Radiofrecuencia pulsada sobre el nervio dorsal del pene: tratamiento eficaz para la neuralgia refractaria del pudendo / On the dorsal penile nerve pulsed radiofrecuency: effective treatment for refractory pudendal neuralgia

La neuralgia del pudendo se define como un síndrome doloroso neuropático, que involucra al dermatomo y a la inervación motora del nervio pudendo. Cualquier punto de su trayecto, desde su origen hasta sus ramificaciones terminales, es susceptible de sufrir diferentes grados de afectación o lesión. La localización del dolor puede ser perineal, rectal o en el área del clítoris/pene, presentándose de forma unilateral o bilateral; se agrava al sentarse y disminuye o desaparece al estar de pie; habitualmente respeta el descanso nocturno y puede asociarse a disfunción urinaria, anal e incluso sexual. Son múltiples las causas que pueden provocar la afectación del nervio pudendo, como partos, caídas, golpes directos y cirugías pélvicas. Esta patología constituye una entidad relativamente frecuente en las unidades de dolor crónico. Son varias las terapias utilizadas, incluyendo fármacos, bloqueos nerviosos del pudendo, cirugía descompresiva y neuromodulación de cordones posteriores medulares. Presentamos el caso de un paciente que, tras ser sometido a prostatectomía radical, consultó por dolor crónico continuo de tipo quemante junto a crisis lancinantes en parte distal derecha del pene (territorio del pudendo) y en el que aplicamos radiofrecuencia pulsada sobre el nervio dorsal derecho del pene obteniendo un buen resultado. Son varios los autores que han publicado tratamientos exitosos con radiofrecuencia pulsada del pudendo para el tratamiento de la neuralgia de dicho nervio, pero hasta ahora no se ha publicado ningún artículo de radiofrecuencia pulsada sobre los nervios dorsales del pene (AU)

Pudendal neuralgia is defined as a neuropathic pain syndrome, involving the dermatome and motor innervation of the pudendal nerve. Any point in its journey, from its origin to its terminal branches, is susceptible to varying levels of damage or injury. The location may be perineal pain, rectal or clitoral/penis area, presenting unilateral or bilateral. It is aggravated by sitting and diminishes or disappears when standing; usually respects people’s sleep and may be associated with urinary or anal dysfunction, and even sex. There are multiple causes that can lead to involvement of the pudendal nerve, such as births, falls, direct hits and pelvic surgeries. This disease is a relatively common condition in chronic pain units. There are several therapies used, including drugs, pudendal nerve blocks, decompressive spinal surgery and neuromodulation posterior columns. We report the case of a patient who, after undergoing radical prostatectomy, chronic pain consulted by continuous burning pain with lancinating type crisis penis right (territory of the pudendal) distal part and in which we apply on the nerve pulsed radiofrequency right dorsal penile obtaining a good result. There are several authors who have published successful treatments with pulsed radiofrequency to treat pudendal neuralgia of the nerve, but so far has not published any articles of pulsed radiofrequency of the dorsal nerves of the penis (AU)

Calidad del registro en OMI-AP de los pacientes con ictus seguidos en atención primaria / Quality of records in OMI-AP of the patients with stroke followed in primary care

Objetivos. 1) Conocer el grado de registro y control de los factores de riesgo cardiovascular en los pacientes con ictus atendidos en atención primaria en la región de Murcia mediante historia clínica informatizada. 2) Analizar el tratamiento farmacológico registrado en los pacientes con ictus. Material y método. Estudio observacional descriptivo, retrospectivo, valorado a través de los registros en OMI (historia clínica electrónica) en todas las zonas de salud del Servicio Murciano de Salud. Se seleccionó una muestra de 407 pacientes con ictus. Las variables analizadas fueron: tipo de ictus, tiempo de evolución, factores de riesgo cardiovascular registrados, enfermedades cardiovasculares registradas, medicación y grado de control de los factores de riesgo modificables. Resultados. Los factores de riesgo cardiovascular registrados fueron hipertensión arterial (81,1%), dislipemia (72,5%), diabetes (41,3%), obesidad abdominal (22,9%), y tabaquismo (8,8%). Las enfermedades cardiovasculares registradas fueron la cardiopatía isquémica (22,1%), fibrilación auricular (13,8%), nefropatía (11,8%), infarto agudo de miocardio (5,7%) e hipertrofia ventricular izquierda (3,4%). El 2,5% (10) de los pacientes registrados cumplieron con todos los criterios de buen control. El LDL colesterol estaba controlado (<100mg/dl) y registrado en el 24,8% de los pacientes y la presión arterial en el 41,3%. Según OMI-AP recibían tratamiento con antihipertensivos el 78,1% de los pacientes, con hipolipemiantes el 47,4% y con antiagregantes o anticoagulantes el 79,1%. Conclusiones. Los pacientes que han sufrido un ictus y según los datos registrados en OMI-AP presentan un deficiente control de sus factores de riesgo cardiovascular(AU)

