Abordaje ecoguiado a nivel antecubital para cirugía del síndrome del túnel del carpo

IntroductionThere are various anaesthetic techniques for ambulatory surgery of carpal tunnel release. The ultrasound-guided nerve blocks offer advantages compared to other techniques. The purpose of this study was to evaluate the efficacy using ultrasound-guided block at the antecubital fossa, as well as to evaluate complications, patient satisfaction and surgeon satisfaction with the block.Materials and methodsProspective observational study with 32 elective patients for carpal tunnel release in a one-day case unit. An ultrasound-guided block with mepivacaine 1% was performed at the antecubital fossa, aiming for the median, ulnar and the lateral and medial cutaneous nerves of the forearm. The measurements of the anteroposterior and laterolateral diameters of the median and ulnar nerves were recorded, before and after injection. Motor and sensory levels were evaluated for the median and ulnar nerves at 5 and 30 min post injection, and compared with the contralateral hand. Pain from the surgical incision time and recovery were recorded, together with complications, and patient and surgeon satisfaction with the block.ResultsThe antecubital fossa ultrasound-guided block was successful in 93.7% of the patients. No patients needed rescue analgesia in recovery and no complications were recorded. Patient satisfaction was 93.7% and surgeon satisfaction was 97%.ConclusionsA selective block of the medial, ulnar and medial and lateral cutaneous nerves of the forearm are effective and satisfactory anaesthetic techniques for carpal tunnel release in a one-day case unit. It allows early mobilization, minimises risks and amount of local anaesthetic used.     

Neurólisis robótica del pudendo en el tratamiento del síndrome de atrapamiento del pudendo

Introduction

Pudendal nerve entrapment syndrome (PNE) is characterised by the presence of neuropathic pain in the pudendal nerve (PN) territory, associated or not with urinary, defecatory and sexual disorders. Surgical PN decompression is an effective and safe alternative for cases when conservative treatment fails. The aim of this study is to describe the first robot-assisted pudendal neurolysis procedure performed in our country.

Manejo anestésico del síndrome del ligamento arcuato medio

Median arcuate ligament syndrome, also known as celiac artery compression syndrome, is a rare and unusual clinical disorder. Its symptoms are non-specific, which complicates its diagnosis, and a multidisciplinary approach is required to treat the disorder. The ligament is circumferentially cleared by laparoscopy. Selective angiography and endovascular techniques may be used after laparoscopy. Vital organs and important vascular structures can be injured during the surgery. The combination of different procedures, as well as the high risk of damage, make this process a significant challenge for the anaesthetist. During corrective surgery for median arcuate ligament syndrome, general anaesthesia must be adapted to the various haemodynamic and ventilatory requirements, and strict control of pain established, as oral tolerance is a key factor in the post-operative recovery of these patients     

Perforatationstrauma im Gesichtsschädel

Facial perforation injuries are very rare. We describe a case of a 48-year-old man who sustained a perforation trauma from an 11 cm long wooden tree branch in the middle of the face in a skiing accident. He suffered from additional injuries, such as fractures of the ribs and hand, but was neurologically without pathologic findings and was cardiopulmonary stable. The branch penetrated the head from the sinus maxillaris through the maxilla just missing the internal and external carotid arteries and ending just short of the cervical vertebra. The patient was transported to a center for oral and maxillofacial surgery and underwent several operations. He could return to his normal social and professional life 8 months after the accident.     

Influencia del inicio precoz del tratamiento conservador en la evolución del paciente pediátrico con vejiga neuropática

