Ultrasound-Guided Radiofrequency Ablation for Chronic Hip Pain Due to Osteoarthritis.

BACKGROUND AND AIMS: Hip osteoarthritis (OA) has a prevalence of 2.9% in Portugal and is a related cause of pain and disability. A sufficient number of patients report these symptoms even after total hip arthroplasty (THA), while others are contraindicated to such surgery and suffer from uncontrolled pain. Percutaneous denervation of hip nerve branches using radiofrequency ablation (RFA) has emerged as a powerful therapeutic avenue to consider for patients with chronic hip pain. METHODS: Between January 2020 and March 2021, 26 patients with chronic hip pain received ultrasound-guided RFA with a pericapsular nerve group (PENG) block technique adaptation. Patients suffering from chronic hip pain for more than three months with radiographic evidence of osteoarthritis were included. A numeric rating scale (NRS) and pain medication reduction were defined as outcome variables assessed before treatment and at three-, six-, nine-, and 12-month follow-ups. RESULTS: All selected patients underwent the procedure. All the patients had hip osteoarthritis. Twelve-month follow-up data revealed a statistically significant decrease in the numeric rating scale. The mean NRS for pain was 2 after the procedure. Over 75% of patients reported >50% pain relief during the follow-up and 85% reduced pain medication consumption. No side effects were reported. CONCLUSION: Hip sensory articular branch RFA is a treatment option with interesting outcomes for chronic hip pain, as demonstrated by our study.

Suprascapular Nerve Pulsed Radiofrequency as an Effective Pain Relief Strategy in Supraspinatus Muscle Tendon Tears.

INTRODUCTION: The supraspinatus muscle tendon is the most frequently rotator cuff muscle torn. Reliable shoulder pain relief strategies are needed for patients with severe pain, refractory to conservative management, and without surgical indication. MATERIALS AND METHODS: We conducted a retrospective analysis in a Portuguese reference Rehabilitation Centre during the 1st of January 2020 and the 30th of June 2021, including all patients with partial or complete supraspinatus tendon tear, older than 50 years, who presented with severe pain and who were submitted to suprascapular nerve pulsed radiofrequency. RESULTS: We included 32 patients in our retrospective analysis, mainly female (53%) with a mean age of 66.50 years old. Most of the patients reported right shoulder pain (21 patients, 66%). The mean baseline pain, reported on the numeric rating scale, was 8.00 ± 0.88. Compared to baseline, mean pain reduced 4.00 ± 3.19 at three months (p<0.001), 3.59 ± 3.13 at six months (p<0.001) and 2.94 ± 2.78 at 12 months (p<0.001). From the 3rd to the 12th month there was an increase of 1.06 ± 2.77 in mean pain (p=0.038). There was no difference (p>0.05) in average pain at 0, 3, 6, or 12 months between patients who were simultaneously submitted to an intra-articular shoulder injection. DISCUSSION: Our analysis revealed 36% average shoulder pain reduction for, at least, 12 months following suprascapular nerve pulsed radiofrequency, with a peak pain reduction of 50% at three months. Slow fading of pain reduction in the following nine months was seen, however, compared to baseline, pain reduction was always statistically significant. Cortico-anaesthetic intra-articular shoulder injections seem not to add benefit in shoulder pain reduction when performed simultaneously with suprascapular nerve pulsed radiofrequency. CONCLUSION: Suprascapular nerve pulsed radiofrequency seems to be an effective strategy for shoulder pain reduction, in patients with severe pain, refractory to other management modalities. Nonetheless, larger prospective studies, analyzing shoulder functionality and quality of life lost scores, besides pain reduction, should be pursued.

Ultrasound-Guided Pulsed Radiofrequency Treatment for Superficial Peroneal Nerve Entrapment in a Professional Handball Player.

Peripheral nerve injury in athletes is rare but deleterious to their performance, entrapment being one of the most frequent causes. Isolated injury to the superficial peroneal nerve (SPN) is rare and often underdiagnosed. The authors reported a clinical case of a 34-year-old handball athlete who presented with neuropathic pain in the inferolateral third of the leg and dorsum of the foot, with three months of evolution, after an ankle sprain, refractory to conservative treatment. After clinical assessment and ultrasound investigation, it was considered that the pain source was likely to be an SPN entrapment. Thus, a diagnostic ultrasound-guided nerve block with 2ml of 2% lidocaine and 3ml of 0.2% ropivacaine was performed, followed by nerve hydrodissection, with a major improvement in the patient's symptoms and functionality for three weeks. Thereafter, a long-lasting alternative was made - pulsed radiofrequency (pRF). There were no complications after the procedure. As a form of neuromodulation, pRF offered pain resolution without tissue damage or painful sequela, after 3, 6, 12, and 24 months of follow-up and complete participation in sports activity, avoiding surgical treatment. With this clinical case, the authors intend to demonstrate the effectiveness of pRF in the resolution of peripheral neuropathy due to entrapment, avoiding more invasive treatment options and, in the case of an athlete, allowing an early return to play. They also intend to corroborate the advantage of using ultrasound in the diagnosis and guide of minimally invasive procedures.

