Sistema de presión negativa en loxoscelismo cutáneo-visceral. Reporte de un caso

Introducción: Las mordeduras por araña parda pueden manifestarse desde una simple lesión dérmica en el área de la mordedura, hasta formas graves, con falla orgánica múltiple. Caso Clínico: presentamos el caso de una paciente con mordedura por araña parda, quien presenta inicialmente lesiones dérmicas sin necrosis, evolucionando con áreas de necrosis y el desarrollo de síndrome compartimental de extremidad, sepsis, choque séptico y falla renal. Mejora tras manejo intensivo, anti veneno y colocación de terapia de presión negativa (TPN) en herida, conservando la extremidad afectada integra y recuperando la función renal. Discusion: Este caso en particular presenta los tres tipos de manifestaciones que se generan en el loxoscelismo, las cuales son una forma de presentación poco frecuente. El tratamiento con TPN se ha introducido como una terapia poderosa, no farmacológica para ayudar a acelerar el proceso de cicatrización de heridas y puede ser de utilidad en pacientes con mordedura de araña (loxoscelismo).

Introduction: The brown spider bites have the peculiarity of manifesting from a simple skin lesion in the area of the bite, to severe forms, with multiple organic failure. Clinical Case: We present the case of a patient with a brown spider bite, initially presenting dermal lesions without necrosis, evolving with areas of necrosis and the development of compartment syndrome of extremities, sepsis, septic shock and renal failure. Improvement after intensive management and installation in negative pressure therapy wound (NPT), keeping the affected limb integrated and recovering renal function. Discussion: This case in particular presents the three types of manifestations that are generated in loxoscelism, which are a rare form of presentation. The NPT treatment has been introduced as a powerful, non-pharmacological and physical therapy to help accelerate the wound healing process and may be useful in patients with spider bites.

Ultrasound Guided Fascia Iliaca Compartment Block Using Either Bupivacaine Or Bupivacaine With Dexmedetomidine For Postoperative Analgesia In Patients With Femur Fractures.

Background: Femur fractures are extremely painful due to the lowest pain threshold of the periosteum among the deep somatic structures. Perioperative Fascia Iliaca Compartment Block (FICB), when administered using a local anesthetic agent, bupivacaine, can reduce morbidity by providing satisfactory pain relief. Dexmedetomidine, an alpha-2 agonist, is known to prolong the local anesthetic effects without causing any significant side effects. We compared analgesic duration of ultrasound guided FICB with bupivacaine alone and bupivacaine with dexmedetomidine for postoperative analgesia. A prospective, randomized, double blinded study was conducted on 50 patientsMaterials And Method: aged 18 to 65 years undergoing femur fracture surgeries. Patients were divided into 2 groups of 25 each. Both groups received USG guided FICB. Group A received 28 ml 0.25% bupivacaine and 2 ml normal saline (NS). Group B received 28 ml 0.25% bupivacaine and 30 mcg dexmedetomidine in NS. Pain scores were assessed every 5 minutes until 15 minutes post FICB, during positioning for subarachnoid block and every 2 hours until 24 hours post-operatively. Total duration of analgesia, cumulative analgesia requested in 24 hours, Ramsay sedation and patient satisfaction scores were recorded. Results: The mean duration of analgesia in Group A was 419.4 ± 115.35 minutes (95%CI: 374.2 – 464.6) and in Group B was 656.6 ± 137.99 minutes (95%CI: 602.5 –710.7), p <0.001. Mean VAS score during positioning for SAB in Group A was 1.60 ± 0.50 and in Group B was 0.96 ± 0.68. USG guided FICB with dexmedetomidine is superior inConclusion: providing prolonged post-operative analgesia in comparison to bupivacaine alone

A PROSPECTIVE STUDY ON THE FUNCTIONAL OUTCOME OF PROXIMAL FIBULAR OSTEOTOMY IN GRADE 2 AND 3 MEDIAL COMPARTMENT ARTHRITIS OF THE KNEE.

