Un estudio de fiabilidad y validez para diferentes ángulos coronales que utilizan ultrasonido en la escoliosis idiopática del adolescente

http://www.columnavertebralpediatricaygeriatrica.com.mx/columna-del-adolescente/un-estudio-de-fiabilidad-y-validez-para-diferentes-angulos-coronales-que-utilizan-ultrasonido-en-la-escoliosis-idiopatica-del-adolescente/

A reliability and validity study for different coronal angles using ultrasound imaging in adolescent idiopathic scoliosis.


Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/29056566
http://www.thespinejournalonline.com/article/S1529-9430(17)31063-X/fulltext


De:

Brink RC1,Wijdicks SPJ2,Tromp IN2,Schlösser TPC2,Kruyt MC2,Beek FJA3,


Castelein RM4.


Author information


1Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: r.c.brink@umcutrecht.nl.2Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.3Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.4Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: r.m.castelein@umcutrecht.nl.


Spine J. 2017 Oct 19. pii: S1529-9430(17)31063-X. doi: 10.1016/j.spinee.2017.10.012. [Epub ahead of print]


Todos los derechos reservados para:


Copyright © 2017 Elsevier Inc. All rights reserved.


Abstract


BACKGROUND CONTEXT:


Radiation exposure remains a big concern in adolescent idiopathic scoliosis (AIS). Ultrasound imaging of the spine could significantly reduce or possibly even eliminate this radiation hazard. The spinous processes (SP) and transverse processes (TP), were used to measure the coronal deformity. Both landmarks provided reliable information on the severity of the curve as related to the traditional Cobb angle. However, it remained unclear which coronal ultrasound angle is the most appropriate method to measure the curve severity.


PURPOSE:


To test the reliability and validity of several ultrasound angle measurements in the coronal plane as compared to the radiographic coronal Cobb angle in AIS patients.


CONCLUSIONS:


Coronal ultrasound angles are based on different landmarks than the traditional Cobb angle measurement and cannot represent the same angle values. In this study, we found excellent correlations between the ultrasound and Cobb measurements, without differences in reliability and validity between the ultrasound angles based on the spinous processes and transverse processes. Therefore, the severity of the deformity in AIS patients can be assessed by ultrasound imaging, avoiding hazardous ionizing radiation and enabling more individualized patient care. It also opens possibilities for screening.


KEYWORDS:


Adolescent idiopathic scoliosis; Coronal angle; Spinous processes; The Scolioscan; Transverse processes; Ultrasound


Resumen


CONTEXTO ANTECEDENTES:


La exposición a la radiación sigue siendo una gran preocupación en la escoliosis idiopática del adolescente (AIS). Las imágenes de ultrasonido de la columna vertebral podrían reducir significativamente o incluso eliminar este riesgo de radiación. Los procesos espinosos (SP) y los procesos transversales (TP) se usaron para medir la deformidad coronal. Ambos puntos de referencia proporcionaron información confiable sobre la gravedad de la curva en relación con el ángulo de Cobb tradicional. Sin embargo, no quedó claro qué ángulo de ultrasonido coronal es el método más apropiado para medir la gravedad de la curva.


PROPÓSITO:


Para probar la fiabilidad y la validez de varias medidas de ángulo de ultrasonido en el plano coronal en comparación con el ángulo de Cobb coronal radiográfico en pacientes AIS.


CONCLUSIONES:


Los ángulos de ultrasonido coronal se basan en diferentes puntos de referencia distintos de la medición tradicional del ángulo de Cobb y no pueden representar los mismos valores de ángulo. En este estudio, encontramos excelentes correlaciones entre las mediciones de ultrasonido y Cobb, sin diferencias en confiabilidad y validez entre los ángulos de ultrasonido basados ​​en procesos espinosos y procesos transversales. Por lo tanto, la severidad de la deformidad en pacientes AIS puede evaluarse mediante imágenes de ultrasonido, evitando la radiación ionizante peligrosa y permitiendo una atención más individualizada del paciente. También abre posibilidades para la detección.


PALABRAS CLAVE:


Escoliosis idiopática adolescente; Ángulo coronal; Procesos espinosos; El escoliosco; Procesos transversales; Ultrasonido


Copyright © 2017 Elsevier Inc. All rights reserved.


PMID: 29056566 DOI:


10.1016/j.spinee.2017.10.012

#Escoliosis idiopática adolescente#Ángulo coronal#ultrasonido

Conceptos actuales en artroplastia de codo

http://www.mihombroycodo.com.mx/academia/conceptos-actuales-en-artroplastia-de-codo/

Current concepts in elbow arthroplasty

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28507780/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5420822/

http://www.efortopenreviews.org/content/2/4/83



De:



Bachman D1, Cil A1.


