ABSTRACT
Resumen: Introducción: Las fracturas escapulares comprenden 1% del total de las fracturas en general y de 3 a 5% del hombro, las cuales se presentan por alta energía en pacientes jóvenes. Sólo 10% tiene indicación quirúrgica al tomarse como base la alteración de complejo suspensorio del hombro. El objetivo es valorar el resultado de pacientes con indicación quirúrgica así como una revisión de la literatura. Reporte de casos: Presentamos dos pacientes con fractura del cuerpo escapular derecho Bartonicek D con desplazamiento mediolateral, deformidad angular anteroposterior y alteración del ángulo glenopolar. Se realizó el manejo quirúrgico con osteosíntesis y placas convencionales y anatómicas. Se realizó valoración funcional y seguimiento radiográfico de ambos casos a los seis meses y se obtuvo arcos de movilidad flexión 180o/170o en ambos casos, así como escalas funcionales DASH 22/25, Constant 90/89 y Simple Shoulder Test 11/11 respectivamente; se obtuvo una consolidación ósea grado III-IV de Montoya. Discusión: Se considera importante realizar una adecuada reducción y estabilización del trazo de fractura debido al bajo grado de satisfacción con tratamiento conservador en pacientes con alta demanda funcional, que consiste en dolor residual, pinzamiento y disquinesia escapular. Se recomienda la cirugía para estas fracturas ya que comprometen la cadena cinética del hombro e impactan en el resultado funcional a corto y mediano plazo.
Abstract: Introduction: Scapular fractures comprise 1% of all fractures and 3 to 5% of the shoulder, they occur in young patients by high energy trauma. Only 10% have surgical indication based on the alteration of the shoulder's suspensory complex. The objective is to assess the outcome of patients with surgical indication as well as a review of the literature. Case report: We present two patients with Bartonicek D fracture of the right scapular body with mediolateral displacement, anteroposterior angular deformity and alteration of the glenopolar angle. Surgery was performed on both cases with conventional and special anatomical plates. Functional assessment and radiographic follow-up of both cases were performed at 6 months, obtaining flexion mobility of 180º/170º in both cases, as well as functional scales DASH 22/25, Constant 90/89 and Simple Shoulder Test 11/11 respectively; with bone consolidation grade III-IV of Montoya. Discussion: Due to the low degree of satisfaction with conservative treatment in patients with high functional demand, and multiple complications consisting in residual pain, impingement and scapular dyskinesia; it is important to perform an adequate reduction and stabilization of the fracture. We recommend surgical management for this type of fractures since they compromise the kinetic chain of the shoulder and impact the functional outcome in the short and medium term.
Subject(s)
Humans , Shoulder Fractures/surgery , Shoulder Joint , Fracture Fixation, Internal , Scapula/injuries , Shoulder , Range of Motion, Articular , Treatment Outcome , Shoulder InjuriesABSTRACT
Resumen: Introducción: La artropatía por desgarro masivo del manguito de los rotadores (ADMMR) condiciona un desplazamiento de la cabeza humeral acompañada de acetabularización del acromion y femoralización de la glenoides. El objetivo de este estudio fue conocer la prevalencia de la ADMMR en el Instituto Nacional de Rehabilitación (INR). Material y métodos: Se realizó un estudio de prevalencia que incluyó la revisión de 400 expedientes para identificar a 136 pacientes con lesión del manguito de los rotadores. Se integró un subgrupo para pacientes con lesión masiva del manguito de los rotadores (LMMR) y ADMMR. Se estudiaron variables y se estadificaron. Resultados: Se incluyeron 34 pacientes con LMMR (26 mujeres y 8 hombres) con una edad promedio de 60.1 ± 10.26 años. Se registró una prevalencia de 25% de LMMR en el grupo global con lesión del manguito de los rotadores. Asimismo, se buscó la prevalencia de ADMMR en el grupo global y en el subgrupo de lesiones masivas, siendo de 19 y 76%, respectivamente. Los pacientes con LMMR se estadificaron para conocer el grado de ADMMR mediante la clasificación de Seebauer, encontrando 32% con estadios 1a, 11% 1b, 32% 2a, 0% 2b y 23% no presentaban datos de ADMMR. Conclusión: La prevalencia de ADMMR en pacientes del servicio incluido con lesión del manguito de los rotadores y LMMR es mayor a la reportada en la literatura sajona.
Abstract: Introduction: Glenohumeral arthritis secondary to massive rotator cuff tear presents with a superior displacement and femoralization of the humeral head with coracoacromial arch acetabularization. The purpose of this study was to establish prevalence of rotator cuff tear artropathy (CTA) at our institution. Material and methods: Four hundred electronic records were reviewed from which we identified 136 patients with rotator cuff tears. A second group was composed with patients with massive cuff tears that were analized and staged by the Seebauer cuff tear arthropathy classification. Results: Thirty four patients with massive rotator cuff tears were identified, 8 male and 26 female (age 60.1 ± 10.26 years). Massive rotator cuff tear prevalence was 25%. CTA prevalence found in the rotator cuff group was 19 and 76% in the massive cuff tears group. Patients were staged according to the classification with 32% in stage 1a, 11% 1b, 32% 2a and 0% 2b. Conclusion: CTA prevalence in patients with rotator cuff tears and massive cuff tears is higher than the one reported in American population. We consider that a revision of the Seebauer classification to be appropriate to determine its reliability.