Introduction: Osteoarthritis of the knee is a common musculoskeletal diseases affecting a major population in India. It can impact the individual's functions and activities of daily living. Total knee arthroplasty may raise controversy when treating the younger, athletic patient with arthritis. Arthroscopic debridement, high tibial osteotomy, unicondylar knee arthroplasty, and total knee arthroplasty allow younger patients to maintain an active, healthy lifestyle but can take a longer time to rehabilitate. PFO could be used as an alternative procedure. The Proximal Fibular Osteotomy, which provides immediate short term relief in cases with medial compartment osteoarthritis. Resecting a segment of fibula, loosens the lateral side allowing the upper tibia to settle into a more favorable lateral alignment, shifting the mechanical axis towards neutral or valgus. Aims & objectives: Ÿ To assess the functional, clinical and radiological outcome of proximal fibular osteotomy in grade 2 and 3 OA of knee and followed up for 1 year. Ÿ The clinical and functional outcome is accessed by Knee Society Score and VAS observed pre-op , post-op ,3 months ,6 months and 12 months. Ÿ The improvement in radiology is accessed using change in the medial joint space improvements in CP angle, change in the ratio of medial joint space to lateral joint space observed pre-op and post-op Methodology: The patients selected had grade 2 and 3 Osteoarthritis of knee according to Kellgren Lawrence classification between the age groups 20yrs-80yrs and are admitted to RajaRajeswari Medical College and Hospital, Bangalore. The Sample Size is 30 and is calculated based on previous studies as well as approximate availability of number of cases in the above mentioned duration satisfying inclusion and exclusion criteria. Clinical, functional and radiological outcome were used, Results were calculated using Knee Society Scoring Scale score. This study Conclusion: suggested that Proximal Fibular Osteotomy is an alternative procedure that can be used to treat medial compartment knee Osteoarthritis, if the patients are selected carefully. Patients followed up for one year showed a significant improvement in radiological, clinical and functional outcomes and thereby is an effective method of treatment in younger patients with Grade 2 and Grade 3 Osteoarthritis with an average BMI of 26.2.

Risk factors of central compartment lymph node metastasis in stage T 1a solitary papillary thyroid carcinoma / 肿瘤研究与临床

Objective:To investigate the correlation of central compartment lymph node metastasis(CLNM) in stage T 1a solitary papillary thyroid carcinoma (PTC) with the clinicopathological characteristics, sonographic features and the number of lymph node dissection, and to analyze the risk factors of CLNM. Methods:The data of 218 patients with stage T 1a solitary PTC who underwent thyroid cancer surgery from January 2017 to May 2021 in Tangshan Union Medical College Hospital were retrospectively analyzed. All patients were divided into CLNM positive group and CLNM negative group according to CLNM. The age, gender, preoperative sonographic features, pathological type, the number of lymph node dissection and the number of metastasis were recorded. Logistic regression was used to analyze the risk factors of CLNM. Results:Among 218 patients, there were 71 cases (32.6%) in CLNM positive group and 147 cases (67.4%) in CLNM negative group. There were statistically significant differences in age, tumor diameter, capsular invasion in thyroid or not, tumor blood supply or not, and the number of lymph node dissection between two groups (all P < 0.05). There were no statistically significant differences in gender, clear tumor boundary or not, tumor shape, tumor aspect ratio, calcification, nodular goiter and Hashimoto's thyroiditis or not (all P > 0.05). Multivariate binary logistic regression analysis showed that age < 55 years ( OR = 2.995, 95% CI 1.228-7.307), capsular invasion in thyroid ( OR = 5.297, 95% CI 2.494-11.248) and the number of lymph node dissection ≥6 ( OR = 4.085, 95% CI 2.059-8.104) were independent risk factors of CLNM (all P < 0.05). Conclusions:Patients with stage T 1a solitary PTC, age < 55 years and capsular invasion in thyroid are prone to CLNM; sufficient number of lymph node dissection can get more accurate CLNM rate.

