Spanish validation of the Stigma of Occupational Stress Scale for Doctors (SOSS-D) and factors associated with physician burnout.

OBJECTIVES: The aim of this study was to investigate the psychometric properties of the Spanish version of the Stigma of Occupational Stress Scale for Doctors (SOSS-D) and the factors associated with Physician Burnout in Paraguay. METHODS: Participants included 747 Paraguayan healthcare workers, aged 24-77 years old, of both sexes. SOSS-D was translated into Spanish and validated through an exploratory and confirmatory factor analysis. Participants were also scored with the Oldenburg Burnout Inventory (OLBI), the CAGE questionnaire, and the stigma subscale of the Perceived Barriers to Psychological Treatment (PBPT) measure. RESULTS: Three factors had a raw eigenvalue greater than 1, and explained 61.7% of total variance. The confirmatory analysis confirmed that the scale is three-dimensional. The model adjustment was good, according to all fit indices. OLBI results indicate clinically significant disengagement in 85.9% and clinically significant exhaustion in 91.6% of participants. Of the 747 participants, 57.6% reported alcoholic beverage consumption and among those, 19.3% had problematic alcohol consumption according to the CAGE questionnaire. The correlation between SOSS-D and the stigma subscale of the PBPT was statistically significant (r = 0.245, p < 0.001). CONCLUSIONS: The Spanish version of the SOSS-D was found to have good psychometric properties and adequately reproduces the three-dimensional model of the original English version.

Dissociable contribution of plasma NfL and p-tau181 to cognitive impairment in Parkinson's disease.

BACKGROUND: Cognitive dysfunction is a disabling complication in Parkinson's disease (PD). Accuracy of diagnosis of mild cognitive impairment in PD (PD-MCI) depends on the tests performed, which limits results generalization. Blood-based biomarkers could provide additional objective information for PD-MCI diagnosis and progression. Blood neurofilament light chain (NfL), a marker of neuronal injury, has shown good performance for PD disease stratification and progression. While NfL is not disease-specific, phosphorylated-tau at threonine-181 (p-tau181) in blood is a highly specific marker of concomitant brain amyloid-ß and tau pathology. METHODS: We investigated the potential of plasma NfL and p-tau181 levels as markers of cognitive impairment in a prospective cohort of 109 PD patients with and without PD-MCI (age 68.1 ± 7 years, education 12.2± 5 years), and 40 comparable healthy controls. After a follow-up of 4 years, we evaluated their predictive value for progression to dementia. RESULTS: Although NfL and p-tau181 levels were significantly increased in PD compared with healthy controls, only NfL levels were significantly higher in PD-MCI compared with PD with normal cognition (PD-NC) at baseline. After a follow-up of 4 years, only NfL predicted progression to dementia (HR 1.23, 95% CI 1.02-1.53; p = 0.038). Significant correlations between fluid biomarkers and neuropsychological examination were only found with NfL levels. CONCLUSIONS: Plasma NfL levels objectively differentiates PD-MCI from PD-NC patients, and may serve as a plasma biomarker for predicting progression to dementia in PD. Plasma levels of p-tau181 does not seem to help in differentiating PD-MCI or to predict future cognitive deterioration.

Psychometric properties of the Spanish version of the Fear of COVID-19 scale in Paraguayan population.

OBJECTIVE: The aim of this study is to test the psychometric properties of the Spanish validation of the Fear of COVID-19 Scale (FCV-19S) in a Paraguayan population. METHODS: Participants were recruited through an Internet-based survey. All participants whose scores in the Hospital Anxiety and Depression Scale (HADS) and The Fear Questionnaire (FQ) were greater than zero were included. 1245 subjects responded voluntarily: 1077 subjects, scoring >0, were considered. RESULTS: To establish construct validity of the FCV-19S, an exploratory factor analysis was performed using the KMO test, which was adequate, and the Bartlett sphericity test, which was significant (p <.0001). The CFI, NFI, GFI, TLI and RMSEA indices were used to evaluate the model and showed good adjustment. Cronbach's α showed valid internal consistency (α = 0.86). This validation was supported by significant correlation (p <.001) with the HADS scale for anxiety and depression and with the FQ scale for specific phobia. CONCLUSIONS: The Spanish version of the FCV-19S is a 7-item scale with two dimensions, psychological symptoms and physiological symptoms, which demonstrated robust psychometric properties in a Paraguayan population.

