Resultado funcional y cosmético de la amputación de un solo dígito en mano

http://www.manoytrauma.com.mx/academia/resultado-funcional-y-cosmetico-de-la-amputacion-de-un-solo-digito-en-mano/

Functional and cosmetic outcome of single-digit ray amputation in hand.

Fuente

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28681161

https://link.springer.com/article/10.1007%2Fs12306-017-0484-x

De:

Bhat AK1,Acharya AM1,Narayanakurup JK2,Kumar B1,Nagpal PS1,Kamath A3.

Musculoskelet Surg.

2017 Jul 5. doi: 10.1007/s12306-017-0484-x. [Epub ahead of print]

Todos los derechos reservados para:

Copyright information

© Istituto Ortopedico Rizzoli 2017AbstractPURPOSE:

To assess patient satisfaction, functional and cosmetic outcomes of single-digit ray amputation in hand and identify factors that might affect the outcome.

CONCLUSION:

Following ray amputation, one can predict an approximate 43.3% loss of grip strength and 33.6% loss of pinch strength. The patients can be counselled regarding the expected time off from work, amount of disability and complications after a single-digit ray amputation. Majority of the patients can return to the same occupation after a period of dedicated hand therapy.

KEYWORDS:

Grip strength; Pinch strength; Ray amputation; Replantation; Transposition

Resumen

PROPÓSITO:
Evaluar la satisfacción del paciente, los resultados funcionales y cosméticos de una amputación de rayos de un solo dígito en la mano e identificar los factores que podrían afectar el resultado.

CONCLUSIÓN:
Después de la amputación de rayos, se puede predecir una pérdida aproximada del 43,3% de la fuerza de agarre y una pérdida del 33,6% de la fuerza de pellizco. Los pacientes pueden ser aconsejados con respecto al tiempo esperado fuera del trabajo, la cantidad de discapacidad y las complicaciones después de una amputación de rayos de un solo dígito. La mayoría de los pacientes pueden volver a la misma ocupación después de un período de terapia de mano dedicada.

PALABRAS CLAVE:
La fuerza de prensión; Fuerza de pellizco; Amputación de rayos; Replantación; Transposición

PMID:  28681161    DOI:  

10.1007/s12306-017-0484-x

#fuerza de prensión#Fuerza de pellizco#amputación

Mas de feocromocitoma / More on pheochromocytoma

Julio 6, 2017. No. 2741

Alfa bloqueo selectivo versus no selectivo antes de adrenalectomía laparoscópica Selective Versus Non-selective α-Blockade Prior to Laparoscopic Adrenalectomy for Pheochromocytoma. Randle RW1, Balentine CJ2, Pitt SC2, Schneider DF2, Sippel RS2. Ann Surg Oncol. 2017 Jan;24(1):244-250. doi: 10.1245/s10434-016-5514-7. Epub 2016 Aug 25. Abstract BACKGROUND: The optimal preoperative α-blockade strategy is debated for patients undergoing laparoscopic adrenalectomy for pheochromocytomas. We evaluated the impact of selective versus non-selective α-blockade on intraoperative hemodynamics and postoperative outcomes. METHODS: We identified patients having laparoscopic adrenalectomy for pheochromocytomas from 2001 to 2015. As a marker of overall intraoperative hemodynamics, we combined systolic blood pressure (SBP) > 200, SBP < 80, SBP < 80 and >200, pulse > 120, vasopressor infusion, and vasodilator infusion into a single variable. Similarly, the combination of vasopressor infusion in the post-anesthesia care unit (PACU) and the need for intensive care unit (ICU) admission provided an overview of postoperative support. RESULTS: We identified 52 patients undergoing unilateral laparoscopic adrenalectomy for pheochromocytoma. Selective α-blockade (i.e. doxazosin) was performed in 35 % (n = 18) of patients, and non-selective blockade with phenoxybenzamine was performed in 65 % (n = 34) of patients. Demographics and tumor characteristics were similar between groups. Patients blocked selectively were more likely to have an SBP < 80 (67 %) than those blocked with phenoxybenzamine (35 %) (p = 0.03), but we found no significant difference in overall intraoperative hemodynamics between patients blocked selectively and non-selectively (p = 0.09). However, postoperatively, patients blocked selectively were more likely to require additional support with vasopressor infusions in the PACU or ICU admission (p = 0.02). Hospital stay and complication rates were similar. CONCLUSION: Laparoscopic adrenalectomy for pheochromocytoma is safe regardless of the preoperative α-blockade strategy employed, but patients blocked selectively may have a higher incidence of transient hypotension during surgery and a greater need for postoperative support. These differences did not result in longer hospital stay or increased complications. PDF Manejo perioperatorio actual de los feocromocitomas Current perioperative management of pheochromocytomas. Ramachandran R1, Rewari V1. Indian J Urol. 2017 Jan-Mar;33(1):19-25. doi: 10.4103/0970-1591.194781. Abstract Neuroendocrine tumors which have the potential to secrete catecholamines are either associated with sympathetic adrenal (pheochromocytoma) or nonadrenal (paraganglioma) tissue. Surgical removal of these tumors is always indicated to cure and prevent cardiovascular and other organ system complications associated with catecholamine excess. Some of these tumors have malignant potential as well. The diagnosis, localization and anatomical delineation of these tumors involve measurement of catecholamines and their metabolic end products in plasma and urine, 123I-metaiodobenzylguanidine scintigraphy, computed tomography, and/or magnetic resonance imaging. Before surgical removal of the tumors, the optimization of blood pressure, as well as intravascular volume, is an important measure to avoid and suppress perioperative adverse hemodynamic events. Preoperative preparation includes the use of alpha-adrenergic antagonists, beta-adrenergic antagonists with or without other antihypertensive agents, fluid therapy as well as insulin therapy for hyperglycemia if required. Due attention should be given to type and dose of alpha-receptor antagonists to be used and the duration of this therapy to achieve an optimal level of preoperative "alpha-blockade." Despite this preoperative preparation, many patients will have hypertensive crises intraoperatively which need to be promptly and carefully managed by the anesthesia team which requires intensive and advanced monitoring techniques. The most common complication after tumor removal is hypotension which may require fluid therapy and vasopressor support for a few hours. With advancement in surgical and anesthetic techniques, the incidence of severe morbidity and mortality associated with the surgery is low in high volume centers. HTLM XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Anestesia, diabetes y corazon / Anesthesia, diabetes and hearth

