Eficacia de las infiltraciones con colágeno en el dolor pélvico causado por cicatrices de episiotomía y cesáreas. Ensayo clínico piloto aleatorizado / Efficacy of collagen infiltrations in the pelvic pain caused by episiotomy and caesarean scars. Pilot randomized clinical trial

Introducción y objetivos: El dolor pélvico es un síntoma frecuente de consulta en las unidades de rehabilitación de suelo pélvico. El objetivo de este estudio fue evaluar la eficacia de las infiltraciones con colágeno en el dolor y el aspecto de las cicatrices de desgarros perineales, episiotomías y/o cesáreas. Material y métodos: Ensayo clínico piloto aleatorizado, controlado y simple ciego. Las pacientes del grupo control (GC) recibieron el tratamiento convencional de rehabilitación. De forma adicional, las del grupo intervención (GI) recibieron de 3 a 5 infiltraciones de colágeno. Las pacientes fueron evaluadas basalmente y 6 semanas postintervención. La variable dependiente principal fue el dolor evaluado con la escala visual analógica y el cuestionario de dolor McGill. Como variable secundaria se evaluó el aspecto de la cicatriz según la escala de cicatrización de Vancouver y la Patient Scar Assessment Scale. Se analizó una muestra de 15 mujeres, 8 en el GC y 7 en el GI. Resultados: La edad media fue de 33,1 años (DE 4,1). En el análisis intragrupos se observó una disminución significativa en la valoración global del dolor según la escala visual analógica y el cuestionario de dolor McGill y en la dimensión PRI-Emocional. En el GI se observó también una disminución significativa en la dimensión PRI-Sensorial y PRI-Valorativa respecto a la situación basal. En ambos grupos se observó una mejoría significativa de la cicatrización de la lesión. En el análisis intergrupos se observó una mayor disminución del dolor pélvico en la subescala PRI-Sensorial del cuestionario de dolor McGill en el GI (−15,1 vs. −6; p=0,040). Conclusiones: Las infiltraciones de colágeno podrían mejorar el dolor y el aspecto de las cicatrices dolorosas.(AU)

Background and aims: Pelvic pain is a frequently consulted symptom in pelvic floor rehabilitation units. The aim of this study was to evaluate the efficacy of collagen infiltrations in pain and the appearance of scars from perineal tears, episiotomies and caesarean sections. Material and methods: Pilot randomized, controlled and single-blind clinical trial. Control group (CG) patients received conventional rehabilitation treatment. Additionally, those in the intervention group (IG) received 3-5 collagen infiltrations. The patients were evaluated at baseline and 6 weeks post-intervention. The main outcome was pain and it was evaluated with the visual analog scale and McGill Pain Questionnaire. As secondary outcomes, the appearance of the scar was evaluated by Vancouver Scar Scale and the Patient Scar Assessment Scale. A sample of 15 women was analyzed, 8 in the CG and 7 in the IG. Results: The mean age was 33.1 years (SD 4.1). The intragroup analysis showed a significant decrease of the visual analog scale punctuation and total McGill Pain Questionnaire score and the PRI-Emotional dimension of the McGill Pain Questionnaire. In the IG, a significant decrease was also observed in the PRI-Sensorial and PRI-Evaluative dimensions in comparison with baseline situation. In both groups, a significant improvement in the appearance of the scar was observed. In the intergroup analysis, a greater decrease in pain was observed in PRI-Sensorial subscale of the McGill Pain Questionnairein the IG (−15.1 vs. −6; P=.040). Conclusions: Collagen infiltrations may improve pain and the appearance of painful scars.(AU)

[Efficacy of collagen infiltrations in the pelvic pain caused by episiotomy and caesarean scars. Pilot randomized clinical trial]. / Eficacia de las infiltraciones con colágeno en el dolor pélvico causado por cicatrices de episiotomía y cesáreas. Ensayo clínico piloto aleatorizado.

