lunes, 28 de mayo de 2018

Músculos anómalos del antebrazo y su relevancia clínica.

http://www.clinicademano.com.mx/academia/musculos-anomalos-del-antebrazo-y-su-relevancia-clinica/

Anomalous Forearm Muscles and Their Clinical Relevance.


Fuente

Este artículo es publicado originalmente en:
https://www.ncbi.nlm.nih.gov/pubmed/29602650
https://www.jhandsurg.org/article/S0363-5023(17)30571-3/fulltext


De:
Andring N1, Kennedy SA1, Iannuzzi NP2.
J Hand Surg Am. 2018 May;43(5):455-463. doi: 10.1016/j.jhsa.2018.02.028. Epub 2018 Mar 27.


Todos los derechos reservados para:
© 2018 by the American Society for Surgery of the Hand. All rights reserved.


Abstract


Despite their relatively low prevalence in the population, anomalous muscles of the forearm may be encountered by nearly all hand and wrist surgeons over the course of their careers. We discuss 6 of the more common anomalous muscles encountered by hand surgeons: the aberrant palmaris longus, anconeus epitrochlearis, palmaris profundus, flexor carpi radialis brevis, accessory head of the flexor pollicis longus, and the anomalous radial wrist extensors. We describe the epidemiology, anatomy, presentation, diagnosis, and treatment of patients presenting with an anomalous muscle. Each muscle often has multiple variations or subtypes. The presence of most anomalous muscles is difficult to diagnose based on patient history and examination alone, given that symptoms may overlap with more common pathologies. Definitive diagnosis typically requires soft tissue imaging or surgical exploration. When an anomalous muscle is present and symptomatic, it often requires surgical excision for symptom resolution.

KEYWORDS:

Anatomy; forearm; hand; muscle; variant


Resumen

A pesar de su prevalencia relativamente baja en la población, casi todos los cirujanos de manos y muñecas pueden encontrar músculos anómalos del antebrazo en el transcurso de sus carreras. Discutimos 6 de los músculos anómalos más comunes encontrados por cirujanos de mano: el aberrante palmar largo, anconeus epitroclear, palmar profundo, flexor radial corto del carpo, cabeza accesoria del flexor largo del pulgar, y los extensores anómalos de la muñeca radial. Describimos la epidemiología, la anatomía, la presentación, el diagnóstico y el tratamiento de pacientes que presentan un músculo anómalo. Cada músculo a menudo tiene múltiples variaciones o subtipos. La presencia de la mayoría de los músculos anómalos es difícil de diagnosticar según la historia del paciente y el examen solo, dado que los síntomas pueden solaparse con las patologías más comunes. El diagnóstico definitivo generalmente requiere imágenes de tejidos blandos o exploración quirúrgica. Cuando un músculo anómalo está presente y es sintomático, a menudo requiere una escisión quirúrgica para la resolución de los síntomas.


PALABRAS CLAVE:

Anatomía; antebrazo; mano; músculo; variante


PMID: 29602650 DOI: 10.1016/j.jhsa.2018.02.028

Lesión del cono medular / Conus medullaris trauma

Mayo 28, 2018. No. 3094
Trauma del cono medular. ¿Hay un mayor riesgo en parturientas?
Conus medullaris trauma: is there a greater risk in parturients?
 
