipereosinofílico/tratamiento farmacológico , Proteínas de Fusión Oncogénica/metabolismo , Piperazinas/uso terapéutico , Pirimidinas/uso terapéutico , Receptor alfa de Factor de Crecimiento Derivado de Plaquetas/metabolismo , Factores de Escisión y Poliadenilación de ARNm/metabolismo , Corticoesteroides/uso terapéutico , Adulto , Anticoagulantes/uso terapéutico , Benzamidas , Quimioterapia Combinada , Endocarditis/tratamiento farmacológico , Endocarditis/patología , Humanos , Síndrome Hipereosinofílico/patología , Síndrome Hipereosinofílico/fisiopatología , Mesilato de Imatinib , Masculino , Prednisona/uso terapéutico , Inducción de Remisión , Trombosis/etiología , Resultado del Tratamiento , Warfarina/uso terapéuticoRESUMEN
PURPOSE: Subintimal angioplasty is becoming more frequently used treatment option for patients with long arterial occlusions or diffuse atherosclerotic changes as an alternative to surgical treatment in claudicants especially in patients with critical limb ischemia. The aim of our article is to retrospectively assess mid-term outcomes of subintimal angioplasty of chronic arterial occlusions in femoropopliteal region followed clinically and by Doppler ultrasonography. MATERIALS AND METHODS: From May 2002 to December 2007, 133 femoropopliteal artery occlusions in 123 patients were indicated for subintimal recanalisation. The indications for treatment were intermittent claudications in 84 patients (63.15%) and critical limb ischemia in 49 patients (36.85%). The median length of lesions was 11.4 cm, range 2-30 cm. Except doppler ultrasonographic examination done 24h after the procedure and clinical examination before discharge, both clinical and ultrasonographic examinations were performed 6 and 12 months after the procedure and yearly thereafter. Statistical analysis of our cohort was performed by Kaplan-Meier analysis, log-rank test and Cox regression. RESULTS: Technical success was achieved in 86.46%. Primary patency rate was 83.1% (SE: 3.9%), 67.5% (SE: 5%), 58% (SE: 5.9%) a 48.4% (SE: 7.1%) at 6, 12, 24 and 36 months respectively. No statistically significant difference of primary patency was found between the group of claudicants and the group of patient with critical limb ischemia. Statistically significant prediction factors for primary patency were only the quality of the run off and the length of the occlusion. Limb salvage rate in our group of patients with critical limb ischemia was 80.8% at 12 months. CONCLUSION: : Subintimal recanalisation is a simple and safe procedure for treatment of chronic peripheral arterial occlusions with high primary technical success rate, acceptable primary patency rate, low percentage of complications and mortality is as low as nil. Subintimal angioplasty is definitely advantageous and fast method in patients with critical limb ischemia with high possibility of limb salvage. Surgical treatment can be replaced by subintimal angioplasty in claudicants with high risk of operative treatment, without suitable autologous vein graft or where distal femoropopliteal or femorocrural bypass is needed.
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Arteriopatías Oclusivas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Arteriopatías Oclusivas/diagnóstico por imagen , Enfermedad Crónica , Femenino , Arteria Femoral , Humanos , Claudicación Intermitente/diagnóstico por imagen , Claudicación Intermitente/cirugía , Isquemia/diagnóstico por imagen , Isquemia/cirugía , Masculino , Persona de Mediana Edad , Arteria Poplítea , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Ultrasonografía DopplerRESUMEN
BACKGROUND: Even with effective smoking cessation medications, many smokers are unable to abruptly stop using tobacco. This finding has increased interest in smoking reduction as an interim step towards complete cessation. METHODS: This multi-center, double-blind placebo-controlled study evaluated the efficacy and safety of nicotine 4 mg gum or nicotine 10 mg inhaler in helping smokers (N = 314) to reduce or quit smoking. It included smokers willing to control their smoking, and participants could set individual goals, to reduce or quit. The study was placebo-controlled, randomized in a ratio of 2:1 (Active:Placebo), and subjects could choose inhaler or gum after randomization. Outcome was short-term (from Week 6 to Month 4) and long-term (from Month 6 to Month 12) abstinence or reduction. Abstinence was defined as not a single cigarette smoked and expired CO readings of <10 ppm. Smoking reduction was defined as a reduction in number of cigarettes per day by 50% or more versus baseline, verified by a lower-than-baseline CO reading at each visit during the same periods. RESULTS: Significantly more smokers managed to quit in the Active group than in the Placebo group. Sustained abstinence rates at 4 months were 42/209 (20.1%) subjects in the Active group and 9/105 (8.6%) subjects in the Placebo group (p = 0.009). Sustained abstinence rates at 12 months were 39/209 (18.7%) and 9/105 (8.6%), respectively (p = 0.019). Smoking reduction did not differ between the groups, either at short-term or long-term. Twelve-month reduction results were 17.2% vs. 18.1%, respectively. No serious adverse events were reported. CONCLUSION: In conclusion, treatment with 10 mg nicotine inhaler or 4 mg nicotine chewing gum resulted in a significantly higher abstinence rate than placebo. In addition a large number of smokers managed to reduce their cigarette consumption by more than 50% compared to baseline.