Author information


1


University of Missouri-Kansas City, Kansas City, USA.


EFORT Open Rev. 2017 Apr 27;2(4):83-88. doi: 10.1302/2058-5241.2.160064. eCollection 2017 Apr.



Todos los derechos reservados para:



Copyright and License information ▼


Copyright © 2017 The author(s)


This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.







Abstract


Distal humeral replacement and the total elbow are two commonly-used arthroplastiesEach prosthesis has evolving indications and surgical techniquesRecent changes in device design and implantation methods are due to biomechanical and clinical outcome-based researchNew prostheses and methods provide: better elbow kinematics, more durable bearings and longer-lasting joint replacement potential Cite this article: EFORT Open Rev 2017;2:83-88. DOI: 10.1302/2058-5241.2.160064.






KEYWORDS:


elbow arthroplasty; total elbow arthroplasty; unicompartmental, distal humerus hemi-arthroplasty










Resumen


La sustitución humeral distal y el codo total son dos artroplastias de uso común. Cada prótesis tiene indicaciones y técnicas quirúrgicas cambiantes. Los recientes cambios en el diseño del dispositivo y los métodos de implantación se deben a la investigación biomecánica y clínica basada en resultados. Nuevas prótesis y métodos proporcionan: mejor codera, más duraderos y potencial de reemplazo de articulaciones más duraderas.


Cite este artículo: EFORT Open Rev 2017; 2: 83-88. DOI: 10.1302 / 2058-5241.2.160064.


PALABRAS CLAVE:


artroplastia de codo; artroplastia total del codo; unicompartimental, hemiartroplastia de húmero distal


PMID: 28507780 PMCID: PMC5420822 DOI: 10.1302/2058-5241.2.160064


Free PMC Article

IRA, IMC y cirugía laparoscópica / AKI, BMI and laparoscopic surgery

Octubre 18, 2017. No. 2885

Asociación entre IMC y falla renal aguda postoperatoria en pacientes sometidos a cirugía laparoscópica Association of Body Mass Index and Postoperative Acute Kidney Injury in Patients Undergoing Laparoscopic Surgery. Argalious MY1, Makarova N2, Leone A1, Cywinski J1, Farag E1. Author information Ochsner J. 2017 Fall;17(3):224-232. Abstract BACKGROUND: Whether the deleterious effects of carbon dioxide pneumoperitoneum on the kidneys are exacerbated in the obese population remains unknown. We hypothesized that increased body mass index (BMI) is associated with an increased incidence of postoperative acute kidney injury (AKI) in patients undergoing noncardiac laparoscopic surgery. METHODS: Following institutional review board approval, we analyzed data on 8,543 adult patients with American Society of Anesthesiologists physical status scores of I-IV who had inpatient noncardiac laparoscopic surgery from 2005-2014. Because the exposure (current BMI) is a chronic condition, we a priori assumed that diabetes mellitus, hypertension, coronary artery disease, and chronic obstructive pulmonary disease might mediate the effect of obesity on outcome. Our primary analysis was a proportional odds logistic regression model with current BMI as a predictor and AKI as an ordinal outcome. RESULTS: After controlling for potential confounding variables, the odds of developing a more serious level of AKI was 7% (95% CI 0%, 15%) greater with a 5-unit increase in BMI (P=0.05). When the analysis was adjusted for the a priori mediators in an attempt to estimate the pure effect of BMI on AKI, the result was no longer significant (Wald test P=0.35), with the residual effect of BMI of 3% (95% CI -4%, 11%). CONCLUSION: We found a marginal association between BMI and an increased risk of developing AKI in adult patients after having noncardiac laparoscopic surgery. The BMI effect became insignificant when potential mediator variables were considered. The association of BMI and AKI after noncardiac laparoscopic surgery is likely mediated through components of the metabolic syndrome. KEYWORDS: Acute kidney injury; body mass index; laparoscopy PDF Falla renal aguda, función renal, y el anciano obeso quirúrgico Acute kidney injury, renal function, and the elderly obese surgical patient: a matched case-control study. Kelz RR1, Reinke CE, Zubizarreta JR, Wang M, Saynisch P, Even-Shoshan O, Reese PP, Fleisher LA, Silber JH. Author information Ann Surg. 2013 Aug;258(2):359-63. doi: 10.1097/SLA.0b013e31829654f3. Abstract OBJECTIVE: To investigate the association between obesity and perioperative acute kidney injury (AKI), controlling for preoperative kidneydysfunction. BACKGROUND: More than 30% of patients older than 60 years are obese and, therefore, at risk for kidney disease. Postoperative AKI is a significant problem. METHODS: We performed a matched case-control study of patients enrolled in the Obesity and Surgical Outcomes Study, using data of Medicare claims enriched with detailed chart review. Each AKI patient was matched with a non-AKI control similar in procedure type, age, sex, race, emergency status, transfer status, baseline estimated glomerular filtration rate, admission APACHE score, and the risk of death score with fine balance on hospitals. RESULTS: We identified 514 AKI cases and 694 control patients. Of the cases, 180 (35%) followed orthopedic procedures and 334 (65%) followed colon or thoracic surgery. After matching, obese patients undergoing a surgical procedure demonstrated a 65% increase in odds of AKI within 30 days from admission (odds ratio = 1.65, P < 0.005) when compared with the nonobese patients. After adjustment for potential confounders, the odds of postoperative AKI remained elevated in the elderly obese (odds ratio = 1.68, P = 0.01.) CONCLUSIONS: : Obesity is an independent risk factor for postoperative AKI in patients older than 65 years. Efforts to optimize kidney function preoperatively should be employed in this at-risk population along with keen monitoring and maintenance of intraoperative hemodynamics. When subtle reductions in urine output or a rising creatinine are observed postoperatively, timely clinical investigation is warranted to maximize renal recovery. PDF 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

