Síndrome axillary web tras cirugía de cáncer de mama. Variante rara con nódulos subcutáneos / Axillary web syndrome following breast cancer surgery. Rare variant with subcutaneous nodules

Se presenta el caso de una mujer de 49 años, tratada e intervenida por cáncer de mama, quien, a las 3semanas de presentar síndrome de axillary web (SAW), desarrolló nódulos subcutáneos, blandos e indoloros a lo largo de su recorrido y cerca de la flexura del codo. Las pruebas complementarias (ecografía Doppler y de partes blandas) descartaron etiología dérmica/subcutánea o neoplásica, y se evidenció trombosis venosa cefálica y cubital. Se pautó tratamiento con anticoagulante y a las 3-4 semanas el SAW mejoró y los nódulos desaparecieron. Con la clínica, evolución y las pruebas complementarias realizadas, junto con la evidencia científica publicada, se diagnosticó de SAW con nódulos subcutáneos. El SAW es una complicación posquirúrgica precoz del cáncer de mama conocida entre los profesionales y cuyo diagnóstico es clínico. La asociación del SAW con nódulos subcutáneos es una de las variantes poco frecuente, en las que es preciso ampliar el estudio. Se cree que los nódulos, al igual que el SAW, son debidos a procesos trombóticos linfovenosos (AU)

We describe the case of a 49-year-old woman who, after surgical treatment of breast cancer, developed axillary web syndrome (AWS) followed, 3 weeks later, by the appearance of soft and painless subcutaneous nodules along the cords and close to the flexure of the elbow. After tests (soft tissue and Doppler ultrasound), a dermal/subcutaneous or neoplastic cause was ruled out, although a cephalic and ulnar venous thrombosis was revealed. Anticoagulant medication was prescribed, with disappearance of the nodules 3-4 weeks later and improvement of AWS. The symptoms, clinical course, diagnostic tests, as well as the published evidence, helped to establish a diagnosis of AWS with subcutaneous nodules. AWS is an early complication after axillary surgery, which is well known among breast cancer professionals and whose diagnosis is based on clinical presentation. Its association with subcutaneous nodules is one of its rare variants and requires compulsory complementary studies to exclude other causes. Like AWS, nodules are believed to be due to lymphatic vessel thrombosis (AU)

Síndrome del trefinado / Syndrome of the trephined

El síndrome del trefinado (ST) consiste en el deterioro neurológico que se produce tras la realización de una craniectomía descompresiva en la que no se lleva a cabo reposición ósea. Su incidencia es variable, aunque se cree que esta entidad está infradiagnosticada. Se caracteriza por la reversión de los síntomas tras dicha reposición del hueso, por lo que este es el único tratamiento definitivo. Mostramos el caso de un paciente valorado por el servicio de rehabilitación en la unidad de cuidados intensivos tras sufrir un accidente cerebrovascular, que presenta alteración del nivel de consciencia y deterioro motor abrupto, siendo diagnosticado de ST. La intervención rehabilitadora, con cambios posturales precoces del paciente ayudó a mitigar los síntomas hasta que se realizó el tratamiento resolutivo final (AU)

Syndrome of the trephined (SoT) is the neurological deterioration that occurs after the performance of decompressive craniectomy in which bone is not replaced. The incidence of SoT varies, but this entity seems to be underdiagnosed. It is characterized by symptom reversal after bone replacement, which is the only definitive treatment. We report the case of a patient assessed by the Rehabilitation Service in the Critical Care Unit after a stroke, who had altered level of consciousness and abrupt motor impairment. The patient was diagnosed with SoT. Rehabilitation, with early postural changes, helped to ameliorate the symptoms until the provision of definitive treatment (AU)

[Syndrome of the trephined]. / Síndrome del trefinado.

Syndrome of the trephined (SoT) is the neurological deterioration that occurs after the performance of decompressive craniectomy in which bone is not replaced. The incidence of SoT varies, but this entity seems to be underdiagnosed. It is characterized by symptom reversal after bone replacement, which is the only definitive treatment. We report the case of a patient assessed by the Rehabilitation Service in the Critical Care Unit after a stroke, who had altered level of consciousness and abrupt motor impairment. The patient was diagnosed with SoT. Rehabilitation, with early postural changes, helped to ameliorate the symptoms until the provision of definitive treatment.

[Axillary web syndrome following breast cancer surgery. Rare variant with subcutaneous nodules]. / Síndrome axillary web tras cirugía de cáncer de mama. Variante rara con nódulos subcutáneos.

We describe the case of a 49-year-old woman who, after surgical treatment of breast cancer, developed axillary web syndrome (AWS) followed, 3 weeks later, by the appearance of soft and painless subcutaneous nodules along the cords and close to the flexure of the elbow. After tests (soft tissue and Doppler ultrasound), a dermal/subcutaneous or neoplastic cause was ruled out, although a cephalic and ulnar venous thrombosis was revealed. Anticoagulant medication was prescribed, with disappearance of the nodules 3-4 weeks later and improvement of AWS. The symptoms, clinical course, diagnostic tests, as well as the published evidence, helped to establish a diagnosis of AWS with subcutaneous nodules. AWS is an early complication after axillary surgery, which is well known among breast cancer professionals and whose diagnosis is based on clinical presentation. Its association with subcutaneous nodules is one of its rare variants and requires compulsory complementary studies to exclude other causes. Like AWS, nodules are believed to be due to lymphatic vessel thrombosis.

