Bloqueo retrolaminar ecoguiado como analgesia para el manejo de neuralgia por herpes zóster: a propósito de un caso / Retrolaminar ultrasound guided block as analgesic treatment for post herpetic neuralgia: case report

Los bloqueos interfasciales (BIF) son el resultado de inyectar un anestésico local en el espacio comprendido entre dos fascias con el objetivo de distribuir el volumen y bloquear la transmisión nerviosa correspondiente. La introducción de los BIF como técnica anestésico-analgésica es relativamente reciente. Su amplia difusión y estandarización en estos últimos años ha venido de la mano del uso de ultrasonidos; como resultado ha aumentado la eficacia de los bloqueos y la seguridad en la práctica de los mismos. El bloqueo retrolaminar (RL) y el bloqueo del plano del erector espinal (ESP) comparten características similares y pueden considerarse una alternativa analgésica para los dolores relacionados con afectación de la pared torácica, siendo el bloqueo RL de gran valor en pacientes con riesgo de neumotórax o en quienes no se obtenga adecuada visualización de la sonoanatomía para el bloqueo ESP. Se describe el caso de un paciente con neuralgia aguda por herpes zóster, a quien se le realizó un bloqueo RL exitoso.(AU)

Interfacial plane blocks (IPB) are the result of the injection of an anesthetic locally in the space created between two fasciae with the purpose of distributing the volume of the medication and block the transmission of the corresponding nerves. The introduction of IPB as an analgesic anesthetic technic is relatively resent, and its widespread and standardization this last few years has come by hand of the ultrasound, as a result the safety and efficiency of the IPB has increased. The retrolaminar block (RB) and the Spinal erector plane block (SPB) share characteristics and could be considered as an alternative to manage the thoracic wall pain pathologies, keeping in mind that the RB is of choice for patients in danger of suffering a pneumothorax or in those in which there is an inappropriate anatomic visualization though the echography for the SPB. In this article a case of a patient with acute neuralgia due to herpes zoster who received a successful RB is described.(AU)

Cobb angle measurement with a conventional convex echography probe and a smartphone.

BACKGROUND CONTEXT: Serial X-rays are needed during the follow-up of adolescent idiopathic scoliosis. They are done every 6 or 3 months in cases of high risk of progression. Thanks to the advances in ultrasound techniques, deformity measurement systems free from ionizing radiations have been validated, although spinal surgeons did not use them routinely due to the need of special software. OBJECTIVE: The aim of our work is to assess the reproducibility and correlation of an ultrasound measuring system based on the positioning of the transverse processes. STUDY DESIGN: Prospective, single center, randomized, triple blinded. METHODS: Two independent researchers trained in ultrasound examined the spinal deformities of 31 children. The measurements were compared against those performed with an X-ray by three scoliosis expert surgeons. Statistics were performed by an independent researcher. Parametric methods were used. RESULTS: We found a 95% [(0.91-0.97) p < 2.2e-16] correlation between the degree of scoliosis measured with the proposed ultrasound system and the 30 cm × 90 cm X-rays in standing position. There was an intra-observer reliability of 97% [r-squared = 0.97; CI 95% (0.95-0.98) p < 2.2e-16] and an inter-observer reliability of 95% [r-squared = 0.95; CI 95% (0.90-0.97) p < 2.2e-16]. CONCLUSIONS: An approximation of the Cobb angle measure is possible with ultrasound by using the transverse processes as reference. This is a very rapid and simple system for assessing the principal spinal deformity measure in young people, although it does not allow estimating the associated axial or sagittal rotation. These slides can be retrieved under Electronic Supplementary Material.

Equilibria and correlation of systems involving 1-hexyl-3-methylpyridinium trifluoromethanesulfonate.

Ionic liquids are being proposed for the improvement of many refinery-related applications where water and oil coexist. However, the lack of relevant thermodynamic data on equilibrium processes involving water, oil and an ionic liquid is a stumbling block. Phase diagrams of these systems are complex, with many different regions, especially when the ionic liquid is solid at room conditions. This greatly complicates modelling, which is usually neglected or carried out only partially. In this work, for the first time, the simultaneous correlation not only of liquid-liquid and liquid-liquid-liquid but also solid-liquid equilibrium data for ternary systems involving ionic liquids has been carried out. To that end, the ionic liquid 1-hexyl-3-methylpyridinium trifluoromethanesulfonate, with an alkyl chain length that favours nano-segregation, was selected. Phase diagrams with water and different representative oils (octane, toluene and cyclohexane) have been determined at various temperatures and atmospheric pressure. The great capacity of the NRTL model, a powerful tool used in all chemical process simulators, was shown by simultaneously correlating data from all the equilibrium regions. However, adequate equilibrium equations and pivotal strategies were required. Low deviations and a good representation of phase diagrams was achieved. A topological analysis based on the Gibbs common tangent criterion and a stability test allowed validation of the proposed correlation parameters.

