viernes, 9 de junio de 2017

Curso de artroscopia de rodilla en espécimen biológico

Curso de artroscopia de rodilla en espécimen biológico

30 VI- 1º VII tenemos un curso en el centro de adiestramiento quirúrgico:

SURGICAL SKILLS

Artroscopia de rodilla en espécimen biológico





Curso de Alta Especialidad en Ortopedia Pediátrica




Atención: abiertas las inscripciones al curso de alta especialidad en ortopedia pediátrica en el Hospital Infantil de México






Artroscopia y Prótesis Patelofemoral

Artroplastia Reversa de Hombro / Académico

Artroplastia Reversa de Hombro
Dr Michell Ruiz
Hospital Ángeles Metropolitano CDMX
15-VI-2017  8:30 pm

http://www.lesionesdeportivas.com.mx/academia/artroplastia-reversa-de-hombro-academico/



jueves, 8 de junio de 2017

¿Es el Índice de Masa Corporal un Factor de Riesgo para los Procedimientos de Revisión Después de la Fusión Intercorporal Lumbar Transforaminal Minimamente Invasiva?


Is Body Mass Index a Risk Factor for Revision Procedures After Minimally InvasiveTransforaminal Lumbar Interbody Fusion?

Fuente
Este artículo es originalmente publicado en:
De:
2017 May 19. doi: 10.1097/BSD.0000000000000547. [Epub ahead of print]
Todos los derechos reservados para:

Copyright © 2016 Ovid Technologies, Inc., and its partners and affiliates. All Rights Reserved.
Some content from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

Abstract
STUDY DESIGN:
Retrospective cohort study.
OBJECTIVE:
To determine if an association exists between body mass index (BMI) and the rate of revision surgery after single-level minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).
SUMMARY OF BACKGROUND DATA:
MIS TLIF is an effective treatment for lumbar degenerative disease. Previous studies in the orthopedic literature have associated increased BMI with increased postoperative complications and need for revision. Few studies have evaluated the association between BMI and the risk for revision after minimally invasive spinal procedures.
CONCLUSIONS:
The results of this study suggest that increasing BMI is not a risk factor for undergoing a revision procedure after MIS TLIF. As such, patients with high BMI should be counseled regarding having similar rates of needing a revision procedure after MIS TLIF as those with lower BMI.


Resumen
DISEÑO DEL ESTUDIO:
Estudio de cohortes retrospectivo.
OBJETIVO:
Determinar si existe una asociación entre el índice de masa corporal (IMC) y la tasa de cirugía de revisión después de la fusión intersomática lumbar transforaminal mínimamente invasiva (MIS TLIF).
RESUMEN DE DATOS ANTERIORES:
MIS TLIF es un tratamiento eficaz para la enfermedad degenerativa lumbar. Estudios anteriores en la literatura ortopédica han asociado aumento del IMC con complicaciones postoperatorias incrementadas y necesidad de revisión. Pocos estudios han evaluado la asociación entre el IMC y el riesgo de revisión después de procedimientos espinales mínimamente invasivos.
CONCLUSIONES:
Los resultados de este estudio sugieren que el aumento del IMC no es un factor de riesgo para someterse a un procedimiento de revisión después de MIS TLIF. Como tal, los pacientes con alto IMC debe ser aconsejado con respecto a tener similares tasas de necesidad de un procedimiento de revisión después de MIS TLIF como aquellos con menor IMC.
LEVEL OF EVIDENCE:
Level IV.
PMID:  28538081DOI:    

Espondilolistesis / Cuestionario de Aprendizaje de Espondilolistesis



Spondylolysis/ Spondylolisthesis Learning Quiz

Fuente
Este artículo es originalmente publicado en:
De y todos los derechos reservados para:
Courtesy: Douglas Gillard, BS, DC, Spine Researcher
http://chirogeek.com/
This is a makeup-video geared to replace the attendance quiz portion of the lecture last Thursday that we missed because of Thanksgiving. If you have not watched the main lecture on spondylolisthesis/spondylolysis, then I would suggest you watch that first and then tackle the quiz.
Best,
Douglas Gillard, DC
  • Categoría
  • Licencia
  • Licencia de YouTube estándar

