Cirugia trans nasal-transesfenoidal / Transnasal transsphenoidal surgery

Julio 26, 2017. No. 2761

Cambios en los resultados funcionales en la cirugía de adenomas hipofisarios después de la ocurrencia intraoperatoria del reflejo trigeminocárdico: primera descripción en un estudio observacional retrospectivo. Functional Outcome Changes in Surgery for Pituitary Adenomas After Intraoperative Occurrence of the Trigeminocardiac Reflex: First Description in a Retrospective Observational Study. Chowdhury T1, Nöthen C, Filis A, Sandu N, Buchfelder M, Schaller B. Medicine (Baltimore). 2015 Sep;94(37):e1463. doi: 10.1097/MD.0000000000001463. Abstract Trigeminocardiac reflex (TCR) represents now a nearly ubiquitary phenomenon in skull base surgery. Functional relevance of the intrainterventional TCR occurrence is hitherto only proven for vestibular schwannoma.  It is presented, for the first time, an impact of TCR on the functional hormonal outcome after pituitary surgery and strongly underline again the importance of the TCR in clinical daily practice. As a consequence, TCR should be considered as a negative prognostic factor of hormonal normalization after surgery for pituitary adenomas that should be included into routine practice. PDF Efectos de la dexmedetomidina y el sulfato de magnesio en adultos sometidos a endoscópica transnasal transsfenoidal para resección de adenoma hipofisario: Un estudio aleatorizado doble ciego. The effects of dexmedetomidine and magnesium sulphate in adult patients undergoing endoscopic transnasal transsphenoidal resection of pituitary adenoma: A double-blind randomised study. Soliman R1, Fouad E1. Indian J Anaesth. 2017 May;61(5):410-417. doi: 10.4103/ija.IJA_581_16. Abstract BACKGROUND AND AIM: Transnasal transsphenoidal resection of pituitary tumours is associated with blood loss and wide fluctuations in haemodynamic parameters. The aim of the present study was to compare the effect of dexmedetomidine and magnesium sulphate during the transsphenoidal resection of pituitary tumours. METHODS: The study was a double-blind, randomised study and included 152 patients classified randomly into two groups: Group D: Dexmedetomidine was given as a loading dose 1 μg/kg over 10 min before induction followed by an infusion at 0.5 μg/kg/h during the surgery. Group M: Magnesium sulphate was given as loading dose of 50 mg/kg over 10 min followed by an infusion at 15 mg/kg/h during the surgery. The systolic, diastolic and mean arterial blood pressures, in addition to the amount of blood loss were measured at specific timepoints. Data were described in terms of mean ± standard deviation, median, frequencies, 95% confidence of interval of mean and percentages. RESULTS: Mean bleeding score was lower in Group D than Group M (1.36 ± 0.48 vs. 3.05 ± 0.65, respectively; P = 0.002). Mean blood loss was lower in Group D (157.43 ± 48.79 ml vs.299.47 ± 77.28 ml in Group M; P < 0.001)Heart rate, mean arterial pressure, fentanyl requirements, end-tidal sevoflurane concentration, and extubation and emergence times were lower, while incidence of bradycardia and hypotension were higher in Group D. CONCLUSIONS: During transsphenoidal pituitary resection, dexmedetomidine, compared to magnesium, is associated with lower blood loss and better operating conditions but with more hypotension and bradycardia. KEYWORDS: Dexmedetomidine; magnesium sulphate; pituitary adenoma; transsphenoidal resection PDF Efecto de la infiltración intramucosa de diferentes concentraciones de adrenalina en la hemodinámica durante la cirugía transesfenoidal. Effect of intramucosal infiltration of different concentrations of adrenaline on hemodynamics during transsphenoidal surgery. Bhatia N1, Ghai B1, Mangal K1, Wig J1, Mukherjee KK2. J Anaesthesiol Clin Pharmacol. 2014 Oct;30(4):520-5. doi: 10.4103/0970-9185.142848. Abstract BACKGROUND AND AIMS: Neurosurgeons routinely instill vasopressors, with or without local anesthetics, to prepare nasal passages prior to transsphenoidal surgeries. As there is a paucity of data comparing the effect of intramucosal nasal infiltration of different concentrations of adrenaline that is, 1:200,000 and 1:400,000 in patients undergoing transsphenoidal surgery, we conducted this study to evaluate the effect of these two concentrations of adrenaline with 2% lignocaine on hemodynamics as well as bleeding. MATERIALS AND METHODS: Fifty-two American Society of Anesthesiologists I/II patients, aged 15-70 years, undergoing transsphenoidalsurgery for pituitary or sellar masses were enrolled. Prior to surgical incision, nasal septal mucosa was infiltrated with lignocaine-adrenaline solution, after randomly allocating them to one of the two groups, with patients in Group A receiving intramucosal infiltration using 2% lignocaine with 1:200,000 adrenaline and those in Group B receiving 2% lignocaine with 1:400,000 adrenaline. Following infiltration, hemodynamic parameters were recorded every 1 min for 5 min and thereafter at every 5 min interval. RESULTS: Fewer patients (3/24 [12.5%]) in Group B had a rise of >50% in systolic blood pressure, from baseline values, after nasal mucosa infiltration as compared with patients in Group A (9/24 [37.5%]). In addition, mean rise in systolic, diastolic and mean arterial pressure was also significantly lower in Group B as compared with Group A. CONCLUSION: Adrenaline in a concentration of 1:400,000 added to 2% lignocaine for nasal mucosa infiltration produces less hemodynamic response as compared with adrenaline 1:200,000 added to 2% lignocaine while at the same time providing similar operating conditions. KEYWORDS: Hemodynamic effects; intramucosal infiltration; lignocaine-adrenaline infiltration; transsphenoidal surgery PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information California Society of Anesthesiologists Reuniones / Events Informacion / Information

