Utilidad de un cuestionario autoadministrado multidimensional para la gestión de una unidad clínica de tratamiento de dolor / Usefulness of a multidimensional self-administered questionnaire for the clinical management of a pain treatment unit

Objective. To study the feasibility of a multidimensional self-administered questionnaire before the patient is seen at the first visit in a clinical Pain Treatment Unit (PTU) of a tertiary hospital, and its impact on the management of patients in the first visit. Patients and methods. Cross-sectional study. Self-administered questionnaire that gathered: socio-demographic data, medical history of pain, pain perception (intensity and characteristics), comorbidity of pain and patient expectations of analgesic treatment ("What do you expect from our treatment? If we cannot resolve your pain, what level of pain would you be willing to live with?). A descriptive analysis was performed. Results. A total of 293 consecutive patients (31% men, 69% women), mean age (SD) 62 (16) years-old, were included in 2011. All patients completed and returned the questionnaire before the first visit to the PTU. The questionnaire was completed fully and correctly by 80% (234, 95% CI: 75-84) of the patients, and the rest completed the questionnaire with some points unanswered. About 24% (70/293, 95% CI: 19-29) of the patients should not have been referred to the PTU [20% were not attended]. A small percentage (9%,26/293, 95% CI: 6-13) were evaluated as «urgent’» and visited over the following 7 days, with 19% (56/293, 95%CI: 15-24) being «preferential» (visited before 15 days) and 52% (152/293, 95% CI: 46-58) as «non-urgent/non-preferential» (visited before 60 days). Almost one third (30%, 87/293, 95% CI: 25-35) did not need a second visit to the PTU. Patient expectations: 21% expected complete pain relief and 64% would accept a lower pain intensity score of 4. Conclusion. The use of a multidimensional self-administered questionnaire before the first visit to a clinical Pain Treatment Unit of a tertiary hospital was a practicable and useful tool for the management of patients on the first visit. Likewise, the questionnaire provided information on the patient's perception of pain and the expectations concerning the analgesic treatment (AU)

Objetivo. Estudiar la factibilidad de un cuestionario autoadministrado multidimensional antes de que el paciente sea atendido en primera visita en la unidad de tratamiento del dolor (UTD) de un hospital terciario, y su impacto en la gestión de pacientes en la primera visita. Pacientes y métodos. Estudio transversal. Cuestionario autoadministrado: características sociodemográficas, historia clínica del dolor, percepción del dolor (intensidad y sus características), comorbilidad del dolor y expectativas del paciente al tratamiento analgésico («¿qué es lo que usted espera de nuestro tratamiento?», si no podemos resolver su dolor «¿qué nivel de dolor aceptaría?»). Se realizó un análisis descriptivo. Resultados. Durante el año 2011 fueron incluidos 293 pacientes consecutivos (31% hombres, 69% mujeres; edad media 62 ± 16 años). Todos los pacientes cumplimentaron y entregaron el cuestionario antes de la primera visita en la UTD. El 80% (234/293, IC 95%: 75-84) de pacientes lo cumplimentaron completa y correctamente; el resto lo aportaron con algunos puntos sin contestar. El 24% (70/293, IC 95%: 19-29) de pacientes no deberían haber sido remitidos a la UTD (un 20% no llegaron a ser visitados en la UTD). Un 9% (26/293, IC 95%: 6-13) de las primeras visitas se consideraron «urgentes» (y estos pacientes fueron visitados en la UTD antes de 7 días), mientras que el 19% (56/293, IC 95%: 15-24) se calificaron de «preferentes» (atendidos antes de 15 días) y el 52% (152/293, IC 95%: 46-58) de «no-urgentes/no-preferentes» (atendidos antes de 60 días). Un 30% (87/293, IC 95%: 25-35) de los casos no necesitaron una segunda visita en la UTD. Respecto a las expectativas del paciente cabe reseñar que el 21% esperaban un alivio completo de su dolor, y el 64% aceptarían continuar con un dolor de intensidad < 4. Conclusión. El uso del cuestionario autoadministrado multidimensional antes de la primera visita en una Unidad Clínica del Tratamiento del Dolor de un hospital terciario fue practicable y útil como instrumento para la gestión de los pacientes en primera visita. Asimismo, proporcionó información sobre la percepción del dolor y las expectativas del paciente referente al tratamiento analgésico (AU)

[Usefulness of a multidimensional self-administered questionnaire for the clinical management of a pain treatment unit]. / Utilidad de un cuestionario autoadministrado multidimensional para la gestión de una unidad clínica de tratamiento de dolor.