Comparison of analgesic efficacy and postoperative recovery between multi-point and single-point fascia iliaca compartment block in patients with hip fracture: a randomized controlled trial / 中华全科医师杂志

Objective:To compare the analgesic effect and postoperative recovery between multi-point and single-point ultrasound-guided fascia iliaca compartment block (FCIB) in elderly patients with hip fracture.Methods:From June 2019 to April 2020, 96 patients aged (71.1±5.4) years undergoing elective surgery for hip fracture in Renji Hospital were randomly assigned in multi-point block group or single-point block group, and the multi-point or single-point ultrasound-guided FCIB was performed for the two groups, respectively. The primary outcomes were the success rate for block of femoral nerve, lateral femoral cutaneous nerve and obturator nerve, and the 24 hours postoperative pain visual analog scale (VAS) score at rest and passive movement. The secondary outcomes were the onset time of sensory blocks of the above three nerves, complications of FICB, the satisfaction score of pain control during 48 hours after surgery and postoperative recovery of patients.Results:The success rate for block of lateral femoral cutaneous nerve in multi-point block group was 97.9% (47/48), which was significantly higher than that in single-point block group (83.3%(40/48)) ( P=0.031). The success rate for block of obturator nerve in multi-point block group was 95.8% (46/48), which was significantly higher than that in single-point block group which was 81.3% (39/48) ( P=0.025). The success rate of femoral nerve block in both groups was 97.9% (47/48) ( P=1.000). The 24 hours postoperative VAS scores at rest and passive movement in the multi-point block group were significantly lower than those in the single-point block group ( P<0.05). The onset time for block of lateral femoral cutaneous nerve and obturator nerve in multi-point block group was shorter than that in single-point block group ( P=0.025 and P<0.01). There was no significant difference in the onset time for block of femoral nerve between the two groups ( P=0.343). The satisfaction score of patients at 48 hours after surgery in multipoint block group was higher than that in single point block group ( P=0.024). The length of hospital stay in the multi-point block group was shorter than that in the single-point block group ( P=0.042), the proportion of intravenous analgesic drugs used after surgery was lower than that in the single-point block group ( P=0.041), and the complication rate within 30 days after surgery was also lower than that in the single point block group ( P=0.026). Conclusion:Compared with single-point block, ultrasound-guided multi-point block in iliac fascia space has advantages of increasing analgesic efficacy and promoting postoperative recovery in elderly patients with hip fracture.

Analysis on effective concentrations and adverse reactions of Ropivacaine in the modified fascial iliac compartment block for pain relief after total knee arthroplasty in elderly patients / 中华老年医学杂志

Objective:To identify the effective concentrations of Ropivacaine in the modified fascial iliac compartment block(FICB)that would not affect the movement of the affected limb but would offer effective pain relief after total knee arthroplasty(TKA)in elderly patients.In addition, adverse reactions within 24 hours of FICB were examined.Methods:This study was a prospective, single-arm sequential trial.Forty-five elderly patients treated with TKA at the First Affiliated Hospital of Soochow University between September 2021 and March 2022 were selected, with an American Society of Anesthesiologists(ASA)score of Ⅰ or Ⅱ.All patients were given ultrasound-guided FICB on the surgical side under general anesthesia and 10 minutes before the operation, and the injection volume was 30 ml.According to preliminary experiments and relevant literature, the initial concentration of Ropivacaine was 0.1%, and the concentration for the next patient was determined using a modified Dixon sequential method.If the quadriceps femoris muscle strength score of the first patient was ≥4, there was no resting pain[visual analogue scale(VAS)score ≤1], and the VAS score during activity was ≤3, the concentration for the next patient would be reduced.Conversely, the concentration would be increased.The Ropivacaine concentration was increased or decreased by 0.01% each time and the trial would be stopped after 12 reentries.The median effective concentration(ED50), 95% effective concentration(ED95)and corresponding 95% confidence interval(CI)of ropivacaine were calculated using the probit model.Meanwhile, adverse reactions within 24 hours of FICB were monitored.Results:Of 43 elderly patients who completed the trial, the intervention was effective in 23 and ineffective in 20.While ensuring that postoperative limb movement in elderly patients was not affected, a single injection of 30 ml ropivacaine through FICB was able to effectively inhibit postoperative pain, and the ED50 and ED95 of ropivacaine were 0.072%(95% CI: 0.065%-0.078%)and 0.093%(95% CI: 0.084%-0.124%), respectively.Within 24 hours of FICB, 2 patients had lower limb weakness and could not get out of bed and walk, and 5 patients had severe pain and needed additional analgesics.No other adverse reactions were found. Conclusions:The effective ED50 and ED95 of Ropivacaine for postoperative pain relief in elderly patients after TKA are 0.072% and 0.093%, respectively.And the incidence of adverse reactions is low.