BACKGROUND AND AIMS: Pelvic pain is a frequently consulted symptom in pelvic floor rehabilitation units. The aim of this study was to evaluate the efficacy of collagen infiltrations in pain and the appearance of scars from perineal tears, episiotomies and caesarean sections. MATERIAL AND METHODS: Pilot randomized, controlled and single-blind clinical trial. Control group (CG) patients received conventional rehabilitation treatment. Additionally, those in the intervention group (IG) received 3-5 collagen infiltrations. The patients were evaluated at baseline and 6 weeks post-intervention. The main outcome was pain and it was evaluated with the visual analog scale and McGill Pain Questionnaire. As secondary outcomes, the appearance of the scar was evaluated by Vancouver Scar Scale and the Patient Scar Assessment Scale. A sample of 15 women was analyzed, 8 in the CG and 7 in the IG. RESULTS: The mean age was 33.1 years (SD 4.1). The intragroup analysis showed a significant decrease of the visual analog scale punctuation and total McGill Pain Questionnaire score and the PRI-Emotional dimension of the McGill Pain Questionnaire. In the IG, a significant decrease was also observed in the PRI-Sensorial and PRI-Evaluative dimensions in comparison with baseline situation. In both groups, a significant improvement in the appearance of the scar was observed. In the intergroup analysis, a greater decrease in pain was observed in PRI-Sensorial subscale of the McGill Pain Questionnairein the IG (-15.1 vs. -6; P=.040). CONCLUSIONS: Collagen infiltrations may improve pain and the appearance of painful scars.

Documento de consenso sobre el uso de la combinación paracetamol/tramadol en pacientes con dolor moderado-intenso / Consensus statement on the use of acetaminophen/tramadol in patients with moderate-severe pain

OBJETIVOS: Desarrollar recomendaciones sobre el uso de la combinación paracetamol/tramadol (P/T) en pacientes con dolor moderado-intenso, basadas en la mejor evidencia y experiencia. MÉTODOS: Se siguió la metodología de grupos nominales y Delphi apoyados por una revisión sistemática de la literatura (RSL). Se seleccionó un panel multidisciplinar de 12 expertos en el manejo del dolor. En la primera reunión de grupo nominal se definió el objetivo, alcance, usuarios, apartados del documento de consenso, así como recomendaciones generales preliminares. Para la RSL se definieron los criterios de inclusión y exclusión, y las estrategias de búsqueda. Dos revisores seleccionaron y analizaron los artículos. Esta evidencia se discutió en una segunda reunión de grupo nominal y se generaron las recomendaciones definitivas. Para cada recomendación, el nivel de evidencia y el grado de recomendación se clasificaron según el modelo de Oxford, y el grado de acuerdo por técnica Delphi. Se definió acuerdo si al menos el 70% de los participantes contestaron ≥ 7 en cada recomendación (1 = total desacuerdo a 10 = total acuerdo). RESULTADOS: Se generaron 20 recomendaciones que cubren aspectos generales, como la evaluación del dolor, y específicos del manejo de P/T. Estos últimos abarcan la indicación de la combinación P/T (perfil de paciente, dosificación, pauta, formulaciones), gestión del riesgo (contraindicaciones, precauciones, interacciones, uso concomitante con otras medicaciones, seguimiento, situaciones especiales) y la educación del paciente. CONCLUSIONES: Estas recomendaciones pretenden resolver algunos interrogantes clínicos habituales y facilitar la toma de decisiones respecto al uso de la combinación P/T en pacientes con dolor moderado-intenso