BackgroundClean intermittent catheterization (CIC) and anticholinergic drugs are the mainstay treatment for neuropathic bladder (NB). However, there is not consensus about the time therapy should be started in pediatric patients.AimTo analyze the impact of early start (first year of life) of CIC and anticholinergic treatment on long-term renal and bladder function. Our hypothesis is that those children who start conservative treatment in the first year of life have better outcome in terms of bladder and renal function and less need of surgical procedures, compared to those who started treatment later in life.Patients and methodRetrospective study of pediatric patients with NB treated in our hospital (1995-2005) dividing them for comparison in two groups: group 1 started treatment in the first year of life and group 2 between 1 and 5 years old. Collected data included: date of CIC and anticholinergic initiation, presence of VUR or UHN, renal function, UTIs, renal scars, bladder behavior, surgery and urinary continence.ResultsSixty-one patients were included, 25 in group 1 and 36 in group 2. Initially vesico-ureteral reflux (VUR) and overactive bladders were more frequent in group 2. In group 1 one overactive bladder changed to low compliant and in group 2, one normal bladder and 4 overactive bladders changed. At the end of follow-up there were 11 low compliant bladders in group 1 and 17 in group 2. However, in group 1, only 2 patients required bladder augmentation (BA) while in group 2, 12 patients needed it. At the end of the study only 2 patients in group 2 had slight renal insufficiency.ConclusionsPatients who started conservative treatment in the first year of life have better long-term outcome in terms of UTI, renal scars and surgical procedures. Even if they initially had low compliant bladders, these patients require less BA.     

Factores pronósticos del resultado del tratamiento rehabilitador en la incontinencia urinaria femenina

BackgroundUrinary incontinence is the involuntary loss of urine. It is highly prevalent in women and has a great biopsychosocial impact. Numerous risk factors are associated with this entity. Rehabilitative treatment is established as the first line, although its use has not been protocolized.AimTo identify which personal risk factors and type of treatment applied are statistically related to patient improvement.MethodsRetrospective cohort study of female patients diagnosed with urinary incontinence who attended the Pelvic Floor Rehabilitation Clinic of the Río Hortega University Hospital of Valladolid, receiving rehabilitation treatment during the year 2021. The minimum follow-up period was 12 weeks, evaluating improvement or not according to 7 objective and subjective variables, establishing improvement as positive evolution in at least 5 of the 7.ResultsA total of 114 women with urinary incontinence were analyzed. The most frequent types of incontinence were stress (53%) and mixed (36%). The most important risk factors and associated pathology were episiotomy (68%), repeated urinary tract infections (61%), and constipation (40.9%). None of these factors showed a statistically significant relationship with patient improvement with a p > 0.05. The most used rehabilitative treatment was kinesitherapy + biofeedback (51%), which showed a statistically significant relationship with the improvement of these patients (p = 0.037), together with biofeedback + posterior tibial nerve electrostimulation (p = 0.044).ConclusionThe results are in line with other published studies. Biofeedback together with kinesitherapy or posterior tibial nerve electrostimulation are established as the most effective rehabilitative procedures.     

Corrección intrauterina de mielomeningocele: experiencia del programa de medicina y terapia fetal del Hospital Universitario Virgen del Rocío

The most frequent form of spina bifida is myelomeningocele. There is no optimal postnatal treatment for this defect. In addition to the motor or sensory deficits, which depend on the location of the lesion, the defect is usually associated with Chiari ii malformation in affected children. Myelomeningocele has high mortality and, in up to 80% to 90% of patients, can be accompanied by hydrocephalus, which causes severe neurocognitive impairment and requires the patient to be shunted for survival. Intrauterine repair of fetal malformations employing open access through hysterotomy has become a therapeutic option due to improved anesthetic and surgical techniques and instrumentation, which have allowed this type of intervention to become relatively frequent. Anesthetic treatment should focus on both the mother and fetus and the hemodynamic factors regulating placental flow, uterine dynamics, blood loss and fetal well-being must remain well-controlled. Within our Program for Fetal Medicine and Therapy, 21 open fetal interventions have been performed: 17 EXIT procedures and 4 procedures for the intrauterine correction of fetal myelomeningocele. We describe our experience of the intrauterine repair of fetal myelomeningocele through open fetal surgery.     

Factores implicados en el fracaso tardío del tratamiento endoscópico del reflujo vesicoureteral

Introduction

The short-term results of endoscopic treatment of vesicoureteral reflux (VUR) are excellent. Over time, however, a number of patients have been identified for whom VUR reappeared after being resolved with this technique. The aim of this study was to analyse the factors related to this event.

Rendimiento del sistema Bethesda en el diagnóstico citopatológico del nódulo tiroideo

Introduction

Fine-needle aspiration biopsies are a key tool for preoperative assessment of thyroid nodules, and the Bethesda system is the preferred method to report cytological analysis. The purpose of this study is to assess the efficiency of the Bethesda system to identify the malignancy risk of thyroid nodules.