Beyond Gonarthrosis in the Elderly: A Case Report of Subchondral Insufficiency Fracture of the Knee.

Subchondral insufficiency fracture of the knee (SIFK) is a non-traumatic condition that has been, historically, associated with the elderly. Early diagnosis and management are essential to prevent evolution to subchondral collapse and secondary osteonecrosis, developing prolonged pain and functional losses. This article presents the case of an 83-year-old patient with severe right knee pain with 15 months of evolution, with sudden onset, and no history of trauma or sprain. Upon observation, the patient presented with a limping gait, antalgic posture with the knee in semi-flexion, pain on palpation of the joint medial line, severe pain on passive mobilization, limited joint range of motion, and a positive McMurray test. The X-ray only demonstrated a gonarthrosis grade 1 in the Kellgren and Lawrence classification with medial compartment affection. Due to the exuberant clinical picture with marked functional compromise, as well as clinical radiological dissociation, MRI was requested to rule out SIFK, which was later confirmed. The therapeutic orientation was then adjusted with an indication for non-weight bearing and analgesia, as well as orientation to an orthopedics consultation to request a surgical evaluation. SIFK is difficult to diagnose and may have an unpredictable outcome due to delayed treatment approaches. This clinical case encourages clinicians to consider subchondral fracture in the differential diagnosis of knee pain when an older patient, with subnormal radiographic findings, reports severe knee pain in the absence of overt traumatic injury.

Ultrasound-Guided Percutaneous Radiofrequency Thermal Neuroablation for the Treatment of Adductor and Rectus Femoris Spasticity.

Spasticity is a very frequent complication of spinal cord injury (SCI) that can limit activities of daily living, reduce the quality of life, and augment caregiver burden. This problem has many treatment options that should be selected according to the clinical and functional scenario.  This case study presents a 60-year-old female patient with complete spastic paraplegia after a spinal stroke. Spasticity interfered with activities of daily living, mainly with intermittent catheterization and transfers, and botulinum toxin injections failed to efficiently treat this issue. It was decided to perform an ultrasound-guided radiofrequency thermal ablation of the anterior and posterior branches of the obturator nerve and motor branches to the rectus femoris of the femoral nerve to treat the adductors and rectus femoris spasticity. One year after the radiofrequency treatment, the patient showed considerably reduced spasticity, allowing her caregiver to do transfers and easier intermittent urinary catheterizations. Nerve radiofrequency thermal ablation has the potential to be an effective therapy in lower limb spasticity, with long-lasting effects.

Platelet-Rich Plasma Injection Associated With Microtenotomy in Lateral Epicondylitis - is a Tendon Tear Associated with the Therapeutic Response?

Objective Ultrasound-guided platelet-rich plasma (PRP) injections, as well as needle tenotomy, are becoming increasingly popular in the treatment of epicondylitis. Whether ultrasound (US) findings predict the clinical benefit of these techniques is unclear at the moment. This study aimed to investigate the relationship between the presence of tendon tear assessed by US and the therapeutic response of the PRP injection following needle microtenotomy in patients with epicondylitis. Methodology This is a retrospective observational study. Twenty-six patients with chronic (>three months) lateral epicondylitis recalcitrant to conservative treatment or corticosteroid injection. Patients underwent US-guided microtenotomy followed by PRP injection. Data regarding gender, age, US findings at baseline, and numeric pain rating scale (NPRS) scores before and after intervention were collected. Pain improvement rates were calculated at several follow-up time points, namely one, three, six, and 12 months post-intervention. Results are stated as mean ± standard deviation. Results At the time of intervention, the mean age was 47.6±6.5 years, and 57.7% of patients were men. Overall, the mean initial NPRS score was 7.5±1.2, and there were no statistically significant differences in mean initial NPRS scores between the groups with or without tendon tear on the US imaging. The mean improvement rate at one, three, and six months was similar between patients with and without tendon tear. However, a statistically significant difference was observed at 12 months (73.1±37.6% vs. 16.0±21.9, p=0.029).  Conclusions Patients with tendon tear demonstrated a higher pain improvement rate at 12 months follow-up. This finding could predict the clinical response to this technique, thus allowing a better selection of the candidates.

