Uso de bromocriptina en pacientes con alteración de conciencia secundaria a traumatismo craneoencefálico / Bromocriptine in disorders of consciouness due to traumatic brain injury

Introducción: el objetivo de este trabajo es evaluar los resultados y efectos secundarios de la administración de bromocriptina en pacientes con traumatismo craneoencefálico (TCE) en estado de síndrome vigilia sin respuesta (SVSR) o estado de mínima conciencia (EMC). Métodos: revisión retrospectiva de 10 casos clínicos: 6 TCE-SVSR y 4 TCE-EMC. Todos los pacientes recibieron bromocriptina con dosis iniciales de 2,5mg 2 veces al día. Esta fue incrementada progresivamente hasta 7,5 o 12,5mg 2 veces al día según respuesta y mantenida durante al menos 4 semanas. Se emplearon diversas escalas de valoración en los siguientes estadios: previo a la administración de bromocriptina, a las 4 semanas de inicio del tratamiento y previo al alta hospitaria. Las escalas de valoración que se emplearon fueron: Coma Recovery Scale-Revised, Disability Rating Scale, Glasgow Coma Scale, Barthel Scale y Marshall Scale. Resultados: de los 10 pacientes 4 en EMC y 4 en SVSR consiguieron al alta 23 puntos en escala CRS-R, emergiendo por tanto de dichos estados y alcanzando un estado de fuera de mínima conciencia. Dos de los 10 pacientes mejoraron, pero de manera más discreta pasando de SVSR a EMC (8 a 11 y de 5 a 10 puntos en CRS-R). Conclusiones: considerando el mal pronóstico de recuperación de estos pacientes el beneficio-riesgo es positivo con bromocriptina a dosis como mínimo de 7,5mg 2 veces al día durante 4 semanas

Introduction: the aim of this study was to assess the results and adverse effects of bromocriptine in patients with traumatic brain injury-vegetative state (TBI-VS) or traumatic brain injury-minimally conscious state (TBI-MCS). Methods: we conducted a retrospective review of 10 patients, six with TBI-VS and four with TBI-MCS. All patients received bromocriptine at a starting dose of 2.5mg twice daily. Bromocriptine was titrated up to 7.5 or 12.5mg twice daily according to response and was maintained for at least 4 weeks. Various assessment scales were used in the following stages: before bromocriptine administration, at 4 weeks post bromocriptine prescription, and at hospital discharge. The assessment scales used were the Coma Recovery Scale-Revised (CRS-R), Disability Rating Scale, Glasgow Coma Scale, Barthel Scale, and Marshall Scale. Results: of the 10 patients, four with TBI-MCS and four with TBI-VS achieved a score of 23 points at discharge in the CRS-R, thus emerging from VS or MCS and regaining functional status. There were only two patients who emerged from VS but remained in MCS (8 to 11 and 5 to 10 points in CRS-R). Conclusions: considering the poor prognosis for recovery in these patients, bromocriptine use has a positive risk-benefit ratio at a dosage of at least 7.5mg twice daily for 4 weeks

[Bromocriptine in disorders of consciouness due to traumatic brain injury]. / Uso de bromocriptina en pacientes con alteración de conciencia secundaria a traumatismo craneoencefálico.

INTRODUCTION: The aim of this study was to assess the results and adverse effects of bromocriptine in patients with traumatic brain injury-vegetative state (TBI-VS) or traumatic brain injury-minimally conscious state (TBI-MCS). METHODS: We conducted a retrospective review of 10 patients, six with TBI-VS and four with TBI-MCS. All patients received bromocriptine at a starting dose of 2.5mg twice daily. Bromocriptine was titrated up to 7.5 or 12.5mg twice daily according to response and was maintained for at least 4 weeks. Various assessment scales were used in the following stages: before bromocriptine administration, at 4 weeks post bromocriptine prescription, and at hospital discharge. The assessment scales used were the Coma Recovery Scale-Revised (CRS-R), Disability Rating Scale, Glasgow Coma Scale, Barthel Scale, and Marshall Scale. RESULTS: Of the 10 patients, four with TBI-MCS and four with TBI-VS achieved a score of 23 points at discharge in the CRS-R, thus emerging from VS or MCS and regaining functional status. There were only two patients who emerged from VS but remained in MCS (8 to 11 and 5 to 10 points in CRS-R). CONCLUSIONS: Considering the poor prognosis for recovery in these patients, bromocriptine use has a positive risk-benefit ratio at a dosage of at least 7.5mg twice daily for 4 weeks.