OBJECTIVES: To present recommendations on the use of the paracetamol/tramadol (P/T) combination in patients with moderate-intense pain based on best evidence and experience. METHODS: The method of nominal groups and Delphi was followed, and supported by a systematic literature review (SLR). A multidisciplinary panel of 12 experts in pain management was selected. In the first nominal group meeting, the aim, scope, users, and sections of the consensus document, were defined, along with the preliminary general recommendations. For the SLR, the inclusion and exclusion criteria, as well as the search strategies, were defined. Two reviewers selected and analysed the articles. This evidence was discussed in a second nominal group meeting, and definitive recommendations were developed. For each recommendation, the evidence levels and grade of recommendation grades were classified according to the Oxford model, and the grade according to the Delphi technique. It was defined as an agreement if at least 70% of the participants scored ≥ 7 for each recommendation (1 = total disagreement to 10 = total agreement). RESULTS: A total of 20 recommendations were produced, which covered general aspects, such as the assessment of pain, and those specific to P/T management. These latter included the indications of the P/T combination (patient profile, dosing, prescription, formulations), risk management (contraindications, precautions, interactions, concomitant use with other medications, follow-up, special situations), and patient education. CONCLUSIONS: These recommendations attempt to resolve any of the routine clinical questions, and help in the making of decisions on the use of the P/T combination in patients with moderate-intense pain

[Consensus statement on the use of acetaminophen/tramadol in patients with moderate-severe pain]. / Documento de consenso sobre el uso de la combinación paracetamol/tramadol en pacientes con dolor moderado-intenso.

OBJECTIVES: To present recommendations on the use of the paracetamol/tramadol (P/T) combination in patients with moderate-intense pain based on best evidence and experience. METHODS: The method of nominal groups and Delphi was followed, and supported by a systematic literature review (SLR). A multidisciplinary panel of 12 experts in pain management was selected. In the first nominal group meeting, the aim, scope, users, and sections of the consensus document, were defined, along with the preliminary general recommendations. For the SLR, the inclusion and exclusion criteria, as well as the search strategies, were defined. Two reviewers selected and analysed the articles. This evidence was discussed in a second nominal group meeting, and definitive recommendations were developed. For each recommendation, the evidence levels and grade of recommendation grades were classified according to the Oxford model, and the grade according to the Delphi technique. It was defined as an agreement if at least 70% of the participants scored ≥7 for each recommendation (1=total disagreement to 10=total agreement). RESULTS: A total of 20 recommendations were produced, which covered general aspects, such as the assessment of pain, and those specific to P/T management. These latter included the indications of the P/T combination (patient profile, dosing, prescription, formulations), risk management (contraindications, precautions, interactions, concomitant use with other medications, follow-up, special situations), and patient education. CONCLUSIONS: These recommendations attempt to resolve any of the routine clinical questions, and help in the making of decisions on the use of the P/T combination in patients with moderate-intense pain.

Infección urinaria en pacientes con vejiga neurógena: patrones de resistencias de los uropatógenos más frecuentes / Urinary Infection in Patients With Neurogenic Bladder: Patterns of Resistance to the Most Frequent Uropathogens

Objetivos: Analizar la etiología y resistencias de los uropatógenos más frecuentes en una población con vejiga neurógena. Material y métodos: Se incluyeron 284 pacientes a los que se practicaron un total de 284 urocultivos. De estos, 106 procedían de pacientes con lesión neurológica, 28 de grupo control no neurógeno, 75 de pacientes ingresados en la Unidad de Cuidados Intensivos (UCI) y 75 de pacientes que acudieron a Urgencias por sintomatología de infección aguda del tracto urinario. Se realizó urocultivo cuantitativo en medio cromogénico, así como identificación y estudio de resistencias de todos los urocultivos positivos para uno o dos microorganismos. Resultados: El 67% de los pacientes neurológicos presentaron urocultivos positivos, frente al25% de los pacientes control. Los urocultivos de pacientes ingresados en UCI y los del grupo Urgencias fueron positivos al 100%, ya que se seleccionaron los primeros 75 urocultivos positivos. E. coli fue el microorganismo más frecuentemente aislado en el grupo de neurológicos, al igual que en enfermos procedentes de Urgencias y del grupo control. En UCI fue Enterococcus spp. (19,4%), seguido de P. aeruginosa (16,5%). En el estudio de resistencias E. coli presentó altas tasas de resistencia a ampicilina y cotrimoxazol y, aunque en menor grado, a ciprofloxacino. Conclusiones: E. coli es el microorganismo más frecuentemente aislado entre todos los grupos, excepto en UCI, en el que es superado por Enterococcus spp. y P. aeruginosa. Las resistencias entre los 4 grupos de población estudiada tienen características diferentes, mostrando globalmente un bajo índice de resistencias a nitrofurantoína y especialmente a fosfomicina, observado en pacientes que provienen de Urgencias o ingresados en UCI y neurológicos (AU)

