Opioides / Opioids

Diciembre 26,  2016. No. 2550

Documento de posición de la Federación Europea del Dolor sobre el uso apropiado de opiáceos en el tratamiento del dolor crónico. European Pain Federation position paper on appropriate opioid use in chronic pain management. O'Brien T1,2, Christrup LL3, Drewes AM4, Fallon MT5, Kress HG6, McQuay HJ7, Mikus G8, Morlion BJ9, Perez-Cajaraville J10, Pogatzki-Zahn E11, Varrassi G12, Wells JC13. Eur J Pain. 2017 Jan;21(1):3-19. doi: 10.1002/ejp.970. Abstract Poorly controlled pain is a global public health issue. The personal, familial and societal costs are immeasurable. Only a minority of European patients have access to a comprehensive specialist pain clinic. More commonly the responsibility for chronic painmanagement and initiating opioid therapy rests with the primary care physician and other non-specialist opioid prescribers. There is much confusing and conflicting information available to non-specialist prescribers regarding opioid therapy and a great deal of unjustified fear is generated. Opioid therapy should only be initiated by competent clinicians as part of a multi-faceted treatment programme in circumstances where more simple measures have failed. Throughout, all patients must be kept under close clinical surveillance. As with any other medical therapy, if the treatment fails to yield the desired results and/or the patient is additionally burdened by an unacceptable level of adverse effects, the overall management strategy must be reviewed and revised. No responsible clinician will wish to pursue a failed treatment strategy or persist with an ineffective and burdensome treatment. In a considered attempt to empower and inform non-specialist opioid prescribers, EFIC convened a European group of experts, drawn from a diverse range of basic science and relevant clinical disciplines, to prepare a position paper on appropriate opioid use in chronicpain. The expert panel reviewed the available literature and harnessed the experience of many years of clinical practice to produce these series of recommendations. Its success will be judged on the extent to which it contributes to an improved pain management experience for chronic pain patients across Europe. SIGNIFICANCE: This position paper provides expert recommendations for primary care physicians and other non- specialist healthcare professionals in Europe, particularly those who do not have ready access to specialists in pain medicine, on the safe and appropriate use of opioid medications as part of a multi-faceted approach to pain management, in properly selected and supervised patients. PDF Las bases farmacológicas de los opioides The pharmacological basis of opioids. Ghelardini C1, Di Cesare Mannelli L1, Bianchi E2. Clin Cases Miner Bone Metab. 2015 Sep-Dec;12(3):219-21. Abstract An opioid is a chemical that binds to opioid receptors, which are widely distributed in the central and peripheral nervous system and gastrointestinal tract. The different effects elicited by activation of these receptors are due to their specific neuronal and extraneuronal distribution. The painkiller effect of opioids is induced by the synergy of the two events, namely reduction of pain threshold and emotional detachment from pain. The opioid effects transcending analgesia include sedation, respiratory depression, constipation and a strong sense of euphoria. There are opioid-like substances endogenously produced by the body. Naturally occurring peptides, called enkephalins, have opioid-like activities but are not derived from opium and exert opioid-like effects by interacting with opioid receptors on cell membranes. Yet, animals do contain the same morphine precursors and metabolites as opium poppy and are able to synthesize endogenous morphine alkaloid. Experimental and clinical studies show that opioids, at doses comparable to those of endogenous opioids, can activate pronociceptive systems, leading to pain hypersensitivity and short-term tolerance, a phenomenon encountered in postoperative pain management by acute opioid administration. Whether endogenous opioids play a role in the acute pain necessary to the survival of the individual, remains an open question. KEYWORDS: analgesia; morphine; opioids; pain PDF 5to Curso Internacional de Anestesiología cardiotorácica, vascular, ecocardiografía y circulación extracorpórea. SMACT Mayo 4-6, 2017, Mexicali, México Informes Dr. Hugo Martínez Espinoza bajamed@hotmail.com Regional Anesthesiology and Acute Pain Medicine Meeting April 6-8, 2017, San Francisco, California, USA ASRA American Society of Regional Anesthesia and Pain Medicine Información / Information California Society of Anesthesiologists Annual Meeting April 27-30, 2017 San Francisco California Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

IMSS Puebla logra el mayor número de trasplantes en el país durante 2016

IMSS Puebla logra el mayor número de trasplantes en el país durante 2016

Rehabilitación post-aguda después del reemplazo total de rodilla: Un ensayo clínico multicéntrico aleatorizado que compara los resultados a largo plazo

Rehabilitación post-aguda después del reemplazo total de rodilla: Un ensayo clínico multicéntrico aleatorizado que compara los resultados a largo plazo

Publicada en diciembre 21, 2016 por admin

Post-acute rehabilitation after total knee replacement: A multicentre randomized clinical trial comparing long-term outcomes

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/27868384

http://onlinelibrary.wiley.com/doi/10.1002/acr.23117/abstract;jsessionid=B8FE860D90647DBD5B4ECAAC83682073.f02t01



De:

Fransen M, Nairn L, Bridgett L, Crosbie J, March L, Parker Mbbs D, Crawford R, Harmer AR

Arthritis Care Res (Hoboken). 2016 Nov 21. doi: 10.1002/acr.23117. [Epub ahead of print]



Todos los derechos reservados para:



© 2016, American College of Rheumatology.