Blood Glucose and Insulin Concentrations after Octreotide Administration in Horses With Insulin Dysregulation.

BACKGROUND: Octreotide is a somatostatin analog that suppresses insulin secretion. HYPOTHESIS: We hypothesized that octreotide would suppress insulin concentrations in horses and that normal (N) horses and those with insulin dysregulation (ID) would differ significantly in their plasma glucose and insulin responses to administration of octreotide. ANIMALS: Twelve horses, N = 5, ID = 7. METHODS: Prospective study. An oral sugar test was performed to assign horses to N and ID groups. Octreotide (1.0 µg/kg IV) was then administered, and blood was collected at 0, 5, 10, 15, 20, 25, 30, 45, 60, 75, and 90 minute, and 2, 3, 4, 6, 8, 12, and 24 hour for measurement of glucose and insulin concentrations. Area under the curve (AUC) values were calculated. RESULTS: Mean AUC values for glucose and insulin did not differ between normal (n = 5) and ID (n = 7) groups after octreotide injection. Significant time (P < .001) effects were detected for glucose and insulin concentrations. A group × time interaction (P = .091) was detected for insulin concentrations after administration of octreotide, but the group (P = .33) effect was not significant. CONCLUSIONS AND CLINICAL IMPORTANCE: Octreotide suppresses insulin secretion, resulting in hyperglycemia, and then concentrations increase above baseline as glycemic control is restored. Our hypothesis that octreotide causes insulin concentrations to decrease in horses was supported, but differences between N and ID groups did not reach statistical significance when blood glucose and insulin responses were compared. The utility of an octreotide response test remains to be determined.

Age effects on blood gas, spirometry, airway reactivity, and bronchoalveolar lavage fluid cytology in clinically healthy horses.

BACKGROUND: Despite the increasing number of geriatric horses attended by veterinarians, there is a lack of understanding of aging-related changes on the respiratory system of horses. OBJECTIVE: To identify aging-related changes on the respiratory function and bronchoalveolar lavage fluid (BALF) cytology of horses. ANIMALS: Fifteen healthy young adult (2-11 years) and 16 healthy aged (≥20 years) horses. METHODS: The respiratory system was examined by measurement of arterial blood gases (ABG), use of respiratory inductive plethysmography (RIP) for assessment of breathing pattern and ventilatory parameters, histamine bronchoprovocation, and BALF cytology. RESULTS: No significant differences were detected with regard to values obtained by ABG or bronchoprovocation of young adult and aged healthy horses. In aged horses, there were significant differences in mean ± SD of the following parameters when compared to young horses: prolonged expiratory time (Te) measured by RIP (3.9 ± 1.5 s versus 3.0 ± 0.6 s), decreased percentage of alveolar macrophages (40.6 ± 11.3% versus 53.5 ± 9.6%), and increased percentage of lymphocytes (53.4 ± 9.5% versus 43.9 ± 11.0%). No correlations between airway reactivity and ventilatory parameters, ABG, or BALF cytology were found in this asymptomatic population. CONCLUSIONS: These results suggest that aging does not cause changes in the results obtained by ABG, most RIP-derived variables, and bronchoprovocation in the horse. A decreased percentage of macrophage and an increased percentage of lymphocytes in the BALF cytology may be expected in the asymptomatic geriatric horse and may be a result of aging.

Pseudoaneurysm of the brachial artery caused by an osteochondroma. A report of two cases.

We present two cases of osteochondroma associated with a pseudoaneurysm of the brachial artery. The diagnosis was confirmed by arteriography and ultrasonography in one case. Treatment was resection of the pseudoaneurysm, and saphenous vein grafting, with excision of the osteochondroma in both patients.

Plantas medicinales y proyectos de investigación

Se plantea que en el Ecuador, pses a ser un país rico en variedad de su flora, sin embargo, pocos son los cultivadores de su estudio y menos aún de las plantas medicinales. Se realiza un breve recuento de los principales aportes en este campo. Se propone la necesidad de desarrollar investigaciones en esta línea. Se expone que hay dos fuentes para conocerlas: la bibliografica -escasa-, y la directa, expresada por curanderos o hierbateros de la medicina tradicional. Se exhorta a identificar los nombres comunes de las plantas utilizadas en las diferentes regiones del país, buscando una unificación en la nomenclatura; autenticidad de sus propiedades médicas; y estudiar la etnobotánica. Finalmente, se exponen algunos ejemplos de plantas de la farmacopea popular que merecen se profundice en su investigación.