Purpose: To analyze the most frequent causes and resistances of the uropathogens in patients affected by neurogenic bladder. Material and methods: A total of 284 patients, in whom a total of 284 urinary cultures were performed, were included. Of these, 106 came from patients with neurological injuries, 28 from a non-neurogenic control group, 75 from patients admitted to the intensive care unit (ICU) of our Hospital and 75 patients who came into the emergency room with the symptoms of an acute urinary tract infection. A quantitative urine culture was performed in a chromogenic media and the resistances of all urine cultures that were positive for one or two micro-organisms were identified and studied. Results: A total of 67% of the patients with neurological injuries had positive urine cultures compared to 25% of control group patients. The urine cultures of patients admitted into the ICU and those of the Emergency Room group were 100% positive, since the first 75 positive urine cultures were selected for the study. E.coli was the most-frequently microorganism isolated in the group of neurological patients, as well as among the patients from the Emergency Room and from the control group. In the ICU, the most-frequently isolated micro-organism was Enterococcusspp. (19.4%), followed by P. aeruginosa (16.5%). The study of resistances in general E. coli has high rates of resistance to ampicillin and co-trimoxazole and, although to a lesser degree to ciprofloxacin. Conclusions: E. coli is the micro-organism most frequently isolated among all of the groups except in the ICU, where it is surpassed by Enterococcus spp. and P. aeruginosa. The resistances among the four population groups studied have different features, overall showing a low rate of resistance to nitrofurantoin and especially to fosfomycin, observed in patients from the Emergency Room or admitted to the ICU and neurological patients (AU)

[Urinary infection in patients with neurogenic bladder: patterns of resistance to the most frequent uropathogens]. / Infección urinaria en pacientes con vejiga neurógena: patrones de resistencias de los uropatógenos más frecuentes.

PURPOSE: To analyze the most frequent causes and resistances of the uropathogens in patients affected by neurogenic bladder. MATERIAL AND METHODS: A total of 284 patients, in whom a total of 284 urinary cultures were performed, were included. Of these, 106 came from patients with neurological injuries, 28 from a non-neurogenic control group, 75 from patients admitted to the intensive care unit (ICU) of our Hospital and 75 patients who came into the emergency room with the symptoms of an acute urinary tract infection. A quantitative urine culture was performed in a chromogenic media and the resistances of all urine cultures that were positive for one or two micro-organisms were identified and studied. RESULTS: A total of 67% of the patients with neurological injuries had positive urine cultures compared to 25% of control group patients. The urine cultures of patients admitted into the ICU and those of the Emergency Room group were 100% positive, since the first 75 positive urine cultures were selected for the study. E.coli was the most-frequently microorganism isolated in the group of neurological patients, as well as among the patients from the Emergency Room and from the control group. In the ICU, the most-frequently isolated micro-organism was Enterococcus spp. (19.4%), followed by P. aeruginosa (16.5%). The study of resistances in general E. coli has high rates of resistance to ampicillin and co-trimoxazole and, although to a lesser degree to ciprofloxacin. CONCLUSIONS: E. coli is the micro-organism most frequently isolated among all of the groups except in the ICU, where it is surpassed by Enterococcus spp. and P. aeruginosa. The resistances among the four population groups studied have different features, overall showing a low rate of resistance to nitrofurantoin and especially to fosfomycin, observed in patients from the Emergency Room or admitted to the ICU and neurological patients.