Ultrasound-Guided Pulsed Radiofrequency Treatment for Meralgia Paresthetica.

Meralgia paresthetica (MP) is one of the most common mononeuropathies of the lower limb, characterized by injury or compression of the lateral cutaneous femoral nerve at the level of the anterior superior iliac spine and inguinal ligament. Many predisposing factors, such as weight gain, obesity, and restrictive clothing, contribute to the injury of the lateral cutaneous femoral nerve along its course from the pelvis towards the thigh. Although a great number of cases are successfully treated with conservative measures, a subgroup of patients suffer chronic dysesthetic pain with intermittent flare-ups in their lifetime, with a negative impact on quality of life, requiring additional treatment. The purpose of this case report is to describe the successful management of MP with ultrasound-guided pulsed radiofrequency of the lateral cutaneous femoral nerve.

About a success case post-ultrasound guided radiofrequency ablation of the lumborum rami medialis

The authors decided to write a letter to the editor to bring an actual and improving technique option to discuss between medical researchers. They show a success case of an ultrasound guided radiofrequency ablation of the lumborum rami medialis, which normally is performed by fluoroscopy, with more costs to the system and radiation exposure to the patient. So, the importance of this letter is showing the good result of US technique which could be an excellent alternative treatment option.

Formación para el manejo de publicaciones científicas y páginas web en el ámbito sociosanitario / Training for management of scientific publications and webpages in the sociosanitary context

Este trabajo presenta nociones básicas de formación sobre la búsqueda del conocimiento científico sociosanitario en internet, y reitera el uso de contenidos especializados y de rigor en revistas científicas indexadas en JCR y/o SCOPUS. Además, se ofrece una correcta formación digital en Alfabetización en Salud electrónica (e_AeS), a través del manejo de páginas correctamente contrastadas, según los 15 criterios de calidad de los sitios web y de contenidos especializados sociosanitarios(AU)

This paper presents basic notions about training for the search of socio-sanitary scientific knowledge on the Internet and reiterates the use of specialized and rigorous content in scientific journals indexed in JCR and/or SCOPUS. In addition, a correct digital training in electronic health literacy is offered, through the management of correctly contrasted pages, according to the fifteen quality criteria of the websites and specialized socio-health content(AU)

Learning Curves for Laparoscopic Repair of Inguinal Hernia and Communicating Hydrocele in Children.

INTRODUCTION: We analyzed the department and surgeon learning curves during implementation of the percutaneous internal ring suturing (PIRS) technique in our department. METHODS: Children proposed for inguinal hernia or communicating hydrocele repair were included (n = 607). After mentorship, all surgeons were free to propose open or PIRS repair. From gathered data, we assessed department and surgeon learning curves through cumulative experience focusing in perioperative complications, conversion, ipsilateral recurrence, postoperative complications, and metachronous hernia, with benchmarks defined by open repair. RESULTS: Department-centered analysis revealed that perioperative complications, conversion, and ipsilateral recurrence rates were higher in the beginning, reaching the benchmarks when each surgeon performed, at least, 35 laparoscopic repairs. Postoperative complications and metachronous hernia rates were independent from learning curves, with the metachronous hernia rate being significantly lower in PIRS patients. During the program, the percentage of males in those operated by PIRS progressively increased reaching the percentage of males, in our sample, when department operated over 230 cases. CONCLUSION: Thirty-five laparoscopic cases per surgeon are required for perioperative complications, conversion, and ipsilateral recurrence reach the benchmark. The gap between the percentage of males, in those operated by PIRS and in those proposed for surgery, monitors the confidence of the team in the program.

A Pediatric Case of Cowden Syndrome with Graves' Disease.

Cowden syndrome (CS) is a rare dominantly inherited multisystem disorder, characterized by an extraordinary malignant potential. In 80% of cases, the human tumor suppressor gene phosphatase and tensin homolog (PTEN) is mutated. We present a case of a 17-year-old boy with genetically confirmed CS and Graves' disease (GD). At the age of 15, he presented with intention tremor, palpitations, and marked anxiety. On examination, he had macrocephaly, coarse facies, slight prognathism, facial trichilemmomas, abdominal keratoses, leg hemangioma, and a diffusely enlarged thyroid gland. He started antithyroid drug (ATD) therapy with methimazole and, after a 2-year treatment period without achieving a remission status, a total thyroidectomy was performed. Diagnosis and management of CS should be multidisciplinary. Thyroid disease is frequent, but its management has yet to be fully defined. The authors present a case report of a pediatric patient with CS and GD and discuss treatment options.