Luchando contra la COVID-19: labor asistencial de los médicos rehabilitadores españoles. Estudio transversal / Fighting against COVID-19: clinical activities of spanish rehabilitation physicians: a cross-sectional study

OBJETIVO: El objetivo de este estudio es analizar el impacto y la organización tanto asistencial como docente en los Servicios de Medicina Física y Rehabilitación de España ante el nuevo y cambiante escenario debido a la pandemia por la COVID-19. MÉTODOS: Se realiza una encuesta dirigida a los tutores de los Servicios de Rehabilitación. Un total de 31 preguntas divididas en 6 apartados: información general de los Servicios, adaptación del Servicio durante el periodo COVID, labor asistencial de los médicos rehabilitadores, abordaje rehabilitador de pacientes COVID, consecuencia de la pandemia sobre la salud de los rehabilitadores y labores de tutoría durante ese periodo. RESULTADOS: Se recibieron un total de 54 encuestas. Casi la mitad de los Servicios cancelaron todas las consultas presenciales (40%) y las salas de terapias se destinaron a camas de pacientes COVID (48%). En 30 hospitales (55,6%) los facultativos han trabajado en plantas COVID. La gran mayoría de los Servicios han elaborado material gráfico y audiovisual con ejercicios, así como protocolos de derivación y tratamiento rehabilitador de pacientes COVID ingresados. Casi la mitad de los Servicios encuestados han tenido algún caso de ansiedad en el personal médico. Las labores de tutoría se han anulado (40,7%) o disminuido (35,2%). CONCLUSIONES: La organización de los Servicios de Rehabilitación para hacer frente a la pandemia ha sido similar en todo el territorio español. La respuesta de los Servicios a la crisis sanitaria ha visualizado la versatilidad de trabajo de los médicos rehabilitadores

OBJECTIVE: The aim of this study was to analyse both the impact of the pandemic and clinical and teaching organisation in Spanish Physical Medicine and Rehabilitation Departments during the COVID-19 pandemic. METHODS: A survey was conducted of the tutors of rehabilitation departments. The questionnaire contained 31 questions divided into 6 parts about the following: general information on the department, adaptation of rehabilitation departments to the COVID pandemic, clinical work of rehabilitation physicians, the approach to rehabilitation in COVID patients, and the effects of the pandemic on the health and teaching activity of rehabilitation physicians during this period. RESULTS: A total of 54 responses were obtained. Almost half of the departments cancelled face-to-face medical consultations (40%) and 48% of the treatment rooms were turned into COVID beds. In 30 hospitals (55.6%), the physicians worked in COVID units. Most of the rehabilitation departments developed both graphic and audiovisual material with exercises, referral protocols and guidelines for the rehabilitation management and treatment of COVID 19 patients. Half of the departments reported some anxiety symptoms in medical staff. Tutorial work has been cancelled (40.7%) or reduced (35.2%). CONCLUSIONS: The organisation of Spanish rehabilitation departments in response to the COVID pandemic has been very similar throughout the country. The response of these departments to the healthcare crisis has revealed the versatility of rehabilitation physicians

[Fighting against COVID-19: clinical activities of spanish rehabilitation physicians: A cross-sectional study]. / Luchando contra la COVID-19: labor asistencial de los médicos rehabilitadores españoles. Estudio transversal.

OBJECTIVE: The aim of this study was to analyse both the impact of the pandemic and clinical and teaching organisation in Spanish Physical Medicine and Rehabilitation Departments during the COVID-19 pandemic. METHODS: A survey was conducted of the tutors of rehabilitation departments. The questionnaire contained 31 questions divided into 6 parts about the following: general information on the department, adaptation of rehabilitation departments to the COVID pandemic, clinical work of rehabilitation physicians, the approach to rehabilitation in COVID patients, and the effects of the pandemic on the health and teaching activity of rehabilitation physicians during this period. RESULTS: A total of 54 responses were obtained. Almost half of the departments cancelled face-to-face medical consultations (40%) and 48% of the treatment rooms were turned into COVID beds. In 30 hospitals (55.6%), the physicians worked in COVID units. Most of the rehabilitation departments developed both graphic and audiovisual material with exercises, referral protocols and guidelines for the rehabilitation management and treatment of COVID 19 patients. Half of the departments reported some anxiety symptoms in medical staff. Tutorial work has been cancelled (40.7%) or reduced (35.2%). CONCLUSIONS: The organisation of Spanish rehabilitation departments in response to the COVID pandemic has been very similar throughout the country. The response of these departments to the healthcare crisis has revealed the versatility of rehabilitation physicians.