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

Angulo BIO-RSA (incremento óseo-artroplastia reversa de hombro compensada) : Una solución para el manejo de la perdida ósea glenoidea y la erosión

http://www.lesionesdeportivas.com.mx/academia/angulo-bio-rsa-incremento-oseo-artroplastia-reversa-de-hombro-compensada-una-solucion-para-el-manejo-de-la-perdida-osea-glenoidea-y-la-erosion/

Angled BIO-RSA (bony-increased offset-reverse shoulder arthroplasty): a solution for the management glenoid bone loss and erosion

Fuente:

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28735842

http://www.jshoulderelbow.org/article/S1058-2746(17)30310-5/fulltext

De:

Boileau P1,Morin-Salvo N2,Gauci MO2,Seeto BL2,Chalmers PN3,Holzer N4,

Walch G5.

J Shoulder Elbow Surg. 2017 Jul 20. pii: S1058-2746(17)30310-5. doi: 10.1016/j.jse.2017.05.024. [Epub ahead of print]

Todos los derechos reservados para:

Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Abstract

BACKGROUND:

Glenoid deficiency and erosion (excessive retroversion/inclination) must be corrected in reverse shoulder arthroplasty (RSA) to avoid prosthetic notching or instability and to maximize function, range of motion, and prosthesis longevity. This study reports the results of RSA with an angled, autologous glenoid graft harvested from the humerus (angled BIO-RSA).

CONCLUSION:

Angled BIO-RSA predictably corrects glenoid deficiency, including severe (>25°) multiplanar deformity. Graft incorporation is predictable. Advantages of using an autograftharvested in situ include bone stock augmentation, lateralization, low donor-site morbidity, low relative cost, and flexibility needed to simultaneously correct posterior and superior glenoid defects.

Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Glenoid bone loss; bony lateralization; bony-increased offset reverse shoulder arthroplasty (BIO-RSA); glenoid erosion; glenoid inclination; glenoid retroversion; reverse total shoulder arthroplasty

Resumen

ANTECEDENTES:

La deficiencia glenoidea y la erosión (retroversión / inclinación excesiva) deben ser corregidas en la artroplastia reversa del hombro (RSA) para evitar la muesca protésica o inestabilidad y para maximizar la función, el rango de movimiento y la longevidad de la prótesis. Este estudio reporta los resultados de RSA con angulación con un injerto glenoideo, autólogo, recolectado del húmero (angulado BIO-RSA).

CONCLUSIÓN:
La BIO-RSA angulada corrige de forma predecible la deficiencia glenoide, incluyendo una deformidad multiplanar severa (> 25 °). La incorporación del injerto es predecible. Las ventajas de usar un autoinjerto in situ incluyen aumento de la masa ósea, lateralización, baja morbilidad del donante, bajo costo relativo y flexibilidad necesaria para corregir simultáneamente los defectos glenoides posteriores y superiores.

Copyright © 2017 Los Autores. Publicado por Elsevier Inc. Todos los derechos reservados.

PALABRAS CLAVE:
Pérdida ósea glenoidea; Lateralización ósea; incremento óseo-artroplastia reversa de hombro compensada(BIO-RSA); Erosión glenoide; Inclinación glenoide; Retroceso glenoideo; Artroplastia total del hombro reversa

PMID:  28735842   DOI:  

10.1016/j.jse.2017.05.024

#Pérdida ósea glenoidea#Lateralización ósea#Erosión glenoide#artroplastia reversa#hombro

Curso Teórico Práctico de Artroscopia de Rodilla en Espécimen Biológico. 4-5 /VIII /2017

http://www.artroscopiayreemplazos.com.mx/academia/curso-teorico-practico-de-artroscopia-de-rodilla-en-especimen-biologico-4-5-agosto-2017/

Informes al tel: 5526253111

#artroscopia de rodilla#rodilla#espécimen biológico

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