Economic analysis of the robotic approach to inguinal hernia versus laparoscopic: is it sustainable for the healthcare system?

INTRODUCTION: There has been a rapid proliferation of the robotic approach to inguinal hernia, mainly in the United States, as it has shown similar outcomes to the laparoscopic approach but with a significant increase in associated costs. Our objective is to conduct a cost analysis in our setting (Spanish National Health System). MATERIALS AND METHODS: A retrospective single-center comparative study on inguinal hernia repair using a robotic approach versus laparoscopic approach. RESULTS: A total of 98 patients who underwent either robotic or laparoscopic TAPP inguinal hernia repair between October 2021 and July 2023 were analyzed. Out of these 98 patients, 20 (20.4%) were treated with the robotic approach, while 78 (79.6%) underwent the laparoscopic approach. When comparing both approaches, no significant differences were found in terms of complications, recurrences, or readmissions. However, the robotic group exhibited a longer surgical time (86 ± 33.07 min vs. 40 ± 14.46 min, p < 0.001), an extended hospital stays (1.6 ± 0.503 days vs. 1.13 ± 0.727 days, p < 0.007), as well as higher procedural costs (2318.63 ± 205.15 € vs. 356.81 ± 110.14 €, p < 0.001) and total hospitalization costs (3272.48 ± 408.49 € vs. 1048.61 ± 460.06 €, p < 0.001). These results were consistent when performing subgroup analysis for unilateral and bilateral hernias. CONCLUSIONS: The benefits observed in terms of recurrence rates and post-surgical complications do not justify the additional costs incurred by the robotic approach to inguinal hernia within the national public healthcare system. Nevertheless, it represents a simpler way to initiate the robotic learning curve, justifying its use in a training context.

Implementing an outpatient surgical management in moderated-high risk patients with groin hernia repair.

PURPOSE: There is a growing trend to expand Ambulatory Surgery (AS) criteria in abdominal wall surgery. No Admission (NOADS) circuit. The present study aimed to assess the impact of classification criteria on postoperative results and hospital stays in a NOADS versus a conventional admission circuit to throw some light on surgical circuit inclusion. METHODS: A retrospective analysis of a prospective;y maintained database was performed comparing groin hernia's interventions in a NOADS vs Admission circuit in our center in 2018-2021. A multiple regression predictive model followed by a retrospective retest were dessigned to assess the impact of each criterion on hospital stay. In total, 743 patients were included, 399 in the Admission circuit (ADC) and 344 in NOADS circuit (NOADS). RESULTS: There were no statistical differences in complication or readmission rates (p = 0.343 and p = 0.563), nevertheless, a shorter hospital stay was observed in NOADS (p = 0.000). A hierarchical multiple regression predictive model proposed two opposite scenarios. The best scenario, not likely to need admission, was a female patient operated via the laparoscopic approach of a unilateral primary hernia (Estimated Postoperative Stay: 0.049 days). The worst scenario, likely to need admission, was a male patient operated via the open approach of a bilateral and recurrent hernia (Estimated Postoperative Stay: 1.505 Days). CONCLUSION: Groin hernia patients could safely benefit from a No Admission (NOADS) circuit. Our model could be useful for surgical circuit decision-making, especially for best/worst scenarios.

Use of polyvinylidene fluoride (PVDF) meshes for ventral hernia repair in emergency surgery.

PURPOSE: The implantation of non-absorbable meshes is the gold standard technique for ventral hernia (VH) repairs. However, emergency surgeries are often related to contaminated/infected fields, where the implantation of prosthetic materials may not be recommendable. Our aim was to evaluate the results of polyvinylidene fluoride (PVDF) meshes used for contaminated and/or complicated VH repairs in the acute setting. METHODS: We conducted a retrospective analysis of patients with VH who underwent emergency surgery involving PVDF meshes, in a tertiary hospital (from November 2013 to September 2019). We analyzed postoperative complications and 1-year recurrence rates. We evaluated the relationships between contamination grade, mesh placement, infectious complications, and recurrences. RESULTS: We gathered data on 123 patients; their mean age was 62.3 years, their mean BMI was 31.1 kg/m2, and their mean CeDAR index was 51.6. 96.4% of patients had a grade 2-3 ventral hernia according to the Rosen index. The mean defect width was 8 cm (IQR 2-18). 93 cases (75.6%) were described as contaminated or dirty surgeries. A PVDF mesh was placed using an IPOM technique in 56.3% of cases, and via interposition location in 39.9%. The one-month recurrence rate was 5.7% and recurrence after one year was 19.1%. The overall mortality rate was 27.6%. Risk of recurrence was related to patients with a Rosen score over 2 (p < 0.001), as well as with postoperative SSI (p = 0.045). Higher recurrence rates were not related to PVDF mesh placement. CONCLUSION: The use of PVDF meshes for emergency VH repairs in contaminated surgeries seems safe and useful, with reasonable recurrence rates, and acceptable infectious complication rates, similar to those published in the literature.

