Hemoperitoneo espontáneo masivo en paciente puérpera afecta de neurofibromatosis tipo 1 / Massive spontaneous haemoperitoneum in a post-partum patient with neurofibromatosis type 1

La neurofibromatosis tipo 1 o enfermedad de von Recklinghausen es una enfermedad genética, progresiva y multisistémica que afecta predominantemente a la piel y el sistema nervioso. La alteración vascular es poco frecuente pero puede tener resultados catastróficos. Las pacientes gestantes afectas de esta enfermedad necesitan un seguimiento exhaustivo y multidisciplinar con el objetivo de controlar las posibles alteraciones vasculares sobre todo renales por ser las más frecuentes. Presentamos el caso de una paciente diagnosticada de NF-1 que presentó un hemoperitoneo masivo espontáneo en el postoperatorio tardío de una cesárea electiva. El sangrado espontáneo de grandes vasos es una rara pero potencial complicación letal que puede producirse en pacientes afectos de neurofibromatosis I y que puede precisar de tratamiento quirúrgico urgente

Neurofibromatosis type 1 (NF-1) or von Recklinghausen's disease is a genetic, progressive, multi-system disease that predominantly affects the skin and nervous system. Vascular involvement is rare, but can have catastrophic results. Pregnant patients with this disease need careful, multidisciplinary follow up in order to control possible vascular alterations, which usually affect the kidneys. We present the case of a patient diagnosed with NF-1 who debuted with massive spontaneous hemoperitoneum in the late postoperative period of an elective Cesarean section. Spontaneous bleeding from large vessels is a rare but potentially lethal complication that can occur in patients with NF-1, and may require urgent surgical treatment

Massive spontaneous haemoperitoneum in a post-partum patient with neurofibromatosis type 1. / Hemoperitoneo espontáneo masivo en paciente puérpera afecta de neurofibromatosis tipo 1.

Neurofibromatosis type 1 (NF-1) or von Recklinghausen's disease is a genetic, progressive, multi-system disease that predominantly affects the skin and nervous system. Vascular involvement is rare, but can have catastrophic results. Pregnant patients with this disease need careful, multidisciplinary follow up in order to control possible vascular alterations, which usually affect the kidneys. We present the case of a patient diagnosed with NF-1 who debuted with massive spontaneous hemoperitoneum in the late postoperative period of an elective Cesarean section. Spontaneous bleeding from large vessels is a rare but potentially lethal complication that can occur in patients with NF-1, and may require urgent surgical treatment.

Analgesia epidural continua para trabajo de parto en una paciente con polineuropatía desmielinizante periférica / Continuous epidural analgesia for labour and delivery in a patient with demyelinating peripheral polyneuropathy

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Tratamiento del dolor irruptivo con fentanilo sublingual en pacientes con úlceras cutáneas crónicas / Breakthrough pain treatment with sublingual fentanyl in patients with chronic cutaneous ulcers

Objetivo. El presente estudio pretende establecer la eficacia y tolerabilidad de los opioides en el tratamiento del dolor en pacientes con úlceras cutáneas crónicas y dolor irruptivo incidental. Material y método. Estudio abierto, multicéntrico, prospectivo, no controlado, realizado en unidades del dolor y de úlceras de 5 hospitales de la Comunidad Valenciana. El criterio de inclusión fue dolor basal mayor o igual a 4 según la escala visual analógica o dolor irruptivo mayor o igual a 4 durante la cura. Los criterios de exclusión fueron alteraciones cognitivas, intolerancia a opioides y rechazo del paciente a dar el consentimiento. El protocolo estableció 5 momentos de evaluación: basal (primera visita), 15 días, un mes, 2 y 3 meses. La variable principal del estudio fue el dolor medido con la escala visual analógica en reposo, en movimiento y durante la cura. Se administraron opioides para el dolor basal y se administró fentanilo sublingual para el dolor irruptivo. Resultados. Treinta y dos pacientes (86,5%) completaron el estudio. El dolor basal experimentó una reducción media de 3,6 (DE 2,3) puntos en la escala visual analógica, el dolor en movimiento disminuyó 3,9 (DE 2,5), y el dolor durante la cura disminuyó 4,5 (DE 2,8), siendo en todos estadísticamente significativa (p < 0,001) desde el primer control. Catorce pacientes (43,8%) presentaron náuseas, 7 (21,9%), somnolencia y estreñimiento, 5 (15,6%), prurito, y uno (3,1%), vómitos. Conclusiones. Los resultados de nuestro estudio evidencian que el tratamiento con opioides en pacientes con úlceras cutáneas crónicas proporciona un alivio efectivo del dolor, tanto basalmente como durante la cura, con escasos efectos adversos (AU)