Subject(s)
Humans , Male , Female , Humeral Head , Rotator Cuff Injuries/epidemiology , Prevalence , Reproducibility of Results , Rotator CuffABSTRACT
Background. Scintigraphy with iodine-123-metaiodobenzylguanidine (123I-MIBG) is a non-invasive tool for the assessment of cardiac sympathetic innervation (CSI) that has proven to be an independent predictor of survival. Recent studies have shown that diabetic patients with heart failure (HF) have a higher deterioration in CSI. It is unknown if 123I-MIBG has the same predictive value for diabetic and non-diabetic patients with advanced HF. An analysis is performed to determine whether CSI with 123I-MIBG retains prognostic utility in diabetic patients with HF, evaluated for a primary prevention implantable cardioverter-defibrillator (ICD). Material and methods. Seventy-eight consecutive HF patients (48 diabetic) evaluated for primary prevention ICD implantation were prospectively enrolled and underwent 123I-MIBG to assess CSI (heart-to-mediastinum ratio - HMR). A Cox proportional hazards multivariate analysis was used to determine the influence of 123I-MIBG images for prediction of cardiac events in both diabetic and non-diabetic patients. The primary end-point was a composite of arrhythmic event, cardiac death, or admission due to HF. Results. During a mean follow-up of 19.5 [9.3-29.3] months, the primary end-point occurred in 24 (31%) patients. Late HMR was significantly lower in diabetic patients (1.30 vs. 1.41, p = 0.014). Late HMR ≤ 1.30 was an independent predictor of cardiac events in diabetic (hazard ratio 4.53; p = 0.012) and non-diabetic patients (hazard ratio 12.31; p = 0.023). Conclusions. Diabetic patients with HF evaluated for primary prevention ICD show a higher deterioration in CSI than non-diabetics; nevertheless 123I-MIBG imaging retained prognostic utility for both diabetic and non-diabetic patients (AU)
Antecedentes. La gammagrafía con yodo-123-metayodobenzilguanidina (123I-MIBG) es una herramienta de la valoración de la actividad simpática cardiaca (ASC) que ha demostrado ser un predictor independiente de supervivencia. Estudios recientes han demostrado que los pacientes diabéticos con insuficiencia cardiaca (IC) presentan mayor deterioro de la ASC. Si 123I-MIBG tiene el mismo valor predictivo en diabéticos y no diabéticos es desconocido. Analizamos si la evaluación de la ASC con 123I-MIBG mantiene su utilidad pronóstica en pacientes diabéticos con IC evaluados para implante de DAI en prevención primaria. Material y métodos. Se incluyeron prospectivamente 78 pacientes (48 diabéticos) consecutivos evaluados para implante de DAI en prevención primaria a los que se les realizó una gammagrafía con 123I-MIBG para evaluar la ASC (índice corazón mediastino - ICM-). Se usó un modelo multivariado de riesgos proporcionales de Cox para analizar la influencia de 123I-MIBG en la predicción de eventos cardiacos tanto en pacientes diabéticos como no diabéticos. La variable principal de resultado es un compuesto de evento arrítmico, muerte cardiaca y hospitalización por IC. Resultados. Durante una media de seguimiento de 19.5 [9.3-29.3] meses, la variable principal de resultado ocurrío en 24 (31%) de los pacientes. El ICM tardío fue significativamente menor en el grupo de pacientes con diabetes mellitus (1.30 vs 1.41, p = 0.014). Un ICM tardío ≤1,30 fue predictor independiente de eventos cardiacos en pacientes diabéticos (HR 4,53; p = 0,012) y no diabéticos (HR 12,31; p = 0,023). Conclusión. Los pacientes diabéticos con IC grave evaluados para implante de DAI en prevención primaria presentan mayor deterioro de la ASC que los no diabéticos. 123I-MIBG mantiene utilidad pronóstica en pacientes diabéticos y no diabéticos con IC (AU)
Subject(s)
Humans , Male , Female , Ventricular Dysfunction/complications , Ventricular Dysfunction , Heart Failure/complications , Heart Failure , Prognosis , Primary Prevention/methods , Iodine Radioisotopes , Predictive Value of Tests , Diabetes Complications , Prospective Studies , Radionuclide Imaging/instrumentation , Radionuclide Imaging/methods , Cohort StudiesABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Necrosis/enzymology , Necrosis/metabolism , Cardiomyopathies/genetics , Coronary Disease/genetics , Observational Study , Therapeutics/methods , Necrosis/complications , Necrosis/diagnosis , Cardiomyopathies/pathology , Coronary Disease/metabolism , Retrospective Studies , Therapeutics/instrumentationABSTRACT