Relación entre síndrome de disfunción temporomandibular y síndrome de latigazo cervical tras un accidente de tráfico. Estudio de cohortes / Relationship between temporomandibular disorders and whiplash after a traffic accident. Cohorts study

Introducción: El síndrome de latigazo cervical (SLC) es una patología frecuente, y según la bibliografía existe controversia acerca de una relación entre este y el síndrome de disfunción temporomandibular (SDT). El objetivo de este estudio es determinar si existe una mayor incidencia de SDT en pacientes diagnosticados de SLC durante los 3 y 12 primeros meses tras haber sufrido un accidente de tráfico y determinar factores de riesgo asociados. Pacientes y método: Estudio de cohortes prospectivo comprendido entre febrero del 2013 a diciembre del 2015 que consta de una cohorte expuesta de 71 adultos (36 hombres y 35 mujeres) que habían sufrido un SLC de grado I o II según la Québec Task Force, y una cohorte no expuesta de 70 adultos (46 hombres y 24 mujeres). Se avaluaron a los 3 y 12 meses mediante el Índice Anamnésico Simplificado de Fonseca (IASF) Resultados: Los resultados obtenidos muestran que en la cohorte expuesta la proporción de SDT a los 3 meses es estadísticamente superior que en la cohorte no expuesta (53 versus 13,4%; p<0,0001). A los 12 meses se evidencia que en la cohorte expuesta la proporción de SDT es estadísticamente superior que en la cohorte no expuesta (53,2 versus 21,7%; p<0,0005). Conclusiones: Las personas que sufren un SLC presentan una mayor probabilidad de desarrollar un SDT. Además, la cohorte expuesta muestra un empeoramiento en las puntuaciones del IASF. Aquellas personas que manifiestan dorsalgia y parestesias tras sufrir un SLC presentan una mayor probabilidad estadísticamente significativa de desarrollar un SDT

Introduction: Whiplash is a frequent condition in rehabilitation centres, and according to the literature there is a great controversy about its relationship with temporomandibular disorders (TD). The objective of this study is to determine whether there is a higher incidence of TD in patients diagnosed with whiplash during the first 3 and 12 months after having suffered a vehicle accident, and to determine associated risk factors. Patients and method: Prospective cohort study conducted between February 2013 to December 2015 with a cohort of 71 adults (36 men and 35 women) that had suffered a Quebec Task Force whiplash grade I or II, together with an unexposed cohort of 70 adults (46 men and 24 women). They were evaluated at 3 and 12 months using the Fonseca's Simplified Anamnestic Index (IASF) Results: The results obtained at 3 months showed that the proportion of TD in the exposed cohort was statistically higher than in the non-exposed cohort (53.0% versus 13.4%, P<.0001). At 12 months, the results showed that the proportion of SDT was statistically higher in the exposed cohort than in the non-exposed cohort (53.2% versus 21.7%, P<.0005). Conclusions: After a whiplash there is a greater probability of developing a TD. In addition, in the exposed cohort there is a greater deterioration over time in the IASF. The back pain and paraesthesias after a whiplash are symptoms to be taken into account, as they show a statistically significant probability of developing TD

Analysis of the First 1000 Liver Transplants in Virgen del Rocío Hospital.