Rom J Anaesth Intensive Care. 2017 Oct;24(2):107-110. doi: 10.21454/rjaic.7518.242.ver.
Abstract
BACKGROUND: There is some evidence that anaesthetists often perform neuraxial blocks at a higher lumbar interspace than intended. It may be questioned whether parturients are at greater risk for neurological damage when the dura is perforated at a more cephalad interspace than L2-L3. METHODS: Thirty-six patients scheduled for elective Caesarean delivery under CSE anaesthesia were selected for study. Using a B-D Durasafe Adjustable needle combination, the skin-to-epidural distance and the width of the epidural space were measured and matched with 36 female patients undergoing the same anaesthetic technique for orthopaedic procedures. RESULTS: Pregnant patients had a higher bodyweight (77 vs. 67 kg, p = 0.007) than those scheduled for orthopaedic surgery. The skin-to-epidural distance was similar in both groups (5.3 vs. 5.1 cm, p = 0.3). The width of the epidural space was 1.1 mm larger in parturients (8.2 vs. 7.1 mm, p = 0.04). More patients in this group had tip-to-tip distances exceeding 10 mm (25 vs. 12%). CONCLUSION:
The greater epidural space or tip-to-tip distance between the epidural and spinal needle points in term parturients results in a lower margin of safety with respect to the distance from the dura to spinal cord or conus medullaris. Puncturing the correct interspace is, therefore, of crucial importance in pregnant patients.
PDF
Congresos Médicos por Especialidades en todo Mundo
Medical Congresses by Specialties around the World
X Foro Internacional de Medicina del Dolor y Paliativa
Taller de Bloqueos guiados por Ultrasonido con el Dr. Philip Peng
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Ciudad de México, 7 al 9 de junio de 2018. 
V Congreso Internacional de Vía Aérea, EVALa, México
Junio 7-9, 2018. Guadalajara. México
Congreso Nacional de Residentes de Anestesiología
7 al 9 de junio, 2018. Lima, Perú 
Safe Anaesthesia Worldwide
Delivering safe anaesthesia to the world's poorest people
Like us on Facebook   Follow us on Twitter   Find us on Google+   View our videos on YouTube 
Anestesiología y Medicina del Dolor

52 664 6848905

Utilidad de los modelos modernos de simulación artroscópica: un metanálisis y una revisión sistemática actualizada.

http://www.ortotrauma.xyz/academia/utilidad-de-los-modelos-modernos-de-simulacion-artroscopica-un-metanalisis-y-una-revision-sistematica-actualizada/

Utility of Modern Arthroscopic Simulator Training Models: A Meta-analysis and Updated Systematic Review.


Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/29366742

https://www.arthroscopyjournal.org/article/S0749-8063(17)31431-7/fulltext


De:

Frank RM1Wang KC2Davey A2Cotter EJ2Cole BJ2Romeo AA2Bush-Joseph CA2Bach BR Jr2Verma NN2.

 2018 May;34(5):1650-1677. doi: 10.1016/j.arthro.2017.10.048. Epub 2018 Jan 20.


Todos los derechos reservados para:

Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.


Abstract

PURPOSE:

To determine the utility of modern arthroscopic simulators in transferring skills learned on the model to the operating room.

CONCLUSIONS:

This review suggests that (1) training on arthroscopic simulators improves performance on arthroscopic simulators and (2) performance on simulators for basic diagnostic arthroscopy correlates with experience level. Limited data suggest that simulator training can improve basic diagnostic arthroscopy skills in vivo.

Resumen


PROPÓSITO:


Determinar la utilidad de los simuladores artroscópicos modernos para transferir las habilidades aprendidas en el modelo a la sala de operaciones.


CONCLUSIONES:


Esta revisión sugiere que (1) el entrenamiento en simuladores artroscópicos mejora el rendimiento en simuladores artroscópicos y (2) el rendimiento en simuladores para correlaciones artroscópicas diagnósticas básicas con el nivel de experiencia. Datos limitados sugieren que el entrenamiento con simulador puede mejorar las habilidades básicas de diagnóstico de artroscopia en vivo.

Copyright © 2017 Arthroscopy Association of North America. Publicado por Elsevier Inc. Todos los derechos reservados.
PMID: 29366742   DOI:   10.1016/j.arthro.2017.10.048



sábado, 26 de mayo de 2018

Ideas no confirmadas en UCI / ICU unconfirmed ideas.

