COVID persistente: ¿es en realidad una encefalomielitis miálgica? Revisión bibliográfica y consideraciones / Long COVID: Is it really myalgic encephalomyelitis? Bibliographic review and considerations

Las secuelas clínicas de una enfermedad tan extendida como la COVID-19 pueden ser de gran importancia para la atención primaria por su prevalencia y la morbilidad que conllevan. La definición de COVID persistente y el establecimiento de su temporalidad son dispares pero algunos autores consideran plausible que este síndrome sea en realidad una encefalomielitis miálgica. Se observan similitudes al comparar los Criterios Internacionales de Consenso para el diagnóstico de encefalomielitis miálgica con los síntomas descritos para la COVID persistente. Se recomienda la realización de analítica sanguínea, pulsioximetría, radiografía de tórax y ecografía torácica en los pacientes con síntomas persistentes después de la infección aguda. El manejo en ambos cuadros consiste en el tratamiento de los principales síntomas. La posibilidad de que la COVID-19 pueda dar lugar a un cuadro crónico como la encefalomielitis miálgica hace imprescindible un seguimiento a largo plazo de los pacientes que han presentado esta infección (AU)

Clinical sequelae of a disease as widespread as COVID-19 can be of great importance for primary care due to their prevalence and the morbidity they entail. The definition of long COVID and the establishment of its temporality are various, but some authors consider possible that this syndrome is actually myalgic encephalomyelitis. Similarities are observed when comparing the International Consensus Criteria for the diagnosis of myalgic encephalomyelitis with the symptoms described for long COVID. Blood tests, pulse oximetry, chest radiography, and thoracic ultrasound are recommended in patients with persistent symptoms after acute infection. Management in both conditions consists of treating the main symptoms. The possibility that COVID-19 can lead to a chronic condition such as myalgic encephalomyelitis makes long-term follow-up of patients who have suffered from this infection essential (AU)

[Long COVID: Is it really myalgic encephalomyelitis? Bibliographic review and considerations]. / COVID persistente: ¿es en realidad una encefalomielitis miálgica? Revisión bibliográfica y consideraciones.

Clinical sequelae of a disease as widespread as COVID-19 can be of great importance for primary care due to their prevalence and the morbidity they entail. The definition of long COVID and the establishment of its temporality are various, but some authors consider possible that this syndrome is actually myalgic encephalomyelitis. Similarities are observed when comparing the International Consensus Criteria for the diagnosis of myalgic encephalomyelitis with the symptoms described for long COVID. Blood tests, pulse oximetry, chest radiography, and thoracic ultrasound are recommended in patients with persistent symptoms after acute infection. Management in both conditions consists of treating the main symptoms. The possibility that COVID-19 can lead to a chronic condition such as myalgic encephalomyelitis makes long-term follow-up of patients who have suffered from this infection essential.

Safe intrathecal fluorescein use for identification of cerebrospinal fluid leaks: Case-report and perioperative algorithm description. / Uso seguro de fluoresceína intratecal en la localización de las fístulas de líquido cefalorraquídeo: descripción de un caso e implementación de un algoritmo perioperatorio.

Intrathecal injection of fluorescein is a method for repairing cerebrospinal fluid fistulas. The most frequent surgical procedure is endonasal endoscopy and the purpose of injecting this dye is to locate the fistula. The anaesthesiologists usually perform the puncture, therefore it is necessary to review this method and to specify some anaesthetic considerations such as correct dosing, safe management protocols and medical-legal aspects. In this case-report we describe the pre, intra and postoperative protocol of action implemented in our department that basically consists of: obtaining a specific consent, prior neurological/ophthalmologic assessment to rule out hypertension and brain damage, use of corticosteroids and previous antihistamines, choosing the correct dose and concentration of intrathecal sodium fluorescein (maximum 1ml at a concentration of 5% diluted in 9ml of cerebrospinal fluid) and close intra and postoperative monitoring.

Fístula de líquido cefalorraquídeo tras implante de electrodos por vía caudal para estimulación sacra, en una enferma con proctalgia crónica / No disponible

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Drenaje biliar de un quiste hidatídico hepático: ¿sedación monitorizada o anestesia general? / No disponible

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Dolor lumbar como manifestación inusual en una valvulopatía: ejemplo de dificultad en el diagnóstico etiológico de las lumbalgias crónicas / Lumbar pain as an uncommon manifestation of valvular disease: an example of the difficulty of etiologic diagnosis of chronic low back pain

La patología más frecuente en las unidades de dolor crónico es la lumbalgia. El diagnóstico diferencial entre las diferentes etiologías que pueden causarlo es, a menudo, difícil. Las comúnmente llamadas banderas rojas (red flags) de la lumbalgia son una serie de “signos-síntomas” que deben alertarnos acerca de la posibilidad de la gravedad del síntoma y han motivado múltiples trabajos. De la misma forma, nosotros, con la exposición de este caso clínico, queremos remarcar la necesidad de la realización de una detallada historia clínica y la revaluación de aquellos pacientes que vienen derivados de otras consultas con un diagnóstico previo, puesto que nos puede evitar errores de diagnóstico y tratamiento. Presentamos el caso de un enfermo de 55 años, remitido a la unidad de dolor crónico por medicina interna, con el diagnóstico de lumbalgia crónica, en tratamiento con analgésicos, sin respuesta eficaz. Durante los dos últimos años el paciente refería dolor en la zona dorsal baja y lumbar, de intensidad moderada/severa. Como antecedentes patológicos de interés había sido intervenido de una afección mitral, con la implantación de una válvula mecánica 17 años antes. Los episodios de dolor crónico se exacerbaban con crisis de dolor agudo en la zona dorsal baja irradiado a la región lumbar e inguinal. Aunque las crisis de anemia hemolítica aguda pueden cursar con dolor lumbar, este antecedente no se tuvo en cuenta como probable origen del dolor. En la resonancia magnética (RM) lumbarse apreciaban cambios degenerativos con polidiscopatía L4-L5, L5-S1 y signos de artrosis interapofisaria. El remplazo de la válvula protésica malfuncionante por una nueva finalizó con la hemólisis y el dolor lumbar. El paciente permanece asintomático un año después (AU)