Objective. The aim of the study was to assess the efficacy and safety of opioids in the management of pain in those patients with chronic cutaneous ulcers and breakthrough/incidental pain. Material and method. An open-label, multicentre, prospective, uncontrolled study was conducted in the pain and ulcer units of 5 hospitals across the Comunidad Valenciana. Eligibility criteria were baseline pain 4 in the visual analogue scale or breakthrough procedural pain 4. Exclusion criteria were cognitive impairment, opioid intolerance, or patient refusal to provide informed consent. The protocol scheduled 5 controls: baseline (enrolment), 15 days, one month, 2 months, and 3 months. The main outcome measure of the study was the visual analogue scale score during rest, movement and procedures. Opioids were administered for release of the baseline pain, and sublingual fentanyl for breakthrough pain. Results. A total of 32 patients (86.5%) completed the study. Baseline pain achieved a mean improvement of 3.6 visual analogue scale points (SD 2.3), movement pain improved by 3.9 points (SD 2.5) and procedural pain improved by 4.5 points (SD 2.8), and the mean pain intensity improvement was statistically significant from the first control and at all controls thereafter (P < .001). Nausea was reported by 14 patients (43.8%), drowsiness and constipation by 7 (21.9%), itching by 5 (15.6%), and one (3.1%) reported vomiting. Conclusions. Structured assessment of pain is a key concept in the management of patient with chronic cutaneous ulcers. The results of this study suggest that opioid therapy provides clinically significant pain relief with few adverse effects (AU)

Gestante a término con miocardiopatía no compactada / A full-term pregnant woman with non-compaction cardiomyopathy

La miocardiopatía no compactada es una miocardiopatía primaria de origen genético. Las pacientes embarazas con miocardiopatía no compactada son más susceptibles a presentar complicaciones, como insuficiencia cardíaca, arritmias y fenómenos embólicos. Presentamos el caso de una embarazada a término con miocardiopatía no compactada asintomática y en tratamiento con bisoprolol a la que se le realizó analgesia epidural para el parto evolucionando de manera favorable. Se describe el curso clínico y se realiza una somera revisión (AU)

Non-compaction cardiomyopathy, a genetic primary cardiomyopathy, is being increasingly diagnosed. Pregnant women with non-compaction cardiomyopathy are more susceptible to complications, such as heart failure, arrhythmias and embolic events. This paper reports the case of a pregnant woman with non-compaction cardiomyopathy under treatment and asymptomatic, who received epidural analgesia during labor and delivery. The clinical course is described and a brief review is presented (AU)

[Breakthrough pain treatment with sublingual fentanyl in patients with chronic cutaneous ulcers]. / Tratamiento del dolor irruptivo con fentanilo sublingual en pacientes con úlceras cutáneas crónicas.