Terapia descongestiva compleja en grados iniciales de linfedema secundario a cáncer de mama / Complex decongestive therapy in the early stages of breast cancer-related lymphoedema

Objetivos: Analizar los resultados del tratamiento con terapia descongestiva compleja (TDC) aplicada por primera vez en sujetos con linfedema secundario a cáncer de mama (LSCM) grados 0-I. Material y métodos: Estudio descriptivo retrospectivo con sujetos diagnosticados de LSCM de grado 0 y I en una Unidad de Linfedema, a los que se les realiza TDC por primera vez entre los años 2013 y 2016. Se compara el porcentaje de exceso de volumen (PEV) del linfedema en 3 intervalos (inicial, postratamiento y en la revisión médica) y se calcula la reducción del mismo (RPEV) después del tratamiento. Se registran datos demográficos, clínicos y las características del linfedema. Resultados: Fueron incluidas 27 mujeres, con una media de edad de 55 años (49-62). El 88,90% de ellas (n = 24) intervenidas de linfadenectomía y el 85,20% (n = 23) con radioterapia coadyuvante. Se realizaron de media de 23 sesiones. Previo a la TDC 7 participantes tenían LSCM de grado 0 y 20 de grado I; después del tratamiento 16 participantes tenían linfedema de grado 0 y 11 de grado I. La media inicial de PEV fue de 11,76%, 8,77% después del tratamiento y 7,57% en la revisión médica. El PEV se redujo en 22 participantes después del tratamiento (81,50%). Exceptuando un caso, la reducción de volumen se mantuvo estable en la revisión médica. La RPEV después del tratamiento fue 28,15% y 44,79% en la revisión médica. Conclusión: Este estudio muestra unos resultados favorables al empleo de TDC para el tratamiento de linfedema secundario a cáncer de mama de grado 0 y/o I

Objectives: To analyse the outcomes of Complex Decongestive Therapy (CDT) applied for the first time in patients with Breast Cancer-Related Lymphoedema (BCRL) stages 0-I. Material and methods: A descriptive and retrospective study performed on subjects with BCRL severity stages 0 and I recruited in the Lymphology Unit, and who had CDT for the first time between 2013 and 2016. A comparison was made of the percent excess volume (PEV) of lymphoedema at 3 intervals (initial, post-treatment, and medical check-up) and we calculated the percent excess volume reduction (PEVR) after treatment. Demographic data, clinical and lymphoedema characteristics were recorded. Results: The study included a total of 27 women, with mean age of 55 years (49-62). A lymphadenectomy had been performed on 88.90% (n = 24), and 85.20% (n = 23) had radiation therapy. There was a mean of 23 sessions. Before CDT, 7 participants had stage 0 BCRL and 20 had stage I. After treatment, 16 participants had lymphoedema stage 0 and 11 had stage I. The mean initial PEV was 11.76%, 8.77% after treatment and 7.57% in the medical check-up. PEV was reduced in 22 participants after treatment (81.50%). There was only one case where the reduction of volume remained stable in the medical check-up. The mean PEVR after treatment was 28.15% and 44.79% in the medical check-up. Conclusion: This study shows favourable results of Complex Decongestive Therapy in Breast Cancer-Related Lymphoedema stages 0 and I

Epidemiology of traumatic spinal cord injury in childhood and adolescence in Galicia, Spain: report of the last 26-years.

