Reinervación muscular dirigida diferida en el manejo del dolor neuropático tras amputación de extremidad inferior / Delayed targeted muscle reinnervation in the management of neuropathic pain after lower limb amputation

Introducción y objetivo: El dolor neuropático es una de las complicaciones más comunes en la cirugía de amputación de extremidad inferior. En este contexto surge la Reinervación Muscular Dirigida (TMR) como técnica con resultados prometedores en el tratamiento del dolor neuropático tras amputación. En este artículo presentamos la técnica quirúrgica y nuestra experiencia clínica. Material y método: Entre enero de 2021 y diciembre de 2022 registramos los pacientes intervenidos para TMR diferida de extremidad inferior en el Servicio de Cirugía Plástica del Hospital Universitario Miguel Servet (Zaragoza, España) evaluando su capacidad de portar prótesis a los 6 meses de la intervención. Asimismo, exponemos la técnica quirúrgica empleada. Resultados: Intervenimos 9 pacientes, 7 amputaciones infracondíleas y 2 supracondíleas. A los 6 meses, 7 eran capaces de deambular con prótesis y en 2 persistía dolor de componente mixto que impedía la protetización. Ambos pacientes habían sido amputados por causas vasculares. Conclusiones: En nuestra serie clínica obtuvimos resultados prometedores que permitieron la protetización en una gran proporción de casos, si bien la selección de pacientes es un punto crucial en la aplicación de esta técnica.(AU)

Background and objective: Neuropathic pain is one of the most common complications in lower extremity amputation surgery. In this context, Targeted Muscle Reinnervation (TMR) emerges as a technique with promising results in the treatment of neuropathic pain after amputation and phantom limb.In this article we describe the surgical technique and our clinical experience. Methods: Between January 2021 and December 2022, we registered the patients operated on for delayed TMR of the lower extremity in the Plastic Surgery Service of the Miguel Servet University Hospital (Zaragoza, Spain) evaluating their ability to wear prostheses 6 months after the intervention. Likewise, we expose the surgical technique used. Results: A total of 9 patients were operated, being 7 infracondylar and 2 supracondylar amputations. Six months after surgery, 7 patients could walk with the prosthesis, while the other 2 ones still experienced pain that prevented fitting the prosthesis. Both patients had been amputated for vascular causes. Conclusions: In our clinical series, we obtained promising results which allow ambulation in a large proportion of patients although we consider that patient selection is a crucial point in the application of this technique.(AU)

Utilidad del índice PROFUND para predecir la mortalidad a los 4 años en pacientes pluripatológicos / Reliability of the PROFUND index to predict 4-year mortality in polypathological patients

Objetivo: Determinar la validez del índice PROFUND para establecer el riesgo de muerte global a los 4 años en pacientes pluripatológicos. Pacientes y métodos: Estudio de cohortes (Medicina Interna y Geriatría) prospectivo y multicéntrico. Se incluyeron pacientes pluripatológicos ingresados entre el 1 de marzo y el 30 de junio de 2011. Se recogieron datos de edad, sexo, si vivían en el domicilio o en una residencia, categorías de pluripatología, índices de Charlson, Lawton-Brody y Barthel, cuestionario de Pfeiffer, escala sociofamiliar de Gijón, delirium, número de fármacos, hemoglobina, creatinina e índice PROFUND. Se realizó un seguimiento durante 4 años. Resultados: Se incluyeron 441 pacientes, 324 de Medicina Interna y 117 de Geriatría, con una edad media de 80,9 (8,7) años, y 245 (55,6%) eran mujeres. Las enfermedades cardiacas (62,7%), neurológicas (41,4%) y respiratorias (37,3%) fueron las más frecuentes. Los pacientes de Geriatría eran de más edad, más dependientes y con más deterioro cognitivo. Al cabo de 4 años habían fallecido 335 (76%) pacientes. Los factores asociados de forma independiente con la mortalidad fueron la edad, la disnea, el índice de Barthel<60, el delirium, las neoplasias avanzadas y haber ingresado 4 o más veces en el último año. El rendimiento del índice PROFUND fue bueno en los pacientes de Medicina Interna y malo en los de Geriatría (0,748, IC 95% 0,689-0,806, p<0,001, y 0,517, IC 95% 0,369-0,666, p=0,818, respectivamente). Conclusiones: El índice PROFUND es útil para predecir la mortalidad global a largo plazo en los pacientes pluripatológicos de Medicina Interna, pero no en los de Geriatría (AU)