Atas: investigação qualitativa em educação / Atas: investigación cualitativa en educación / Atas: qualitative research in education

O sucesso do 5º Congresso Ibero-Americano em Investigação Qualitativa (CIAIQ2016) é um importante indicador da existência de uma comunidade multidisciplinar, empenhada e de qualidade nesta área da investigação. O CIAIQ2016 decorreu nos dias 12, 13 e 14 de julho de 2016, na Universidade Lusófona do Porto, Portugal. Nesta edição da conferência foi realizada, em paralelo, a primeira edição do International Symposium on Qualitative Research (ISQR2016), que se mostrou um evento também muito bem-recebido pela comunidade científica internacional em investigação qualitativa. Assumem-se como eventos de prestígio, incontornáveis e de presença obrigatória nas agendas dos investigadores que desenvolvem pesquisas de abordagem qualitativa.

Duhamel pull-through assisted by transrectal port: a hybrid natural orifice transluminal endoscopic surgery approach.

One of the latest surgical innovations is natural orifice transluminal endoscopic surgery (NOTES). We hypothesize that the principles of NOTES could be applied to the laparoscopic Duhamel procedure. Between March 2008 and May 2010, 3 children underwent the laparoscopic Duhamel procedure assisted by transrectal NOTES. Three 5-mm transabdominal trocars were combined with a 12-mm transrectal trocar. We were able to safely apply the principles of NOTES, improving the performance of laparoscopic Duhamel pull-through using current instruments and technology. This new approach avoids the need of an extra transabdominal 12-mm trocar for the endoscopic stapler, allows an easier creation of a smaller rectal stump, and offers the possibility of an extra working port. This hybrid concept can be seen as a transition into the emerging field of NOTES in colorectal surgery.

[Quality of life evaluation of the patients and parents satisfaction after Nuss procedure in the management of Pectus Excavatum]. / Avaliação da qualidade de vida dos doentes e pais dos doentes após tratamento do pectus excavatum com a técnica de Nuss.

Pectus Excavatum is the most common congenital deformity of the chest. Although Pectus Excavatum can be associated with heart or lung problems, the main indication for surgical correction of this congenital anomaly is the body image dissatisfaction. The Nuss technique is a minimally invasive procedure that allows the placement of an intrathoracic prosthetic convex bar, previously bended, which mobilize the sternum anteriorly. The aim of this study was to evaluate the degree of satisfaction of the patients and parents after the application of the Nuss technique using the Pectus Excavatum Evaluation Questionnaire. All parameters of psychosocial character - self-image, difficulties in exposing the chest, frustration, sadness, social isolation and ridicule - found a statistically significant improvement after surgical correction of Pectus Excavatum from the perspective of patients and their parents. There was not a marked improvement and consensus regarding the overall physical performance of patients. Which is understandable, since, theoretically, the physical deformity is not responsible for significant limitations on exertion. The current surgical correction of Pectus Excavatum by the Nuss technique allows obtaining aesthetic results of the chest with the resolution of the main problems with body image. Increase awareness of health issues for psychosocial and physical factors which might be involved in this kind of deformities is important, especially when there is a satisfactory solution.

Pessoas com Deficiências como Clientes Internos e Externos: Investigando a Inclusão como Potencial Atrativo para Jovens Talentos / Disabled People as Internal and External Customers: Investigating inclusion as a Possible Attractive for Young Talents

De acordo com a literatura, a capacidade de atrair e reter profissionais qualificados parece ser maior nas empresas que investem em diversidade. O objetivo da presente pesquisa é avaliar se a orientação de uma organização para necessidades de clientes internos e externos com deficiências constitui um fator valorizado por jovens talentos que ingressam no mercado de trabalho. A pesquisa também buscou comparar essa orientação com outros fatores, como a perspectiva de desenvolvimento profissional e a remuneração superior. No trabalho empírico, utilizou-se de modelo quase-experimental com suporte de cenários. Os resultados sugerem que uma imagem corporativa construída por meio da ênfase na preocupação com as necessidades de pessoas com deficiência diminui o potencial de uma organização de captar novos talentos. Os resultados indicam também que a remuneração superior é mais atraente do que o desenvolvimento profissional e do que a orientação da organização para clientes internos e externos com deficiências (AU)

According to the literature, the ability to attract and retain qualified professionals seems to be higher in companies that invest in diversity. The objective of this research is to evaluate whether the organizational orientation for the needs of the internal and external customers with disabilities is a factor valued by young talents entering the labor market. The research also attempted to compare this orientation with other factors such as the perspective of professional development and higher salaries. The empirical work employed a quasi-experimental design with the support of scenarios. The results suggest that a corporate image built by means of an emphasis on the concern for the needs of people with disabilities reduces the potential for an organization to attract new talents. The results also suggest that higher salaries are more attractive than professional development and the orientation of the organization towards internal and external customers with disabilities (AU)

An approach to minimize postoperative enterocolitis in Hirschsprung's disease.

