lunes, 2 de octubre de 2017

La introducción del ultrasonido universal para la displasia del desarrollo de la cadera duplicó la tasa de tratamiento.

http://www.ortopediapediatricaisunza.com.mx/academia/la-introduccion-del-ultrasonido-universal-para-la-displasia-del-desarrollo-de-la-cadera-duplico-la-tasa-de-tratamiento/

Introducing universal ultrasound screening for developmental dysplasia of the hip doubled the treatment rate.

Fuente

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28871598

http://onlinelibrary.wiley.com/doi/10.1111/apa.14057/abstract?systemMessage=Wiley+Online+Library+will+be+unavailable+on+Saturday+7th+Oct+from+03.00+EDT+%2F+08%3A00+BST+%2F+12%3A30+IST+%2F+15.00+SGT+to+08.00+EDT+%2F+13.00+BST+%2F+17%3A30+IST+%2F+20.00+SGT+and+Sunday+8th+Oct+from+03.00+EDT+%2F+08%3A00+BST+%2F+12%3A30+IST+%2F+15.00+SGT+to+06.00+EDT+%2F+11.00+BST+%2F+15%3A30+IST+%2F+18.00+SGT+for+essential+maintenance.+Apologies+for+the+inconvenience+caused+.

De:

Olsen SF1,Blom HC2,Rosendahl K3,4.

Acta Paediatr.

2017 Sep 4. doi: 10.1111/apa.14057. [Epub ahead of print]

Abstract

AIM:

There is no evidence on the effect of universal ultrasound screening on developmental dysplasia of the hip. We examined the impact of adding an ultrasound examination to a one examiner clinical screening strategy on treatment, follow-up rates and the number of cases detected late in a low-prevalence population.

CONCLUSION:

Adding universal ultrasound to clinical screening performed by the same, experienced paediatrician doubled the treatment rate, without influencing the already low numbers of late cases. This article is protected by copyright. All rights reserved.

KEYWORDS:

Developmental dysplasia of the hip; Frejka pillow; late cases; neonatal screening; ultrasound screening

Resumen

OBJETIVO:
No hay evidencia sobre el efecto de la ecografía universal en la displasia del desarrollo de la cadera. Se examinó el impacto de la adición de un examen de ultrasonido a una estrategia de cribado clínico de un examinador sobre el tratamiento, las tasas de seguimiento y el número de casos detectados tarde en una población de baja prevalencia.

CONCLUSIÓN:
La adición de ultrasonido universal a la exploración clínica realizada por el mismo pediatra experimentado duplicó la tasa de tratamiento, sin influir en el ya bajo número de casos tardíos. Este artículo está protegido por derechos de autor.

PALABRAS CLAVE:
Displasia del desarrollo de la cadera; Frejka almohada; casos tardíos; rastreo neonatal; ultrasonido

PMID: 28871598 DOI:

10.1111/apa.14057

#displasia del desarrollo de la cadera #casos tardíos #rastreo neonatal #ultrasonido

Medwave edición septiembre-octubre 2017

Medwave edición septiembre-octubre 2017

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Síndrome del Túnel Cubital: Conceptos Actuales

http://www.clinicademano.com.mx/academia/sindrome-del-tunel-cubital-conceptos-actuales/

Cubital Tunnel Syndrome: Current Concepts

Fuente

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/?term=Cubital+Tunnel+Syndrome%3A+Current+Concepts

https://insights.ovid.com/crossref?an=00124635-201710000-00010

http://journals.lww.com/jaaos/Abstract/2017/10000/Cubital_Tunnel_Syndrome___Current_Concepts.10.aspx

De:

Staples JR1,Calfee R.

J Am Acad Orthop Surg.

2017 Oct;25(10):e215-e224. doi: 10.5435/JAAOS-D-15-00261.

Copyright © 2017 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

Cubital tunnel syndrome is the second most common upper extremity compressive neuropathy. In recent years, rates of surgical treatment have increased, and the popularity of in situ decompression has grown. Nonsurgical treatment, aiming to decrease both compression and traction on the ulnar nerve about the elbow, is successful in most patients with mild nerve dysfunction. Recent randomized controlled trials assessing rates of symptom resolution and ultimate success have failed to identify a preferred surgical procedure. Revision cubital tunnel surgery, most often consisting of submuscular transposition, may improve symptoms. However, ulnar nerve recovery after revision cubital tunnel surgery is less consistent than that after primary cubital tunnel surgery.

Resumen
El síndrome del túnel cubital es la segunda neuropatía compresiva de extremidad superior más común. En los últimos años, las tasas de tratamiento quirúrgico han aumentado, y la popularidad de la descompresión in situ ha crecido. El tratamiento no quirúrgico, con el objetivo de disminuir tanto la compresión y la tracción en el nervio cubital sobre el codo, tiene éxito en la mayoría de los pacientes con disfunción nerviosa leve. Ensayos controlados aleatorios recientes que evalúan las tasas de resolución de los síntomas y el éxito final no han podido identificar un procedimiento quirúrgico preferido. La cirugía de revisión del túnel cubital , la mayoría del tiempo que consiste en la transposición submuscular, puede mejorar síntomas. Sin embargo, la recuperación del nervio cubital después de la cirugía de revisión del túnel cubital es menos coherente que después de la cirugía del túnel cubital primario.