The effect of fascia iliaca compartment block continuous analgesia in the early stage on early postoperative cognitive in patients with hip fractures / 中国医师进修杂志

Objective:To investigate the effect of fascial iliaca compartment block (FICB) continuous analgesia in the early stage after admission on early postoperative cognitive and motor function in elderly patients with hip fractures.Methods:A total of 80 elderly patients with hip fractures admitted toThe First Affiliated Hospital of Tsinghua University from June 2018 to June 2020 were selected and randomly divided into the control group and the observation group, with 40 cases in each group. The control group adopted the routine postoperative analgesia regimen, while the observation group adopted FICB analgesia immediately after admission to the hospital until before the operation. Postoperative analgesia pattern was consistent with that of the control group, and both groups were given postoperative analgesia for 48 h. The scores of visual analogue scale (VAS), mini mental state assessment scale (MMSE), Harris hip score (Harris) and surgical indexes, stress indexes and incidence of adverse reactions were compared between the two groups.Results:The levels of postoperative blood glucose, cortisol, angiotensin Ⅱin the observation group were lower than those in the control group: (5.21 ± 1.03) mmol/L vs. (7.03 ± 1.06) mmol/L, (643.08 ± 77.28) nmol/L vs. (747.96 ± 82.80) nmol/L, (41.03 ± 5.22) ng/L vs. (57.15 ± 8.16) ng/L, there were statistically differences ( P<0.05). The dosage of sufentanil in the observation group was lower than that in the control group: (27.48 ± 3.25) mg vs. (58.54 ± 4.86) mg, there was statistically difference ( P<0.05). The scores of VAS score at 12 h before surgery, 12 h and 48 h after surgery in the observation group were lower than those in the control group, and the scores of MMSE score were higher than those in the control group, there were statistically differences ( P<0.05). After the surgery, the Harris scores in the observation group was higher than that in the control group: (76.09 ± 6.11) scores vs. (65.62 ± 6.13) scores, there was statistically difference ( P<0.05). The incidence rate of postoperative cognitive dysfunction (POCD) in the observation group was lower than that in the control group: 2.5%(1/40) vs. 15.0%(6/40), there was statistically difference ( χ2 = 3.91, P<0.05). Conclusions:FICB continuou sanalgesic in the early stage after admission of elderly patients with hip fracture is satisfactory, which can effectively relieve postoperative pain, while the stress response is relatively mild, the recovery of postoperative cognitive function and hip function is good.

Compartment Syndrome following Intramedullary Nail Fixation in Closed Tibial Shaft Fractures

@#Introduction: Compartment syndrome complicating intramedullary nailing of closed tibia fractures has been described as early as the 1980s, but currently remains less described in literature compared to compartment syndrome directly following trauma. This study aims to review this potentially disabling complication and highlight the importance of timely diagnosis and management of compartment syndrome following fracture fixation, not just after fracture itself, via a review of three cases. Material and methods: A retrospective study of a series of three cases was conducted. The type of fracture, wait time to fixation, surgery duration, reaming, size of nail implant used, tourniquet time, and surgical technique were recorded. Time to diagnosis of compartment syndrome, compartment pressure if available, extent of muscle necrosis, reconstructive procedures performed, and post-operative complications were analysed. Results: The three cases following high-energy trauma from road traffic accidents presented from January to May 2010. Compartment syndrome was diagnosed clinically for all cases, between one to six days post-operatively and supported by elevated compartment pressure measurements in two of the three cases. Conclusion: This study advocates thorough clinical monitoring and maintaining strong clinical suspicion of compartment syndrome in patients even after intramedullary nail fixation of tibial shaft fractures to achieve timely limbsalvaging intervention. While intercompartmental pressure can be used to aid in diagnosis, we do not advise using it in isolation to diagnose compartment syndrome. Tendon transfer improves functional mobility and provides a good result in patients with severe muscle damage, while skin grafting sufficient in patients with minimal muscle damage.

