Paciente con notalgia parestésica y siringomielia: ¿relación o coincidencia? / A patient with notalgia paresthetica and syringomyelia: association or coincidence?

La notalgia parestésica (NP) es una neuropatía sensitiva comúnmente manifestada con prurito y aparición de una mácula hiperpigmentada a nivel del raquis dorsal en la mayoría de los casos. La fisiopatología de la NP es aún desconocida, aunque se considera su origen, por distintas causas, en una lesión producida en los nervios espinales. No existe un tratamiento definitivo para este desorden aunque son muchas las alternativas terapéuticas descritas. Presentamos el caso clínico de una paciente diagnosticada de NP y tratada satisfactoriamente con capsaicina, en quien encontramos una posible asociación etiológica con una siringomielia subclínica evidenciada en el estudio por resonancia magnética. Aunque teóricamente posible, no hemos encontrado otros artículos que asocien dichos cuadros (AU)

Notalgia paresthetica (NP) is a sensory neuropathy commonly manifested by pruritus and the appearance of a hyperpigmented macula, usually in the thoracic spine. The physiopathology of NP is unknown, although, for different reasons, its origin is considered to be an injury to the spinal nerves. There is no definitive treatment for this disorder, although many therapeutic alternatives have been used. We report the case of a patient diagnosed with notalgia paresthetica and successfully treated with capsaicin. In this patient, we found a possible etiological association with subclinical syringomyelia revealed by magnetic resonance imaging. Although this association is theoretically possible, we have found no other reports of an association between these two disorders (AU)

Guía en DVD en la Cirugía Mayor Ambulatoria. Análisis de los resultados iniciales / Ambulatory surgery DVD guide. Analysis of the initial results

Introducción: Con la intención de mejorar la calidad asistencial se ha producido colateralmente una mayor complejidad en los circuitos peroperatorios. Así, en nuestro centro hemos asistido en los últimos años a un incremento de los pasos que deben realizar los pacientes desde que son derivados al cirujano para ser valorado un posible tratamiento quirúrgico hasta la fecha de la operación. Todo ello puede ocasionar confusión y angustia al paciente, a pesar del soporte y de la información oral y escrita que recibe de los diferentes profesionales sanitarios que visita. Objetivos: Para paliar esta situación se realizó un DVD que es entregado al paciente en la primera visita del especialista. Dicho DVD da a conocer una visión general del circuito de la CMA de nuestro centro y detalla cada paso que deberá realizar. De esta forma, el paciente puede verlo en su domicilio todas las veces que considere oportunas. Su observación familiariza al paciente con nuestras instalaciones y el ambiente hospitalario, complementa las explicaciones orales y escritas entregadas para clarificar las dudas que todavía pudieran persistir y creemos ayuda a disminuir la ansiedad del enfermo ante este acontecimiento. Material y método: Voluntariamente, el paciente realiza na encuesta de satisfacción que es remitida varias semanas tras el alta. Los resultados se comparan con los de un grupo de control que han visualizado el DVD. Resultados: Actualmente el estudio no está finalizado. Se han recibido 35 encuestas de las entregadas a los pacientes de cirugía general, de las cuales solo a 13 pacientes se le había entregado el DVD. El 31% de los pacientes a los que se entregó el DVD no tuvieron interés en verlo, los que lo consultaron refieren que la información fue útil en el 100% de los casos. Comparando los que reciben DVD de los que no, referente a sus preferencias de ingreso, el 11% hubieran preferido ingresar en comparación al 14% del grupo a los que no se les entregó. El grado de satisfacción fue elevado en ambos grupos, 8,8 puntos sobre 10. Conclusiones: La información perioperatoria puede ser mejorada con la entrega de material audiovisual complementario. Esta herramienta sintetiza y aclara todas las etapas que debe realizar el paciente. Incrementa el grado de satisfacción y la calidad asistencial percibida del paciente de la CMA realizada en nuestro hospital (AU)