Objectives. 1) To determine the level of registration and control of cardiovascular risk factors in stroke patients treated in primary care in Murcia through electronic medical records. 2) To describe the registered drug treatment in patients with stroke. Material and Methods. Observational descriptive, retrospective, evaluated through the records in OMI (electronic medical records) in all areas of Murcia Health Service. Material and Methods. A sample of 407 patients with stroke was analyzed. The analyzed variables were type of stroke, time of evolution, registered cardiovascular risk factors, registered cardiovascular disease, medication and degree of control of modifiable risk factors. Results. Cardiovascular risk factors recorded were hypertension (81.1%), dyslipemia (72.5%), diabetes (41.3%), abdominal obesity (22.9%) and tobacco (8.8%). Registered cardiovascular diseases were ischemic heart disease (22.1%), atrial fibrillation (13.8%), nephropathy (11.8%), myocardial infarction (5.7%) and left ventricular hipertrophy (3.4%). 2.5% (10) of patients met all criteria for good control. The LDL cholesterol was controlled (<100mg/dl) and recorded in 24.8% of patients and blood pressure in 41.3%. 78.1% of patients were being treated with antihypertensive drugs, 47.4% with lipid-lowering drugs, and 79.1% with antiplatelet or anticoagulant. Conclusions. According to data recorded at OMI-AP the patients who have suffered a stroke have poor control of cardiovascular risk factors(AU)

[Quality of records in OMI-AP of the patients with stroke followed in primary care]. / Calidad del registro en OMI-AP de los pacientes con ictus seguidos en atención primaria.

OBJECTIVES: 1) To determine the level of registration and control of cardiovascular risk factors in stroke patients treated in primary care in Murcia through electronic medical records. 2) To describe the registered drug treatment in patients with stroke. MATERIAL AND METHODS: Observational descriptive, retrospective, evaluated through the records in OMI (electronic medical records) in all areas of Murcia Health Service. A sample of 407 patients with stroke was analyzed. The analyzed variables were type of stroke, time of evolution, registered cardiovascular risk factors, registered cardiovascular disease, medication and degree of control of modifiable risk factors. RESULTS: Cardiovascular risk factors recorded were hypertension (81.1%), dyslipemia (72.5%), diabetes (41.3%), abdominal obesity (22.9%) and tobacco (8.8%). Registered cardiovascular diseases were ischemic heart disease (22.1%), atrial fibrillation (13.8%), nephropathy (11.8%), myocardial infarction (5.7%) and left ventricular hypertrophy (3.4%). 2.5% (10) of patients met all criteria for good control. The LDL cholesterol was controlled (<100mg/dl) and recorded in 24.8% of patients and blood pressure in 41.3%. 78.1% of patients were being treated with antihypertensive drugs, 47.4% with lipid-lowering drugs, and 79.1% with antiplatelet or anticoagulant. CONCLUSIONS: According to data recorded at OMI-AP the patients who have suffered a stroke have poor control of cardiovascular risk factors.

[Pneumonia and acute renal failure as complications of varicella in adults]. / Neumonía e insuficiencia renal aguda como complicaciones de la varicela en el adulto.

Varicella is a disease in childhood. When it affects adults, serious complications can develop, the most frequent and most dangerous being pneumonia. Acute renal failure is an exceptional complication which infrequently is reported in relevant current literature. The association of pneumonia with acute renal failure in a patient with varicella is unusual. We report a varicella case in an adult patient who suffered from pneumonia with respiratory distress syndrome and acute renal failure, both of them had a favourable clinical course.

Neumonía e insuficiencia renal aguda como complicaciones de la varicela en el adulto / Pneumonia and acute renal failure complicating varicella in the adult

La varicela es una enfermedad propia de la infancia que puede afectar a adultos con serias complicaciones. La neumonía es la más frecuente y grave. La afectación renal está apenas descrita en la literatura. La presentación conjunta de ambas complicaciones es inusual. Presentamos un caso de varicela en el adulto que desarrolló simultáneamente neumonía con distrés respiratorio e insuficiencia renal aguda que evolucionaron favorablemente. (AU)