The goal of this work has been to analyze the first 1000 liver transplantations (LTs) performed in the Virgen del Rocío Hospital of Seville and to evaluate the changes in that time. We included 916 patients who had 1000 LTs. We distinguish 2 stages in the follow-up: the first stage, between 1990 and 2002, and the second, from 2003 to 2013 (Model for End-stage Liver Disease [MELD] stage). We analyzed recipient features, LT indications, donation criteria, surgical technique, complications, and survival both for patients and grafts. The median age of recipients was 53.50 ± 46.49 years old, with a noticeable increase after 2000. There were 3 times as many men as women. The most frequent indications for LT were hepatocellular disease (48.8%), followed by hepatocarcinoma (17.8%), retransplantation (8.1%), and cholestatic diseases (3.6%). Donors of Andalusian centers accounted for 88.2% of LTs, and 8.3% of LTs presented some arterial or venous complication. Biliary complications occurred in 15.6%. Patient survival at 1, 5, and 10 years was 77%, 63.5%, and 51.3%, respectively. In conclusion, some of the factors that negatively influenced survival of the patient were stage of the LT, hepatitis C virus-positive recipient, emergency cases, hepatocarcinoma, high consumption of blood products, and second transplantations.

Survival Outcomes in Liver Transplantation With Elderly Donors: Analysis of Andalusian Transplant Register.

Recently, there has been a large discrepancy between the number of patients on the waiting list for a liver transplant and the availability of deceased donors, with an increase in annual wait list mortality rates. Elderly donor livers are thought to be marginal grafts; however, in recent years, their utilization has constantly increased. The aim of this study is to evaluate the utilization of elderly donors in Andalusia and post-transplant outcomes. This retrospective observational study of 2408 liver transplants, performed in Andalusia between 2000 and 2014, analyzes the outcomes from donors aged 70 plus (n = 423) in terms of survival rates of the graft and the recipient, the type of transplant, donor age, and D-MELD score (product of donor age and preoperative Model for End-stage Liver Disease score). The most frequent indications for transplant were alcoholic cirrhosis (49.2%), hepatitis C cirrhosis (13%), and hepatocellular carcinoma (12.5%). The overall survival at 5 years was 64%, with a significant fall in survival for recipients with a D-MELD greater than 1500 (57%; P = .045). In the 70-year-old-plus donor group, the overall patient survival was 58.4%. The retransplant rate increased proportionately with donor age. In the alcoholic cirrhosis recipient subgroup, the overall survival at 5 years was 67.6% (P < .05) compared with 33.5% in patients with hepatitis C. Use of elderly donors is a safe strategy to reduce the scarcity of donors, provided that a D-MELD score below 1500 is obtained. Retransplant rates increase progressively with donor age. It is necessary to carefully screen recipients of older organs, taking into account that the best results are obtained for alcoholic cirrhosis, negative viral load hepatitis C, and a D-MELD score below 1500.

Resultados en la calidad de vida y la severidad de la incontinencia urinaria tras rehabilitación en varones prostatectomizados por neoplasia de próstata / Results of rehabilitation on quality of life and urinary incontinence severity after radical prostatectomy

Introducción. La incontinencia urinaria en varones tras prostatectomía radical puede suponer un problema importante de calidad de vida. El tratamiento rehabilitador disminuye las pérdidas urinarias y el empleo de protectores, mejorando así la calidad de vida de estos pacientes. Material y métodos. Se evaluó una cohorte de 84 varones tras cirugía radical de próstata. Todos los pacientes presentaban incontinencia urinaria secundaria a la cirugía y 71 pacientes completaron el tratamiento rehabilitador. La media de edad de los pacientes fue de 64 años. El tiempo medio de sondaje vesical postoperatorio fue de 23,4 días. Se analizaron los resultados obtenidos en las escalas de Sandvik e ICIQ y la cantidad de protectores empleados antes y después del tratamiento. Los pacientes realizaron una media de 12,7 sesiones de rehabilitación. Resultados. Se analizaron las diferencias obtenidas en ambas escalas y en el empleo de protectores y su correlación mediante el test de Wilcoxon y el coeficiente de Spearman. Se observó una mejoría estadísticamente significativa en los resultados obtenidos en las escalas de valoración antes y después del tratamiento rehabilitador (p < 0,0005); los porcentajes de cambio en los resultados obtenidos en dichas escalas se correlacionaron de forma estadísticamente significativa con la disminución en el empleo de protectores al finalizar el tratamiento. Conclusión. El tratamiento rehabilitador es útil para mejorar la calidad de vida y disminuir la severidad de la incontinencia urinaria en pacientes sometidos a cirugía radical de próstata (AU)