OBJECTIVE: To study the feasibility of a multidimensional self-administered questionnaire before the patient is seen at the first visit in a clinical Pain Treatment Unit (PTU) of a tertiary hospital, and its impact on the management of patients in the first visit. PATIENTS AND METHODS: Cross-sectional study. Self-administered questionnaire that gathered: socio-demographic data, medical history of pain, pain perception (intensity and characteristics), comorbidity of pain and patient expectations of analgesic treatment ("What do you expect from our treatment? If we cannot resolve your pain, what level of pain would you be willing to live with?). A descriptive analysis was performed. RESULTS: A total of 293 consecutive patients (31% men, 69% women), mean age (SD) 62 (16) years-old, were included in 2011. All patients completed and returned the questionnaire before the first visit to the PTU. The questionnaire was completed fully and correctly by 80% (234, 95% CI: 75-84) of the patients, and the rest completed the questionnaire with some points unanswered. About 24% (70/293, 95% CI: 19-29) of the patients should not have been referred to the PTU [20% were not attended]. A small percentage (9%,26/293, 95% CI: 6-13) were evaluated as «urgent'¼ and visited over the following 7 days, with 19% (56/293, 95%CI: 15-24) being «preferential¼ (visited before 15 days) and 52% (152/293, 95% CI: 46-58) as «non-urgent/non-preferential¼ (visited before 60 days). Almost one third (30%, 87/293, 95% CI: 25-35) did not need a second visit to the PTU. Patient expectations: 21% expected complete pain relief and 64% would accept a lower pain intensity score of 4. CONCLUSION: The use of a multidimensional self-administered questionnaire before the first visit to a clinical Pain Treatment Unit of a tertiary hospital was a practicable and useful tool for the management of patients on the first visit. Likewise, the questionnaire provided information on the patient's perception of pain and the expectations concerning the analgesic treatment.

[Results of surgical treatment of patients with solid malignant chest tumours and superior vena cava syndrome].

Superior vena cava syndrome results from blood flow disturbances caused by compression or tumour invasion of the superior vena cava and its tributaries. In most cases, malignant lung tumours are responsible for its development. In 1995-2010, we performed surgical treatment of 55 patients with malignant chest neoplasms and superior vena cave syndrome. Vertical sternotomy was employed most frequently. Some patients additionally underwent antero-lateral thoracotomy to facilitate the surgical approach. Polytetrafluoroethylene prostheses 18-20 mm in diameter (Russia) were used to superior vena cava. Radical and cytoreductive surgery was the method of choice in 60 and 40% of the patients respectively. The signs of obstruction disappeared in all patients immediately after surgery. 21.8% of the patients died during the early postoperative period, 5 ones survived without signs of relapses. Median survival was 21 months.

Intraoperative warming and post-operative cognitive dysfunction after total knee replacement.

BACKGROUND: Post-operative cognitive dysfunction (POCD) can affect 30% of orthopedic surgery patients. We hypothesized that perioperative temperature has an impact on POCD. METHODS: We included 150 patients over 65 years of age scheduled for total knee replacement under spinal anesthesia. They were randomized to receive standard care (sheet cover) or active warming. Neurocognitive assessment (11 subtests) was performed pre-operatively and at day 4 (three subtests) and 3 months (10 subtests). A control group of 55 nonsurgical patients took the same tests at equivalent times. POCD was defined as an individual score decrease of more than 2 standard deviations (SDs) below the baseline on at least two subtests or 2 SDs in the combined z-score, in both cases using control-adjusted changes. RESULTS: Tympanic temperature declined below 35 °C in 88% of standard-care patients; 25.3% of warmed patients had a temperature ≥36 °C. On day 4, 3.2% of standard-care patients and 19.4% of warmed patients had POCD (P=0.0058). At 3 months, there were no between-group differences (standard care, 14.3%; warmed, 6.5%) (P=0.2440). CONCLUSIONS: Perioperative warming was associated with a higher incidence of cognitive dysfunction at 4 days after total knee replacement in patients >65 years of age.

[Use of high-energy intraluminal brachytherapy in radio- and radiochemotherapy for anal cancer].

Complete local response to radio- and chemoradiation for anal cancer was improved due to use of high-energy dosage of intraluminal brachytherapy (complete clinical regression (chemoradiation)--85.7%; combined irradiaton--75%). No signs of tumor progression have been reported in 20 survivors (median duration--21.6 months) (mean recurrence-free survival--12.5 months). Loco-regional relapse was in 4, local--2 patients. Intrapelvic lymph nodes were involved in 2 cases of previously morphologically confirmed regression of primary tumor. 18-month-long recurrence-free survival was in 86.3%, colostomy-free--91.6%. When combined with distant irradiation (+/-chemotherapy), brachytherapy is a relatively effective, safe and well tolerated procedure.