Tratamiento de la artroplastia reversa de hombro dolorosa


Management of painful reverse shoulder arthroplasty

Fuente
Este artículo es originalmente publicado en:
De:
2017 Jul;9(3):212-222. doi: 10.1177/1758573217702333. Epub 2017 Apr 9.
Todos los derechos reservados para:
Copyright © 2017 by The British Elbow & Shoulder Society

Abstract
Even though reverse shoulder arthroplasty is a very successful procedure, painful complications occur. During the initial postoperative years, the most common reasons for pain are instability, postoperative fracture of the acromion or spine, and periprosthetic infection. Later, aseptic loosening, with humeral loosening being more frequent that glenoid loosening, can be a source of pain and reduction in function. A careful patient history, clinical examination, plain radiographs, computed tomography and blood tests give an explanation for the pain in most cases. The majority of these complications can be successfully treated, maintaining a functional reverse shoulder arthroplasty. However, if all examinations are normal, it is important to remember that nonshoulder conditions such as tumour of the lung or degenerative changes of the cervical spine can give shoulder pain.

KEYWORDS:
infection; instability; pain; reverse arthroplasty; scapular spine fracture
Resumen
Aunque la artroplastia inversa del hombro es un procedimiento muy exitoso, se producen complicaciones dolorosas. Durante los primeros años postoperatorios, las razones más comunes para el dolor son la inestabilidad, la fractura postoperatoria del acromion o la columna vertebral y la infección periprotésica. Posteriormente, el aflojamiento aséptico, siendo el aflojamiento humeral más frecuente que el aflojamiento glenoideo, puede ser una fuente de dolor y reducción de la función. Una historia cuidadosa del paciente, examen clínico, radiografías simples, tomografía computarizada y análisis de sangre dan una explicación para el dolor en la mayoría de los casos. La mayoría de estas complicaciones pueden tratarse con éxito, manteniendo una artroplastia reversa funcional del hombro. Sin embargo, si todos los exámenes son normales, es importante recordar que las condiciones que no son relacionadas con el hombro, como tumor del pulmón o cambios degenerativos de la columna cervical puede dar dolor en el hombro.
PALABRAS CLAVE:
infección; inestabilidad; dolor; Artroplastia inversa; Fractura de la columna escapular
PMID:28588662     PMCID:    PMC5444609    
[Available on 2018-07-01]DOI:    10.1177/1758573217702333

Hipertermia maligna / Malignant hyperthermia

Junio 8, 2017. No. 2713



Estimad@ Dr@ Víctor Valdés:  


Chichen Itza

Rabdomiólisis por ejercicio  y golpe de calor: Tenga cuidado con la sedación volátil anestésica.
Exertional rhabdomyolysis and heat stroke: Beware of volatile anesthetic sedation.
World J Crit Care Med. 2017 Feb 4;6(1):21-27. doi: 10.5492/wjccm.v6.i1.21. eCollection 2017 Feb 4.
Abstract
In view of the enormous popularity of mass sporting events such as half-marathons, the number of patients with exertional rhabdomyolysis or exercise-induced heat stroke admitted to intensive care units (ICUs) has increased over the last decade. Because these patients have been reported to be at risk for malignant hyperthermia during general anesthesia, the intensive care community should bear in mind that the same risk of life-threatening rhabdomyolysis is present when these patients are admitted to an ICU, and volatile anesthetic sedation is chosen as the sedative technique. As illustrated by the three case studies we elaborate upon, a thorough diagnostic work-up is needed to clarify the subsequent risk of strenuous exercise, and the anesthetic exposure to volatile agents in these patients and their families. Other contraindications for the use of volatile intensive care sedation consist of known malignant hyperthermia susceptibility, congenital myopathies, Duchenne muscular dystrophy, and intracranial hypertension.
KEYWORDS: Congenital myopathies; Exertional rhabdomyolysis; Heat stroke; Inhalational anesthetics; Intensive care sedation; Malignant hyperthermia