Abstract

OBJECTIVE:

To evaluate the long-term benefit of providing a post-acute outpatient group exercise program for patients following primary total knee replacement (TKR) surgery for osteoarthritis.

CONCLUSIONS:

Providing access to a post-acute group exercise program did not result in greater reductions in long-term knee pain or activity limitations than usual care. Patients undergoing primary TKR retain marked physical performance deficits 12 months after surgery. This article is protected by copyright. All rights reserved.

Resumen
OBJETIVO:
Evaluar el beneficio a largo plazo de proporcionar un programa de ejercicio de grupo ambulatorio post-agudo para pacientes después de la cirugía de reemplazo total de rodilla (TKR) primaria para la osteoartritis.
CONCLUSIONES:
Proporcionar acceso a un programa de ejercicios de grupo post-agudo no resultó en mayores reducciones en el dolor a largo plazo de rodilla o limitaciones de actividad que la atención habitual. Los pacientes sometidos a TKR primaria mantienen déficit de rendimiento físico marcado 12 meses después de la cirugía. Este artículo está protegido por derechos de autor. Todos los derechos reservados

Cómo prevenir las lesiones más frecuentes del ciclismo

Cómo prevenir las lesiones más frecuentes del ciclismo

Lesiones del ligamento cruzado anterior alteran la cinemática de rodillas con o sin deficiencia meniscal

Lesiones del ligamento cruzado anterior alteran la cinemática de rodillas con o sin deficiencia meniscal

Categorías:

academia

(Editar Entrada)

Por admin

Anterior Cruciate Ligament Injuries Alter the Kinematics of Knees With or Without Meniscal Deficiency

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/27511793

http://journals.sagepub.com/doi/full/10.1177/0363546516658026

De:



Zhang Y^1,2, Huang W^3,2, Yao Z^3,2, Ma L³, Lin Z³, Wang S⁴, Huang H³

Am J Sports Med. 2016 Dec;44(12):3132-3139. Epub 2016 Aug 10



Todos los derechos reservados para:

© 2016 The Author(s).

Abstract

BACKGROUND:

Numerous studies have investigated kinematic alterations in patients with an isolated anterior cruciate ligament (ACL) injury. However, a substantial proportion of patients with injured ACLs also have concomitant meniscal tears.

PURPOSE:

To evaluate the in vivo alteration of knee kinematics after an ACL tear, with or without a combined medial or lateral meniscal tear, during level walking activity.

CONCLUSION:

The results indicate that meniscal injuries alter the kinematics of the ACLD knee when compared with knees with an isolated ACL injury. The location of the meniscal tear also affects knee kinematics.

CLINICAL RELEVANCE:

Considering the varying effects of meniscal injuries on knee joint kinematics, these data provide insight into the pathological function of the ACL-injured knee joint during walking.

© 2016 The Author(s).

KEYWORDS:

6 DOF; combined deficiency; kinematic alteration; knee injury

Conducto lumbar estrecho ¿Como esta clasificado?

Conducto lumbar estrecho ¿Como esta clasificado?

http://www.columnayortopedia.com.mx/academia/conducto-lumbar-estrecho-como-esta-clasificado/

Lumbar Spinal Stenosis: How Is It Classified?

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/27849674

http://sso.aaos.org/login.aspx?vi=8&vt=3ac8020bdc4830d70ecd3616884ec59fc352f3b3e5210a2b771e8a4aaac4bb790bf34cbf60caad7416050b34b12f1325af4188fd1f2bdc72a91a9d64ebf0911642621661ebedee044a1b27c31767ea1c2a2921ed74c22d83cfc1d97cbd234e8bbe16eb10e9e757e06823c0bbe1549e50a191f3a2b8b045f008f684dbcd7a22e7a27bbeba0c55f6e3cf5bf9006959cb6d6d164123269c31771a1c6331ce84eb661305db3fa9dab5c1b1c4163c6728ae4545627d9a31f011e788abedd38963d27fbbe4a2f4513e60dcfb1dcbcc22cbd069

http://journals.lww.com/jaaos/pages/articleviewer.aspx?year=2016&issue=12000&article=00003&type=abstract

De:

Schroeder GD¹, Kurd MF, Vaccaro AR.

J Am Acad Orthop Surg. 2016 Dec;24(12):843-852

Todos los derechos reservados para:

© 1995-2016 by the American Academy of Orthopaedic Surgeons. “All Rights Reserved.”

Abstract

The prevalence of lumbar spinal stenosis is approximately 9.3%, with people most commonly affected in the sixth or seventh decade of life. Patients often have pain, cramping, and weakness in their legs that is worsened with standing and walking. Although the Spine Patient Outcomes Research Trial clearly demonstrated that surgery improves health-related quality of life, treatment for lumbar spinal stenosis varies widely from the type of decompression performed to the need for fusion. This variability can be attributed largely to the lack of an accepted classification system. A good classification system serves as a common language to define the severity of a condition, guide treatment, and facilitate clinical research.