Attitude of Medical Students in Paraguay Towards Homosexuality.

INTRODUCTION: The attitude of medical students towards homosexuality may affect the quality of care for homosexual patients. This study aimed to describe the attitude of medical students at the National University of Asuncion, Paraguay towards homosexuality. METHODS: This observational, cross-sectional study was conducted in June 2016 in consecutive medical students from the National University of Asunción (Santa Rosa del Aguaray branch), Paraguay. The 10-item attitude towards homosexuality scale (EAH-10) was used to assess participants' acceptance/ rejection of homosexuals as individuals, homosexuality as a sexual orientation, and public manifestations of homosexuality. RESULTS: A total of 48 female and 29 male participants (mean age, 21 ± 2 years) were included. Most were Catholic (71.4%), followed by non-Catholic Christian (10.4%), agnostic (9.1%), atheist (2.6%), and other (6.5%). 71.4% reported having at least one homosexual friend. The mean EAH-10 score was 27.23 ± 9.379. 42.9% of participants were indifferent or undecided in their attitude towards homosexuality and 28.6% were discriminatory. Having homosexual friends was associated with a lower EAH-10 score (t = -3.447 [75], p = 0.001). CONCLUSION: Education about health issues of homosexuals is needed for medical students in Paraguay.

Estrés, ansiedad y depresión en estudiantes secundarios de la ciudad de Santa Rosa del Aguaray, Departamento de San Pedro, 2016 / Stress, anxiety and depression in high school students of the city of Santa Rosa del Aguaray, Department of San Pedro, 2016

Introducción: En este estudio interesa investigar los niveles de estrés, ansiedad y depresión que tiene una población de estudiantes secundarios. Creemos importante estudiar esta temática, en particular porque al tratarse de preuniversitarios debe darse especial énfasis a la detección e intervención precoz sobre situaciones que podrían afectar su desarrollo personal, académico, familiar y social. Materiales y métodos: Estudio observacional, descriptivo, con corte transversal y muestreo no probabilístico a criterio, realizado en estudiantes de educación media del Colegio Nacional "Santa Rosa", del Departamento de San Pedro. Para medir estrés, ansiedad y depresión, se utilizó el DASS-21, que consta de 21 ítems. Resultados: Se evidenció la existencia de al menos cierto nivel del estrés en el 43,5% de los estudiantes entrevistados, siendo de nivel extremo en 8,7% de los participantes. Se reportó algún grado de ansiedad en por lo menos el 71,7%, y algún grado de depresión en al menos 52,2% de los participantes. Discusión: Si bien los niveles de estrés encontrados en la presente investigación son menores a los reportados en la bibliografía, los valores de ansiedad y depresión superan los reportados por otros estudios en población similar. La investigación sobre los niveles de estrés, ansiedad y depresión en estudiantes preuniversitarios es un tema actual e innovador, que busca encontrar soluciones efectivas para hacer frente a estas condiciones que repercuten negativamente en la vida de los estudiantes.