Objetivo. La incidencia del manejo inadecuado del dolor oncológico es muy elevada a pesar de la multitud de guías de práctica clínica creadas. El objetivo es revisar de forma sistemática las guías de práctica clínica actuales sobre el manejo del dolor oncológico, analizar su metodología y contenido de forma crítica, y conocer su calidad y validez. Material y métodos. Revisión sistemática en las principales bases de datos en inglés, francés y español entre 2008 y 2013. Se realizó un análisis de la calidad metodológica con AGREE-II, incluyendo fiabilidad interobservador. Se extrajeron las recomendaciones, clasificándolas por categorías y nivel de evidencia, con el fin de realizar un análisis de la variabilidad entre las guías y de la validez de su contenido. Resultados. Seis guías fueron incluidas en el análisis, existiendo gran variabilidad tanto en la calidad formal y metodológica, como en el contenido y el nivel de evidencia de sus recomendaciones. La guía de Scottish Intercollegiate Guidelines Network fue la mejor valorada en AGREE-II mientras que la de la Sociedad Española de Oncología Médica resultó la peor valorada. La guía del Ministerio de Salud de Malasia fue la que contó con mayor validez, seguida por la Scottish Intercollegiate Guidelines Network. Conclusiones. Las guías actuales para el manejo del dolor en pacientes con cáncer presentan importantes limitaciones en su calidad y contenido. Entre las existentes, se recomiendan las del Ministerio de Salud de Malasia y Scottish Intercollegiate Guidelines Network, mientras que la de la Sociedad Española de Oncología Médica presenta oportunidades de mejora frente a estas (AU)
Objective. Although several clinical practice guidelines have been developed in the last decades, cancer pain management is still deficient. The purpose of this work was to carry out a comprehensive and systematic literature review of current clinical practice guidelines on cancer pain management, and critically appraise their methodology and content in order to evaluate their quality and validity to cope with this public health issue. Materials and methods. A systematic review was performed in the main databases, using English, French and Spanish as languages, from 2008 to 2013. Reporting and methodological quality was rated with the Appraisal of Guidelines, Research and Evaluation II (AGREE-II) tool, including an inter-rater reliability analysis. Guideline recommendations were extracted and classified into several categories and levels of evidence, aiming to analyse guidelines variability and evidence-based content comprehensiveness. Results. Six guidelines were included. A wide variability was found in both reporting and methodological quality of guidelines, as well as in the content and the level of evidence of their recommendations. The Scottish Intercollegiate Guidelines Network guideline was the best rated using AGREE-II, while the Sociedad Española de Oncología Médica guideline was the worst rated. The Ministry of Health Malaysia guideline was the most comprehensive, and the Scottish Intercollegiate Guidelines Network guideline was the second one. Conclusions. The current guidelines on cancer pain management have limited quality and content. We recommend Ministry of Health Malaysia and Scottish Intercollegiate Guidelines Network guidelines, whilst Sociedad Española de Oncología Médica guideline still needs to improve (AU)
Subject(s)
Humans , Male , Female , Neoplasms/metabolism , Neoplasms/pathology , Pain Management/methods , Pain Management/nursing , 34002 , Therapeutics/psychology , /standards , Neoplasms/rehabilitation , Neoplasms/therapy , Pain Management/psychology , Pain Management/standards , Spain , Therapeutics/methodsABSTRACT
Se realizó una revisión sistemática de guías de práctica clínica basadas en evidencia que tuvieran recomendaciones explícitas sobre el tratamiento del dolor lumbar crónico, con el objetivo de analizar su contenido y proveer una síntesis que sirviese para su traslación a la práctica. Las recomendaciones se analizaron y clasificaron según el tipo de tratamiento; se identificó el nivel de evidencia y fuerza de recomendación de las mismas, traduciéndolos a un sistema de gradación común. Ocho guías cumplieron los criterios de inclusión. El ejercicio y la escuela de espalda se perfilan como la terapia más efectiva. La farmacoterapia está indicada durante cortos periodos. Las guías analizadas ofrecen vías de acción similares frente a los principales tratamientos. Se han resumido las recomendaciones de forma clara y estructurada para permitir una elección clínica de los tratamientos más adecuados, evitar gastos y recursos en tratamientos inútiles y una recuperación del paciente más eficiente (AU)
This paper presents a systematic review of clinical practice guidelines based on evidence, with explicit recommendations on the treatment of chronic low back pain. The main objective was to analyze their content and provide a synthesis in order to improve the translation of this evidence into practice. The recommendations were analyzed and then classified by treatment; evidence level and strength of recommendation were identified and translated into our gradation system. Eight guidelines met the inclusion criteria. Exercise and back school treatment are shown as the best therapies. Pharmacotherapy is indicated during short periods of time. The guidelines analyzed show similar therapeutic approaches. The recommendations have been synthesized in order to allow clinical selection of the best treatment and avoid bad practices with their corresponding costs, providing a more efficient management of the patient (AU)
Subject(s)
Humans , Low Back Pain/therapy , Chronic Pain/therapy , Exercise Therapy/methods , Analgesia/methods , Practice Patterns, Physicians' , Evidence-Based Practice , Pain Management/methods , Analgesics/therapeutic useABSTRACT