OBJECTIVE: The aim of the study was to assess the efficacy and safety of opioids in the management of pain in those patients with chronic cutaneous ulcers and breakthrough/incidental pain. MATERIAL AND METHOD: An open-label, multicentre, prospective, uncontrolled study was conducted in the pain and ulcer units of 5 hospitals across the Comunidad Valenciana. Eligibility criteria were baseline pain 4 in the visual analogue scale or breakthrough procedural pain 4. Exclusion criteria were cognitive impairment, opioid intolerance, or patient refusal to provide informed consent. The protocol scheduled 5 controls: baseline (enrolment), 15 days, one month, 2 months, and 3 months. The main outcome measure of the study was the visual analogue scale score during rest, movement and procedures. Opioids were administered for release of the baseline pain, and sublingual fentanyl for breakthrough pain. RESULTS: A total of 32 patients (86.5%) completed the study. Baseline pain achieved a mean improvement of 3.6 visual analogue scale points (SD 2.3), movement pain improved by 3.9 points (SD 2.5) and procedural pain improved by 4.5 points (SD 2.8), and the mean pain intensity improvement was statistically significant from the first control and at all controls thereafter (P<.001). Nausea was reported by 14 patients (43.8%), drowsiness and constipation by 7 (21.9%), itching by 5 (15.6%), and one (3.1%) reported vomiting. CONCLUSIONS: Structured assessment of pain is a key concept in the management of patient with chronic cutaneous ulcers. The results of this study suggest that opioid therapy provides clinically significant pain relief with few adverse effects.

[A full-term pregnant woman with non-compaction cardiomyopathy]. / Gestante a término con miocardiopatía no compactada.

Non-compaction cardiomyopathy, a genetic primary cardiomyopathy, is being increasingly diagnosed. Pregnant women with non-compaction cardiomyopathy are more susceptible to complications, such as heart failure, arrhythmias and embolic events. This paper reports the case of a pregnant woman with non-compaction cardiomyopathy under treatment and asymptomatic, who received epidural analgesia during labor and delivery. The clinical course is described and a brief review is presented.

Hidrotórax tras cateterización de vena yugular interna derecha / No disponible

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Punción intraneural del nervio ciático en la región poplítea. Demostración mediante el uso de la ecografía / No disponible

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[Sciatic nerve block with 1% mepivacaine for foot surgery: posterior versus lateral approach to the popliteal fossa]. / Estudio comparativo del bloqueo del nervio ciático en el hueco poplíteo por abordaje posterior frente al abordaje lateral con mepivacaína al 1% para cirugía del pie.

AIMS: To compare the efficacy and feasibility of the sciatic nerve block performed using either a posterior or a lateral approach to the popliteal fossa, taking into consideration patient comfort during puncture and postoperative analgesia. PATIENTS AND METHODS: Sixty patients scheduled for foot surgery were randomly assigned to 2 groups: a posterior approach was used in performing the sciatic nerve block in 1 group (n = 30) and a lateral approach was in the other group (n = 30). The local anesthetic employed was mepivacaine 1%. RESULTS: Duration of sensory block was used significantly longer with the lateral approach (5.4 hours, range 3.3-8 hours) than with the posterior approach (4.4 hours, range 1.5-7 hours) (P < 0.001). Time to onset of the block was significantly shorter with the lateral approach (10 minutes, range 5-25 minutes) than with the posterior approach (17 minutes, range 4-45 minutes) (P < 0.01). Quality of the blockade was similar with both approaches. CONCLUSIONS: The lateral approach to the block of the sciatic nerve in the popliteal fossa provides analgesia comparable to that obtained with the posterior approach, with a faster onset and longer postoperative duration.

[Control of hypertensive crisis with urapidil in two cases of adrenalectomy]. / Control de las crisis hipertensivas con urapidilo en dos casos de suprarrenalectomía.

We review the use of urapidil to manage hypertension in two patients undergoing adrenalectomy for pheochromocytoma and aldosterone producing adenoma. Bolus administration (25 mg/i.v.) of urapidil provided good control of blood pressure during surgical manipulation of the tumor, although continuous perfusion of the drug was required by one patient before complete excision was achieved. No changes in heart rate or sudden decrease in blood pressure were observed. We believe that urapidil may be useful for treating hypertension during tumor adrenalectomy.