Low back pain is the most frequent complaint in chronic pain units. The differential diagnosis among the distinct causes is frequently difficult. The “red flags” of low back pain consist of a series of “signs and symptoms” that should warn clinicians of the possibility of the severity of the symptom and have been the subject of numerous publications. The present case report aims to highlight the need to take a detailed clinical history and to reevaluate patients with a prior diagnosis referred by other services in order to avoid diagnostic and treatment errors. We present the case of a 55-year-old man, who was referred to the chronic pain clinic by the internal medicine service, with a diagnosis of chronic low back pain unresponsive to analgesics. For the previous 2 years, the patient had reported moderate-severe pain in the lower dorsal and lumbar region. Seventeen years previously, a prosthetic mitral valve had been implanted. The patient’s chronic pain episodes were exacerbated by crises of acute pain in the lower dorsal region radiating to the lumbar and inguinal areas. Although acute hemolytic anemia is described as an etiology of low back pain, this antecedent was not taken into account as a probable cause of the pain. Lumbar magnetic resonance imaging showed degenerative osteoarthritis. Replacement of the prosthetic valve resolved the lumbar pain and hemolysis. One year later, the patient remains asymptomatic (AU)

Cirugía mayor ambulatoria en un paciente con hemiplejia alternante infantil / No disponible

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Abordaje del ganglio de Walter por vía transdiscal coccígea en coccigodina / Cocygeal transdiscal approach of ganglion impar for the treatment of coccygodynia

Objetivo Valorar la eficacia y seguridad del abordaje transdiscal coccígeo para el bloqueo con anestésicos locales y corticoides del ganglio de Walter en la coccigodinia. Pacientes y Método Estudiamos prospectivamente 6 pacientes, 4 mujeres (66´6%) y 2 hombres ( 33,4%) , con coccigodinia de más de 6 meses de duración, de origen benigno y puntuación media 6 en la escala analógica visual (EVA). Se llevó a cabo el abordaje del ganglio de Walter para su bloqueo (con anestésicos locales y corticoides) por vía transdiscal coccígea en quirófano. Se evaluó la eficacia analgésica, el grado de satisfacción y las complicaciones. Resultados Cinco de los seis pacientes, fueron dados de alta sin dolor (EVA<1). El total de la muestra manifestó estar satisfecho con el tratamiento. Tras cuatro meses de seguimiento, no registramos complicaciones. Conclusiones El abordaje transdiscal del ganglio de Walter es sencillo, seguro (con menos riesgo de perforación del recto y de inyección peri-ósea de la solución, que la vía clásica utilizada para su bloqueo) y eficaz en el tratamiento de la coccigodinia

Objetive To test the efficacy and safety of the Walter ganglion blockade trough coccygeal disc, in patients who suffered from coccygodynia. Patients and Methods We evaluated six patients, 4 women (66,6%) and two men (33,4%), with chronic coccyx pain (>6 months), and more than 6 points in Visual Analogue Scale (VAS). We described the trans-coccygeal disc approach to Walter ganglion blockade technique. The improvement of pain score, degree of satisfaction and complications of the patients were evaluated. Results Five patients improved VAS score 6 to 1. All the patients were satisfied with the treatment. We had no complications. Conclusions The trans-discal approach of the Walter ganglion is easy, safe (with less risk of rectal perforation and bone traumatism than the classical ano-coccygeal ligament via), and effective for chronic coccygodynia

[Use of EMLA cream and ropivacaine in dacryocystorhinostomy with locoregional anesthesia and sedation]. / Uso de crema EMLA y ropivacaína en la dacriocistorrinostomía con anestesia locorregional y sedación.

OBJECTIVE: To assess the usefulness of locoregional anesthesia and sedation as an alternative to general anesthesia for dacryocystorhinostomy. PATIENTS AND METHOD: Study of 20 patients undergoing dacryocystorhinostomy between April and October 1999. All the processes were carried out by the same surgeon under locoregional anesthesia plus sedation. We used EMLA cream to anesthetize nasal mucosa and ropivacaine for infiltration and anesthetic block; midazolam and fentanyl were used for sedation. RESULTS: Surgery was possible in all cases under locoregional anesthesia with no noteworthy complications. Anesthesia in the zone was good (assessed by hemodynamic changes and by asking the patient during and after the process). The experience was described as good by 70% of patients and poor by only 5%; the surgeon emphasized that bleeding was less than when the procedure is performed under general anesthesia. All patients were released within 24 hours. CONCLUSIONS: Using locoregional anesthesia and sedation for dacryocystorhinostomy is safe and effective and provides a valid alternative to general anesthesia. We suggest using EMLA cream in the nasal dressing and ropivacaine for infiltration. The process can be considered major outpatient surgery.