Antecedentes y objetivo. El objetivo del trabajo es presentar una metodología basada en el empleo de los cadáveres frescos congelados para el entrenamiento de las habilidades en el tratamiento de la vía aérea y presentar el grado de satisfacción entre los alumnos. Material y métodos. Sobre 6 cadáveres frescos congelados se estructuraron 14 estaciones de trabajo en las que los alumnos entrenaron las diferentes habilidades necesarias para el tratamiento de la vía aérea. Se explican los detalles de preparación de los cadáveres que resultan fundamentales para un adecuado trabajo. Se evaluó el grado de satisfacción de los alumnos mediante la escala de evaluación de Likert de 5 puntos sobre las 14 estaciones, la valoración global y la utilidad clínica del curso. Resultados. La valoración global y la utilidad media del curso fueron de 4,75 y 4,9 sobre 5, respectivamente. Todas las partes del curso fueron valoradas por encima de 4 sobre 5. La elevada satisfacción sobre el curso se mantuvo homogénea en las 2 ediciones analizadas. La satisfacción global del curso no fue definitiva e unívocamente determinada por ninguna de sus partes en especial. Conclusión. El modelo de cadáver fresco para el entrenamiento de los médicos en técnicas de manejo de la vía aérea constituye una propuesta docente satisfactoria para el alumno, y con un realismo que se aproxima al paciente vivo (AU)
Background and objective. The aim of this paper is to present a methodology based on the use of fresh-frozen cadavers for training in the management of the airway, and to evaluate the degree of satisfaction among learning physicians. Material and methods. About 6 fresh-frozen cadavers and 14 workstations were prepared where participants were trained in the different skills needed for airway management. The details of preparation of the cadavers are described. The level of satisfaction of the participant was determined using a Likert rating scale of 5 points, at each of the 14 stations, as well as the overall assessment and clinical usefulness of the course. Results. The mean overall evaluation of the course and its usefulness was 4.75 and 4.9, out of 5, respectively. All parts of the course were rated above 4 out of 5. The high level of satisfaction of the course remained homogeneous in the 2 editions analysed. The overall satisfaction of the course was not finally and uniquely determined by any of its particular parts. Conclusion. The fresh cadaver model for training physicians in techniques of airway management is a proposal satisfactory to the participant, and with a realism that approaches the live patient (AU)
Subject(s)
Humans , Male , Female , Cadaver , Bronchoscopy/education , Catheterization, Peripheral/instrumentation , Teaching/methods , Teaching/trends , Teaching Materials , Bronchoscopy/instrumentation , Bronchoscopy/methods , Aptitude/physiologyABSTRACT
Objetivo. El objetivo de este estudio fue la recogida sistemática y el análisis de la frecuencia, tipo y severidad de todos los problemas anestésicos intraoperatorios ocurridos en nuestro hospital durante 6 meses. Métodos. Estudio observacional, sistemático, prospectivo y transversal, en el que se estudia el suceso y sus factores de riesgo. Se basó en una recogida de datos rutinaria de todas las anestesias. Incluye anestesia, sedación y analgesia de parto. Las variables recogidas fueron demográficas y de procedimiento, así como una lista de verificación con el tipo de problema y su grado de severidad. Los datos se analizaron mediante los tests de Chi al cuadrado, Fisher, o t de Student, aceptando p<0,05 como significativa. Resultados. La frecuencia de problemas anestésicos intraoperatorios fue de 17,2%, con 1,3 problemas por caso, siendo 9 veces mas frecuentes los problemas con bajo grado de severidad. Durante la anestesia, aparecieron problemas respiratorios en 13, circulatorios en 8, y técnicos en 2 de cada 100 procedimientos. Los factores asociados con los pacientes que presentaron problemas anestésicos se asociaron al uso de la anestesia general, cirugía supraumbilical y mayor riesgo anestésico preoperatorio. Conclusiones. La recogida sistemática de problemas intraoperatorios relacionados con la anestesia, mediante una lista de verificación de problemas y severidad, juega un importante papel en las estrategias de gestión de calidad. El análisis de problemas menores puede ayudar a establecer acciones correctivas antes de la aparición de morbilidad, separando los problemas propios de la cirugía de los de la anestesia(AU)