Julio 10, 2017. No. 2745

Diabetes, isquemia perioperatoria y anestésicos volátiles: consecuencias de trastornos en el metabolismo del sustrato miocárdico. Diabetes, perioperative ischaemia and volatile anaesthetics: consequences of derangements in myocardial substrate metabolism. van den Brom CE1, Bulte CS, Loer SA, Bouwman RA, Boer C. Author information Cardiovasc Diabetol. 2013 Mar 4;12:42. doi: 10.1186/1475-2840-12-42. Abstract Volatile anaesthetics exert protective effects on the heart against perioperative ischaemic injury. However, there is growing evidence that these cardioprotective properties are reduced in case of type 2 diabetes mellitus. A strong predictor of postoperative cardiac function is myocardial substrate metabolism. In the type 2 diabetic heart, substrate metabolism is shifted from glucose utilisation to fatty acid oxidation, resulting in metabolic inflexibility and cardiac dysfunction. The ischaemic heart also loses its metabolic flexibility and can switch to glucose or fatty acid oxidation as its preferential state, which may deteriorate cardiac function even further in case of type 2 diabetes mellitus.Recent experimental studies suggest that the cardioprotective properties of volatile anaesthetics partly rely on changing myocardial substrate metabolism. Interventions that target at restoration of metabolic derangements, like lifestyle and pharmacological interventions, may therefore be an interesting candidate to reduce perioperative complications. This review will focus on the current knowledge regarding myocardial substrate metabolism during volatile anaesthesia in the obese and type 2 diabetic heart during perioperative ischaemia. PDF El preacondicionamiento inducido por isoflurano es atenuado por la diabetes. Isoflurane-induced preconditioning is attenuated by diabetes. Tanaka K1, Kehl F, Gu W, Krolikowski JG, Pagel PS, Warltier DC, Kersten JR. Am J Physiol Heart Circ Physiol. 2002 Jun;282(6):H2018-23. Abstract Volatile anesthetics stimulate, but hyperglycemia attenuates, the activity of mitochondrial ATP-regulated K(+) channels. We tested the hypothesis that diabetes mellitus interferes with isoflurane-induced preconditioning. Acutely instrumented, barbiturate-anesthetized dogs were randomly assigned to receive 0, 0.32, or 0.64% end-tidal concentrations of isoflurane in the absence or presence of diabetes (3 wk after administration of alloxan and streptozotocin) in six experimental groups. All dogs were subjected to a 60-min left anterior descending coronary artery occlusion followed by 3 h of reperfusion. Myocardial infarct size (triphenyltetrazolium staining) was 29 +/- 3% (n = 8) of the left ventricular area at risk in control experiments. Isoflurane reduced infarct size (15 +/- 2 and 13 +/- 1% during 0.32 and 0.64% concentrations; n = 8 and 7 dogs, respectively). Diabetes alone did not alter infarct size (30 +/- 3%; n = 8) but blocked the protective effects of 0.32% (27 +/- 2%; n = 7) and not 0.64% isoflurane (18 +/- 3%; n = 7). Infarct size was directly related to blood glucose concentrations in diabetic dogs, but this relationship was abolished by higher concentrations of isoflurane. The results indicate that blood glucose and end-tidal isoflurane concentrations are important determinants of infarct size during anesthetic-induced preconditioning. PDF  Anestésicos como cardioprotectores: traducibilidad y mecanismo. Anaesthetics as cardioprotectants: translatability and mechanism. Kikuchi C1, Dosenovic S, Bienengraeber M. Br J Pharmacol. 2015 Apr;172(8):2051-61. doi: 10.1111/bph.12981. Epub 2015 Jan 12. Abstract The pharmacological conditioning of the heart with anaesthetics, such as volatile anaesthetics or opioids, is a phenomenon whereby a transient exposure to an anaesthetic agent protects the heart from the harmful consequences of myocardial ischaemia and reperfusion injury. The cellular and molecular mechanisms of anaesthetic conditioning appear largely to mimic those of ischaemic pre- and post-conditioning. Progress has been made on the understanding of the underlying mechanisms although the order of events and the specific targets of anaesthetics that trigger protection are not always clear. In the laboratory, the protection afforded by certain anaesthetics against cardiac ischaemia and reperfusion injury is powerful and reproducible but this has not necessarily translated into similarly robust clinical benefits. Indeed, clinical studies and meta-analyses delivered variable results when comparing in the laboratory setting protective and non-protective anaesthetics. Reasons for this include underlying conditions such as age, obesity and diabetes. Animal models for disease or ageing, human cardiomyocytes derived from stem cells of patients and further clinical studies are employed to better understand the underlying causes that prevent a more robust protection in patients PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Encuentro Internacional de Manejo de la Vía Aérea Bariloche. Argentina. Nov 30-Dic 2, 20l7 Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org