Resultados funcionales a largo plazo de la cirugía abierta de liberación del túnel carpiano / Long-term functional outcomes of open carpal tunnel release surgery

Introducción: El síndrome del túnel carpiano es la neuropatía por atrapamiento más común que genera compresión del nervio mediano. La cirugía de liberación abierta del nervio mediano tiene un papel importante, especialmente, en pacientes que no responden al manejo conservador o con diagnóstico de síndrome del túnel carpiano con criterios de gravedad. El propósito de este estudio fue describir los resultados funcionales, la satisfacción y la fuerza objetiva a mediano (6-24 meses) y largo plazo (>24 meses) con la técnica abierta convencional en la población local. Materiales y métodos: Estudio observacional descriptivo con datos retrospectivos de resultados clínicos funcionales a mediano y largo plazo en pacientes sometidos a cirugía de liberación abierta del nervio mediano como tratamiento del síndrome del túnel carpiano. Se determinaron el nivel funcional según el BCTQ y la FSS, la fuerza de agarre con un dinamómetro electrónico y la satisfacción. Resultados: Se realizaron 100 procedimientos entre mayo de 2012 y septiembre de 2018, con un seguimiento posoperatorio >6 meses. La mayoría eran mujeres (83%) con una mediana de la edad de 59 años. El 97% obtuvo resultados buenos y excelentes a mediano plazo y el 90%, a largo plazo, con una mediana de fuerza de 17 kg (RIC 7,4) y una satisfacción de 90 (RIC 20) a mediano y largo plazo. Conclusiones: La cirugía abierta de liberación del nervio mediano en pacientes con síndrome del túnel carpiano logra resultados buenos y excelentes a mediano y largo plazo en cuanto a funcionalidad, fuerza y satisfacción. Nivel de Evidencia: IV

Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy that causes compression of the median nerve. Open median nerve release surgery plays an important role, especially in patients with failed conservative management or with a diagnosis of severe CTS. The purpose of the following study is to describe the functional outcomes, satisfaction, and objective strength in the medium (6 to 24 months) and long term (greater than 24 months) with the conventional open technique in the local population. Materials and methods: Descriptive observational study based on retrospective data of functional clinical outcomes in the medium and long term in patients undergoing open release surgery of the median nerve as a treatment for CTS. Functional level according to the BCTQ and FSS, grip strength with an electronic dynamometer, and satisfaction were determined. Results: 100 procedures were performed between May 2012 and September 2018, with a follow-up of more than 6 months. The majority were women (83%) with a total median age of 59 years showing good to excellent results in the 97% in the medium term and 90% in the long term, with a median strength of 17 kg (Interquartile range: 7.4) and satisfaction of 90 (Interquartile range: 20). Conclusions: Open surgery to release the median nerve in patients with CTS shows good to excellent functional outcomes, satisfaction, and strength in the medium and long term. Level of Evidence: IV

A brief review of ventricular assist devices and a recommended protocol for pathology evaluations.

UNLABELLED: Heart failure is a leading cause of death in human populations, and as people live longer, it is becoming an increasingly prominent problem. Because of the insufficient numbers of donor hearts, physicians and engineers are turning to mechanical circulatory support in the form of ventricular assist devices (VADs). Their clinical performance and increasing availability of various types, sizes, and functions are increasing VAD recognition. However, for any implantable medical device, especially one that is life supporting, performance and safety must be evaluated both pre- and postmarket. It has been demonstrated that specific pathology analysis can provide unique and important information to augment the evaluation of performance and safety. To help ensure the safety and efficacy of a device, we propose that regulatory agencies include pathology analysis by experienced, independent pathologists with relevant expertise as an integral component of device submissions. We believe that this analysis should include both gross and microscopic components and, when warranted, supplementary data obtained through radiography, electron microscopy, or both. The pathology data acquired through these analyses should be correlated with clinical data to yield a more thorough data set for submission to the governing regulatory body. Submitting this coordinated analysis of data will demonstrate to regulatory agencies (United States Food and Drug Administration, Therapeutic Goods Administration, Brazilian Health Surveillance Agency, etc.) that the device manufacturer shares their objective: making medical devices as safe and effective as possible. SUMMARY: This review of ventricular assist devices introduces a recommended protocol for pathology evaluations of devices from organizations or researchers seeking approval by a governing regulatory agency.

Adenocarcinoma mucinoso de uraco / Urachal adenocarcinoma: sonographic and CT findings

Se presenta el caso de una paciente de 43 años cuyo motivo de consulta consistió en dolor hipogástrico, incontinencia urinaria, mucosuria y hematuria. La ecografía y la tomografía axial computada (TC) con y sin contraste endovenoso de la región abdominopelviana demostraron una voluminosa masa heterogénea en contacto con la cúpula vesical. Se realizó cistectomía radical, histerectomía y plástica de pared abdominal. La anatomía patológica reveló un adenocarcinoma mucinoso de uraco (AU)

Adenocarcinoma mucinoso de uraco / Urachal adenocarcinoma: sonographic and CT findings

Se presenta el caso de una paciente de 43 años cuyo motivo de consulta consistió en dolor hipogástrico, incontinencia urinaria, mucosuria y hematuria. La ecografía y la tomografía axial computada (TC) con y sin contraste endovenoso de la región abdominopelviana demostraron una voluminosa masa heterogénea en contacto con la cúpula vesical. Se realizó cistectomía radical, histerectomía y plástica de pared abdominal. La anatomía patológica reveló un adenocarcinoma mucinoso de uraco