Evaluación del virus del papiloma humano en varones: primera revisión exhaustiva de la literatura

Human papilloma virus (HPV) infection is the most common sexually transmitted infection worldwide. There is a high detection rate in sexually active young people but the risk, in males, persists over years. Currently, the American Center for Disease Control and Prevention does not recommend the evaluation of men for HPV and, the extant bibliography, backs up this stance for several reasons. Objective of the paper was to evaluate the usefulness of HPV detection methods for men; A comprehensive and exhaustive review of the literature was performed. Many are methods for HPV detection used in cervical cancer screening as well as in the study and management of patients with cytological alterations of the lower genital tract. Need for HPV detection methods in men are numerous: screening for both partner/gender; anogenital warts; recurrent respiratory papillomatosis; HPV-related cancer in men; fertility. No HPV test for men has been approved by the FDA, nor has any test been approved for detection of the virus in areas other than the cervix. Many are methods for HPV detection that have shown their usefulness in some of the pathologies associated with male HPV but, despite this, none of them has been approved for man.     

Zur Technik der Osteoplastik am Schädel

Ohne Zusammenfassung     

Impacto del tratamiento del cáncer de cérvix sobre la función miccional y sexual

ContextCervical cancer is the second most common tumor in women worldwide and due to diagnostic and therapeutic advances, the overall survival rates at 5 years is approaching 70%. Disorders in micturition, defecation, sexuality and quality of life have been described, frequently caused by different treatments. Addressing these comorbidities in the medical follow-up is often limited or nonexistent.MethodsA systematic review of studies to identify the articles related with urogynecological sequels from cervical cancer treatment was carried out.Summary of evidenceDuring radical hysterectomy, disruption of the autonomic nerve fibers which innervate the bladder appears to be the main cause of voiding dysfunction. Up to 36% of women report voiding dysfunction; from 10 to 80%, stress urinary incontinence (SUI), due to the decrease in urethral closure pressure. After radical hysterectomy and/or radiotherapy, vaginal shortening and stenosis after is often observed. Sexual function is altered in these women and those who are sexually active women after the surgery frequently report sexual dysfunction due to lack of lubrication and pain.ConclusionsVoiding dysfunction and urinary incontinence are the most frequent urinary problems that occur in patients treated for cervical cancer. Systemic urogynecologic assessment of the symptoms suggestive of micturition dysfunctions during oncologic follow-up may be useful to detect the cases that can be evaluated and treated in an Urogynecology Unit.     

Factores pronósticos del tratamiento endoscópico del reflujo vesicoureteral en pacientes con lesión medular

IntroductionVesicoureteral reflux (VUR) is an important complication in patients with spinal cord injury due to its frequency and morbidity. One of the most extended therapeutic options is endoscopic injection of obliteration substances in the urethral meatus.ObjectiveTo analyze the prognostic factors of VUR treatment using obliterative substances in patients with spinal cord injury.Material and methodsA prospective study was performed in a cohort of 76 patients (age 48.9 ± 14.4 years), of both genders, with spinal cord injuries, who underwent endoscopic treatment of the VUR during the years 2008 to 2011. In all the patients, a clinical history was obtained and a pre-operative videourodynamic study was performed. Another study was carried out at 7.32 months (standard deviation: 6.28 months) of the intervention. Treatment consisted in endoscopic injection of dextranomer/hyaluronic acid copolymer (62 cases) and polydimethylsiloxane (14). The statistical tests applied were the Fisher's exact test and the Student's T test comparing the means. Bilateral significance level was established at 95%.ResultsResolution of VUR was achieved in 46 cases (61%). The statistically significant prognostic factors were age (younger aging cured patients), bilaterality and reflects great (greater grade in bilaterality in the cases with persistence of reflux) and presence of neurogenic detrusor overactivity (greater percentage in the cases of reflux persistence). Stress urinary incontinence (greater percentage in cured patients), contractile potency (lower percentage in cured patients) and urethral resistance (greater percentage in cured patients) were also statistically significant prognostic factors.ConclusionsAmong the prognostic factors that affected the endoscopic treatment results of the VUR in patients with neurogenic lower urinary tract dysfunction (NLUTD), anatomical as well as functional factors were found.