Introduction. Male urinary incontinence after radical prostatectomy can substantially impair quality of life. Rehabilitation is used to reduce urinary leakage and the use of pads and diapers, and consequently to improve quality of life. Material and methods. A total of 84 patients were evaluated after radical prostatectomy. All of them had postoperative urinary incontinence and 71 completed rehabilitation treatment. The mean age was 64 years. The mean length of bladder catheterization after surgery was 23.4 days. The results of the Sandvik and International Consultation on Incontinence Questionnaire scales and pad use were analyzed before and after rehabilitation treatment. The mean length of rehabilitation treatment was 12.7 days. Results. The Wilcoxon and Spearman tests showed a significant pos-treatment improvement in both scales (p < .0005). This improvement was significantly correlated with a decrease in pad use at the end of the treatment. Conclusion. Rehabilitation treatment is useful to improve quality of life and decrease the severity of urinary incontinence in men after radical prostatectomy (AU)

Mejora de la eficiencia de un servicio de rehabilitación mediante metodología Lean Healthcare / Improvement in the efficiency of a rehabilitation service using Lean Healthcare methodology

Introducción. El objetivo fue evaluar si la aplicación de la metodología Lean a un servicio de rehabilitación disminuye los derroches (mudas en la terminología Lean) y agrega valor al cliente. Material y métodos. Se creó un equipo multidisciplinar, que mediante la realización de un diagnóstico de proceso estableció 3 áreas potenciales de mejora: el almacén, la estandarización de los materiales y los recorridos que realizaba el profesional en el área terapéutica. Posteriormente se implementaron acciones de mejora utlilizando 3 herramientas Lean: kanban, 5S y 2P. Resultados. Tras la implantación de la metodología Lean el coste del material almacenado se redujo un 43%, y el consumo por paciente tratado un 19%, incrementándose en un 7% el tiempo de dedicación al paciente. Conclusiones. En las condiciones del estudio se consiguió estandarizar los procesos y eliminar los mudas, reduciendo los costes y aumentando el valor sobre el paciente. De confirmarse estos resultados se demostraría que es posible aplicar herramientas de origen industrial al ámbito sanitario, con el objetivo de mejorar la calidad asistencial y conseguir la máxima eficiencia (AU)

Introduction. The aim of this study was to evaluate the reduction in costs and the increase in time devoted to the patient, by applying Lean Healthcare methodology. Material and methods. A multidisciplinary team was formed, setting up three potential areas for improvement by performing a diagnostic process, including the storage and standardization of materials, and professional tasks in the therapeutic areas, by implementing three Lean tools: kanban, 5S and 2P. Results. Stored material costs decreased by 43%, the cost of consumables per patient treated by 19%, and time dedicated to patient treatment increased by 7%. Conclusions. The processes were standardized and “muda” (wastefulness) was eliminated, thus reducing costs and increasing the value to the patient. All this demonstrates that it is possible to apply tools of industrial origin to the health sector, with the aim of improving the quality of care and achieve maximum efficiency (AU)

[Improvement in the efficiency of a rehabilitation service using Lean Healthcare methodology]. / Mejora de la eficiencia de un servicio de rehabilitación mediante metodología Lean Healthcare.

INTRODUCTION: The aim of this study was to evaluate the reduction in costs and the increase in time devoted to the patient, by applying Lean Healthcare methodology. MATERIAL AND METHODS: A multidisciplinary team was formed, setting up three potential areas for improvement by performing a diagnostic process, including the storage and standardization of materials, and professional tasks in the therapeutic areas, by implementing three Lean tools: kanban, 5S and 2P. RESULTS: Stored material costs decreased by 43%, the cost of consumables per patient treated by 19%, and time dedicated to patient treatment increased by 7%. CONCLUSIONS: The processes were standardized and "muda" (wastefulness) was eliminated, thus reducing costs and increasing the value to the patient. All this demonstrates that it is possible to apply tools of industrial origin to the health sector, with the aim of improving the quality of care and achieve maximum efficiency.