Introduction: Nowadays there is more complexity in the per-operative circuits as a collateral consequence of trying to improve the health care quality. In the last years, we have seen an increase in steps that patients should be at our hospital since they are derived to the surgeon to be valued a possible surgical treatment until the date of the operation. All this can cause confusion and distress to the patient, despite the support and the oral and written information received from different specialists visited. Objective: A DVD was made to remedy this situation that is delivered to the patient in the first surgeon's visit. This DVD gives a general vision of the circuit of the ambulatory surgery of our center and details of each step. In this way the patient can see it at his home every time he deems appropriate. Its observation familiarizes him with our facilities and the hospitable atmosphere, clarifies the doubts that could still persist and we believe helps to decrease his anxiety before this event. Material and method: The patient performs a satisfaction questionnaire and he returns it several weeks after discharge from hospital. The results are compared with those of a control group that not viewed the DVD. Results: Currently the study is not complete. There have been 35 surveys delivered to the general surgery patients, of which only 13 patients had been given the DVD. 31% of patients who gave the DVD had no interest in seeing it, those who report that looked at the information was useful in 100% of cases. Comparing those who received the DVD not concerning their preferences for income, 11% would have preferred to enter compared to 14% of the group to which they were not given. The degree of satisfaction was high in both groups, 8.8 ut of 10. Conclusions: The preoperative information can be improved with the delivery of additional audiovisual material. This tool summarizes and clarifies all the stages that the patient should perform, increases the degree of satisfaction and the perceived quality in the care of ambulatory surgery patient in our hospital (AU)

Tortícolis muscular congénita en fase de adulto / Congenital muscular torticollis in adults

La tortícolis muscular congénita (TMC) es una enfermedad frecuente, que debido a su fácil reconocimiento y exitoso tratamiento en los primeros meses de vida no suelen mostrar alteraciones clínicas en edades infantiles tardías o adultos. El escaso número de casos que prevalecen por encima de los primeros años de vida hace que exista una menor información sobre las decisiones terapéuticas a seguir. Básicamente se relegan, tras fracasar la fisioterapia, al uso de toxina botulínica o de una cirugía específica. Presentamos el caso clínico de una paciente diagnosticada finalmente, ya en edad adulta de TMC, y que fue tratada mediante sección unipolar de la porción clavicular del esternocleidomastoideo seguida de una rehabilitación específica, intensa y precoz, con muy buenos resultados estéticos y funcionales (AU)

Congenital muscular torticollis is a common condition. Because it is easy to recognize and its successful treatment during the first months of life, clinical changes are not usually found in the late childhood or adult age. As few cases prevail after the first years of life, there is less information about treatment decisions to follow. When physical therapy fails, these treatments are basically relegated to botulinum toxin or specific surgery. We report the case of a patient who was finally diagnosed in adulthood of congenital muscular torticollis. This patient was treated by unipolar sectioning of the clavicular portion of the sternocleidomastoid muscle. This was followed by specific, early and intense rehabilitation, with very good esthetic and functional results (AU)

Hydrodynamic regimes of active rotators at fluid interfaces.

We analyze the collective motion of suspensions of active rotators at low Reynolds numbers which interact hydrodynamically. We introduce a simple model for a rotator which allows us to classify the relevant dynamical regimes of the suspension. We characterize the collective velocity at which rotators displace and analyze its implications at long times, when these rotator suspensions diffuse. We analyze the differences with respect to diffusion in suspensions of passive particles, and assess the relevance of the Stokes-Einstein relation on rotators' diffusivity.

Sedimentation of pairs of hydrodynamically interacting semiflexible filaments.

We describe the effect of hydrodynamic interactions in the sedimentation of a pair of inextensible semiflexible filaments under a uniform constant force at low Reynolds numbers. We have analyzed the different regimes and the morphology of such polymers in simple geometries, which allow us to highlight the peculiarities of the interplay between elastic and hydrodynamic stresses. Cooperative and symmetry breaking effects associated to the geometry of the fibers gives rise to characteristic motion which give them distinct properties from rigid and elastic filaments.