Dolor de cuello, hernia de disco cervical y Radiculopatía

http://www.columnavertebralpediatricaygeriatrica.com.mx/academia/dolor-de-cuello-hernia-de-disco-cervical-y-radiculopatia-2/

Neck pain, Cervical Disc Herniation and Radiculopathy

Fuente

Este artículo y/o video es originalmente publicado en:

https://youtu.be/qyxpcN68_ws

De y Todos los derechos reservados para:

Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

nabil ebraheim

Publicado el 16 oct. 2017

Dr. Ebraheim’s animated educational video describes Neck Pain, Cervical Disc Herniation & Cervical Radiculopathy.

Follow me on twitter:

https://twitter.com/#!/DrEbraheim_UTMC

Donate to the University of Toledo Foundation Department of Orthopaedic Surgery Endowed Chair Fund:

https://www.utfoundation.org/foundati…

Categoría

Formación

Licencia

Licencia de YouTube estándar

Analgesia multimodal en dolor postoperatorio / Multimodal analgesia in POP

Octubre 19, 2017. No. 2886

Gabapentinoides como parte de un régimen multimodal para alivio del dolor después de colecistectomía laparoscópica. Estudio randomizado Gabapentinoids as a Part of Multi-modal Drug Regime for Pain Relief following Laproscopic Cholecystectomy: A Randomized Study. Kochhar A1, Chouhan K1, Panjiar P1, Vajifdar H1. Author information Anesth Essays Res. 2017 Jul-Sep;11(3):676-680. doi: 10.4103/0259-1162.204208. Abstract BACKGROUND: Gabapentinoids have been used as preemptive analgesics for pain management following laparoscopic cholecystectomy. Recently, multimodal analgesic techniques have been found superior to preemptive analgesia alone. AIM: The aim of this study is to evaluate and compare a single preoperative dose of pregabalin 150 mg and gabapentin 300 mg for pain relief following laparoscopic cholecystectomy as a part of multimodal drug regime. SETTINGS AND DESIGN: This randomized, single-blind study was conducted after Ethical Committee approval and written informed consent from the patients. MATERIALS AND METHODS: Fifty patients undergoing laparoscopic cholecystectomy under general anesthesia were randomly allocated to receive either 150 mg pregabalin (Group PG), or 300 mg gabapentin (Group GB) orally, 2 h before surgery. Standard anesthesia induction and maintenance were done. For intraoperative pain management, injection fentanyl 2 μg.kg-1 intravenous (IV) along with injection voveran 75 mg IV and port site infiltration was used. Postoperatively, injection diclofenac 75 mg intramuscular TDS was continued. Severity of postoperative pain (visual analog scale [VAS]), postoperative fentanyl requirement and incidence, and severity of side effects were assessed. When VAS >40 mm or on patient's request, a Fentanyl bolus at an increment of 25-50 μg IV was given as rescue analgesia. RESULTS: Intraoperative fentanyl requirement was 135 ± 14 μg in Group PG and 140 ± 14 μg in Group GB (P = 0.21). Postoperative, fentanyl requirement was 123 ± 18 μg in Group PG and 131 ± 23 μg in Group GB (P = 0.17) There was no statistically significant difference in the VAS score for static and dynamic pain. Time to the first requirement of analgesic was 5.4 ± 1.1 h in Group PG and 4.6 ± 1.6 h in Group GB (P = 0.015). No side effects were observed. CONCLUSION: We conclude that a single preoperative dose of pregabalin (150 mg) or gabapentin (300 mg) are equally efficacious in providing pain relief following laparoscopic cholecystectomy as a part of multimodal regime without any side effects. KEYWORDS: Gabapentin; laparoscopic cholecystectomy; multi-modal analgesia; pregabalin PDF Pregabalina puede disminuir el dolor agudo y el consumo de morfina en pacientes con colecistetomía laparoscópica. Meta-análisis de estudios controlados Pregabalin can decrease acute pain and morphine consumption in laparoscopic cholecystectomy patients: A meta-analysis of randomized controlled trials. Li S1, Guo J, Li F, Yang Z, Wang S, Qin C. Author information Medicine (Baltimore). 