Estudio retrospectivo de 49 pacientes con parálisis braquial obstétrica: factores de riesgo, incidencia y evolución / Retrospective study of 49 patients with obstetric brachial palsy: risk factors, incidence and evolution

Introducción. La parálisis braquial obstétrica (PBO) es la lesión del plexo braquial en el período neonatal asociada al parto. Objetivos. Conocer la incidencia de PBO en los niños nacidos en el Hospital Materno Infantil de Canarias en los últimos 5 años, estudiar los factores de riesgo de embarazo y parto asociados, revisar la literatura comparando los resultados obtenidos y seguir la evolución de los pacientes. Método. Estudio observacional retrospectivo de todos los pacientes afectos de PBO nacidos entre enero de 2000 y diciembre de 2004. Se recogieron datos de la madre, del recién nacido, tipo de parto y de la lesión, que fueron comparados con el resto de los partos. Análisis estadístico: programa informático SPSS versión 13.0. Se halló la incidencia de PBO por mil nacidos con intervalos de confianza del 95 %. Se analizaron por separado los niños afectos de PBO transitoria (curación antes del año) de los niños afectos de PBO permanente (persistencia al año). Resultados. Se diagnosticaron 49 pacientes afectos de PBO. La incidencia fue de 1,23 ‰. Se encontraron resultados significativos entre la incidencia de PBO y el alto peso al nacimiento, el uso de fórceps, la existencia de test de Apgar y pH inferior al habitual. A los 12 meses un 86 % de los pacientes presentaban movilidad simétrica. Conclusiones. La PBO está relacionada con los factores de riesgo habituales. Los resultados son similares a los encontrados en la literatura. El control de los niños con PBO es primordial para minimizar la aparición de secuelas

Introduction. Obstetric brachial palsy (OBP) is a lesion of the brachial plexus during the neonatal period associated to delivery. Objectives. Know the incidence of OBP in children born in the Materno Infantil University Hospital of the Canary Islands in the last 5 years, study the risk factors of pregnancy and delivery associated to OBP, make a review of the literature in order to compare the results obtained and follow the patient’s evolution. Method. Observational retrospective study of all patients affected by OBP born at our hospital between January 2000 and December 2004. Data of the mother, newborn, type of delivery and lesion were recorded and compared with the rest of deliveries. Statistical analysis: we used the SPSS 13.0 program. Results are expressed as incidence of OBP per thousand, with confidence intervals at 95 %. In addition, children affected by a transitory OBP (those who had been cured before one year) were analyzed separately from those affected by a permanent OBP (with clinical affectation persisting one year later). Results. A total of 49 patients affected by OBP were diagnosed. Incidence was 1.23 ‰. Statistically significant results were found between OBP incidence and high birth weight, use of forceps and the existence of Apgar’s test and pH with lower than usual scores. At 12 months 86 % of the patients presented symmetric mobility. No cases of distal palsies were found. Conclusions. Brachial plexus lesions are related to the common risk factors. The results are similar to those found in the literature. Control of children with OBP is essential to minimize the appearance of sequelae

Eficacia de la gabapentina en el tratamiento del dolor neuropático secundario a la lesión medular / Efficacy of the gabapentine in the treatment of the neuropathic pain due to spinal cord injury

en el tratamiento del dolor neuropático en pacientes afectos de lesión medular. Pacientes y métodos: Estudio prospectivo y comparativo en el que se incluyeron pacientes con lesión medular y dolor neuropático de acuerdo con la clasificación de Siddall y definición de la IASP, de más de tres meses de evolución y que no hubieran recibido tratamiento previo con gabapentina. Se valoraron y cuantificaron las características e intensidad del dolor neuropático y su interferencia con el sueño, así como su tolerabilidad a través de visitas seriadas. Resultados: Fueron incluidos 43 pacientes, 80,5 % varones con una edad media de 42 + 10,2 años. Se apreció mejoría en la descripción, valoración e intensidad del dolor en las escalas de Lattinen y McGill (p< 0,0001); así como en la interferencia con el sueño (p<0,0001) entre las dos visitas de seguimiento. La tolerabilidad del medicamento fue calificada como excelente en el 73,8%. Conclusiones: El tratamiento del dolor neuropático secundario a la lesión medular con gabapentina ofrece resultados satisfactorios en cuanto a la reducción de la intensidad y frecuencia del mismo; consigue disminuir la interferencia que produce en el sueño y constituye una alternativa segura, con pocos efectos secundarios