Resumen

La prevalencia de estenosis espinal lumbar es de aproximadamente el 9,3%, con las personas más afectadas en la sexta o séptima década de vida. Los pacientes a menudo tienen dolor, cólicos y debilidad en sus piernas que se agrava con pie y caminar. Aunque el ensayo de investigación de resultados de pacientes con columna vertebral demostró claramente que la cirugía mejora la calidad de vida relacionada con la salud, el tratamiento para la estenosis espinal lumbar varía ampliamente desde el tipo de descompresión realizada hasta la necesidad de fusión. Esta variabilidad puede atribuirse en gran parte a la falta de un sistema de clasificación aceptado. Un buen sistema de clasificación sirve como un lenguaje común para definir la gravedad de una condición, guiar el tratamiento y facilitar la investigación clínica

PMID: 27849674 DOI:

10.5435/JAAOS-D-15-00034

[PubMed – in process]

Fuente:columnayortopedia.com.mx

#conductolumbarestrecho#estenosis

Cirugía plástica / Plastic surgery

Diciembre 21,  2016. No. 2545

Contorno del cuerpo y escultura Body Contouring and Sculpting Edited by Nikolay P. Serdev, ISBN 978-953-51-2830-4, Print ISBN 978-953-51-2829-8, 234 pages, Publisher: InTech, Chapters published December 14, 2016 under CC BY 3.0 license DOI: 10.5772/62515 Edited Volume Over the past decades, surgical techniques have greatly progressed to improve and correct appearance. They are artistic procedures to give the highly demanded proportions. The growing public interest in aesthetic and plastic surgery interventions such as body contouring and sculpting requires clear description and differentiation of these highly sophisticated techniques, their results and combinations, as well as scientific information about the different instrumentation, devices and materials used. Such clarification will be hugely beneficial both for patients and doctors, having in mind the increasing number of such interventions and progressing interest for a better and healthy living including improved appearance in society. The book adds some scientific news to the understanding of body contouring treatments. Currently, the request for atraumatic, short downtime procedures predominates and demonstrates the importance of hi-tech and safe liposculpture and fat transfer, although they cannot totally replace surgical excision methods. Libro / Book El papel de los cirujanos plásticos en el avance del desarrollo global The Role of Plastic Surgeons in Advancing Development Global. Broer PN1, Jenny HE2, Ng-Kamstra JS3, Juran S4. World J Plast Surg. 2016 May;5(2):109-13. Abstract In September 2015, the international community came together to agree on the 2030 Agenda for Sustainable Development, a plan of action for people, the planet, and prosperity. Ambitious and far-reaching as they are, they are built on three keystones: the elimination of extreme poverty, fighting climate change, and a commitment to fighting injustice and inequality. Critical to the achievement of the Agenda is the global realization of access to safe, affordable surgical and anesthesia care when needed. The landmark report by the Lancet Commission on Global Surgery estimated that between 28 and 32 percent of the global burden of disease is amenable to surgical treatment. However, as many as five billion people lack access to safe, timely, and affordable surgical care, a burden felt most severely in low- and middle-income countries (LMICs). Surgery, and specifically plastic surgery, should be incorporated into the international development and humanitarian agenda. As a community of care providers dedicated to the restoration of the form and function of the human body, plastics surgeons have a collective opportunity to contribute to global development, making the world more equitable and helping to reduce extreme poverty. As surgical disease comprises a significant burden of disease and surgery can be delivered in a cost-effective manner, surgery must be considered a public health priority. KEYWORDS: Capacity development; Global burden of disease; Global surgery; Plastic surgery; Sustainable development PDF Revisión de 2975 cirugías consecutivas por un cirujano en un centro quirúrgico ambulatorio acreditado. Experiencia canadiense A review of 2975 consecutive operations by one surgeon in an accredited outpatient plastic surgicentre: A Canadian experience. Chasmar LR1. Can J Plast Surg. 2005 Winter;13(4):188-90. Abstract The present paper constitutes a retrospective review of 2975 consecutive operations performed by the author, one of the three owners of the Saskatoon Plastic Surgicentre. The unit opened in 1987; therefore, the study spans 17 years. Patients are not kept overnight, and the Surgicentre is approved and equipped as a level C facility for general anesthesia. Only patients who score 1 or 2 according to the American Association of Anesthesiologists are treated. Only certified anesthesiologists are used. Of the patients with postoperative complications, only two required transfer to a hospital. One developed a pneumothorax, which was treated on arrival at the intensive care unit with no sequelae. The other collapsed following facelift surgery. She was transferred to University of Saskatchewan hospital and died later that evening with a massive pulmonary embolus. In a properly established outpatient centre, a large number of patients can be safely treated with very few complications. However, despite placing patient safety as the first consideration and adhering strictly to the highest standards, death can occur. KEYWORDS: Ambulatory surgery; Retrospective review; Surgical complications PDF Regional Anesthesiology and Acute Pain Medicine Meeting April 6-8, 2017, San Francisco, California, USA ASRA American Society of Regional Anesthesia and Pain Medicine Información / Information California Society of Anesthesiologists Annual Meeting April 27-30, 2017 San Francisco California Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015