[Quality of life evaluation in spinal cord injured patients comparing different bladder management techniques]. / Evaluación de la calidad de vida en pacientes con lesión medular comparando diferentes métodos de vaciado vesical.

OBJECTIVES: This study examines quality of life among patients with spinal cord injury requiring bladder management techniques, according to the validated King s Health Questionnaire (KHQ). MATERIAL AND METHODS: Prospective and observational study of 91 spinal cord-injured patients (21 women 23% and 70 men 77%). Mean age was 40 years (SD 13.4) and average time since spinal injury was 11.4 (SD 10.4) years. Patients completed the KHQ quality of life instrument and 10 additional questions related to urinary disturbance developed for the study, and filled in a form to subjectively rank their main concerns related to spinal injury. Patients were divided according to the bladder management techniques they regularly used: intermittent catheterization, condom catheter or indwelling catheter, and differences between the mean groups were assessed with de SPSS 13.0 statistic package. RESULTS: The overall KHQ score for the sample was 39.9 (SD 54.4) with higher scores (poorer QoL) in patients using an indwelling catheter. A thorough analysis of the test showed no significant differences between the groups other than in the physical role limitation item (p

Evaluación de la calidad de vida en pacientes con lesión medular comparando diferentes métodos de vaciado vesical / Quality of life evaluation in spinal cord injured patients comparing different bladder management techniques

Material y métodos: Estudio observacional y prospectivo con 91 pacientes (21 mujeres 23%, 70 hombres 77%) afectos de lesión medular que acudieron a la consulta durante marzo 2004 y diciembre del 2005, con media de edad 40 años (DS 13,4) y tiempo medio de evolución de la lesión 11,4 (DS 10,4) años. Los pacientes completaron el KHQ, así como una valoración subjetiva de los principales problemas relacionados con la lesión medular. Se clasificaron los pacientes en función del sistema de evacuación urinaria habitual en: Cateterismos Intermitentes (CI), Sondaje Vesical Permanente (SVP) y Colector Permanente (CP). Analizamos con el paquete estadístico SPSS 12.0 las diferencias entre las medias de las dimensiones del KHQ de los tres grupos. Resultados: La media de la puntuación total del KHQ fue de 39,9 puntos (DT 54,4), con mejor puntuación en el grupo portador de CP. Encontramos que no hay diferencias significativas, excepto en la dimensión de la limitación de los roles, donde obtienen mejor puntuación el grupo portador de CP que los de SVP y los CI (p=0,025).La sexualidad se presenta en primer lugar en la lista de problemas que más preocupa a los pacientes, seguidos de los trastornos de defecación y urinarios. Conclusión: El grupo con mejor puntuación global en el KHQ es el portador de CP, aunque no hay diferencias significativas entre los 3 grupos. Lo que más preocupa a nuestros pacientes son los problemas sexuales (AU)

Material and methods: Prospective and observational study of 91 spinal cord-injured patients (21 women 23% and 70 men 77%). Mean age was 40 years (SD 13.4) and average time since spinal injury was 11.4 (SD 10.4) years. Patients completed the KHQ quality of life instrument and 10 additional questions related to urinary disturbance developed for the study, and filled in a form to subjectively rank their main concerns related to spinal injury. Patients were divided according to the bladder management techniques they regularly used: intermittent catheterization, condom catheter or indwelling catheter, and differences between the mean groups were assessed with de SPSS 13.0 stadistic pakagge. Results: The overall KHQ score for the sample was 39.9 (SD 54.4) with higher scores (poorer QoL) in patients using an indwelling catheter. A thorough analysis of the test showed no significant differences between the groups other than in the physical role limitation item (p=0.025). Patients using a condom catheter reported lower physical limitation scores (better QoL) than patients using an indwelling catheter or intermittent catheterization. Sexuality was the main concern of most patients, followed by bowel dysfunction, urinary incontinence and ambulation or gait problems. Conclusion: Patients treated with condom catheters reported the best quality of life according to KHQ scores, although there were no significant differences versus the other urinary management techniques. The patients’ main concern was related to sexuality (AU)

[Characteristics of urinary tract infections in different patient subpopulations and depending on the bladder emptying system]. / Características de las infecciones urinarias en pacientes con vejiga neurógena según el sistema de vaciado vesical utilizado en comparación con pacientes sin vejiga neurógena.