Objective: To evaluate the efficacy and tolerability of gabapentin in the treatment of neuropathic pain in patients with spinal cord injury. Patients and methods: Prospective and comparative study was designed. Individuals with spinal cord injury and neuropathic pain in accord with Siddall's classification and IASP's definition were included. The evolution of pain was longer than three moths and any patient had received previously treatment with gabapentine. Intensity and characteristic of neurophatic pain and its interference with sleep were measured and the tolerability was also assessed. Results: Fourty three patients were included, 80,5% men, 42+10,2 years aged. The results of description and intensity of pain in Lattinen and McGill scales were better (p<0,001), as also the interference with sleep (p<0,001) between the visits of control. Conclusions: The treatmet of neurophatic pain due to spinal cord with gabapentine offers satisfactory results to decrease its intensity and frecuency, to get a lower interference with sleep and it is a safe alternative with very few secundary effects

Fentanilo transdérmico en el tratamiento para el dolor neuropático del lesionado medular / Transdermal fentanyl in the treatment of neuropathic pain of spinal cord injured patient

Diseño. Estudio prospectivo, longitudinal y abierto. Objetivos. Valorar la eficacia analgésica del fentanilo transdérmico en dolor neuropático secundario a lesión medular comparándola con otros grupos de pacientes con dolor neuropático. Material y métodos. Se incluyeron pacientes con dolor neuropático afectos de lesión medular, conformándose un grupo control de enfermos amputados y afectos de un accidente cerebrovascular. Fueron registradas las características del dolor: intensidad según escala analógica visual y escala de Latineen, interferencia con el sueño y los efectos secundarios presentados. Se realizaron controles mediante visitas seriadas, monitorizándose los cambios manifestados respecto al dolor tras la administración del fentanilo transdérmico. En el estudio estadístico se emplearon la prueba de x 2 de Pearson y la prueba t, siendo considerados significativos valores de p < 0,05. Resultados. Treinta y dos pacientes fueron incluidos en el estudio, 20 lesionados medulares, 8 amputados y 4 pacientes afectos de un accidente cerebrovascular. La intensidad del dolor neuropático se redujo en ambos grupos, determinándose el descenso global en la escala analógica visual, de 7,54 a 3,8 a los tres meses (p < 0,05) y en la escala de Lattinen de 12,78 a 7,14 (p < 0,05). El descenso en la escala analógica visual fue menos intenso en el grupo de lesionados medulares, de 7,7 a 4,91 (p < 0,05), que en amputados y en pacientes con accidentes cerebrovasculares. Conclusiones. El fentanilo transdérmico es una alternativa terapéutica eficaz para el tratamiento del dolor neuropático secundario a lesión medular, si bien el descenso de intensidad del dolor es menor que en pacientes con dolor neuropático de otro origen

Design. Prospective, longitudinal and open-labeled study. Objectives. Assess analgesic efficacy of transdermal fentanyl in neuropathic pain secondary to spinal cord injury comparing it with other groups of patients with neuropathic pain. Material and methods. Patients with neuropathic pain affected by spinal cord injury were included, the control group being formed by amputee patients and those affected by cerebrovascular accident. The pain characteristics were recorded: intensity according to visual analogue scale and Lattinen scale, interference with sleep and side effects presented. Controls were conducted by seriated visits, monitoring the changes seen regarding pain after administration of transdermal fentanyl. Pearson's x 2 test and the t-test were used in the statistical study, values of p < 0.05 being considered as significant. Results. A total of 32 patients were included in the study, 20 with spinal cord injury, 8 amputees and 4 patients with cerebrovascular accident. Neuropathic pain intensity decreased in both groups, the global decrease on the visual analogue scale being determined from 7.54 to 3.8 at three months (p < 0.05) and on the Lattinen scale from 12.78 to 7.14 (p < 0.05). Decrease on the visual analogue scale was less intense in the spinal cord injured group, from 7.7 to 4.91 (p < 0.05), than in the amputees and in patients with cerebrovascular accidents. Conclusions. Transdermal fentanyl is an effective therapeutic alternative for treatment of neuropathic pain secondary to spinal cord injury although the decrease in pain intensity is less than in patients with neuropathic pain of another origin