Capsulitis adhesiva idiopática bilateral de cadera / Bilateral idiopathic adhesive capsulitis of the hip

La capsulitis adhesiva es una condición patológica de etiología desconocida en muchas ocasiones, caracterizada por la presencia de dolor y limitación de la movilidad. Esta alteración se produce con frecuencia en la articulación del hombro (frozen shoulder), aunque puede encontrarse en otras articulaciones. En la cadera es un cuadro infrecuente, normalmente relacionado con traumatismos locales. Presentamos el caso clínico de una mujer de 33 años con una capsulitis adhesiva bilateral e idiopática de caderas ya que no se encontró enfermedad reumatológica, hematológica, endocrina, tumoral o traumática que justificara su aparición. Debido a los problemas diagnósticos que se presentaron, y a pesar de realizar una rehabilitación intensa, posiblemente se planteó una indicación quirúrgica de forma tardía, por lo que se consiguieron unos resultados funcionales muy pobres. Se discute, a partir de la escasa literatura existente, diversos aspectos diagnósticos y terapéuticos de este proceso, comparándolo en ocasiones con la mayor información publicada en el caso del hombro

Adhesive capsulitis is a pathology of unknown ethiology, often characterized by the presence of pain and limited movility. It typically affects the shoulder joint (frozen shoulder), but can also affect other joints. Hip adhesive capsulitis is not very common and is usually associated with local traumatisms. We hereby present the clinical case of a 33 year old female with hip bilateral idiopatic adhesive capsulitis. No sign of illness (reumatological, haematological, endocrine, tumor or traumatism injury) that could cause the development of capsulitis was found. Due to the appearance of some problems during the diagnosis, and despite an intensive rehabilitation treatment, a late chirurgical intervention was carried out, showing poor functional improvement. Based on the sparse literature available, various diagnostical and therapeutical issues are discussed sometimes compared with the more numerous shoulder capsulitis reports

Distribution of serum paraoxon hydrolyzing activity in a large Spanish population using a routine automized method in clinical laboratory.

This work was performed to adapt the manual laboratory method of measuring serum paraoxonase activity using a routine automatized method in the clinical laboratory and to study the distribution of paraoxonase activity in a large population from Alcoy, a region of Spain. The serum samples for the study were obtained from extractions of blood from 2891 individuals, distributed by sex and age groups, in a routine check in a primary care facility of Alcoy. Paraoxonase activity was assayed by measuring the release of p-nitrophenol according to a previously published method adapted to an automatized analyzer. The mean paraoxonase activity recorder was 70.2 +/- 16.5 IU/L. Paraoxonase activity in children (both males and females) was significantly lower (p < 0.0005) than in older individuals. Paraoxonase activity detected in males and females older than 56 was slightly lower than that detected in younger individuals, although in this case the difference was not statistically significant. The paraoxonase activity shows higher mean values in females than in males (p < 0.0005). Human paraoxonase activity shows a unimodal distribution pattern in the studied population, which is in contrast with other studies showing bimodal distribution.

Early infections in adult patients undergoing unrelated donor cord blood transplantation.

Early transplant-related mortality after cord blood transplantation from unrelated donors (UD-CBT) is close to 50%, mainly due to infectious complications. We have studied the incidence and characteristics of early infections (before day 100) in a series of 27 adult patients (median age 30 years, range 16-46) undergoing UD-CBT at a single institution. All 27 patients experienced at least one infectious episode and 18 (66%) suffered a severe infection. Bacteremia occurred in 55% of patients (13 with Gram-positive and 11 with Gram-negative microorganisms). Eleven of 19 CMV-seropositive patients (58%) developed CMV antigenemia and one patient had CMV disease. Fungal infections were documented in three patients (11%), comprising invasive fungal infections in two cases and a localized esophagitis in one. Ten patients (37%) died before day 100 after transplantation. Infection was considered the primary cause of death in four patients (sepsis by Acinetobacter spp. bacteremia in three cases) and contributed to death in another four. The most striking findings in this series were the high incidence of, and mortality due to multiresistant Acinetobacter spp. and the low incidence of and lack of mortality due to CMV disease. This report confirms that infection is a major complication in adults undergoing UD-CBT.