INTRODUCTION: To analyze the prevalence and etiology of urinary tract infection in patients with neurogenic bladder depending on the bladder emptying system used as compared to a population with no neurological impairment. To assess perception of urinary tract infection by patients with neurogenic bladder. MATERIALS AND METHODS: An epidemiological and prospective study was conducted on 283 patients, in whom a total of 283 urethral cultures were performed. Of these, 106 came from patients with neurological damage, 28 from a control group with no neurological impairment, 74 from patients admitted to the intensive care unit (ICU) of our hospital, and 75 from patients who attended the emergency room for symptoms of acute urinary tract infection. The sensitivity and specificity of patient perception as indicative of urinary tract infection was analyzed using ROC curves. RESULTS: Positive urethral cultures were found in 66% of patients with neurological damage and 25% of control patients. Within the neurological group, patients with the highest rates of positive urethral cultures were those with myelomeningocele (MMC) (81.5%) and spinal cord injuries (71.7%), with a statistically significant difference (p=0.01). The microorganism most commonly found in all subgroups was Escherichia coli, followed by Enterococcus faecalis and Pseudomonas aeruginosa in the neurological subgroup, Enterococcus faecalis and Proteus mirabilis in the control subgroup, and Klebsiella pneumoniae and Staphylococcus agalactiae in the emergency room subgroup. In the ICU subgroup, the most commonly found microorganism was Enterococcus faecalis, followed by Escherichia coli and Pseudomonas aeruginosa. Sensitivity for perception by neurological patients as an indication of the presence of urinary tract infection was 97.2%, as compared to 80% in the control group. Specificity was low in both groups. CONCLUSIONS: E. coli was the microorganism found in positive urethral cultures from all subgroups, except in the ICU group. The groups with the highest urinary tract infection rates were patients with MMC and spinal cord injuries. Sensitivity and specificity (as measured using ROC curves) for perception by neurological patients as an indication of the presence of urinary tract infection was higher in neurological patients than in the non-neurological control group (p=0.0004, area: 0.643).

Características de las infecciones urinarias en pacientes con vejiga neurógena según el sistema de vaciado vesical utilizado en comparación con pacientes sin vejiga neurógena / Characteristics of urinary tract infections in different patient subpopulations and depending on the bladder emptying system