Objective. The purpose of the study was to systematically collect and analyse the frequency, type and severity of all untoward intraoperative anaesthetic-related problems in a hospital over a 6-month period. Methods. An observational, systematic, prospective, and cross sectional study was conducted on the events and their risk factors. The study is based on a system in which anaesthesia-related data are recorded from all anaesthetic cases on a routine basis, including sedation and obstetric analgesia. The variables were demographic, procedural data, and a checklist with problem type and severity. Data were analysed using chi-square, Fisher's test, or Student's test. A P<.05 was considered statistically significant. Results. The frequency of intraoperative anaesthetic-related problems was 17.2%, with 1.3 anaesthetic problems per case, being 9 times more frequent the adverse effects with low severity grade. During anaesthesia, respiratory problems occurred in 13, circulatory problems in 8, and technical problems in 2 out of every 100 procedures. The factors associated with the patient in whom the anaesthetic problem occurred were: the use of general anaesthesia, supraumbilical surgery, and a higher preoperative anaesthetic risk. Conclusions. Use of a systematic intraoperative anaesthetic-related database with a checklist of problems and severity plays an important part in quality assurance strategies. An analysis of non-fatal problems provides a basis for establishing corrective strategies before significant morbidity occurs, and by separating the surgical and anaesthesia problems(AU)
Subject(s)
Humans , Male , Female , Intraoperative Care/statistics & numerical data , Risk Factors , Data Collection/methods , Data Collection/statistics & numerical data , Patient Safety/statistics & numerical data , Patient Safety/standards , Quality Control , Random and Systematic Sampling , Prospective Studies , Cross-Sectional Studies/methods , Cross-Sectional Studies/statistics & numerical data , Morbidity Surveys , Anesthesia/adverse effects , AnesthesiaABSTRACT
Introducción y objetivo. Las concentraciones plasmáticas de colesterol unido a lipoproteínas de alta densidad (cHDL) descendidas constituyen un indicador de mal pronóstico en pacientes con síndrome coronario agudo. Hemos evaluado la relación entre las cifras de cHDL y la extensión de la necrosis miocárdica estimada por cardiorresonancia magnética en pacientes con infarto agudo de miocardio y elevación persistente del segmento ST en quienes se indicó reperfusión miocárdica. Pacientes y métodos. Análisis retrospectivo de 139 pacientes (edad media: 59,8 años; hombres: 79%) ingresados por infarto agudo de miocardio con elevación persistente del segmento ST y a quienes se efectuó una cardiorresonancia magnética. Las imágenes indicativas de necrosis miocárdica (realce tardío del gadolinio) se cuantificaron y relacionaron con la concentración de cHDL. Resultados. Los pacientes con cHDL≤40mg/dl (69% del total), en comparación con los que tenían un cHDL >40mg/dl, mostraron un área de necrosis miocárdica más extensa: el número de segmentos miocárdicos con patrón de necrosis transmural fue significativamente mayor (4,7 vs. 2,1; p<0,001), al igual que el porcentaje de necrosis miocárdica de la masa miocárdica total (18,2 vs. 11,3%; p=0,01). Los pacientes con disminución de cHDL tuvieron una menor fracción de eyección del ventrículo izquierdo (49,7 vs. 57,2%; p<0,001). Conclusiones. La concentración de cHDL disminuido es muy frecuente en los pacientes con infarto agudo de miocardio y elevación persistente del segmento ST. Este descenso de cHDL se asoció a una mayor área de necrosis y peor fracción de eyección del ventrículo izquierdo(AU)
Introduction and aim. Low plasma levels of high-density lipoprotein cholesterol (HDLC) is a prognostic factor in patients with acute coronary syndrome. The aim of this study was to evaluate the relationship between HDLC and myocardial necrosis estimated by cardiac magnetic resonance (CMR) in patients with acute ST-segment elevation myocardial infarction (STEMI) and reperfusion strategy. Methods. Retrospective analysis of 139 patients (mean age 59.8 years; 79% men) admitted with STEMI who underwent a CMR in the first week. Results. With a comparable reperfusion strategy used and time of ischemia, patients with HDLC ≤ 40mg/dL (69% of total) had more extensive areas of myocardial necrosis after STEMI, in number of segments with late gadolinium enhancement (RTG) with transmural necrosis pattern (4.7 vs. 2.1, P<.001) and in percentage of RTG with respect total mass myocardial (18.2 vs. 11.3%, P<.01), and worst left ventricular ejection fraction (LVEF) (49.7 vs. 57.2%, P<.001). Conclusions. We conclude that low HDLC are very common in patients with STEMI and associated with increased necrosis and a worse LVEF in the CRM study(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Myocardial Infarction/diagnosis , Myocardial Infarction/therapy , Lipoproteins, HDL/analysis , Lipoproteins, HDL , Lipoproteins, HDL/pharmacokinetics , Acute Coronary Syndrome/epidemiology , Acute Coronary Syndrome , Myocardial Infarction/physiopathology , Myocardial Infarction , Retrospective StudiesABSTRACT
La artroplastia femoro-patelar continúa siendo una técnica quirúrgica poco utilizada por los discutidos resultados obtenidos. En un intento de mejorar sus resultados se introdujo el diseño con polietileno móvil. Presentamos un caso clínico con una complicación poco frecuente: la luxación del polietileno de la base metálica de la patela; y a propósito realizamos una revisión bibliográfica de esta complicación (AU)