BACKGROUND/PURPOSE: Enterocolitis (EC) is a common and severe complication after pull-through for Hirschsprung's disease; its pathogenesis remains unclear, but the role of coexistent intestinal neuronal dysplasia (IND) in the proximal colon may be relevant. This study evaluated the relationship between postoperative EC and IND and assessed whether a surgical protocol including resection of coexistent IND could prevent postoperative EC. METHODS: Between June 1993 and June 2002, 36 patients with aganglionosis were submitted to definitive surgical treatment. There were 2 sequential sets of patients: group I (n = 17), in whom the resection was confined to the aganglionic colon, and group II (n = 19), who were additionally submitted to resection of the coexistent IND segment; excision was restricted to the hepatic flexure in long segmental IND. The prevalence of postoperative EC and anorectal function were evaluated and compared between the 2 groups. RESULTS: There was no mortality. Fifteen patients had isolated aganglionosis, and 21 presented with aganglionosis plus proximal IND. All 6 children who developed postoperative EC had coexistent IND. In group I, 9 patients had coexistent IND and 5 developed postoperative EC (5/17, 29%). In group II, 12 patients had coexistent IND but only 1 patient, with long segmental IND, developed postoperative EC (1/19, 5%). Among the patients with proximal IND, the prevalence of postoperative EC was 29%; but it was significantly lower in group II than in group I (1/12 or 8% vs 5/9 or 56%; P = .02). Anorectal function was excellent or good in more than 80% of the patients in both groups. CONCLUSIONS: Postoperative EC was associated with retained proximal IND, suggesting that coexisting IND may be, at least, a predictive marker for this complication. Histochemical characterization of the proximal colon with no radical resection of the IND segment seems to be an effective and safe approach to minimize the prevalence of postoperative EC.

Hemorrhagic abdominoscrotal hydrocele. A challenging entity.

Abdominoscrotal hydrocele (ASH) is a rare condition in childhood. It presents an intraabdominal portion with homogeneous content that is usually excised through a groin approach. A pale child with a recurrent scrotal hydrocele and a huge solid-cystic retroperitoneal mass is reported. Because the diagnostic workup has not ruled out malignancy, a laparotomy was performed; however, ultimate diagnosis was hemorrhagic ASH. The clinical features and surgical management of ASH are addressed. This entity should be considered in front of tense or recurrent hydroceles or coexistent abdominal mass even though with heterogeneous content.

Can esophageal pH monitoring predict delayed gastric emptying?

BACKGROUND/PURPOSE: Delayed gastric emptying (DGE) is frequent in patients with gastroesophageal reflux disease (GERD) and may require additional investigation. The current study assesses whether relative esophageal exposure, postprandial (PP) versus fasting, diagnosed by pH monitoring could predict DGE. METHODS: Thirty patients with GERD underwent extended esophageal pH monitoring and were assigned as DGE or non-DGE according to scintigraphy. The PP to fasting ratio for reflux index, relative frequency of long episodes in PP, and distribution of the longest episode were used to assess the relative esophageal exposure. The effectiveness of these parameters to predict DGE was estimated; the cutoffs for continuous variables were chosen with receiver operating characteristics (ROC) curves and the probabilities were calculated using a logistic regression model. RESULTS: The area under the ROC curve of PP to fasting ratio for reflux index was greater than that of relative frequency of long episodes in PP. There was a good equilibrium between sensitivity and specificity at a PP to fasting ratio of 1. A PP to fasting ratio greater than 1, ie, a reflux index in PP greater than in fasting, presented a sensitivity of 93% and a negative predictive value of 91%. The occurrence of the longest episode in PP had a specificity of 94% and a positive predictive value of 89%. A reflux index greater in PP plus a longest episode in PP presented a 94% probability of DGE; a reflux index greater in fasting plus a longest episode in fasting had a 95% probability of non-DGE. These combinations represented 60% of the series. CONCLUSIONS: PP to fasting ratio for reflux index and distribution of the longest episode seem accurate to identify DGE; thus, additional investigation to assess gastric emptying may be avoided in the majority of patients.