Introduction: In this study it is interesting to investigate the levels of stress, anxiety and depression in a population of high school students. We believe that it is important to study this issue, particularly as they are pre-university students. Special emphasis should be placed on early detection and intervention on situations that could affect personal, academic, family and social development of high school students. Materials and methods: Observational, descriptive and cross-sectional study, with non-probabilistic and at criterion sampling, of students of the "Santa Rosa" National School, Department of San Pedro, enrolled in secondary education. To measure stress, anxiety and depression, we used the DASS-21, which consists of 21 items. Results: There was evidence of at least a certain level of stress in 43,5% of the students interviewed. Extreme level of stress was found in 8,7% of the participants. Some degree of anxiety was reported in at least 71,7% of the population, and some degree of depression in at least 52,2% of the participants. Discussion: Although the levels of stress found in the present study are lower than those reported in the literature, the values of anxiety and depression exceed those reported by other studies in a similar population. Research on the levels of stress, anxiety and depression in pre-university students is a current and innovative topic, which seeks to find effective solutions to address these conditions that have a negative impact on the lives of students.

Uso de cannabis y desarrollo de esquizofrenia: ¿cuáles son los vínculos? / Cannabis use and schizophrenia development: which are the links?

El cannabis es la droga más utilizada por personas con esquizofrenia. Sin embargo, la relación entre el consumo de cannabis y el desarrollo de esquizofrenia aún no ha sido completamente aclarada. Esta comunicación corta pretende destacar algunos vínculos estudiados entre el consumo de cannabis y el desarrollo de esquizofrenia. Los autores resumen algunos de los principales hallazgos de varias investigaciones realizadas sobre este tema, incluyendo estudios sobre la sustancia blanca del cerebro, el circuito de recompensa cerebral, la fisiopatología del hipocampo, el volumen cerebral, la edad de inicio de la psicosis, las características del uso de cannabis y los rasgos de personalidad, la genética, la neuroquímica, así como la respuesta al estrés. Los autores concuerdan con la noción de que hay dos hipótesis más convincentes sobre el vínculo entre el cannabis y la esquizofrenia: 1. Cannabis como causa contribuyente y, 2. Vulnerabilidad compartida. Los autores hacen hincapié en que el consumo de cannabis no provoca por sí mismo un trastorno psicótico; sin embargo, tanto el uso temprano como el uso intensivo del mismo son más probables en individuos con una vulnerabilidad a la psicosis. El uso del cannabis es posiblemente el factor de riesgo medioambiental más modificable de la esquizofrenia, por lo que es necesaria una advertencia de salud pública de que el consumo de cannabis puede aumentar el riesgo de trastornos psicóticos.

Cannabis is the drug most often used by persons with schizophrenia. However, the relationship between cannabis use and schizophrenia development has not yet been fully clarified. This short communication aims to highlight some studied links between cannabis use and schizophrenia development. The authors summarize some of the main findings of several investigations done on this topic, including studies on brain white matter, brain reward circuit, hippocampal pathophysiology, brain volume, age of psychosis onset, and characteristics of cannabis use, personality traits, genetics, neurochemistry, and stress response. The authors agree with the notion that there are two most convincing hypotheses regarding the link between cannabis and schizophrenia: 1. Cannabis as a contributing cause and, 2. Shared vulnerability. The authors stress that cannabis use does not in itself cause a psychotic disorder; however, both early use and heavy use of it are more likely in individuals with a vulnerability to psychosis. The use of cannabis is arguably the most modifiable environmental risk factor for schizophrenia, so it is necessary to ensure a public health warning that cannabis use can increase the risk of psychotic disorders.

Aptitudes vocacionales y procesos de aprendizaje en estudiantes secundarios del Colegio Nacional "Santa Rosa", Departamento de San Pedro, Paraguay, 2016 / Vocational skills and learning processes in high school students of the "Santa Rosa" National School, San Pedro Department, Paraguay, 2016