Patellofemoral arthroplasty is an infrequently used surgical technique because of its controversial results. In an attempt to improve the results, a design with a mobile-bearing poliethylene patellar component has been developed. We describe a clinical case with an unusual complication: the dislocation of poliethylene from the metal backing; and accordingly, we carried out a literature review of this complication (AU)
Subject(s)
Humans , Male , Adult , Polyethylene/adverse effects , Polyethylene/therapeutic use , Arthroplasty/methods , Arthroplasty , Osteoarthritis/complications , Osteoarthritis/diagnosis , Patellofemoral Joint/injuries , Patellofemoral Joint/surgery , Femoral Fractures/complications , Femoral Fractures/diagnosis , Prostheses and Implants , Artificial Limbs , Patellofemoral Joint/physiopathology , Patellofemoral JointABSTRACT
Objetivo: conocer la situación actual, en términos de organización y administración, de las Unidades del Dolor Crónico (UDO) de los hospitales públicos de la Región de Murcia. Material y método: encuesta on-line que exploraba aspectos de estructura y de proceso, dirigida a cada uno de los responsables de las UDO de todos los hospitales públicos del Servicio Murciano de Salud. Resultados: respondieron el 87,5% de las UDO, que representan una cobertura poblacional del 90% de la Región, todas ellas dirigidas por un anestesiólogo, de las que el 85,7% eran multi-disciplinares. Cada UDO realiza una media de 4,6 consultas y 0,75 quirófanos semanales. El 42,8% dedican a la asistencia menos de 8 h a la semana. Con una demora media para primera demanda de 66 días y de 49,2 para las revisiones, siendo la demanda mensual de primeras visitas de 32,5 pacientes. Algunas UDO expresan rechazar ciertos procesos dolorosos. El 42,8% realiza triaje, pero solo el 28,6% utiliza para ello criterios explícitos. Sólo el 28,6% emplea criterios explícitos de derivación, y solo el 57,1% dispone de protocolos de actuación clínica. Conclusiones: las UDO de la Región de Murcia presentan una gran disparidad en accesibilidad, presión asistencial, continuidad en los cuidados, gestión de la demanda y estructura, lo que hace muy difícil la posibilidad de comparación de resultados entre centros, al no disponer de la homogeneidad necesaria en la estructura y en los procesos asistenciales (AU)
Objective: to know about the current situation in terms of organization and management of Chronic Pain Clinics (UDO) of public hospitals in the Region of Murcia. Material and methods: on-line questionnaires that explored aspects of structure and process, addressed to each of the heads of the UDO of every public hospitals of Murcia Health Service. Results: the 87.5% of the UDO answered the questions, representing a 90% of population coverage in the region, all of them directed by an anaesthesiologist, 85.7% of which were multi-disciplinary. Each UDO develops an average of 4.6 consults per week and 0.75 operating rooms. 42.8% of them dedicate less than 8 h per week to assistance. With an average delay of 66 days for the first demand and 49.2 days for the reviews, being the monthly demand for the first visits of 32.5 patients. Some UDO expresses rejection to certain painful processes. 42.8% of them make triage, but only 28.6% use explicit criteria for it. Furthermore, only 28.6% use explicit criteria to send patients to another hospital, and only 57.1% have clinical intervention protocols. Conclusions: UDO in the Region of Murcia has a wide disparity in accessibility, workload, continuity of care, demand management and structure, making it very difficult to compare the results between units, due to the lack of the necessary homogeneity in the structure and care processes (AU)
Subject(s)
Humans , Male , Female , Pain Clinics/organization & administration , Pain Clinics/trends , Hospital Units/trends , Hospitals, Public/organization & administration , Pain Clinics/standards , Pain Clinics , Hospitals, Public/statistics & numerical data , Hospitals, Public/trends , Hospitals, Public , Socioeconomic SurveyABSTRACT
Literatures on intestinal parasitic infections in Saharawi children were scarce and distributed in non parasitological journals. This was the first article that specifically highlighted on the prevalence of these infections in 270 Saharawi children aged from 6 to 12 years hosted in Spain. Six different intestinal parasites were identified in this study and 78, 46, 40, 24, 13 and 5 were positive for Giardia lamblia (29%), Entamoeba coli (17%), Blastocystis hominis (15%), Endolimax nana (9%), Hymenolepis nana (5%) and Enterobius vermicularis (2%), respectively. Mixed intestinal parasitic infections were seen in 12 (4.4%) studied children. Six (2.2%) double infections for G. lamblia and B. hominis were seen in these children while in four (1.5%) had G. lamblia and H. nana. Triple intestinal parasitic infections of G. lamblia, B. hominis and H. nana were observed in two (0.7%) of the children studied. In the other hand, about 14.8% of the studied children had a mild anaemia and 15.5 and 16.6% had iron deficiency and eosinophilia, respectively.
