Cerclaje cervical por vía abdominal. Primer caso en Extremadura / Cervical cerclage by the abdominal route. First case in Extremadura

El cerclaje cervical es una opción de tratamiento en aquellas pacientes que presentan abortos o partos pretérmino por incompetencia cervical. Si bien, la vía vaginal es la más ampliamente utilizada, el abordaje abdominal constituye una alternativa útil y reservada a aquellos casos en los que la primera falla o las condiciones dificultan técnicamente su realización (AU)

Cervical cerclage is a treatment option in those patients who have abortions or preterm deliveries due to cervical incompetence. Although the vaginal route is the most widely used, the abdominal approach is a useful alternative and reserved for those cases in which the first failure or the conditions technically make it difficult to perform (AU)

Derivaciones de atención primaria a una consulta monográfica de cefaleas: análisis de los 1.000 primeros pacientes / Referrals from primary care to a dedicated headache clinic: analysis of the first 1, 000 patients

Introducción. Es habitual en las consultas monográficas o unidades de cefaleas que atiendan a pacientes complejos derivados desde consultas generales de neurología. En nuestro centro, parte de la agenda de la consulta monográfica de cefaleas (CMC) se reserva a pacientes remitidos desde atención primaria (AP) con formato de alta resolución. Objetivos. Analizar las características de los pacientes derivados por AP a la CMC y la adecuación a los criterios de derivación consensuados, y compararlos con las primeras visitas por cefalea en una consulta general de neurología. Pacientes y métodos. Muestra de 1.000 pacientes (741 mujeres y 259 varones) en la CMC y 290 (203 mujeres y 87 varones) en la consulta general. Recogemos prospectivamente variables demográficas, uso previo de tratamientos sintomáticos o preventivos, necesidad de exploraciones complementarias y adecuación a los criterios de derivación. Codificamos las cefaleas de acuerdo con la segunda edición de la Clasificación Internacional de Cefaleas (CIC-2). esultados. En el grupo de la CMC se codificaron 1.562 cefaleas, y en la consulta general, 444; su distribución en los grupos de la CIC-2 era similar, y la mayoría se encuadraba en el grupo 1 (migraña). El porcentaje de pacientes que habían recibido tratamiento preventivo era mayor en la CMC. El porcentaje de derivaciones adecuadas fue alto y algo mayor en la consulta general. Conclusiones. Las características de los pacientes derivados desde AP a una CMC en nuestro medio son similares a las previamente descritas. Estos pacientes han recibido tratamiento con más frecuencia que los atendidos en una consulta general de neurología (AU)

Introduction. It is commonplace practice in dedicated clinics or headache units to deal with complex patients referred from general neurology clinics. In our centre, part of the schedule of the dedicated headache clinic (DHC) is reserved for patients referred from primary care (PC) in the form of one-stop clinics. Aims. To analyse both the characteristics of the patients referred by PC to DHC and the suitability of the agreed referral criteria, and to compare them with the first visits due to headache in a general neurology clinic. Patients and methods. The study was conducted on a sample of 1,000 patients (741 females and 259 males) in the DHC and 290 (203 females and 87 males) in the general clinic. Data were collected retrospectively and included demographic variables, previous use of symptomatic or preventive treatments, need for complementary examinations and adjustment to referral criteria. Headaches were coded in accordance with the second edition of the International Headache Classification (IHC-2). Results. A total of 1,562 headaches were coded in the DHC group and 444 in the general clinic group; their distribution over the groups of the IHC-2 was similar, and most of them fell into group 1 (migraine). The percentage of patients who had received preventive treatment was higher in the DHC. The percentage of appropriate referrals was high and a little higher still in the general clinic. Conclusions. The characteristics of the patients referred from PC to a DHC in our milieu were similar to those reported in previous studies. These patients have received treatment more frequently than those who were seen in a general neurology clinic (AU)

[Referrals from primary care to a dedicated headache clinic: analysis of the first 1,000 patients]. / Derivaciones de atencion primaria a una consulta monografica de cefaleas: analisis de los 1.000 primeros pacientes.