Revisión sobre la etiopatogenia, diagnóstico y tratamiento actual de la distonía ocupacional / Review on etiopathogeny, diagnosis and present treatment of occupational dystonia

En los últimos años ha habido un creciente interés en las patologías ocupacionales. La distonía ocupacional es una de las alteraciones más oscuras, tanto en su etiología como en su patogenia. Se ha descrito como un trastorno motor de intensidad variable caracterizado por la contracción involuntaria de determinados grupos musculares que interfiere en la habilidad del individuo. La distonía ocupacional se ha estudiado principalmente en músicos y escribientes, aunque se ha descrito también en deportistas. Los estudios neurofisiológicos, neurorradiológicos y vasculares han añadido más información sobre el cuadro. Tras los últimos trabajos parece evidente que el origen de la distonía se encuentra en una alteración en los circuitos de los ganglios basales que conllevarían unas alteraciones sensoriales y motoras. Asimismo, existen diferentes pautas terapéuticas que, aunque precisan de estudios más amplios, van dirigidas a un programa de reeducación sensorial con el objetivo de una reversión en la representación del córtex sensorial. El objetivo de este estudio ha sido realizar una revisión bibliográfica (Medline y PubMed 1985-2004) sobre el estado actual de la etiopatogenia, diagnóstico y tratamiento de la distonía ocupacional

In recent years, there has been a growing interest in occupational diseases. Occupational dystonia is one of the most obscure alterations in regards to its etiology and pathogeny. It has been described as a motor disorder having variable intensity characterized by involuntary contractions of certain muscular groups that interfere in the individual's skill. Occupational dystonia has been mainly studied in musicians and clerks although it has also been described in athletes. Neurophysiological, neuroradiological and vascular studies have added more information on the picture. After the last studies, it seems clear that the origin of dystonia is found in an alteration in the basal ganglia circuits that entails sensorial and motor alterations. In addition, there are different therapeutic guidelines, which although they require larger studies, are aimed at a sensorial reeducation program in order to have a reversion in sensorial cortex representation. This study has aimed to conduct a bibliographic review (Medline and PubMed 1985-2004) on the present status of the etiopathogeny, diagnosis and present treatment of occupational dystonia

Determination of changes in blood pressure during administration of sildenafil (Viagra) in patients with spinal cord injury and erectile dysfunction.

STUDY DESIGN: Prospective, open-label, comparative study, to assess the effects of sildenafil on blood pressure in a population of patients with spinal cord injury (SCI). OBJECTIVES: To determine the effect of sildenafil on blood pressure in patients with erectile dysfunction secondary to SCI by comparing changes in blood pressure in SCI patients with a neurologic level below T5 versus higher levels. To establish a relationship between the potential hypotensive effect and protective muscle spasm against blood pressure reduction. To assess the effects of age, complexity and duration of SCI on changes in blood pressure. To record any adverse effects occurring during the study. SETTING: Spinal Cord Injury Unit, Insular University Hospital of Gran Canaria, Canary Islands, Spain. SUBJECTS: In total, 22 male SCI patients aged 18 years or older with a history of SCI greater than 3 months in duration. METHODS: Patients with erectile dysfunction secondary to SCI were included in the study, without excluding patients with a neurologic level above 75 or asymptomatic low blood pressure. Patients with specific contraindications for use of the drug were excluded. A personal history was obtained, and the level of injury (ASIA/IMSOP scales of international standards), impairment grade (ASIA impairment scale), spasticity grade (modified Ashworth scale) and baseline sitting and supine blood pressure values were determined. A single dose of 50 mg of sildenafil was administered, and patients remained sitting at 45 degrees . Blood pressure was monitored every 10 min for 4 h and whenever the patient reported symptoms. Any relevant signs and symptoms manifested during the study period were also recorded. Analysis of the changes in blood pressure values was performed using a paired t-test in each group of patients according to neurologic level and spasticity grade. RESULTS: A decrease in blood pressure was observed in all patients, although patients with a level of injury at T5 or above and those with a complete SCI showed a less intense decrease (P<0.05). The spasticity grade of the patients was protective against the fall in blood pressure, as it was less significant in patients with grade 3 (P>0.1) than in those with grade 0. Adverse effects were few and transient. None were related to hypotension. CONCLUSION: Sildenafil caused a decrease in blood pressure in SCI patients with a neurologic level of injury above T5 and complete injuries (grade A), but did not have clinical implications in the patients studied. A higher spasticity grade tends to protect the patient from the fall in blood pressure. Age and duration of injury do not appear to influence this decrease.