Objective: To determine the usefullness of the PROFUND index to assess the risk of global death after 4 years in polypathological patients. Patients and methods: Multicenter prospective cohort (Internal Medicine and Geriatrics) study. Polypathological patients admitted between March 1st and June 30th 2011 were included. For each patient, data concerning age, sex, living at home or in a nursing residence, polypathology categories, Charlson, Barthel and Lawton-Brody indexes, Pfeiffer questionnaire, socio-familial Gijon scale,delirium, number of drugs, hemoglobin and creatinine values were gathered, and the PROFUND index was calculated. The follow-up lasted 4 years. Results: We included 441 patients, 324 from Internal Medicine and 117 from Geriatrics, with a mean age of 80.9 (8.7) years. Of them, 245 (55.6%) were women. Heart (62.7%), neurological (41.4%) and respiratory (37.3%) diseases were the most frequent. Geriatrics inpatients were older and more dependants and presented greater cognitive deterioration. After 4 years, 335 (76%) patients died. Mortality was associated with age, dyspnoea, Barthel index<60,delirium, advanced neoplasia and≥4 admissions in the last year. The area under the curve of the PROFUND index was 0.748, 95% CI 0.689-0.806, P<.001 in Internal Medicine and 0.517, 95% CI 0.369-0.666, P=.818 in Geriatrics patients, respectively. Conclusions: The PROFUND index is a reliable tool for predicting long-term global mortality in polypathological patients from Internal Medicine but not from Geriatrics departments (AU)

[Reliability of the PROFUND index to predict 4-year mortality in polypathological patients]. / Utilidad del índice PROFUND para predecir la mortalidad a los 4 años en pacientes pluripatológicos.

OBJECTIVE: To determine the usefullness of the PROFUND index to assess the risk of global death after 4 years in polypathological patients. PATIENTS AND METHODS: Multicenter prospective cohort (Internal Medicine and Geriatrics) study. Polypathological patients admitted between March 1st and June 30th 2011 were included. For each patient, data concerning age, sex, living at home or in a nursing residence, polypathology categories, Charlson, Barthel and Lawton-Brody indexes, Pfeiffer questionnaire, socio-familial Gijon scale, delirium, number of drugs, hemoglobin and creatinine values were gathered, and the PROFUND index was calculated. The follow-up lasted 4 years. RESULTS: We included 441 patients, 324 from Internal Medicine and 117 from Geriatrics, with a mean age of 80.9 (8.7) years. Of them, 245 (55.6%) were women. Heart (62.7%), neurological (41.4%) and respiratory (37.3%) diseases were the most frequent. Geriatrics inpatients were older and more dependants and presented greater cognitive deterioration. After 4 years, 335 (76%) patients died. Mortality was associated with age, dyspnoea, Barthel index<60, delirium, advanced neoplasia and≥4 admissions in the last year. The area under the curve of the PROFUND index was 0.748, 95% CI 0.689-0.806, P<.001 in Internal Medicine and 0.517, 95% CI 0.369-0.666, P=.818 in Geriatrics patients, respectively. CONCLUSIONS: The PROFUND index is a reliable tool for predicting long-term global mortality in polypathological patients from Internal Medicine but not from Geriatrics departments.

Empiemas pleurales por Gemella spp: una etiología no tan infrecuente / Pleural empyema due to Gemella spp: Report of 12 cases

Background: Gemella genus bacteria can produce localized or generalized severe infections, but very rarely they have been described as causingpulmonary infections or pleural empyemas. Aim: To characterize patients with empyema caused by Gemella genus bacteria. Material and Methods: The database of a Microbiology laboratory of a Spanish hospital was reviewed, searchingfor Gemella positive cultures ofpleural effusions in a period offive years. Results: We identified 12 patients (11 males) with Gemella spp pleural empyema. Eight were infected with G. haemolysans and four with G. morbillorum. All patients had predisposingfactors such as poor oral hygiene, smoking, chronic cardiovascular or respiratory disease, alcoholism or malignancies. In ten cases, a thoracic drainage tube was placed with fibrinolysis in seven. One patient needed surgery because of a relapse of the empyema. Two patients died because of an advanced neoplasm, and the empyema was resolved in the rest. Conclusions: Gemella pleural empyema can occur and its isolation must not be seen as a contamination.

[Pleural empyema due to Gemella spp: report of 12 cases]. / Empiemas pleurales por Gemella spp: una etiología no tan infrecuente.

BACKGROUND: Gemella genus bacteria can produce localized or generalized severe infections, but very rarely they have been described as causing pulmonary infections or pleural empyemas. AIM: To characterize patients with empyema caused by Gemella genus bacteria. MATERIAL AND METHODS: The database of a Microbiology laboratory of a Spanish hospital was reviewed, searching for Gemella positive cultures of pleural effusions in a period of five years. RESULTS: We identified 12 patients (11 males) with Gemella spp pleural empyema. Eight were infected with G. haemolysans and four with G. morbillorum. All patients had predisposing factors such as poor oral hygiene, smoking, chronic cardiovascular or respiratory disease, alcoholism or malignancies. In ten cases, a thoracic drainage tube was placed with fibrinolysis in seven. One patient needed surgery because of a relapse of the empyema. Two patients died because of an advanced neoplasm, and the empyema was resolved in the rest. CONCLUSIONS: Gemella pleural empyema can occur and its isolation must not be seen as a contamination.