Fascitis eosinofílica. A propósito de un caso / Eosinophilic fasciitis. Apropos of a case

La fascitis eosinofílica es un síndrome esclerodermiforme poco frecuente y de etiología desconocida que afecta predominantemente a las extremidades. Se han barajado varias hipótesis sobre su etiología y en algunos casos se ha descrito antecedente traumático. Presentamos un caso de una paciente de 54 años que tras presentar traumatismo sobre las rodillas inicia un cuadro de mialgias, induración cutánea y retracción progresiva de diversas articulaciones iniciado en los miembros inferiores y posteriormente en los miembros superiores y en el tronco. Realizamos el seguimiento de la paciente, mostrando su manejo desde el punto de vista rehabilitador y evolución. La paciente mejoró tanto sus balances articulares como la marcha y el dolor. La fascitis eosinofílica es una enfermedad infrecuente en la que debemos realizar el diagnóstico diferencial con otros síndromes esclerodermiformes. La rehabilitación puede ayudar a reducir y evitar el progreso de las contracturas (AU)

Eosinophilic fasciitis is a rare scleroderma syndrome of unknown cause that predominantly affects the extremities. Several hypotheses have been proposed to explain its etiology and there have been reports of some patients with a history of trauma. We present the case of a 54-year-old woman who, after a knee injury, developed myalgia, progressive skin induration and retraction of various joints, starting in the lower limbs and spreading to the upper limbs and trunk. We describe the rehabilitation management and outcome of this patient. The patient showed improvement in both balance, joint pain, and gait. Eosinophilic fasciitis is a rare disease that requires a differential diagnosis with other scleroderma syndromes. Rehabilitation can help reduce and prevent progression of contractures (AU)

Impact of the learning curve on the outcome of domino liver transplantation.

Domino liver transplantation (DLT) is a strategy used to increase the number of available grafts. In this procedure, the transplant recipient is a living donor of her own liver. It is mandatory that the graft should be fully functional and the genetic defect should recur with sufficient latency period in the new recipient. Corino-Andrade disease, or familial amyloidotic polyneuropathy (FAP), satisfies these conditions. We retrospectively reviewed our prospective database of DLT. From July 2004 to April 2013, we performed 12 DLTs. We assessed age, sex, real Model for End-Stage Liver Disease (MELD) score, waiting list time, cold and warm ischemia times, intraoperative transfusion requirements, hospital stay, early peritransplantation morbidity (post-reperfusion syndrome, intraoperative cardiac arrest, post-transplantation thrombotic events, and biliary morbidity), acute cellular rejection, retransplantation, mortality, patient and graft survivals. With the intention to study the effect of the learning curve in the global survival results (including both donors and recipients of livers with FAP), we divided our series into 2 periods: the early period (from 2004 to 2008) and the present period (from 2009 to 2013). The crude mortality was 40% vs 0% (P = .042) in the early and present periods, respectively. The cumulative patient survival was also significantly in favor of the present period (P = .049). The graft loss prevalence was 60% vs 7.1% (P = .019) in the early and present periods, respectively. The cumulative graft survival was also significantly in favor of the present period (P = .030; Fig 2). In conclusion, we consider DLT to be a complex procedure, whose initial results are conditioned by the learning curve.

Fifteen years of follow-up of a liver transplant recipient with glycogen storage disease type Ia (Von Gierke disease).

Von Gierke's disease or glycogen storage disease type Ia (GSD-Ia) is an infrequent metabolic disease caused by an atypical accumulation of glycogen. The principal cause of this pathology is deficiency of the glucose-6-phosphatase enzyme. Herein we have reported a case of a young man with a history of Von Gierke's disease (GSD-Ia) since childhood who developed hepatocellular adenomatosis brought to light by ultrasounds and TACs. The patient began to develop early chronic renal failure, necessitating simultaneous liver and kidney transplantation. Years later continuous reviews at the nephrology and hepatobiliopancreatic surgery services show he has a good quality of life and a normal hepatorenal profile.