INTRODUCTION: It is commonplace practice in dedicated clinics or headache units to deal with complex patients referred from general neurology clinics. In our centre, part of the schedule of the dedicated headache clinic (DHC) is reserved for patients referred from primary care (PC) in the form of one-stop clinics. AIMS: To analyse both the characteristics of the patients referred by PC to DHC and the suitability of the agreed referral criteria, and to compare them with the first visits due to headache in a general neurology clinic. PATIENTS AND METHODS: The study was conducted on a sample of 1,000 patients (741 females and 259 males) in the DHC and 290 (203 females and 87 males) in the general clinic. Data were collected retrospectively and included demographic variables, previous use of symptomatic or preventive treatments, need for complementary examinations and adjustment to referral criteria. Headaches were coded in accordance with the second edition of the International Headache Classification (IHC-2). RESULTS: A total of 1,562 headaches were coded in the DHC group and 444 in the general clinic group; their distribution over the groups of the IHC-2 was similar, and most of them fell into group 1 (migraine). The percentage of patients who had received preventive treatment was higher in the DHC. The percentage of appropriate referrals was high and a little higher still in the general clinic. CONCLUSIONS: The characteristics of the patients referred from PC to a DHC in our milieu were similar to those reported in previous studies. These patients have received treatment more frequently than those who were seen in a general neurology clinic.

TITLE: Derivaciones de atencion primaria a una consulta monografica de cefaleas: analisis de los 1.000 primeros pacientes.Introduccion. Es habitual en las consultas monograficas o unidades de cefaleas que atiendan a pacientes complejos derivados desde consultas generales de neurologia. En nuestro centro, parte de la agenda de la consulta monografica de cefaleas (CMC) se reserva a pacientes remitidos desde atencion primaria (AP) con formato de alta resolucion. Objetivos. Analizar las caracteristicas de los pacientes derivados por AP a la CMC y la adecuacion a los criterios de derivacion consensuados, y compararlos con las primeras visitas por cefalea en una consulta general de neurologia. Pacientes y metodos. Muestra de 1.000 pacientes (741 mujeres y 259 varones) en la CMC y 290 (203 mujeres y 87 varones) en la consulta general. Recogemos prospectivamente variables demograficas, uso previo de tratamientos sintomaticos o preventivos, necesidad de exploraciones complementarias y adecuacion a los criterios de derivacion. Codificamos las cefaleas de acuerdo con la segunda edicion de la Clasificacion Internacional de Cefaleas (CIC-2). Resultados. En el grupo de la CMC se codificaron 1.562 cefaleas, y en la consulta general, 444; su distribucion en los grupos de la CIC-2 era similar, y la mayoria se encuadraba en el grupo 1 (migraña). El porcentaje de pacientes que habian recibido tratamiento preventivo era mayor en la CMC. El porcentaje de derivaciones adecuadas fue alto y algo mayor en la consulta general. Conclusiones. Las caracteristicas de los pacientes derivados desde AP a una CMC en nuestro medio son similares a las previamente descritas. Estos pacientes han recibido tratamiento con mas frecuencia que los atendidos en una consulta general de neurologia.

Characteristics of the first 1000 headaches in an outpatient headache clinic registry.

OBJECTIVE: To analyze the incidence and characteristics of the first 1000 headaches in an outpatient clinic. BACKGROUND: Headache is a common cause of medical consultation, both in primary care and in specialist neurology outpatient clinics. The International Classification of Headache Disorders, 2nd Edition (ICHD-II), enables headaches to be classified in a precise and reproducible manner. METHODS: In January 2008, an outpatient headache clinic was set up in Hospital Clínico Universitario, a tertiary hospital in Valladolid, Spain. Headaches were classified prospectively in accordance with ICHD-II criteria. In each case we recorded age and sex, duration of headache, ancillary tests required, and previous symptomatic or prophylactic therapies. RESULTS: In January 2010, the registry included 1000 headaches in 682 patients. The women/men ratio was 2.46/1 and the mean age of the patients was 43.19 ± 17.1 years (range: 14-94 years). Patients were referred from primary care (53.4%), general neurology clinics (36.6%), and other specialist clinics (9%). The headaches were grouped (ICHD-II classification) as follows: group 1 (Migraine), 51.4%; group 2 (Tension-type headache), 16%; group 3 (Trigeminal autonomic cephalalgias), 2.6%; group 4 (Other primary headaches) and group 13 (Cranial neuralgias), 3.4%. The diagnostic criteria of chronic migraine were satisfied in 8.5% of migraines. Regarding secondary headaches, 1.1% of all cases were included in group 5 (Headaches attributed to trauma) and 8.3% in group 8 (Headaches attributed to a substance or its withdrawal). Only 3.4% of headaches were classified in group 14 (Unspecified or not elsewhere classified), and 5.2% were included in the groups listed in the ICHD-II research appendix. CONCLUSION: This registry outlines the characteristics of patients seen in an outpatient headache clinic in a tertiary hospital; our results are similar to those previously reported for this type of outpatient clinic. Migraine was the most common diagnosis. Most headaches can be classified using ICHD-II criteria.