Introducción: Los procesos de aprendizaje son técnicas de estudio utilizadas por los estudiantes con el objeto de lograr la excelencia académica. Las aptitudes vocacionales engloban aquellos ejes referentes a distintas profesiones en las que los estudiantes pueden desempeñarse. Materiales y métodos: Estudio observacional, descriptivo, de corte transverso, con muestreo no probabilístico a criterio realizado en estudiantes del Colegio Nacional "Santa Rosa", del Departamento de San Pedro, matriculados en la educación media. Resultados: 58,7% fueron mujeres. Edad media fue de 17±1 años. Las aptitudes vocacionales con más respuestas positivas fueron aquellas del eje de servicio social, seguido por el eje científico. En cuanto a los procesos de aprendizaje, se encontró que los estudiantes se sienten bastante conformes con su técnica y lugar de estudio. Los problemas principales en su proceso de aprendizaje se encontraron en su estado físico y su plan de trabajo. Discusión: Se deben estudiar las aptitudes vocacionales que tienen los estudiantes de secundaria para ayudarlos y guiarlos en el proceso de selección de una futura carrera, así como para detectar precozmente problemas de aprendizaje, evitando así el bajo rendimiento académico y el abandono de la carrera.

Introduction: Learning processes are study techniques used by students in order to achieve academic excellence. Vocational skills encompass those axes related to different professions in which students can perform. Materials and methods: Observational, descriptive and cross-sectional study, with non-probabilistic and at criterion sampling, of students of the "Santa Rosa" National School, Department of San Pedro, enrolled in secondary education. Results: 58.7% were women. Mean age was 17±1 years. The vocational skills with the most positive responses were those of the social service axis, followed by the scientific axis. In terms of learning processes, students were found to be quite comfortable with their technique and place of study. The main problems in their learning process were found in their physical state and in their work plan. Discussion: The vocational skills of high school students have to be evaluated to help and guide them in the process of selecting a future career, as well as to detect early learning problems, in order to avoid poor academic performance and dropping out of the career.

Autoestima en estudiantes de medicina de la universidad nacional de Asunción, Paraguay / Self-esteem in medical students of the national university of Asunción, Paraguay

Introducción: Autoestima puede ser definida como el desarrollo de la convicción de que uno es competente para vivir y merece la felicidad, es por tanto capaz de enfrentar la vida con confianza, benevolencia y optimismo lo cual ayuda a alcanzar las metas. Materiales y método: Fue un estudio observacional descriptivo con corte transverso con muestreo no probabilístico de casos consecutivos que se realizó de mayo a junio del 2016 a estudiantes de medicina de la Universidad Nacional de Asunción. Se incluyó a todos los estudiantes que aceptaron participar voluntariamente. Resultados: Se incluyó a 75 sujetos. 60% fue del sexo femenino con edades comprendidas entre 18 y 28 años y una media de 22±2 años. El 48% presenta autoestima elevada, el 18,7% autoestima baja y el 33,3% autoestima baja. Discusión: La prevalencia de autoestima baja en nuestro estudio fue mayor a la encontrada en una población similar donde el 24,5% mostraba puntajes acordes a baja autoestima en contraste con el 33,3% de nuestro estudio. Estos resultados pueden ser explicados por las altas prevalencias de ansiedad, depresión, estresores psicosociales y estrés académico propios de esta población.

Introduction: Self-esteem can be defined as the development of the conviction that one is competent to live and deserves happiness, it is therefore able to face life with confidence, benevolence and optimism which helps to achieve the goals. Methods: It was a descriptive study with transverse cutting non-probability sampling of consecutive cases was conducted from May to June 2016 to medical students at the National University of Asuncion. All students who agreed to participate were included voluntarily. Results: We included 75 subjects. 60% were female with aged between 18 and 28 years and a mean of 22 ± 2 years. 48% have high self-esteem, 18.7% low self-esteem and 33.3% low self-esteem. Discussion: The prevalence of low self-esteem in our study was higher than that found in a similar population where 24.5% had low self-esteem scores chords in contrast to 33.3% of our study. These results can be explained by the high prevalence of anxiety, depression, psychosocial stressors and academic stress of this population.

[May-Thurner syndrome and surgery for scoliosis]. / Síndrome de May-Thurner y cirugía de escoliosis.