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Nicotina/uso terapéutico , Cese del Hábito de Fumar/métodos , Adulto , Anciano , Pruebas Respiratorias , Monóxido de Carbono/análisis , Goma de Mascar , Cotinina/sangre , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nebulizadores y Vaporizadores , Nicotina/administración & dosificación , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: The success of balloon dilatation treatment of benign biliary strictures (BBS) is usually evaluated by 'clinical test'. For objective evaluation of treatment success, measurement of the pressure inside the biliary tree after treatment has been proposed. AIM: The aim of this article is to assess the role of biliary manometric perfusion test (BMPT) in the evaluation of treatment success of BBS and to assess the long term biliary patency after evaluation by BMPT. MATERIALS AND METHODS: From February 2003 to January 2008, 12 patients (median age 53.5 years) after balloon dilatation treatment were evaluated by BMPT. BMPT was done after a mean of 3 dilatations over a mean period of 6.85 months. An intrabiliary pressure less than 20 cm of water during the test was considered as success threshold. RESULTS: The pressures during BMPT were less than 20 cm of water in 11 out of 12 patients. Subsequently the drain was removed and patients were followed up clinically. Two patients on follow-up required re-intervention 13 days and 11 months later. The remaining 9 patients had no evidence of biliary obstruction at a mean following of 15.3 months. Using the statistical Kaplan-Meier analysis, the probability of biliary patency up to 9 months was 90.9% and at 1, 2 and 3 years was 77%. CONCLUSION: BMPT is effective in the evaluation of treatment success of BBS. It is simple, cost effective, gives immediate results and helps us to determine the treatment end point.
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Sistema Biliar/fisiopatología , Cateterismo , Colestasis/terapia , Adulto , Anciano , Anciano de 80 o más Años , Colestasis/fisiopatología , Femenino , Humanos , Masculino , Manometría , Presión , Análisis de SupervivenciaRESUMEN
BACKGROUND: During the last ten years we diagnosed two cases of venous aneurysm. The purpose of this report was to point out a certain risk of the thrombembolism of superficial venous aneurysms and to review our experience in the management of superficial and deep venous aneurysms. METHODS: The presentation and management of these lesions were reviewed and discussed together with other cases from available literature. RESULTS: In the first case an aneurysm of lesser saphenous vein with a possible threat of thrombembolism was revealed and surgically solved with saphena resection. Ten years after the surgery she is still symptom free. In the second case a small fusiforme popliteal vein aneurysm without any evidence of mural thrombus was diagnosed. The patient was treated conservatively with regular venous duplex imaging follow up. Two years later the disease has been stable. CONCLUSIONS: Superficial venous aneurysms can have a certain risk of the thrombembolism. Since surgical therapy is very simple, it can be recommended in all cases. Nevertheless, trombembolism is more common in deep venous aneurysms, especially popliteal ones, in which surgical repair can be based on their pathological features and presentation or can be indicated in all cases.
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Aneurisma/diagnóstico , Vena Poplítea , Vena Safena , Adulto , Aneurisma/complicaciones , Aneurisma/cirugía , Femenino , Humanos , Persona de Mediana Edad , Tromboembolia/etiologíaRESUMEN
AIM: Prolonged temporary implantation of retrievable vena cava filter is little discussed in literature. The aim of our article is to present our experience with a new type of retrievable "Recovery IVC Filter" with prolonged period of placement in the inferior vena cava (IVC). MATERIALS AND METHODS: "Recovery IVC Filter" was implanted in another department for a 27 year old patient with congenital deficiency of anti thrombin III with deep vein thrombosis (DVT) complicated by pulmonary embolism (PE). After 383 days from implantation of vena cava filter, the patient was indicated for removal of the filter from the right jugular vein access. RESULTS: Filter was removed with the help of a special extraction system without significant technical complications in our department. On control phlebography after extraction of cava filter, there were no signs of injury to the wall of inferior vena cava, extravasation or stenosis. CONCLUSION: Removal of "Recovery IVC Filter" after long term temporary implantation is possible and safe.