Introducción: La infección urinaria es una patología muy frecuente en las disfunciones miccionales neurógenas. Existen pocos trabajos sobre dicha problemática y menos respecto al sistema de vaciado vesical empleado en estos casos (sonda vesical permanente, colector permanente, cateterismos intermitentes). El objetivo de este estudio fue analizar la prevalencia y la etiología de la infección urinaria en pacientes afectados de vejiga neurógena según su sistema de vaciado vesical en comparación con una población no neurógena, así como valorar la percepción de la infección urinaria en los pacientes afectados de vejiga neurógena. Material y métodos: Se realizó un estudio epidemiológico y prospectivo consecutivo en el que se incluyó a 283 pacientes a los que se les practicó un total de 283 urocultivos. De éstos, 106 procedían de pacientes con lesión neurológica, 28 de un grupo control no neurógeno, 74 de pacientes ingresados en la Unidad de Cuidados Intensivos (UCI) de nuestro hospital y 75 de pacientes que acudieron a urgencias por sintomatología de infección aguda del tracto urinario. Se analizó la sensibilidad y la especificidad que tiene la percepción del propio paciente como indicativo de infección urinaria mediante las curvas ROC. Resultados: El 66% de los pacientes con lesión neurológica presentó urocultivos positivos respecto al 25% de los controles. Dentro del grupo neurológico, el colectivo con más urocultivos positivos fueron pacientes con mielomeningocele (81,5%) y con lesión medular (71,7%), con una significación estadística (p=0,01). El microorganismo más frecuente en todos los subgrupos fue Escherichia coli en primer lugar, seguido de Enterococcus faecalis y Pseudomonas aeruginosa en el subgrupo neurológico, de E. faecalis y Proteus mirabillis en el subgrupo control y de Klebsiella pneumoniae y Streptococcus agalactiae en el subgrupo de urgencias. En el subgrupo de la UCI, el microorganismo más frecuente en primer lugar fue E. faecalis, seguido de E. coli y P. aeruginosa. La sensibilidad para la percepción del paciente neurológico como indicativa de tener una infección urinaria fue del 97,2 respecto al 80% en el grupo control. Las especificidades fueron bajas en ambos grupos. Conclusiones: El microorganismo hallado en los urocultivos positivos en todos los subgrupos fue E. coli, excepto en los de la UCI. Los colectivos con más infecciones urinarias fueron mielomeningocele y lesión medular. La sensibilidad y la especificidad (medidas con la curva ROC) para la percepción del paciente neurológico como indicativas de tener una infección urinaria fueron más altas en los pacientes neurológicos respecto al grupo control no neurológico (p=0,0004; área: 0,643) (AU)

Introduction: To analyze the prevalence and etiology of urinary tract infection in patients with neurogenic bladder depending on the bladder emptying system used as compared to a population with no neurological impairment. To assess perception of urinary tract infection by patients with neurogenic bladder. Materials and methods: An epidemiological and prospective study was conducted on 283 patients, in whom a total of 283 urethral cultures were performed. Of these, 106 came from patients with neurological damage, 28 from a control group with no neurological impairment, 74 from patients admitted to the intensive care unit (ICU) of our hospital, and 75 from patients who attended the emergency room for symptoms of acute urinary tract infection. The sensitivity and specificity of patient perception as indicative of urinary tract infection was analyzed using ROC curves. Results: Positive urethral cultures were found in 66% of patients with neurological damage and 25% of control patients. Within the neurological group, patients with the highest rates of positive urethral cultures were those with myelomeningocele (MMC) (81.5%) and spinal cord injuries (71.7%), with a statistically significant difference (p=0.01). The microorganism most commonly found in all subgroups was Escherichia coli, followed by Enterococcus faecalis and Pseudomonas aeruginosa in the neurological subgroup, Enterococcus faecalis and Proteus mirabilis in the control subgroup, and Klebsiella pneumoniae and Staphylococcus agalactiae in the emergency room subgroup. In the ICU subgroup, the most commonly found microorganism was Enterococcus faecalis, followed by Escherichia coli and Pseudomonas aeruginosa. Sensitivity for perception by neurological patients as an indication of the presence of urinary tract infection was 97.2%, as compared to 80% in the control group. Specificity was low in both groups. Conclusions: E. coli was the microorganism found in positive urethral cultures from all subgroups, except in the ICU group. The groups with the highest urinary tract infection rates were patients with MMC and spinal cord injuries. Sensitivity and specificity (as measured using ROC curves) for perception by neurological patients as an indication of the presence of urinary tract infection was higher in neurological patients than in the non-neurological control group (p=0.0004, area: 0.643) (AU)

Rotación en el extranjero durante la residencia. ¿Por qué no la aprovechamos más? / No disponible

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Porfiria aguda intermitente: programa de rehabilitación e impacto en la calidad de vida / Acute intermittent porphyria. Rehabilitation program and impact on quality of life