2017 May;96(21):e6982. doi: 10.1097/MD.0000000000006982. Abstract BACKGROUND: Pregabalin has been used as an adjunct for the management of acute pain in laparoscopic cholecystectomy. This meta-analysis aimed to illustrate the efficacy and safety of pregabalin for pain management following laparoscopic cholecystectomy.  CONCLUSIONS: Pregabalin was efficacious in the reduction of postoperative pain, total morphine consumption, and morphine-related complications following laparoscopic cholecystectomy. In addition, a high dose of pregabalin was more effective than a low dose. The dose of pregabalin differed across the studies, and the heterogeneity was large. More studies are needed to verify the optimal dose of pregabalin in laparoscopic cholecystectomy patients. PDF Dexmedetomidina en el manejo perioperatorio del dolor agudo. Un coadyuvante analgésico no opioide Dexmedetomidine in perioperative acute pain management: a non-opioid adjuvant analgesic. Tang C1, Xia Z1. Author information J Pain Res. 2017 Aug 11;10:1899-1904. doi: 10.2147/JPR.S139387. eCollection 2017. Abstract Many nociceptive, inflammatory, and neuropathic pathways contribute to perioperative pain. Although opioids have long been a mainstay for perioperative analgesia, other non-opioid therapies, and dexmedetomidine, in particular, have been increasingly used as part of a multimodalanalgesic regimen to provide improved pain control while minimizing opioid-related side effects. This article reviews the evidence supporting the preoperative, intraoperative, and postoperative efficacy of dexmedetomidine as an adjuvant, and the efficacy of intravenous, spinal canal, and nerve block analgesia with dexmedetomidine for perioperative acute pain treatment. While there have not been any large-scale clinical trials conducted, the current body of evidence suggests that dexmedetomidine is suitable for use as an adjuvant analgesic at all perioperative stages. However, there are potential adverse effects, such as hypotension and bradycardia, which must be taken into consideration by clinicians. KEYWORDS: adjuvant; analgesia; dexmedetomidine; non-opioid; perioperative pain PDF 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

Diferencias zonales en el riesgo y patrón de perforaciones de tornillo pedicular en la escoliosis idiopática del adolescente (AIS): una revisión de tomografía computarizada (CT) de 1986 tornillos .

http://www.columnavertebralpediatricaygeriatrica.com.mx/columna-pediatrica/diferencias-zonales-en-el-riesgo-y-patron-de-perforaciones-de-tornillo-pedicular-en-la-escoliosis-idiopatica-del-adolescente-ais-una-revision-de-tomografia-computarizada-ct-de-1986-tornillos/

Zonal differences in risk and pattern of pedicle screw perforations in adolescentidiopathic scoliosis (AIS): a computerized tomography (CT) review of 1986 screws.

Fuente

Este artículo es publicado originalmente en:

https://www.ncbi.nlm.nih.gov/pubmed/29058137

https://link.springer.com/article/10.1007%2Fs00586-017-5350-x

De:

Chan CYW1, Kwan MK2.

Eur Spine J. 2017 Oct 20. doi: 10.1007/s00586-017-5350-x. [Epub ahead of print]

Todos los derechos reservados para:

Copyright information

© Springer-Verlag GmbH Germany 2017

PMID:   29058137    DOI:  10.1007/s00586-017-5350-x

Abstract

PURPOSE:

To evaluate the zonal differences in risk and pattern of pedicle screw perforations in adolescentidiopathic scoliosis (AIS) patients.

