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.

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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. PDF 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 PDF !Aún Puede Inscribirse al Congreso Virtual más Solicitado en Latinoamérica! XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo XXVII Congreso Peruano de Anestesiología Lima, Noviembre 2-4, 2017 Informes / Informataion

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

Obesidad / Obesity

Octubre 2, 2017. No. 2829

El papel del aumento del índice de masa corporal en la evolución de la sepsis. Una revisión sistemática y meta-análisis. The role of increased body mass index in outcomes of sepsis: a systematic review and meta-analysis. Wang S1,2, Liu X3, Chen Q4, Liu C1, Huang C5, Fang X6. Author information BMC Anesthesiol. 2017 Aug 31;17(1):118. doi: 10.1186/s12871-017-0405-4. Abstract BACKGROUND: The role of increased body mass index (BMI) in sepsis is controversial. We aimed to evaluate the associations between overweight (25 kg/m2 < BMI ≤ 29.9 kg/m2), obese (30 kg/m2 < BMI ≤ 39.9 kg/m2) and morbidly obese (BMI > 40 kg/m2) BMIs and outcomes in septic patients. METHODS: We searched the PubMed, Embase, Web of Science, Cochrane Library and ClinicalTrials.gov databases for studies published by December 1, 2016. Electronic database searches yielded 3713 articles, eight of which were included in this meta-analysis. Data were independently extracted by two reviewers, and a third reviewer participated in making decisions as needed. We used Review Manager to conduct the analysis, and the outcomes were reported with odds ratios (ORs) or mean differences (MDs). The primary outcome was mortality, and the secondary outcome was length of stay (LOS) in the intensive care unit (ICU) or the hospital. RESULTS: Data from eight studies involving a total of 9696 patients were pooled in our final analysis. Compared with patients with normal BMI (18.5 kg/m2 < BMI ≤ 24.9 kg/m2), patients with BMI ≥ 25 kg/m2 exhibited decreased mortality (OR 0.81; 95% confidence interval (CI), 0.74-0.89, P < 0.0001). In subgroup analysis, compared with normal-weight patients, overweight patients had lower mortality (OR 0.87; 95% CI 0.77-0.97, P = 0.02), whereas obese (OR 0.89, 95% CI 0.72-1.10, P = 0.29) and morbidly obese (OR 0.64, 95% CI 0.38-1.08, P = 0.09) patients did not exhibit significantly reduced mortality. CONCLUSIONS: In sepsis cases, overweight, but not obesity or morbid obesity, was associated with lower mortality. Further prospective studies are needed to clarify this relationship. KEYWORDS: Body mass index; Length of stay; Mortality; Obesity; Sepsis PDF Aumento del índice de masa corporal y la mortalidad ajustada en pacientes en UCI con sepsis o choque séptico: una revisión sistemática y meta-análisis. Increased body mass index and adjusted mortality in ICU patients with sepsis or septic shock: a systematic review and meta-analysis. Pepper DJ1, Sun J2, Welsh J3, Cui X2, Suffredini AF2, Eichacker PQ2. Author information Crit Care. 2016 Jun 15;20(1):181. doi: 10.1186/s13054-016-1360-z. Abstract BACKGROUND: At least 25 % of adults admitted to intensive care units (ICU) in the United States have an overweight, obese or morbidly obese body mass index (BMI). The effect of BMI on adjusted mortality in adults requiring ICU treatment for sepsis is unclear. We performed a systematic review of adjusted all-cause mortality for underweight, overweight, obese and morbidly obese BMIs relative to normal BMI for adults admitted to the ICU with sepsis, severe sepsis, and septic shock.  CONCLUSIONS: This is the first meta-analysis to show that overweight or obese BMIs reduce adjusted mortality in adults admitted to the ICU with sepsis, severe sepsis, or septic shock. More rigorous studies that address these limitations are needed to clarify the impact of BMI on sepsis ICU outcomes. KEYWORDS: Body mass index; Meta-analysis; Mortality; Obesity; Overweight; Sepsis PDF Obesidad simple y función renal. Simple obesity and renal function. Sikorska D1,2, Grzymislawska M3, Roszak M4,5, Gulbicka P6, Korybalska K4, Witowski J4. Author information J Physiol Pharmacol. 2017 Apr;68(2):175-180. Abstract Increasing evidence accumulate to suggest that obesity increases the risk of chronic kidney disease independently of dyslipidemia, diabetes, and hypertension. This so-called obesity-related glomerulopathy is characterized at early stages by glomerular hypertrophy with or without secondary focal segmental glomerulosclerosis. Since, however, kidney biopsies are usually not performed at this phase, an early diagnosis of the disease is often difficult. Here, we review new developments in the pathophysiology of obesity-associated kidney dysfunction and discuss the potential of appropriate monitoring of glomerular filtration rate and albuminuria for early detection of the disease. We also present the benefits conferred by even moderate dietary restriction on the course of the disease. PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo XXVII Congreso Peruano de Anestesiología Lima, Noviembre 2-4, 2017 Informes / Informataion

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

Surgical Skills Cuso de Hombro en espécimen biológico Lab

http://www.artroscopiayreemplazos.com.mx/academia/surgical-skills-cuso-de-hombro-cadaver-lab/
13 y 14 de octubre de 2017
Informes: 5526253111

#hombro#artroscopia#artroscopiadehombro#espécimen biológico

Origen y Tratamiento del Pie Equinovaro (Pie Zambo)

http://www.ortopediainfantil.com.mx/academia/origen-y-tratamiento-del-pie-equinovaro-pie-zambo/

Entrevista al aire para el lunes 02 de octubre del 2017 a las 10:00 horas por TV Canal 21.2 ‘El Canal de la Asamblea Legislativa’ con la conducción de Pita Ojeda quien hablará sobre el tema de “Origen y Tratamiento del Pie Equinovaro (Pie Zambo)” con la participación del Dr. Juan Agustín Valcarce León, Médico Ortopedista Pediatra adscrito al Servicio de Pie y Tobillo en el Hospital de Ortopedia “Dr. Victorio de la Fuente Narváez”. La cita es en Av. Insurgentes Sur No. 1605, Col. San José Insurgentes, décimo piso de la Torre MURAL. (Junto al Teatro de los Insurgentes).

#pie equinovaro#pie zambo