PMID: 28953087 DOI:

10.5435/JAAOS-D-15-00261

#síndrome del túnel cubital #neuropatía compresiva #nervio cubital

Analgesia para mamas / Breast analgesia

Octubre 1, 2017. No. 2828

Analgesia perioperatoria de mamas: Una revisión cualitativa de la anatomía y técnicas regionales.

Perioperative Breast Analgesia: A Qualitative Review of Anatomy and Regional Techniques.

Woodworth GE1, Ivie RMJ, Nelson SM, Walker CM, Maniker RB.

Author information

Reg Anesth Pain Med. 2017 Sep/Oct;42(5):609-631. doi: 10.1097/AAP.0000000000000641.

Abstract

Breast surgery is exceedingly common and may result in significant acute as well as chronic pain. Numerous options exist for the control of perioperative breast pain, including several newly described regional anesthesia techniques, but anesthesiologists have an insufficient understanding of the anatomy of the breast, the anatomic structures disrupted by the various breast surgeries, and the theoretical and experimental evidence supporting the use of the various analgesic options. In this article, we review the anatomy of the breast, common breast surgeries and their potential anatomic sources of pain, and analgesic techniques for managing perioperative pain. We performed a systematic review of the evidence for these analgesic techniques, including intercostal block, epidural administration, paravertebral block, brachial plexus block, and novel peripheral nerve blocks.

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Bloqueo paravertebral en el manejo del dolor agudo postoperatorio y de la neuralgia intercostal en cirugía mayor de mama

Paravertebral block for management of acute postoperative pain and intercostobrachial neuralgia in major breast surgery.

Gacio MF1, Lousame AM2, Pereira S3, Castro C4, Santos J5.

Author information

Braz J Anesthesiol. 2016 Sep-Oct;66(5):475-84. doi: 10.1016/j.bjane.2015.02.007. Epub 2016 Jul 14.

Abstract

BACKGROUND: Several locoregional techniques have been described for the management of acute and chronic pain after breast surgery. The optimal technique should be easy to perform, reproducible, with little discomfort to the patient, little complications, allowing good control of acute pain and a decreased incidence of chronic pain, namely intercostobrachial neuralgia for being the most frequent entity. OBJECTIVES: The aim of this study was to evaluate the paravertebral block with preoperative single needle prick for major breast surgery and assess initially the control of postoperative nausea and vomiting (PONV) and acute pain in the first 24h and secondly the incidence of neuropathic pain in the intercostobrachial nerve region six months after surgery. METHODS: The study included 80 female patients, ASA I-II, aged 18-70 years, undergoing major breast surgery, under general anesthesia, stratified into 2 groups: general anesthesia (inhalation anesthesia with opioids, according to hemodynamic response) and paravertebral (paravertebral block with single needle prick in T4 with 0.5% ropivacaine+adrenaline 3μgmL(-1) with a volume of 0.3mLkg(-1) preoperatively and subsequent induction and maintenance with general inhalational anesthesia). In the early postoperative period, patient-controlled analgesia (PCA) was placed with morphine set for bolus on demand for 24h. Intraoperative fentanyl, postoperative morphine consumption, technique-related complications, pain at rest and during movement were recorded at 0h, 1h, 6h and 24h, as well as episodes of PONV. All variables identified as factors contributing to pain chronicity age, type of surgery, anxiety according to the Hospital Anxiety and Depression Scale (HADS), preoperative pain, monitoring at home; body mass index (BMI) and adjuvant chemotherapy/radiation therapy were analyzed, checking the homogeneity of the samples. Six months after surgery, the incidence of neuropathic pain in the intercostobrachial nerve was assessed using the DN4 scale. RESULTS: The Visual Analog Scale (VAS) values of paravertebral group at rest were lower throughout the 24h of study 0h 1.90 (±2.59) versus 0.88 (±1.5) 1h 2.23 (±2.2) versus 1.53 (±1.8) 6h 1.15 (±1.3) versus 0.35 (±0.8); 24h 0.55 (±0.9) versus 0.25 (±0.8) with statistical significance at 0h and 6h. Regarding movement, paravertebral group had VAS values lower and statistically significant in all four time points: 0h 2.95 (±3.1) versus 1.55 (±2.1); 1h 3.90 (±2.7) versus 2.43 (±1.9) 6h 2.75 (±2.2) versus 1.68 (±1.5); 24h 2.43 (±2.4) versus 1.00 (±1.4). The paravertebral group consumed less postoperative fentanyl (2.38±0.81μgkg(-1) versus 3.51±0.81μgkg(-1)) and morphine (3.5mg±3.4 versus 7mg±6.4) with statistically significant difference. Chronic pain evaluation of at 6 months of paravertebral group found fewer cases of neuropathic pain in the intercostobrachial nerve region (3 cases versus 7 cases), although not statistically significant. CONCLUSIONS: Single-injection paravertebral block allows proper control of acute pain with less intraoperative and postoperative consumption of opioids but apparently it cannot prevent pain chronicity. Further studies are needed to clarify the role of paravertebral block in pain chronicity in major breast surgery.

KEYWORDS: Acute pain; Bloqueio paravertebral; Cirurgia de mama; DN4; Dor aguda; Dor neuropática; Intercostal nerve; Major breast surgery; Nervo intercostobraquial; Neuropathic pain; Paravertebral block

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