Luxación de hombro, rotura del manguito de los rotadores y lesión del nervio axilar: una tríada a tener en cuenta / Shoulder dislocation, rotator cuff rupture and axillary nerve lesion: a triad to keep in mind

Se han publicado numerosos estudios de lesiones aisladas del manguito de los rotadores o del plexo braquial secundarias a fractura o luxación del hombro. Sin embargo existen pocas referencias de la asociación de luxación de hombro, rotura completa del manguito de los rotadores y lesión del nervio axilar en el mismo paciente. Presentamos dos pacientes remitidos, tras reducción e inmovilización de una luxación anterior de hombro, por una limitación en la movilidad activa de dicha articulación. Ante la sospecha en la exploración inicial de la tríada (luxación de hombro-rotura del manguito de los rotadores-neuropatía axilar) y tras el estudio realizado (Eco, RNM y EMG) comprobamos la coexistencia de una rotura completa en el tendón del supraespinoso y una neuropatía axilar aislada. Se discuten ciertos aspectos de la incidencia de dichas complicaciones así como de la necesidad de una profunda exploración en la valoración inicial de todo paciente con luxación de hombro, ya que de ello va a depender el pronóstico y el tipo-duración del tratamiento rehabilitador (AU)

Absence of platelet response after eradication of Helicobacter pylori infection in patients with chronic idiopathic thrombocytopenic purpura.

Eradication of Helicobacter pylori infection has been associated with the correction of thrombocytopenia in patients with idiopathic thrombocytopenic purpura (ITP). We have analysed the response to eradication of H. pylori in a series of 56 adult patients with chronic ITP. Forty patients had H. pylori infection (71%) that was eradicated in 23 of 32 evaluable patients (72%). Platelet counts did not significantly vary according to H. pylori treatment outcome. Three of 56 patients (5%) achieved a partial response attributable to H. pylori eradication. Therefore, detection of H. pylori infection should not be routinely included in the initial work-up of ITP.

A multicentre study of the hospital care of 1500 patients with myelomeningocele.

The purpose of this paper is to describe the medical attention that is given to patients affected by myelomeningocele in Spain. We have used information extracted from the 'Multicentre study of patients suffering from spina bifida in Spain'. This material was collected between 1986 and 1988 from experiences with 1500 patients all over our country. 52.9% of the patients were male, and 47% female, and of the total number, 72.2% were under 15 years of age. Most of these patients attended public hospitals (78.5%) and on average each one had been admitted about seven times. The cost of hospitalisation of the sample has been assessed. Urology, orthopaedic surgery and rehabilitation are the specialties most involved. The most frequent complications were those related to the urinary system (66.1%).

Ambulation in patients with myelomeningocele: a study of 1500 patients.

Data from 1500 patients affected by spina bifida have been collected in a multicentre study in Spain from 1986 to 1988. This paper is concerned with a part of the data, specifically regarding the walking of patients and certain factors that influence the prognosis for ambulation. The neurological level of lesion most commonly present was lumbosacral (65.6%). Hydrocephalus was frequent (62% of the sample), and has significant implications regarding prognosis for walking. Hip dislocation (32%) and scoliosis (22.9%) were orthopaedic problems noted in our sample. Pressure sores appeared in 31.7% of the patients. The onset of walking ability has been studied; 15% of the sample started walking at an age older than 5 years. Finally, different modalities of ambulation are described according to the use of ancillary devices, and in independence in activities of daily living.