Epidemiología de la lesión medular en la provincia de Las Palmas / Epidemiology of the spinal cord injury in the province of Las Palmas

Introducción: La asistencia terapéutica al lesionado medular requiere una planificación que exige el manejo de parámetros epidemiológicos. El conocer la prevalentablacia de la lesión medular en una zona permite abordar el control y tratamiento de la misma desde un plano más real. La apertura de una nueva Unidad de Lesionados Medulares en Canarias ha puesto de relieve la necesidad de ajustar estos parámetros a la población dependiente de la misma. La ausencia de datos y registros de pacientes con lesión medular en esta Comunidad ha impulsado a este grupo de trabajo a realizar un estudio de prevalencia de la lesión medular en la provincia de Las Palmas y la observación de otras variables epidemiológicas relacionadas.Material y métodos: Entre noviembre de 2000 y diciembre de 2001 se procedió a realizar un registro de todos los afectos de lesión medular residentes en la provincia de Las Palmas. Tanto aquellos lesionados con anterioridad a la apertura de la Unidad como los que ingresaron en la misma.Los pacientes fueron entrevistados individualmente mediante una encuesta que incluía las siguientes variables: datos identificadores del paciente, edad en el momento de la lesión, sexo, etiología de la lesión, tipo de la lesión al alta, nivel de la lesión al alta, grado de la lesión al alta y centro especializado donde recibió tratamiento. Para obtener el valor de prevalencia se comparó la cifra de lesionados medulares con la población censada en la provincia.Resultados: La prevalencia estimada para la provincia fue de 30,87 casos por 100.000 habitantes, con valores más altos para varones, 44,92 frente a 16,98 casos por 100.000 habitantes en mujeres. El grupo de edad con mayor número de casos se encontró en los 15-29 años y la etiología traumática resultó la más habitual (AU)

Secondary tetraplegia due to giant-cell tumors of the cervical spine.

BACKGROUND AND PURPOSE: Giant-cell tumor of the bone is a neoplasm which rarely affects the spine, and occurs even more infrequently above the sacrum. The symptomatology depends on the tumor site, and may be attributable to a compression mechanism. Spinal cord injury is seldom a complication and tetraplegia is even more infrequent. In this paper, we present an unusual case involving a giant cell tumor. We also review its possible diagnoses and treatments. CLINICAL CASE: We present the case of giant-cell tumors in the cervical spine affecting C6 and C7, in a young woman who suffered tetraplegia due to spinal cord compression. After surgery and radiotherapy, the tumor reappeared, requiring a second operation. CONCLUSION: Early clinical diagnosis of giant-cell tumors of the spine is difficult because their development tends to go unnoticed. Imaging techniques, especially MRI, help identify them; but their diagnosis still requires histopathologic tests. Resection of the neoplasm is recommended, when possible. Curettage may allow recurrence and radiotherapy may lead to sarcomatous degeneration of the tumor.

[Brachial plexus palsy associated with birth. A review of 30 cases]. / La parálisis del plexo braquial asociada al nacimiento. Revisión de 30 casos.

OBJECTIVE: Our objective was to perform an updated analysis of the incidence and risk factors during pregnancy and labor related to obstetrical brachial palsy. PATIENTS AND METHODS: A retrospective study of all cases of brachial palsy associated with birth detected in our hospital between January 1994 and March 1998 was performed. Data recorded included age of mother, parity, gestational age at the moment of birth, type of birth, presentation, duration of delivery, sex of child, weight, Apgar test at 5 minutes, arterial pH of umbilical cord, type of brachial palsy, side affected and association with other injuries. RESULTS: Thirty cases of brachial palsy associated with birth were diagnosed. The incidence was 1.04%. In addition to a high birth weight, other factors related to the increase in the incidence of obstetric brachial palsy were the presence of dystocia of shoulders at birth, the use of forceps and Apgar and pH under the usual limits. No case of distal paralysis was found. CONCLUSIONS: This study demonstrates the influence of the risk factors known in the development of brachial palsy associated with birth. However, it also establishes doubts about the etiology of traction as the only cause. In addition, it stresses the necessity of adequate birth planning of babies suspected of being macrosomic.