Descripción de un caso de neuroartropatía de Charcot y tuberculosis de tobillo / Description of a case of Charcot's neuroarthropathy and ankle tuberculosis

Presentamos a un varón de 68 años con dolor y deformidad progresiva en pie derecho, de evolución tórpida, secundario a un traumatismo. Dos años después del traumatismo presenta tumefacción dolorosa en región periaquílea externa que desemboca en fístula y precisa limpieza quirúrgica. A los 6 meses de la cirugía se obtiene cultivo positivo para M. tuberculosis y el cuadro se considera una neuroartropatía de Charcot (NC). Las causas más frecuentes de NC son diabetes, tuberculosis (TBC) y sífilis. La TBC articular es rara en los países desarrollados; es frecuente un retraso en su diagnóstico (12–18m). Cualquier articulación se puede afectar, en tobillo es infrecuente (7,4%). Puede estar precedida de un traumatismo articular (37%). El mecanismo fisiopatológico de la NC es independiente de la causa. Existen múltiples causas de NC, incluso un traumatismo menor puede desencadenar una cascada inflamatoria, que estaría iniciada por citoquinas proinflamatorias relacionadas con el sistema RANKL/OPG, que es el sistema enzimático responsable del metabolismo óseo. De diagnóstico diferencial difícil, se puede confundir con otras entidades y hay que sospecharla siempre que aparezca un cuadro inflamatorio. El tratamiento es fundamentalmente médico, en algunos casos se emplean bifosfonatos, aunque puede requerir cirugía. La rehabilitación debe ir orientada a minimizar secuelas y a la optimización funcional (AU)

A 68 years old man is presented. The patient complained of long term pain and progressive deformity of his right foot, attributed to a traumatism. Two years after the traumatism a painful inflammation was developed at the lateral region of the ankle, whith a fistulae and then surgery was needed. 6 month after surgery a positive culture for M. tuberculosis is obtained and finally a Charcot neuroarthropaty (CN) was considered. The more frequent causes of CN are diabetes, tuberculosis and syphilis. Articular tuberculosis is not common in developed countries and a delay on diagnosis is usual (12–18mo). Any articulation can be affected, but ankle is infrequent (7.4). In 37% of cases it is preceded by a traumatism. The physiopatological mechanism of CN is independent of the cause. There are multiple situations causing CN and a minor traumatism can trigger an inflammatory cascade, iniciated by proimmflamtory cytoquines related to the RNKL/OPG system, involved in the bone metabolism. The differential diagnosis is difficult because CN is similar to other conditions, but it should be suspected if an inflammatory reaction is present. Treatment is basically pharmacological, sometimes biphosphonates are used but surgery may be required. Rehabilitation is oriented to avoid sequelae and to optimize functionality (AU)

Neurofibromatosis y schwannoma. A propósito de un caso. Revisión de la literatura / Neurofibromatosis and schwannoma. Based on one case. Review of the literature

Con el término de neurofibromatosis sedescribe el más frecuente de los trastornos genéticos queafecta al sistema nervioso. De herencia autosómica dominante,los síndromes neurocutáneos se asocian con múltiplestumores del sistema nervioso incluyendo neurofibromas,schwannomas, meningiomas y gliomas intracraneales. La afectaciónde la médula espinal en la neurofibromatosis se producetípicamente por el crecimiento extramedular de tumoresen las raíces espinales. Los tumores intramedulares en la neurofibromatosisson infrecuentes y con pocos casos recogidosen la literatura especializada.Se presenta el caso de un paciente de 35 años de edaddiagnosticado 15 años antes de neurofibromatosis tipo 1, quese manifestó con un cuadro de lumbalgia, inicialmente mecánica,que posteriormente se convirtió en una ciática de predominionocturno. La resonancia magnética (RM) mostró unatumoración intrarraquídea intradural de la raíz L4-L5 a nivelde la cola de caballo. La anatomía patológica lo describiócomo un schwannoma celular. El paciente fue intervenidoquirúrgicamente con exéresis de la tumoración y desaparicióncompleta de la sintomatología.Se concluye que ante la aparición de sintomatología radicularen pacientes diagnosticados de neurofibromatosis sedebe valorar la posibilidad de diferentes tipos de tumoraciones,siendo la técnica de elección para su estudio la RM