Transient neurologic symptoms after spinal anaesthesia using isobaric 2% mepivacaine and isobaric 2% lidocaine.

BACKGROUND: Transient Neurological Symptoms (TNS) syndrome following subarachnoid anaesthesia was initially associated with hyperbaric lidocaine 50 mg/ml, but has also been reported with most local anaesthetics, including hyperbaric mepivacaine 40 mg/ml. The aim of this study was to determine the incidence of TNS after subarachnoid anaesthesia using isobaric mepivacaine 20 mg/ml and isobaric lidocaine 20 mg/ml. METHODS: Eighty patients of both sexes, ASA class I-II, scheduled for elective minor orthopaedic surgery under subarachnoid anaesthesia, were prospectively included and randomly allocated to receive 40-60 mg of either isobaric mepivacaine 20 mg/ml (Group M) or isobaric lidocaine 20 mg/ml (Group L). Patients were evaluated on the first postoperative day by one investigator unaware of the grouping, looking for symptoms suggestive of TNS, such as pain or dysaesthesias in the buttocks or lower limbs with or without back pain. RESULTS: TNS symptoms were observed in three patients (7.5%) of Group M and in one patient (2.5%) of Group L, without statistically significant differences between the groups. Symptoms had an abrupt onset and relief, lasted from 45 min to 24 h, and had a complete resolution without sequelae. The only statistically significant difference between groups was longer motor blockade in Group M (P=0.0031). CONCLUSION: In this study TNS was associated with isobaric mepivacaine 20 mg/ml, with an incidence of 7.5%, and with isobaric lidocaine 20 mg/ml, with an incidence of 2.5%, in patients having orthopaedic procedures in the supine position.

Alternativa en el tratamiento del dolor neuropático de la vulvodinia: combinación de ketamina y metadona por vía oral / Alternative for the management of neuropathic pain in vulvodinia: combination of ketamine and methadone by oral route

La vulvodinia es un cuadro clínico de difícil tratamiento, sus características clínicas lo hacen pertenecer a los cuad ros de dolor neuropático. El tratamiento convencional con AINEs y/o opioides no resulta sastisfactorio. Presentamos dos casos clínicos de sendas pacientes afectas de vulvodinia de varios años de evolución; fueron tratadas con analgésicos convencionales, anticomiciales y antidepresivos y se les practicó en diferentes sesiones diversos bloqueos del neuroeje pero, a pesar de ello, no se consiguió un adecuado control sintomatológico por lo que se inició tratamiento con una solución por vía oral compuesta de ketamina (30 mg*8 h- 1) y metadona (0,6 mg.8 h- 1). Al cabo de tres meses ambas pacientes presentaban mejoría clínica evidente sin asociar efectos secundarios relevantes (AU)

[Diclofenac does not change the characteristics of anesthetic induction with midazolam]. / El diclofenaco no modifica las características de la inducción anestésica con midazolam.

To examine the possible interaction between diclofenac and midazolam, 20 patients undergoing orthopedic or traumatologic surgery were studied. All were anesthetized with 0.3 mg/kg intravenous midazolam after having been premedicated randomly with either placebo (control group, n = 10) or with 1 mg/kg intravenous diclofenac (n = 10). Anesthetic characteristics (rate of induction and depth) were similar in both groups, indicating that no clinical interaction between the two drugs can be identified.

[Hypnotic doses of midazolam administered by continuous perfusion. Analysis of predictive factors]. / Dosis hipnótica de midazolam administrado en perfusión continua. Análisis de los factores predictivos.

The hypnotic dose of midazolam administered in continuous perfusion was investigated in 76 patients undergoing programmed traumatologic or orthopedic surgery. In all cases an infusion of midazolam at a rate of mg-1 kg-1 h-1 was administered until patients closed eyes but opened them under auditive stimuli (hypnotic dose of midazolam). This dose was 5.25 +/- 2.78 mg (0.08 +/- 0.04 mg/kg) and showed a statistically significant correlation with age (r = 0.43, p = 0.002) and weight (r = 0.3, p = 0.02). There was no significant correlation with sex, ASA class, premedication, plasma proteins, and plasma albumin. Interindividual variability, especially in young patients, was high.

[The development of a radioimmunological method for determining autoantibodies to thyroglobulin]. / Razrabotka radioimmunologicheskogo metoda dlia opredeleniia autoantitel k tireoglobulinu.