METHODS:

The scoliosis curves were divided into eight zones. CT scans were used to assess perforations: Grade 0, Grade 1(< 2 mm), Grade 2(2-4 mm) and Grade 3(> 4 mm). Anterior perforations were classified into Grade 0, Grade 1(< 4 mm), Grade 2(4-6 mm) and Grade 3(> 6 mm). Grade 2 and 3 (except lateral grade 2 and 3 perforation over thoracic vertebrae) were considered as ‘critical perforations’.

RESULTS:

1986 screws in 137 patients were analyzed. The overall perforation rate was 8.4% after exclusion of the lateral perforation. The highest medial perforation rate was at the transitional proximal thoracic (PT)/main thoracic (MT) zone (6.9%), followed by concave lumbar (6.7%) and convex main thoracic (MT) zone (6.1%). The overall critical medial perforation rate was 0.9%. 33.3% occurred at convex MT and 22.2% occurred at transitional PT/MT zone. There were 39 anterior perforations (overall perforation rate of 2.0%). 43.6% occurred at transitional PT/MT zone, whereas 23.1% occurred at concave PT zone. The overall critical anterior perforation rate was 0.6%. 5/12 (41.7%) critical perforations occurred at concave PT zone, whereas four perforations occurred at the transitional PT/MT zone. There were only two symptomatic left medial grade 2 perforations (0.1%) resulting radiculopathy, occurring at the transitional main thoracic (MT)/Lumbar (L) zone.

CONCLUSION:

Overall pedicle perforation rate was 8.4%. Highest rate of critical medial perforation was at the convex MT zone and the transitional PT/MT zone, whereas highest rate of critical anterior perforation was at the concave PT zone and the transitional PT/MT zone. The rate of symptomatic perforations was 0.1%.

KEYWORDS:

Adolescent idiopathic scoliosis; Computed tomography; Pedicle screw; Perforation

Resumen

PROPÓSITO:
Evaluar las diferencias zonales en el riesgo y el patrón de perforaciones de tornillo pedicular en pacientes con escoliosis idiopática en adolescentes (AIS).

MÉTODOS:
Las curvas de escoliosis se dividieron en ocho zonas. Se usaron tomografías computarizadas para evaluar las perforaciones: Grado 0, Grado 1 (<2 mm), Grado 2 (2-4 mm) y Grado 3 (> 4 mm). Las perforaciones anteriores se clasificaron en Grado 0, Grado 1 (<4 mm), Grado 2 (4-6 mm) y Grado 3 (> 6 mm). Los grados 2 y 3 (excepto la perforación lateral de grado 2 y 3 sobre las vértebras torácicas) se consideraron como “perforaciones críticas”.

RESULTADOS:
1986 tornillos en 137 pacientes fueron analizados. La tasa de perforación global fue del 8,4% después de la exclusión de la perforación lateral. La tasa más alta de perforación medial fue en la zona torácica proximal de transición (PT) / torácica principal (MT) (6,9%), seguida de la zona torácica principal (MT) lumbar cóncava (6,7%) y convexa (6,1%). La tasa de perforación medial crítica global fue del 0.9%. 33.3% ocurrieron en MT convexa y 22.2% ocurrieron en la zona de transición PT / MT. Hubo 39 perforaciones anteriores (tasa de perforación global de 2.0%). 43.6% ocurrieron en la zona transitoria de PT / MT, mientras que 23.1% ocurrieron en la zona PT cóncava. La tasa de perforación anterior crítica global fue del 0,6%. 5/12 (41.7%) perforaciones críticas ocurrieron en la zona PT cóncava, mientras que cuatro perforaciones ocurrieron en la zona transitoria PT / MT. Solo hubo dos perforaciones sintomáticas de grado medial izquierdo 2 (0.1%) que dieron como resultado una radiculopatía, que se produjo en la zona principal de transición torácica (MT) / Lumbar (L).

CONCLUSIÓN:
La tasa global de perforación pedicular fue del 8,4%. La tasa más alta de perforación medial crítica fue en la zona convexa MT y la zona transitoria PT / MT, mientras que la tasa más alta de perforación anterior crítica fue en la zona PT cóncava y en la zona transitoria PT / MT. La tasa de perforaciones sintomáticas fue del 0,1%.

PALABRAS CLAVE:
Escoliosis idiopática adolescente; Tomografía computarizada; Tornillo pedicular; Perforación

PMID: 29058137   DOI:  10.1007/s00586-017-5350-x