ABSTRACT
Antecedentes. La cirugía de control de daños se ha ganado un espacio en el tratamiento de un pequeño número de enfermos con traumatismos graves. Objetivo. Actualizar los conocimientos que se han aportado para perfeccionar esta táctica clínico-quirúrgica. Lugar de aplicación. C.M.P.F. "Churruca-Visca" Diseño. Análisis de los nuevos conceptos desarrollados en el último decenio. Conclusiones. Este tema ha sido actualizado con la intención de exponer los nuevos avances en la resucitación, el traslado y el sostén del medio interno de estos enfermos. Esta táctica médico-quirúrgica se ha puesto en boga para un selecto grupo de pacientes que reúnen condiciones excepcionales y probables chances de muerte. El control del daño en fase cero obliga a una resucitación más dinámica en el lugar del hecho y durante el traslado. El control del daño resuscitatorio involucra un nuevo concepto basado en un antiguo precepto de la cirugía del aneurisma complicado "la resucitación hipotensiva". El manejo de las lesiones arteriales y venosas son la llave del éxito de este procedimiento. El uso de la arteriografía selectiva las 24 hs permiten rescatar muchos enfermos con lesiones de difícil abordaje.(AU)
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General Surgery , Harm Reduction , Wounds and InjuriesABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Glomus Tumor/diagnosis , Glomus Tumor/therapy , Immunohistochemistry/methods , Glomus Tumor/physiopathology , Glomus Tumor , Immunohistochemistry/standards , ImmunohistochemistryABSTRACT
Sepsis is a systemic inflammatory response that can lead to tissue damage and death. In order to increase our understanding of sepsis, experimental models are needed that produce relevant immune and inflammatory responses during a septic event. We describe a lipopolysaccharide tolerance mouse model to characterize the cellular and molecular alterations of immune cells during sepsis. The model presents a typical lipopolysaccharide tolerance pattern in which tolerance is related to decreased production and secretion of cytokines after a subsequent exposure to a lethal dose of lipopolysaccharide. The initial lipopolysaccharide exposure also altered the expression patterns of cytokines and was followed by an 8- and a 1.5-fold increase in the T helper 1 and 2 cell subpopulations. Behavioral data indicate a decrease in spontaneous activity and an increase in body temperature following exposure to lipopolysaccharide. In contrast, tolerant animals maintained production of reactive oxygen species and nitric oxide when terminally challenged by cecal ligation and puncture (CLP). Survival study after CLP showed protection in tolerant compared to naive animals. Spleen mass increased in tolerant animals followed by increases of B lymphocytes and subpopulation Th1 cells. An increase in the number of stem cells was found in spleen and bone marrow. We also showed that administration of spleen or bone marrow cells from tolerant to naive animals transfers the acquired resistance status. In conclusion, lipopolysaccharide tolerance is a natural reprogramming of the immune system that increases the number of immune cells, particularly T helper 1 cells, and does not reduce oxidative stress.
Subject(s)
Animals , Male , Mice , Cytokines/immunology , Disease Models, Animal , Lipopolysaccharides/immunology , Oxidative Stress/immunology , Sepsis/immunology , Cell Proliferation , Immune Tolerance/immunology , Mice, Inbred BALB CABSTRACT
Sepsis involves a systemic inflammatory response of multiple endogenous mediators, resulting in many of the injurious and sometimes fatal physiological symptoms of the disease. This systemic activation leads to a compromised vascular response and endothelial dysfunction. Purine nucleotides interact with purinoceptors and initiate a variety of physiological processes that play an important role in maintaining cardiovascular function. The purpose of the present study was to investigate the effects of ATP on vascular function in a lipopolysaccharide (LPS) model of sepsis. LPS induced a significant increase in aortic superoxide production 16 h after injection. Addition of ATP to the organ bath incubation solution reduced superoxide production by the aortas of endotoxemic animals. Reactive Blue, an antagonist of the P2Y receptor, blocked the effect of ATP on superoxide production, and the nonselective P2Y agonist MeSATP inhibited superoxide production. Nitric oxide synthase (NOS) inhibition by L-NAME blocked vascular relaxation and reduced superoxide production in LPS-treated animals. In the presence of L-NAME there was no ATP effect on superoxide production. A vascular reactivity study showed that ATP increased maximal relaxation in LPS-treated animals compared to controls. The presence of ATP induced increases in Akt and endothelial NOS phosphorylated proteins in the aorta of septic animals. ATP reduces superoxide release resulting in an improved vasorelaxant response. Sepsis may uncouple NOS to produce superoxide. We showed that ATP through Akt pathway phosphorylated endothelial NOS and re-couples NOS function.
Subject(s)
Animals , Male , Rats , Adenosine Triphosphate/pharmacology , Aorta, Thoracic/enzymology , Endothelium, Vascular/enzymology , Nitric Oxide Synthase/biosynthesis , Purine Nucleotides/physiology , Sepsis/enzymology , Superoxides/metabolism , Aorta, Thoracic/physiopathology , Endothelium, Vascular/physiopathology , Lipopolysaccharides , Phosphorylation , Rats, Wistar , Sepsis/physiopathologyABSTRACT
Shock and resuscitation render patients more susceptible to acute lung injury due to an exacerbated immune response to subsequent inflammatory stimuli. To study the role of innate immunity in this situation, we investigated acute lung injury in an experimental model of ischemia-reperfusion (I-R) followed by an early challenge with live bacteria. Conscious rats (N = 8 in each group) were submitted to controlled hemorrhage and resuscitated with isotonic saline (SS, 0.9 percent NaCl) or hypertonic saline (HS, 7.5 percent NaCl) solution, followed by intratracheal or intraperitoneal inoculation of Escherichia coli. After infection, toll-like receptor (TLR) 2 and 4 mRNA expression was monitored by RT-PCR in infected tissues. Plasma levels of tumor necrosis factor α and interleukins 6 and 10 were determined by ELISA. All animals showed similar hemodynamic variables, with mean arterial pressure decreasing to nearly 40 mmHg after bleeding. HS or SS used as resuscitation fluid yielded equal hemodynamic results. Intratracheal E. coli inoculation per se induced a marked neutrophil infiltration in septa and inside the alveoli, while intraperitoneal inoculation-associated neutrophils and edema were restricted to the interseptal space. Previous I-R enhanced lung neutrophil infiltration upon bacterial challenge when SS was used as reperfusion fluid, whereas neutrophil influx was unchanged in HS-treated animals. No difference in TLR expression or cytokine secretion was detected between groups receiving HS or SS. We conclude that HS is effective in reducing the early inflammatory response to infection after I-R, and that this phenomenon is achieved by modulation of factors other than expression of innate immunity components.