Ultrasound-guided continuous fascia iliaca compartment block for perioperative pain management in elderly patients undergoing hip fracture surgery / 中国骨伤

OBJECTIVE@#To study the effect of ultrasound-guided fascia iliaca compartment block on perioperative analgesia and postoperative complications in geriatric patients with hip fractures.@*METHODS@#A total of 127 elderly patients undergoing hip fracture surgery from January 2021 to September 2021 were randomized to receive ultrasound-guided continuous fascia iliaca compartment block(group F) either intravenous analgesia control group(group C). There were 62 cases in group F, including 19 males and 43 females with an average age of (82.4±7.2) years old ranging from 66 to 95 years old, involving 25 femoral neck fractures and 37 femoral intertrochanteric fractures. There were 65 cases in control group, including 18 males and 47 females, with an average age of (81.4±8.7) years old ranging from 65 to 94 years old, involving 29 femoral neck fractures and 36 femoral intertrochanteric fractures. The visual analogue scale(VAS), minimental state examination (MMSE), observer's assessment of alertness/sedation(OAA/S) scale, modified Bromage score, postoperative complications and general conditions during hospitalization in two groups were observed.@*RESULTS@#The resting and exercise VAS at 30 min after block, anesthesia placement and 6, 24 and 48 h after surgery were lower than those in group C(P<0.05). In group F, MMSE scores at 12 h before surgery, and 1, 3 d after surgery and OAA/S scores at 3 d after surgery were higher than those in group C(P<0.05). The incidence of adverse effects and the number requiring additional analgesia were lower than those in group C(P<0.05). Group F had better perioperative analgesia satisfaction and hospital stay than group C(P<0.05). But there was no significant difference regarding Bromage score and 30-day mortality between two group(P>0.05).@*CONCLUSION@#Ultrasound-guided continuous fascia iliacus space block was safe and effective for elderly patients with hip fracture, and could significantly reduce perioperative pain, improve postoperative cognitive function, and reduce postoperative complications, thereby shortening hospital stay and improving the quality of life during hospitalization.

Síndrome compartimental após ruptura espontânea de pseudoaneurisma da artéria radial esquerda / Compartment syndrome after spontaneous rupture of a left radial artery pseudoaneurysm

A abordagem transradial é indicada para reduzir risco de morte, complicações vasculares ou sangramento. Em pacientes com doença cardíaca isquêmica estável, a abordagem radial é recomendada para diminuir sangramento no local de acesso e complicações vasculares. As complicações são raras, podendo ocorrer hematoma, perfuração e, muito raramente, pseudoaneurisma da artéria radial. Neste relato de caso, é descrito um caso raro de pseudoaneurisma da artéria radial esquerda associada à síndrome compartimental no antebraço esquerdo após realização de cateterismo eletivo. O diagnóstico foi confirmado por ultrassonografia com Doppler, que evidenciou pseudoaneurisma da artéria radial esquerda, medindo 2,1x1,5cm, com colo de 0,3cm. O tratamento cirúrgico do pseudoaneurisma e da síndrome compartimental restaurou a função completa do membro.

The transradial approach is indicated to reduce the risk of death, vascular complications, or bleeding. In patients with stable ischemic heart disease, the radial approach is recommended to reduce vascular complications and bleeding on access site. The complications are rare, and hematoma, perforation, and pseudoaneurysm (very rarely) of the radial artery may occur. This case report describes a rare case of left radial artery pseudoaneurysm associated with compartment syndrome in the left forearm after elective catheterization. The diagnosis was confirmed by Doppler ultrasonography, which showed a left radial artery pseudoaneurysm, measuring 2.1x1.5cm, with a 0.3-cm long/wide neck. Surgical treatment of pseudoaneurysm and compartment syndrome restored full limb function.