The term of neurofibromatosis describesthe most frequent genetic disorder that affects the nervoussystem. Of dominant autosomal inheritance, neurocutaneoussyndromes are associated with multiple tumors of the nervoussystem, including neurofibromas, Schwannomas, meningiomasand intracranial gliomas. Involvement of the spinal cord in neurofibromatosis is typically produced by extramedullargrowth of tumors in the spinal roots. Intramedullarytumors in the neurofibromatosis are rare andfew cases are reported in the literature.We present the case of a 35 year old patient diagnosed oftype 1 neurofibromatosis 15 years ago. It initiated with a pictureof back pain, initially mechanical that then became a sciaticone having nighttime predominance. The MRI showedan intradural intraspinal tumoration of the L4-L5 root in thecauda equina. Pathology described it as a cellular schwannoma.The patient was operated on with exeresis of the tumorand complete disappearance of the symptoms.It is concluded that when there is radicular symptoms inpatients diagnosed of NF, the possibility of different types oftumors should be assessed, the technique of choice for itsstudy being the MRI

Espondilodiscitis cervical / Cervical spondylodiscitis

La discitis séptica es un proceso inflamatorio del disco intervertebral que suele extenderse a los cuerpos vertebrales afectando, en ocasiones, al espacio epidural y tejidos blandos paraespinales. Presentamos el caso de un paciente de 57 años que acudió a urgencias por presentar un cuadro de fiebre, odinofagia con dolor y limitación cervical. Se diagnosticó inicialmente de absceso retrofaríngeo, que fue tratado mediante antibióticos y, posteriormente, drenaje quirúrgico. Tras la mejoría clínica inicial, el paciente fue remitido a rehabilitación por persistir el dolor cervical irradiado a la extremidad superior izquierda. En la exploración destacaba la existencia de una movilidad cervical limitada, con dolor a la palpación de C6-C7, así como un balance muscular en bíceps y tríceps de 4-/5. Ante la sospecha de una patología no mecánica se solicitó una resonancia magnética que confirmó la existencia de una espondilodiscitis C5-C6 y C6-C7. Tras descartar un proceso activo mediante analítica y gammagrafía ósea con galio, se indicó tratamiento conservador mediante collar tipo Philadelphia durante 3 meses. La evolución fue satisfactoria y a los 4 meses sólo presentaba discretas molestias a la movilización cervical (AU)

Inestabilidad glenohumeral: capsulorrafia térmica / Glenohumeral instability: thermal capsulorrhaphy

La inestabilidad glenohumeral afecta entre el 2-8 por ciento de la población limitando considerablemente la actividad laboral, deportiva y la vida diaria de los pacientes que la padecen. Existen diversos tratamientos que se basan en el fortalecimiento de los tejidos blandos periarticulares ya sea mediante tratamiento conservador o quirúrgico incluyendo técnicas abiertas o artroscópicas. En los últimos años se está aplicando una nueva técnica quirúrgica, la capsulorrafia térmica, que se basa en la aplicación artroscópica de energía térmica mediante láser en los tejidos capsulares y ligamentosos glenohumerales provocando una retracción de la cápsula articular y una estabilización de la articulación. Este tipo de tratamiento favorece una rehabilitación más rápida y una reincorporación más precoz a las actividades laborales y deportivas de los pacientes respecto a las técnicas habituales. De todas formas aún son necesarios estudios más amplios para evidenciar que los resultados a largo plazo son equiparables a los tratamientos clásicos (AU)

Magnetoterapia en retardos de consolidación / Magnetotherapy in delayed consolidations

La utilización de campos magnéticos con fines terapéuticos ha sido estudiada sobre todo en relación a su efecto de estimulación de la osteogénesis. Existen estudios controlados a doble ciego en los que se ha demostrado su efecto para estimular la formación ósea en retrasos de consolidación de fracturas tibiales. Se presentan dos casos clínicos de pacientes afectos de fracturas de hueso largo que presentaban retardo de consolidación tras ocho meses de tratamiento quirúrgico. Realizaron 36 y 28 sesiones respectivamente de magnetoterapia durante 30 minutos diarios, a una frecuencia de 50 Hz e intensidad de 80 Gauss. En controles posteriores se confirmó radiológicamente la consolidación de ambas fracturas. Se realiza también un comentario de artículos publicados en los que se valoran los resultados del tratamiento con campos magnéticos pulsantes en series de pacientes más largas afectos de retrasos de consolidación y pseudoartrosis, así como una breve explicación de su efecto biológico y posibles efectos nocivos (AU)