La porfiria aguda intermitente es una enfermedad poco frecuente en España producida por una hipo-actividad generalizada de la uroporfirinógeno I-sintetasa (PBG-desaminasa) con una reducción del 50 % de la concentración de la proteína enzimática. Las crisis suelen iniciarse con un cuadro de dolor abdominal junto con náuseas, vómitos y estreñimiento. En un 75 % de los pacientes aparecen manifestaciones neurológicas en forma de neuropatía periférica. La parálisis puede llegar a afectar a la musculatura respiratoria y obligar a la ventilación mecánica asistida. La recuperación suele ser lenta pero completa. Presentamos un caso clínico de porfiria aguda intermitente que inició la sintomatología con un cuadro de dolor abdominal seguido de crisis comiciales y polineuropatía axonal sensitivo motora periférica con afectación de la musculatura respiratoria que requirió intubación orotraqueal; interesante por su infrecuente prevalencia y por sus múltiples formas de presentación junto a su amplio abanico de posibles diagnósticos diferenciales. Se describe el tratamiento rehabilitador pautado y su evolución posterior. Se revisan los principales aspectos sobre el tema expuestos en la literatura médica

Acute intermittent porphyria is a rare diseasein Spain produced by generalized hypoactivity of uroporphyrinogenI-synthetase (PBG-desaminase) with a 50 % reduction of the enzymatic protein concentration. The episodes generally initiate with a picture of abdominal pain together with nausea, vomiting and constipation. In 75 % of the patients, there are neurological manifestations in form of peripheral neuropathy. Paralysis may affect respiratory musculature and require assisted mechanical ventilation. Recoveryis generally slow but complete. We present a clinical case of Intermittent Acute Porphyria whose symptoms initiated with a picture of abdominal pain followed by seizures and peripheral axonal sensory-motor polyneuropathy with involvement of the respiratory musculaturethat required orotracheal intubation. It is interesting due to its uncommon prevalence and multiple presentation forms together with its wide range of possible differential diagnoses. We describe the rehabilitation treatment prescribed and its posterior course. We review the main aspects on the subject presented in the literature

Linfedema después de la cirugía por cáncer de mama. Estudio de la incidencia y factores de riesgo en 113 pacientes / Lymphedema after breast cancer surgery. Study of the incidence and risk factors in 113 patients

El objetivo de este estudio ha sido cuantificar el número de pacientes que desarrollan linfedema a lo largo de los 4 años posteriores a la intervención quirúrgica por cáncer de mama, y valorar si los factores de riesgo que se analizan son o no significativos. Se ha realizado un estudio observacional retrospectivo de pacientes que fueron intervenidas por cáncer de mama en nuestro hospital. Se realizó linfadenectomía en todas ellas, que se acompañó de mastectomía y/o tumorectomía. Se han recogido las pacientes que acudieron a nuestro servicio en el período de tiempo comprendido entre enero y diciembre de 1998. Se obtuvo una muestra inicial de 190 pacientes, de las cuales 77 no acudieron a los controles por causas ajenas y, de las 113 restantes (edad media, 54,4 años; límites, 31-79), desarrollaron linfedema durante el transcurso de estos 4 años el 32 por ciento de las pacientes. El linfedema se cuantificó con la medición de los perímetros a cuatro niveles: articulaciones metacarpofalángicas, muñeca, a 12 cm distales, y a 12 cm proximales a epicóndilo comparando con la extremidad contralateral. Se ha clasificado el grado de linfedema en tres grupos basados en el diámetro medido: leve (de 2 a 3 cm), moderado (> 3 a 5 cm) y grave (> 5 cm).Se han estudiado los siguientes factores de riesgo asociados: edad de la paciente, tipo de intervención, lateralidad de la intervención en relación al lado dominante de la paciente, causa desencadenante conocida, haber realizado radioterapia como tratamiento coadyuvante, presencia de complicaciones quirúrgicas como seroma, estadio del tumor analizándose la invasión ganglionar en el momento del diagnóstico y presencia de metástasis durante los 4 años de seguimiento; por último, la evolución del linfedema después de realizar tratamiento fisioterápico. El único factor de riesgo estadísticamente significativo ha sido el tipo de intervención (p = 0,03) (AU)