May-Thurner syndrome consists of the compression of the left iliac vein by the right iliac artery. We present the case of a 13-year-old girl with severe scoliosis and May-Thurner syndrome that became evident during surgery to correct the scoliosis. An initial attempt to treat the scoliosis employed a posterior approach using Isola instrumentation; however, the procedure was aborted due to the presence of enormous dilated perimedullary veins and hemorrhage. Angiography and venography confirmed the diagnosis of May-Thurner syndrome. Given the patient's age, the condition was not treated with an endovascular stent. She is currently awaiting definitive treatment. This is the first case in the literature in which varicose dilatation of the perimedullary veins in the spinal canal interfered with the surgical treatment of scoliosis. This case underlines the potential difficulties of surgery in the presence of myriad dilated perimedullary veins. May-Thurner syndrome should be suspected in scoliotic patients with dilated perimedullary veins.

Síndrome de May-Thurner y cirugía de escoliosis / May-Thurner syndrome and surgery for scoliosis

El síndrome de May-Thurner (M-T) consiste en la compresión de la vena iliaca izquierda por la arteria iliaca derecha. Presentamos el caso de una niña de 13 años con escoliosis severa y síndrome de M-T, que se evidenció tras una complicación durante la cirugía correctora de la escoliosis. El tratamiento inicial consistió en un abordaje posterior e instrumentación de Isola, pero fue concluido de manera prematura por la presencia de enormes venas perimedulares dilatadas y hemorragia. Se realizó una angiografía y flebografía diagnosticándose un síndrome de May-Thurner. Dada la edad de la paciente no se realizó tratamiento endovascular con stent. La paciente se encuentra a la espera de tratamiento definitivo. No existen casos en la literatura de dilatación varicosa de las venas perimedulares en el canal espinal que interfieran el tratamiento quirúrgico de la escoliosis. Este caso subraya la dificultad potencial de la técnica quirúrgica en presencia de una miríada de venas perimedulares dilatadas. El síndrome de May-Thurner debería sospecharse en pacientes escolióticos con venas perimedulares dilatadas (AU)

May-Thurner syndrome consists of the compression of the left iliac vein by the right iliac artery. We present the case of a 13-year-old girl with severe scoliosis and May-Thurner syndrome that became evident during surgery to correct the scoliosis. An initial attempt to treat the scoliosis employed a posterior approach using Isola instrumentation; however, the procedure was aborted due to the presence of enormous dilated perimedullary veins and hemorrhage. Angiography and venography confirmed the diagnosis of May-Thurner syndrome. Given the patient's age, the condition was not treated with an endovascular stent. She is currently awaiting definitive treatment. This is the first case in the literature in which varicose dilatation of the perimedullary veins in the spinal canal interfered with the surgical treatment of scoliosis. This case underlines the potential difficulties of surgery in the presence of myriad dilated perimedullary veins. May-Thurner syndrome should be suspected in scoliotic patients with dilated perimedullary veins (AU)

Design, synthesis, and anticonvulsant activity of some sulfamides.

As part of our search for potential anticonvulsant agents, a set of compounds were designed, synthesized, and evaluated against MES and PTZ tests. Bioisosteric functional group information was used to design a new functionality, sulfamides, that complies with the requirements of the pharmacophore previously defined. Some of the molecules showed a promising anticonvulsant profile as selective anti-MES drugs, being active at low concentrations (30mg/kg). The biological data were confirmed in Phase II of the Anticonvulsant Drug Development Program of the National Institute of Health.