OBJECTIVE: To analyze the characteristics of traumatic spinal cord injury in children of Galicia (Spain). DESIGN: Descriptive and retrospective study. METHODS: Data extracted from the internal registry of the Spinal Cord Injury Unit and the patient's medical records, between March 1988 and December 2014. Inclusion criteria: patients aged ≤ 17 years with a traumatic spinal cord injury.Outcome measures: Total patients, percentages, incidence, ASIA scale results and improvement. RESULTS: A total of 68 patients were included. The incidence was 5.6 cases/1,000,000 inhabitants/year. The mean age was 14.4 years (median: 16). Only 25% were younger than 15. Male patients accounted for 73.5% of the total. The main cause were traffic accidents (60.3%; n = 41), being higher (77.8%) in children ≤ 10 years. Other etiologies included falls (19.1%), diving accidents (16.2%) and other causes (4.4%). Eleven patients (16.2%) had injuries classified as SCIWORA, 8 (72.7%) of them aged ≤ 10 years. The mean age of the SCIWORA group was 7.5 years versus 15.7 years in the non-SCIWORA group (P < 0.001). Half (50%) of these patients had a complete spinal cord injury and, of these, 64.6% were paraplegic. CONCLUSIONS: Traumatic spinal cord injuries are rare in children, and most cases occur between 15 and 17 years. Unlike in adults, SCIs in children mostly involve the thoracic spine. Most patients aged ≤ 10 years have SCIWORA. The most common etiology continues to be traffic accidents, although sports accidents prevail among adolescent patients.

Manejo del linfedema secundario a cáncer de mama empleando terapia descongestiva compleja con presoterapia multicompartimental secuencial. Experiencias en una unidad de linfedema / Management of breast cancer-related lymphoedema utilizing complex decongestive therapy and intermittent multi-chamber pneumatic compression. Experiences of a lymphoedema unit

Objetivo: El protocolo de tratamiento para los pacientes con linfedema sigue siendo controvertido. El objetivo de este trabajo es analizar el resultado de la Terapia Descongestiva Compleja con presoterapia multicompartimental secuencial aplicada por primera vez a pacientes con linfedema secundario a cáncer de mama en una Unidad de Linfedema. Material y métodos: Este estudio observacional con seguimiento retrospectivo está basado en la revisión de historias clínicas durante el periodo 2013-2016. 48 pacientes reunieron los criterios de inclusión de: diagnóstico de linfedema secundario a cáncer de mama, realizar por primera vez sesiones completas de Terapia Descongestiva Compleja (con drenaje linfático manual, presoterapia multicompartimental secuencial y vendaje multicapas) haber realizado la toma de medidas y firmar el consentimiento informado. La valoración se realizó comparando las medidas en centímetros del perímetro del miembro tratado y el contralateral en 7 niveles en 3 momentos (inicial, postratamiento y en la revisión) usando la fórmula de Kuhnke para obtener los volúmenes aproximados. Resultados: La diferencia entre los volúmenes de ambos miembros bajó desde el 21,61% de media inicial, al 15,98% a corto plazo y al 15,64% a medio plazo, consiguiéndose bajada de volumen en 39 de los pacientes y bajada del grado de linfedema en 21 de ellos. Conclusiones: Los resultados avalan la elección de la Terapia Descongestiva Compleja con presoterapia multicompartimental secuencial como tratamiento estándar en el linfedema secundario a cáncer de mama. Es necesaria más investigación con estudios objetivables y reproducibles que incluyan resultados a largo plazo

Objective: The optimal treatment protocol for lymphoedema patients is still controversial. Therefore, the aim of this study was to analyse the results of Complex Decongestive Therapy with intermittent multi-chamber pneumatic compression applied for the first time in patients with breast cancer-related lymphoedema in a Lymphoedema Unit. Material and methods: This retrospective observational study was based on a review of medical records from 2013-2016. A total of 48 patients met the inclusion criteria, ie, those who had received a diagnosis of breast cancer-related lymphoedema, had undergone complete sessions of Complex Decongestive Therapy (with manual lymphatic drainage, intermittent multi-chamber pneumatic compression and multi-layer bandaging) for the first time, had available recorded measurements and had signed an informed consent form. The assessment was conducted by comparing the measurement in centimetres of the circumference of the affected limb with the contralateral measurements at 7 levels in 3 time intervals (initial, post-treatment and at the medical follow-up). The Kuhnke method was used to obtain the approximate volumes. Results: The difference between the volumes of the two limbs decreased from an initial mean of 21.61%, to 15.98% in the short-term and 15.64% in the medium-term, so there was a volume reduction in 39 patients. Moreover, the stage of lymphoedema decreased in 21 of them. Conclusions: The results support the choice of Complex Decongestive Therapy with intermittent multi-chamber pneumatic compression as a standard treatment in breast cancer-related lymphoedema. Further research is required on this issue with measurable and reproducible studies that include long-term-results