Subject(s)
Animals , Male , Rats , Acute Lung Injury/immunology , Escherichia coli Infections/immunology , Inflammation/immunology , Reperfusion Injury/immunology , Saline Solution, Hypertonic/therapeutic use , Shock, Hemorrhagic/drug therapy , Acute Disease , Acute Lung Injury/blood , Acute Lung Injury/microbiology , Cytokines/blood , Disease Models, Animal , Immunity, Innate , Inflammation/blood , Inflammation/drug therapy , Rats, Wistar , Reverse Transcriptase Polymerase Chain Reaction , RNA, Messenger/blood , Shock, Hemorrhagic/immunology , /bloodABSTRACT
OBJETIVOS: Evaluar la mejora obtenida tras la implementación de una Unidad del Dolor Agudo basada en laenfermería (UDABE) en un Hospital de Área, utilizandométodos de control estadístico de procesos.MATERIAL Y MÉTODO: Medimos mensualmente 3 indicadoresde la calidad de la UDABE (prevalencia de dolor, alivio y satisfacción con su manejo). Monitorizamoslos indicadores mediante gráficos P de control estadístico de procesos para conocer su ajuste a los estándares fijados, así como su variabilidad.RESULTADOS: En un año hemos conseguido estabilizarel dolor agudo en todo el hospital en una prevalencia del30%, que el 85% de nuestros pacientes consigan alivioadecuado, y que su satisfacción con el manejo del dolorsea del 90%.CONCLUSIONES: La implementación de una UDABEdiseñada y gestionada con herramientas procedentes delControl de Calidad, produce mejoras significativas,absoluta y relativa, en la prevalencia del dolor, en su alivio, y en la satisfacción de los pacientes (p<0,001), consiguiendo ahorrar en un año, más de 15.000 días de sufrimiento innecesario
OBJECTIVE: To evaluate improvement after implementationof care through a nurse-managed acute pain unit in adistrict hospital, using statistical process control (SPC) methods.MATERIAL AND METHODS: Each month we measured 3acute pain unit quality indicators: pain prevalence, painrelief, and satisfaction with pain management. Theindicators were monitored on P-charts according to SPCprocedures that determine their distribution withincontrol limits and track variability.RESULTS: The hospital prevalence of acute painstabilized at 30% after a year. Eight-five percent ofpatients achieved adequate pain relief and 90% weresatisfied with pain management.CONCLUSIONS: A nurse-managed acute pain unitdesigned and managed with tools for monitoring qualityassurance produces significant absolute and relativeimprovements in the prevalence of pain, pain relief, andpatient satisfaction (P<.001), leading to a savings of 15000 days of unnecessary suffering per year
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Humans , Pain/therapy , Pain Clinics/organization & administration , Quality Assurance, Health Care , Quality Indicators, Health Care , Outcome and Process Assessment, Health CareABSTRACT
No disponible
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Humans , Pain Clinics/organization & administration , Quality Assurance, Health Care , Total Quality Management/trendsABSTRACT
The aim was to analyze the changes in centralcorneal thickness values due to soft contact lens wear. We analyzed the central corneal thickness values (baseline measurements) of 15 myopic adolescent soft contact lens wearers (15 eyes; aged 15 to 16 years old). Three years later, the central corneal thickness wasmeasured again. We also measured the central corneal thickness of 31 myopic adolescents who did not use contact lenses (31 eyes; aged 15 to 16 years old) and 34 myopic contact lens wearers aged between 25 and 40 yearsold (34 eyes). We obtained the mean of fivemeasurements using the Orbscan Topography System II (Orbscan, Inc., Salt Lake City, UT,USA). In the later measurements (three years)there was a significant decrease in the central corneal thickness values (p=0.012) of the adolescent contact lens wearers and the contact lens subjects aged 25 to 40 years old(p<0.001). This decrease was not found in theadolescent non-contact lens wearers (p=0.476). The central corneal thickness values of the adolescent contact lens wearers were significantly lower than the baseline values up to four weeks after removal of theircontact lenses (p=0.201). In conclusion, therewas a significant reduction in the anatomic values of corneal thickness associated with soft contact lens wearers, although baseline thickness values recovered to normal levels approximately one month after the use of contact lenses had ceased (AU)
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