Cirugía endovascular de la disección aguda tipo B / Endovascular surgery for acute type B dissection

Introducción. La disección aguda tipo B de la aorta torácica es una entidad compleja y grave, asociada a una elevada morbilidad y mortalidad. Desarrollo. Tradicionalmente, el tratamiento médico se ha preferido para las disecciones no complicadas, y se ha reservado la reparación quirúrgica para las que presentan complicaciones isquémicas o rotura. El tratamiento endovascular con endoprótesis ha aportado mayores esperanzas para los casos complicados, a la vez que se ha postulado su aplicación en casos asintomáticos. Estos aspectos se revisan y se discuten a fondo en el presente documento. Asimismo, se analizan aspectos técnicos del tratamiento endovascular pertenecientes al pre, peri y posprocedimiento. Conclusión. Por el momento, el uso de endoprótesis sólo está justificado en el tratamiento de disecciones agudas complicadas o inestables, o en las crónicas con expansión aneurismática

Introduction. Acute type B dissection of the thoracic aorta is a complex, severe condition associated to a high rate of morbidity and mortality. Development. Medical treatment has traditionally been preferred for non complicated dissections while surgical repair has been reserved for those with ischaemic complications or rupture. Endovascular treatment with a stent has brought greater hope for complicated cases, and its application in asymptomatic cases has also been suggested. These issues are reviewed and discussed at length in this article. Likewise, technical aspects of the endovascular treatment belonging to the pre-, peri- and post-operative periods are also analysed. Conclusions. For the time being, the use of stents is only justified in the treatment of complicated or unstable acute dissections, or in chronic cases with aneurysmal expansion

Remodelación aórtica en la disección tipo B crónica tras la reparación con stents recubiertos / Aortic wall remodeling of the chronic type B dissection after stent graft repair

Objetivo. Estudiar los cambios morfológicos de la pared aórtica en la disección crónica tipo B de Stanford tratada mediante stents recubiertos. Pacientes y métodos. Fueron tratados 17 pacientes (edad media: 61 años; rango: 35-70 años) por disección crónica tipo B. Se implantaron endoprótesis Talent (n = 11) y Excluder (n = 6); abordaje femoral (n = 15) y retroperitoneal (n = 2); control intraoperatorio mediante fluoroscopia y ecocardiografía transesofágica; cobertura intencionada de la arteria subclavia en cinco casos. Resultados. Éxito técnico con cierre de la puerta de entrada (17/17); tiempo quirúrgico: 73 ± 22 min (rango: 55-160 min); sin conversiones ni paraplejía; estancia postoperatoria media: 48 horas; trombosis de la falsa luz torácica completa (n = 13) y parcial (n = 4). El diámetro mínimo de la luz verdadera (LV) aumentó de 18,1 ± 5,4 a 27,9 ± 5,06 mm (p < 0,01). La luz falsa (LF) se redujo de 39,22 ± 18 a 26,6 ± 12,7 mm (p < 0,01). Seguimiento medio: 18 meses (rango: 1-58 meses); sin migraciones, fugas u otras complicaciones relacionadas con la endoprótesis; tres pacientes necesitaron a posteriori cobertura de la reentrada distal. Conclusiones. El cierre de la puerta de entrada mediante stents recubiertos suele inducir la trombosis en la LF torácica, ello conlleva una remodelación aórtica: estabilización del diámetro aórtico máximo, con cambios estadísticamente significativos del índice LV/LF (reducción de la LF, aumento de la LV). La aorta abdominal suele permanecer inalterada por persistencia de reentradas paraviscerales. Los resultados preliminares sugieren que el tratamiento endovascular de la disección crónica tipo B es una opción terapéutica factible y efectiva, con excelentes resultados a medio plazo