Hipertermia  maligna. Una revisión
Malignant hyperthermia: a review.
Orphanet J Rare Dis. 2015 Aug 4;10:93. doi: 10.1186/s13023-015-0310-1.
Abstract
Malignant hyperthermia (MH) is a pharmacogenetic disorder of skeletal muscle that presents as a hypermetabolic response to potent volatile anesthetic gases such as halothane, sevoflurane, desflurane, isoflurane and the depolarizing muscle relaxant succinylcholine, and rarely, in humans, to stressors such as vigorous exercise and heat. The incidence of MH reactions ranges from 1:10,000 to 1: 250,000 anesthetics. However, the prevalence of the genetic abnormalities may be as great as one in 400 individuals. MH affects humans, certain pig breeds, dogs and horses. The classic signs of MH include hyperthermia, tachycardia, tachypnea, increased carbon dioxide production, increased oxygen consumption, acidosis, hyperkalaemia, muscle rigidity, and rhabdomyolysis, all related to a hypermetabolic response. The syndrome is likely to be fatal if untreated. An increase in end-tidal carbon dioxide despite increased minute ventilation provides an early diagnostic clue. In humans the syndrome is inherited in an autosomal dominant pattern, while in pigs it is autosomal recessive. Uncontrolled rise of myoplasmic calcium, which activates biochemical processes related to muscle activation leads to the pathophysiologic changes. In most cases, the syndrome is caused by a defect in the ryanodine receptor. Over 400 variants have been identified in the RYR1 gene located on chromosome 19q13.1, and at least 34 are causal for MH. Less than 1 % of variants have been found in CACNA1S but not all of these are causal. Diagnostic testing involves the in vitro contracture response of biopsied muscle to halothane, caffeine, and in some centres ryanodine and 4-chloro-m-cresol. Elucidation of the genetic changes has led to the introduction of DNA testing for susceptibility to MH. Dantrolene sodium is a specific antagonist and should be available wherever general anesthesia is administered. Increased understanding of the clinical manifestation and pathophysiology of the syndrome, has lead to the mortality decreasing from 80 % thirty years ago to <5 % in 2006.

Manejo de la hipertermia maligna. Diagnóstico y tratamiento
Management of malignant hyperthermia: diagnosis and treatment.
Ther Clin Risk Manag. 2014 May 14;10:355-62. doi: 10.2147/TCRM.S47632. eCollection 2014.
Abstract
Malignant hyperthermia is a potentially lethal inherited disorder characterized by disturbance of calcium homeostasis in skeletal muscle. Volatile anesthetics and/or the depolarizing muscle relaxant succinylcholine may induce this hypermetabolic muscular syndrome due to uncontrolled sarcoplasmic calcium release via functionally altered calcium release receptors, resulting in hypoxemia, hypercapnia, tachycardia, muscular rigidity, acidosis, hyperkalemia, and hyperthermia in susceptible individuals. Since the clinical presentation of malignant hyperthermia is highly variable, survival of affected patients depends largely on early recognition of the symptoms characteristic of malignant hyperthermia, and immediate action on the part of the attending anesthesiologist. Clinical symptoms of malignant hyperthermia, diagnostic criteria, and current therapeutic guidelines, as well as adequate management of anesthesia in patients susceptible to malignant hyperthermia, are discussed in this review.
KEYWORDS: genetics; in vitro contracture test; malignant hyperthermia; succinylcholine; volatile anesthetics

Hipertermia maligna
Malignant hyperthermia.
Swiss Med Wkly. 2012 Jul 31;142:w13652. doi: 10.4414/smw.2012.13652.
Abstract
Malignant hyperthermia (MH) is a subclinical myopathy, usually triggered by volatile anaesthetics and depolarising muscle relaxants. Clinical symptoms are variable, and the condition is sometimes difficult to identify. Nevertheless, rapid recognition and specific as well as symptomatic treatment are crucial to avoid a lethal outcome. Molecular genetic investigations have confirmed the skeletal muscle type ryanodine receptor to be the major MH locus with more than 70% of MH families carrying a mutation in this gene. There is no screening method to test for MH, as current tests are invasive (open muscle biopsy) or restricted to MH families with known MH-associated mutations (molecular genetic testing). The prevalence of the MH trait is unknown, because the clinical penetrance after contact with triggering agents is very variable. More recently, MH mutations have been associated with rhabdomyolysis following statin therapy or with non-pharmacological triggering, such as exertional heat stroke.





IX Foro Internacional de Medicina del Dolor y Paliativa
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Ciudad de México, 8 al 10 de Junio
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Anestesiología y Medicina del Dolor

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