Testicular decompression and tunica vaginalis flap in human acute testicular torsion: modified step-by-step technique description and preliminary outcomes

ABSTRACT Objective To report the effects of a tunica vagina flap on testicular compartment syndrome. Methods This single-arm clinical trial was conducted from September 2020 to October 2021. Consecutive patients with suspected testicular torsion within 24 hours of pain onset were included. Patients with past testicular torsion, bilateral torsion, or previous atrophy were excluded. The tunica vaginalis was opened, and the intratesticular pressure was measured before testicular retrieval from the scrotum and detorsion (P1), after detorsion (P2), and after transverse incision (P3). A tunica vaginalis flap was performed and a new intratesticular pressure was recorded (P4). The contralateral testicular pressure was recorded before fixation (Pc). The minimum follow-up period was 6 months. Results Fifteen patients were recruited from September 2020 to October 2021. Nine patients completed the follow-up. The median age (range) was 15 years (9-19). The mean P1, P2, P3, P4, and Pc (range) were 43, 60, 23, 20, and 14mmHg, respectively. The atrophy rate was 66.3% and the viability was 88.9%. No major complications were observed. Conclusion The modified tunica vaginalis flap in acute testicular torsion decreased intratesticular pressure. Furthermore, normal testicular pressure can improve testicular preservation. It can also decrease testicular pressure to normal levels and preserve the testicular parenchyma.

Compartment Syndrome Secondary to Bothrops spp. Envenomation in Triângulo Mineiro, Region, Minas Gerais, Brazil

ABSTRACT Background: Snakebite is a neglected global health problem with high morbidity. We describe compartment syndrome (CS) cases related to snakebites by Bothrops spp. Methods: The medical records of patients admitted with snakebites envenomation were reviewed. Results: Of 47 patients with Bothrops spp. envenomation (4 male; mean age: 42 years), 7 (15%) developed CS. The mean time to antivenom administration was 9.5 hours. The time to fasciotomy was variable. Seven patients developed infection and four had acute kidney injury. Conclusions: The incidence of CS is higher than that reported previously. This may be due to the clinical severity and long delay before administering antivenom.

Mordeduras de ofidios en mano pediátrica y sus complicaciones locales / Snake bites in pediatric hand and their local complications / Mordidas de serpentes de mão pediátricas e suas complicações locais

Introducción: el envenenamiento por mordedura de ofidios es reconocido como un problema de salud pública según la Organización Mundial de la Salud. La baja incidencia sumada a la diversidad de presentaciones clínicas, edades, topografías afectadas, así como los diferentes protocolos en la bibliografía existente sobre algunos aspectos del tratamiento, hacen difícil el manejo sistematizado de estos pacientes. El objetivo de este trabajo es realizar una revisión sistemática de la literatura sobre mordedura de serpientes en pacientes pediátricos con afectación en mano y miembro superior, haciendo hincapié en la conducta frente las complicaciones loco-regionales. Por importancia y frecuencia destacamos al síndrome compartimental, las flictenas y las infecciones. Metodología: se realizó una búsqueda bibliográfica en MedLine/PubMed con las palabras clave: "Snake Bite hand Children" y "Snake Bite compartimental syndrome". Se incluyeron los artículos publicados en los últimos 10 años (2012 al 2022). Resultados: la búsqueda de artículos ante las palabras "Snake Bite hand Children" resultó en 20 articulos y la busqueda ante las palabras "Snake Bite compartimental syndrome" derivó en 34. Luego de aplicar los criterios de inclusión y exclusión se obtuvieron 30 artículos para el análisis. Conclusiones: la población pediátrica se encuentra más expuesta a las mordeduras por serpientes y a su vez a presentar lesiones más severas. El tratamiento del síndrome compartimental continúa siendo un tema de debate. El veneno inoculado puede simular un síndrome compartimental que puede revertir sin fasciotomías con el tratamiento adecuado. Igualmente, ante síntomas y signos claros de síndrome compartimental se sugiere realizar fasciotomías frente a las graves secuelas potenciales. Ante la aparición de flictenas, el destechado cuidadoso de la misma es un tratamiento adecuado. La mayoría de los autores coinciden con el tratamiento profiláctico con antibioticoterapia.