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Deficiencia de Antitrombina III/complicaciones , Remoción de Dispositivos/métodos , Filtros de Vena Cava , Adulto , Femenino , Humanos , Embarazo , Complicaciones Hematológicas del Embarazo/terapia , Trastornos Puerperales/terapia , Embolia Pulmonar/prevención & control , Trombosis de la Vena/terapiaRESUMEN
PURPOSE: To evaluate the efficacy of endovascular treatment of paraaortic postoperative abdominal aortic pseudoaneurysms. MATERIALS AND METHODS: From April 1996 to November 2007 five men with paraaortic postoperative abdominal aortic pseudoaneurysm underwent endovascular treatment. Average age was 64.2 years (range 54-73). The average time interval between the primary surgery and endovascular treatment was 12.4 years (4 months-23 years). Three patients were treated by aortouniiliacal stentgrafts and two patients by tube stentgrafts. RESULTS: Technical success rate was 100%. Pseudoaneurysms were primarily excluded from circulation without perioperative complications in all patients. At follow-up (mean 38.5 months) there were no deaths and no endoleaks. In one patient thrombosis of stentgraft was found and it was successfully treated by thrombectomy. All pseudoaneurysms still continued to be excluded from circulation in the last follow-up. CONCLUSION: Endovascular treatment is minimally invasive, effective and safe option of surgery for paraaortic postoperative pseudoaneurysms.
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Anastomosis Quirúrgica/efectos adversos , Aneurisma Falso/etiología , Aneurisma Falso/terapia , Aorta Abdominal/cirugía , Embolización Terapéutica/métodos , Procedimientos de Cirugía Plástica/efectos adversos , Anciano , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Spinal cord stimulation (SCS) consisting of electrical stimulation of the dorsal spinal cord using epidural electrodes has been shown to relieve chronic neuropathic pain. To analyze the cerebral activation patterns related to SCS, and to evaluate the effects of SCS on the processing of acute experimental pain, we performed functional magnetic resonance imaging (fMRI) on eight patients suffering from failed back surgery syndrome who were also being treated with SCS for severe pain in their legs and lower back. Three types of stimulation were used, each lasting 36s: (i) SCS, (ii) heat pain (HP) applied to the leg affected by neuropathic pain, and (iii) simultaneous HP and SCS. During SCS, we found increased activation of the medial primary sensorimotor cortex somatotopically corresponding to the foot and/or perineal region, contralateral posterior insula, and the ipsilateral secondary somatosensory cortex (S2). Decreased activation was seen in the bilateral primary motor cortices and the ipsilateral primary somatosensory cortex corresponding to the shoulder, elbow and hand. Compared to separately presented HP and SCS, simultaneous HP and SCS showed statistically significant activation of the bilateral inferior temporal cortex and the ipsilateral cerebellar cortex. The activation of the primary motor cortex, insula and S2 during SCS may directly interfere with the processing of neuropathic pain. When SCS is associated with heat pain, the paralimbic association cortex and cerebellum show activation exceeding the sum of activations resulting from separate SCS and heat pain stimulation. The explanation of this could possibly rest with the continuous comparisons of simultaneous pain and somatosensory sensations occurring in a single dermatome.
Asunto(s)
Dorso , Encéfalo/fisiopatología , Terapia por Estimulación Eléctrica , Pierna , Imagen por Resonancia Magnética , Neuralgia/terapia , Médula Espinal/fisiopatología , Adulto , Dorso/cirugía , Terapia por Estimulación Eléctrica/efectos adversos , Terapia por Estimulación Eléctrica/métodos , Femenino , Calor/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Corteza Motora/fisiopatología , Dolor/etiología , Corteza Somatosensorial/fisiopatología , Síndrome , Insuficiencia del TratamientoRESUMEN
BACKGROUND: Benign biliary strictures treated radiologically by percutaneous dilatation treatment are usually evaluated by 'clinical test'. For objective evaluation of treatment success, measurement of the pressure inside the biliary tree has been proposed. AIM: The aim of this article is to report our experience with the measurement of the pressure in the biliary tree after treatment, to present the biliary manometric perfusion test (BMPT) as an alternative method of treatment evaluation and to demonstrate why the perfusion test is a better method of evaluation. MATERIALS AND METHODS: A 65 year old lady with post operative biliary stricture and symptoms of jaundice was treated in our Department with percutaneous dilatation treatment and long-term drainage. The perfusion test (BMPT) was adopted for evaluating treatment success after the treatment for 9 months. An intrabiliary pressure less than 20 cms of water during perfusion test was considered success threshold. RESULTS: The test was carried out without any complications and the pressure inside the biliary tree was less than 20 cms of water during the test. Eventually the drain was removed. On follow-up at 6 months the patient developed no recurrence of jaundice and the quality of life improved clinically. Periodic liver function tests during follow-up were normal. CONCLUSION: The perfusion test (BMPT) is promising efficacious alternative method for the evaluation of radiological treatment of benign biliary strictures. It helps us to decide the end points in treatment and also helps in identifying patients who might later develop strictures.