Aim. To study the morphologic evolution in the aortic wall of the chronic aortic type B dissection treated by means of stent-graft. Patients and methods. 17 patients (average age: 61 years; range 35-70 years) were treated by chronic aortic type B dissection. The endoprosthesis implanted were Talent (n = 11) and Excluder (n = 6); femoral access (n = 15) and iliac (n = 2); intraoperative transesophageal ecocardiography; intentionally left subclavian artery coverture in five patients. Results. Closure of the entry tear in all cases; surgical time: 73 ± 22 min (range: 55-160 min); no conversions, no neurological complications; median postoperative length of stay 48 hours; thrombosis of the thoracic false lumen (FL), complete (n = 13) and partial (n = 4). The minimum diameter of the true lumen (TL) increase from 18.1 ± 5.4 to 27.9 ± 5.06 mm (p < 0.01). FL reduction from 39.22 ± 18 o 26.6 ± 12.7 mm (p < 0.01). Mean follow up: 18 months; no related graft complications. In the follow up three patients needed to seal distal thoracic re-entry. Conclusions. The clossure of the entry tear usually induces the thrombosis of the thoracic FL. It promotes a remodelling of the aortic wall consistent in the stabilization of the maximum aortic diameter with significant changes of the index TL/FL (reduction of the LF and increase of the TL). The abdominal aorta usually remains unchanged by persistence of paravisceral reentries. The preliminary results suggest that stent-graft repair of the aortic dissection B type is a feasible and effective therapeutic option with excellent mid-term results

Aspectos epidemiológicos de la diarrea aguda en el Hospital de Niños de la Ciudad Hospitalaria "Enrique Tejera" / Epidemiological aspects of the acute diarrhea in the Children Hospital of the Hospitalary City

El objetivo del estudio fue determinar las características clínicas y epidemiológicas de pacientes con diarrea que requirieron atención en las áreas observación-hospitalización y ambulatoria, entre noviembre 1997 y mayo 1999 de la Ciudad Hospitalaria "Enrique Tejera" (CHET), Valencia. La identificación de rotavirus y bacterias se efectuó mediante ELISA y métodos convencionales respectivamente. Las diarreas fueron mas frecuentes en varones (56 por ciento) que en hembras (44 por ciento) y sólo el 13 por ciento de los niños menores de 6 meses recibieron lactancia materna exclusiva. El 32 por ciento fue atendido en observación-hospitalización y el 68 por ciento fue ambulatorio. El 82 por ciento fueron niños menores de 2 años. Las manifestaciones clínicas fueron: deshidratación (33 por ciento), fiebre (36 por ciento), vómitos (65 por ciento) y déficit nuticional (23 por ciento). Rotavirus se identificó en 26 por ciento de los casos con un patrón estacional de dos picos en 1998: enero (56 por ciento) y noviembre (47 por ciento) y la prevalencia mas baja (2 por ciento) en junio. En una muestra seleccionada se identificó Shigella (6 por ciento), Salmonella (5 por ciento) y Campylobacter (3 por ciento). Estas enfermedades son importantes epidemiológicamente y clínicamente por el impacto y costos que generan

Anterior thoracoscopic epiphysiodesis in the treatment of a crankshaft phenomenon.

We report our first performance of a multiple anterior thoracoscopic epiphysiodesis in the treatment of a crankshaft phenomenon. In the last 2 years, video-assisted thoracoscopy has been introduced as a new therapeutic technique in the field of spinal diseases. Its use has been most documented in the treatment of vertebral abscesses and disc herniations, while its performance in treating deformities is less known. The patient in our case was an 11-year-old boy with a 7-year history of aggressive left thoracic idiopathic scoliosis that had previously needed three subcutaneous instrumentations and finally a Cotrel-Dubousset-instrumented arthrodesis. Following these operations, a continuous clinical and radiographical evolution of the curve was recorded and an anterior T6-T11 video-assisted thoracoscopic epiphysiodesis was therefore performed. The patient did not need postoperative narcotics; Argyle chest tubes were removed after 48h with only 150ml of serohaematic drainage, no blood transfusion was required. One year after the intervention, we found a well-consolidated T6-T11 arthrodesis with no evolution of the deformity. The endoscopic technique allowed us to perform an extensive anterior arthrodesis using only three small incisions, with a reduction of bed-confinement to 3 days and reduced postthoracotomy pain.