Mayo 24, 2018. No. 3090
Siete ideas no confirmadas para mejorar la práctica futura de la UCI.
Seven unconfirmed ideas to improve future ICU practice.
Crit Care. 2017 Dec 28;21(Suppl 3):315. doi: 10.1186/s13054-017-1904-x.
Abstract
With imprecise definitions, inexact measurement tools, and flawed study execution, our clinical science often lags behind bedside experience and simply documents what appear to be the apparent faults or validity of ongoing practices. These impressions are later confirmed, modified, or overturned by the results of the next trial. On the other hand, insights that stem from the intuitions of experienced clinicians, scientists and educators-while often neglected-help place current thinking into proper perspective and occasionally point the way toward formulating novel hypotheses that direct future research. Both streams of information and opinion contribute to progress. In this paper we present a wide-ranging set of unproven 'out of the mainstream' ideas of our FCCM faculty, each with a defensible rationale and holding clear implications for altering bedside management. Each proposition was designed deliberately to be provocative so as to raise awareness, stimulate new thinking and initiate lively dialog.
KEYWORDS: Adaptive clinical trials; Melatonin; Metabolic monitoring; Microcirculation; Personalized medicine; Resuscitation; Sepsis; Shock; Ventilator-induced lung injury
Algunas de nuestras ideas favoritas sin confirmar.
A few of our favorite unconfirmed ideas.
Crit Care. 2015;19 Suppl 3:S1. doi: 10.1186/cc14719. Epub 2015 Dec 18.Abstract
Medical practice is rooted in our dependence on the best available evidence from incremental scientific experimentation and rigorous clinical trials. Progress toward determining the true worth of ongoing practice or suggested innovations can be glacially slow when we insist on following the stepwise scientific pathway, and a prevailing but imperfect paradigm often proves difficult to challenge. Yet most experienced clinicians and clinical scientists harbor strong thoughts about how care could or should be improved, even if the existing evidence base is thin or lacking. One of our Future of Critical Care Medicine conference sessions encouraged sharing of novel ideas, each presented with what the speaker considers a defensible rationale. Our intent was to stimulate insightful thinking and free interchange, and perhaps to point in new directions toward lines of innovative theory and improved care of the critically ill. In what follows, a brief background outlines the rationale for each novel and deliberately provocative unconfirmed idea endorsed by the presenter.
Congresos Médicos por Especialidades en todo Mundo
Medical Congresses by Specialties around the World
Safe Anaesthesia Worldwide
Delivering safe anaesthesia to the world's poorest people
X Foro Internacional de Medicina del Dolor y Paliativa
Taller de Bloqueos guiados por Ultrasonido con el Dr. Philip Peng
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Ciudad de México, 7 al 9 de junio de 2018. 
V Congreso Internacional de Vía Aérea, EVALa, México
Junio 7-9, 2018. Guadalajara. México
Like us on Facebook   Follow us on Twitter   Find us on Google+   View our videos on YouTube 
Anestesiología y Medicina del Dolor

52 664 6848905

Cuidado cardiovascular agudo / Acute cardiovascular care

Mayo 25, 2018. No. 3091
Los mejores artículos descargados de 2017 de la revista European Heart Journal: Acute Cardiovascular Care
Top Downloaded Papers of 2017 from European Heart Journal: Acute Cardiovascular Care
Congresos Médicos por Especialidades en todo Mundo
Medical Congresses by Specialties around the World
X Foro Internacional de Medicina del Dolor y Paliativa
Taller de Bloqueos guiados por Ultrasonido con el Dr. Philip Peng
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Ciudad de México, 7 al 9 de junio de 2018. 
V Congreso Internacional de Vía Aérea, EVALa, México
Junio 7-9, 2018. Guadalajara. México
Congreso Nacional de Residentes de Anestesiología
7 al 9 de junio, 2018. Lima, Perú 
Safe Anaesthesia Worldwide
Delivering safe anaesthesia to the world's poorest people
Like us on Facebook   Follow us on Twitter   Find us on Google+   View our videos on YouTube 
Anestesiología y Medicina del Dolor

52 664 6848905