A radioimmunoassay to determine a titer of autoantibodies to thyroglobulin in human blood serum was developed. The scheme of analysis included a reaction between 125I-thyroglobulin and autoantibodies to thyroglobulin with subsequent separation of the produced immune complex and free polyethylene glycol-labeled thyroglobulin. A high specificity of the radioimmunoassay is ensured by the use of highly purified thyroglobulin for obtaining the labeled agent. A possibility of the use of the method for the diagnosis of autoimmune thyroid diseases was shown.

[Effect of intravenous anesthetic premedication using diazepam and fentanyl on the arterial oxygen saturation. A pulse-oximetric study]. / Efecto de la premedicación anestésica intravenosa con diacepam y fentanil sobre la saturación arterial de oxígeno. Estudio pulsioximétrico.

The effects of anesthetic premedication with diazepam and phentanyl on the arterial oxyhemoglobin saturation (SpO2) were monitored with a pulsioximeter (BIOX 3700, Ohmeda) in 83 patients scheduled for traumatologic and orthopedic surgery who had baseline SpO2 higher than 95%. Premedication was carried out with phentanyl (0.1 mg) and diazepam (2.5 mg increments) until a somnolence state (eye closure), reversible with verbal stimuli, was achieved. The patients were breathing room air during the study. Premedication induced a significant reduction of SpO2 (p less than 0.001) from baseline values of 96.6 +/- 1.2% to 92.7 +/- 2.9% after sedation and to minimal values of 85.9 +/- 6.1%. In 60 patients (72.3%), minimal SpO2 was lower than 90%, and it was lower than 85% in 32 (38.8%). However, 34 of them (73.3%) recovered a SpO2 higher than 90% with verbal respiratory stimuli, but 16 (26.7%) only did so with oxygen administration. Cyanosis was not detected in any case. Minimal saturation was significantly correlated with baseline SpO2, age and smoking habit. Pulsioximetric monitoring or, if not available, routine oxygen administration, are recommended in patients undergoing pharmacological sedation.

[Variations in the internal pressure of the pneumatic cuffs of endotracheal tubes according to their contents and the anesthetic mixtures used. Experimental study]. / Variaciones de la presión interna de los neumotaponamientos de los tubos endotraqueales según su contenido y las mezclas anestésicas utilizadas. Estudio experimental.

With the purpose of measuring pressure changes in the pneumatic cuffs of endotracheal tubes when the composition of the mixture of gases used for ventilation had to change for the same content, we designed a model of artificial respiration that consisted of a tube with a low pressure pneumatic cuff measuring 8.5 mm in inner diameter introduced in a replica of a human trachea, adjusted to two anesthetic bags. The cuff valve was connected to a pressure transducer by a three-ended stopcock and, after aspiration of its content, it was inflated with air, saline or nitrous oxide and oxygen at 60% up to a basal pressure of 20 mmHg. The tube was connected to a respirator adjusted to inflate 10 l/min at a rate of 15 insufflations/min of: oxygen 100% for 5 minutes, then nitrous oxide and oxygen at 60% for 30 minutes and oxygen 100% again for 15 minutes. When inflating the pneumatic cuff with air and ventilating with nitrous oxide and oxygen at 60%, its pressure reached a maximum mean value of 58 mmHg (190% with respect to base values). When insufflating with saline and ventilating in the same conditions, pressure reached a maximum mean value of 33 mmHg (65% with respect to base values). When the pneumatic cuff was inflated with nitrous oxide and oxygen at 60%, important changes in pressure were observed when the characteristics of the inspired gases were modified. We conclude that some method for monitoring pneumatic cuff pressure should be systematized.

[Internal irradiation doses in patients during the diagnostic use of colloidal radiopharmaceutics]. / Dozy vnutrennego oblucheniia patsientov pri diagnosticheskom ispol'zovanii kolloidnykh RFP.

The assessment of the human organs and body systems exposed to radiation was based on the investigation of colloidal radiopharmaceuticals employed in the USSR for liver and spleen visualization. Seven radiopharmaceuticals (functional analogs: 3 were imported to the USSR, 4--made in this country) were investigated. Pharmacokinetics of the agents was studied by a human counter that permitted obtaining quantitative data on their distribution and elimination from the body. A computerized program based on the heterogeneous model of a "standard" man. Dose calculation results have shown that the critical organ for all investigated radiopharmaceuticals is the liver, the radiation dose in it being at 90-120 microSv/MBq and the mean effective equivalent dose at 14 +/- 1 microSv/MBq.