Introduction: Ophidian bite poisoning is recognized as a public health problem by the World Health Organization. The low incidence added to the diversity of clinical presentations, ages, affected topographies, as well as the different protocols in the existing literature on some aspects of treatment, make the systematized management of these patients difficult. The aim of this work is to carry out a systematic review of the literature on snakebite in pediatric patients with hand and upper limb involvement, with emphasis on the management of loco-regional complications. In terms of importance and frequency, we highlight compartment syndrome, phlyctenas and infections. Methodology: a literature search was carried out in MedLine/PubMed with the keywords: "Snake Bite hand Children" and "Snake Bite compartment syndrome". Articles published in the last 10 years (2012 to 2022) were included. Results: the search for articles with the words "Snake Bite hand Children" resulted in 20 articles and the search for the words "Snake Bite compartment syndrome" resulted in 34 articles. After applying the inclusion and exclusion criteria, 30 articles were obtained for the analysis. Conclusions: the pediatric population is more exposed to snake bites and in turn to present more severe lesions. The treatment of compartment syndrome continues to be a subject of debate. Inoculated venom can simulate a compartment syndrome that can be reversed without fasciotomies with proper treatment. Likewise, in the presence of clear symptoms and signs of compartment syndrome, fasciotomies are suggested because of the serious sequelae generated. In the event of the appearance of phlyctenas, careful unroofing of the phlyctenas would be an appropriate treatment. Most authors agree with prophylactic treatment with antibiotic therapy.

Introdução: O envenenamento por mordidas ofídias é reconhecido como um problema de saúde pública pela Organização Mundial da Saúde. A baixa incidência, juntamente com a diversidade de apresentações clínicas, idades, topografias afetadas, bem como os diferentes protocolos da literatura existente sobre alguns aspectos do tratamento, tornam difícil o gerenciamento sistemático desses pacientes. O objetivo deste trabalho é realizar uma revisão sistemática da literatura sobre mordida de cobra em pacientes pediátricos com envolvimento de mãos e membros superiores, com ênfase no gerenciamento de complicações loco-regionais. Em termos de importância e freqüência, destacamos a síndrome compartimental, as flectenas e as infecções. Metodologia: foi realizada uma pesquisa bibliográfica no MedLine/PubMed com as palavras-chave: "Snake Bite hand Children" e "Snake Bite compartment syndrome". Os artigos publicados nos últimos 10 anos (2012 a 2022) foram incluídos. Resultados: a busca de artigos usando as palavras "Snake Bite hand Children" resultou em 20 artigos e a busca das palavras "Snake Bite compartment syndrome" resultou em 34 artigos. Após a aplicação dos critérios de inclusão e exclusão, foram obtidos 30 artigos para análise. Conclusões: a população pediátrica está mais exposta às picadas de cobra e, por sua vez, a lesões mais graves. O tratamento da síndrome compartimental continua a ser motivo de debate. O veneno inoculado pode simular uma síndrome de compartimento que pode ser revertida sem fasciotomias com tratamento apropriado. Da mesma forma, se houver sinais e sintomas claros de síndrome compartimental, são sugeridas fasciotomias por causa das severas seqüelas. Se as flectenas aparecerem, o desenrolamento cuidadoso das flectenas seria um tratamento apropriado. A maioria dos autores concorda com o tratamento profilático com a antibioticoterapia.

Acute Compartment Syndrome of the Forearm and Hand due to Extravasation of Computed Tomography Contrast Material

Although Compartment Syndrome is a common surgical emergency with a plethora of aetiologies, Intravenous extravasation of Computed Tomography (CT) contrast medium causing acute compartment syndrome has been reported very rarely. We present a 61-year-old female who underwent abdominal CT with Intravenous contrast for irreducible, recurrent incisional hernia, presented with persistent excruciating pain and progressive multiple blister formation over the left forearm and hand following intravenous contrast material injection via the left dorsum of the hand. Clinical diagnosis of compartment syndrome was made, X-ray left forearm and hand confirmed soft tissue contrast extravasation. She was taken for emergency decompression fasciotomy of the left forearm and hand compartments, and later partial wound closure and split skin graft into remaining areas were carried out. Clinicians and radiologist should aware of this potential complication for its early recognition, management and prevention.

Síndrome compartimental: una presentación atípica como causa de la púrpura de Henoch-Schönlein / Compartment syndrome: an atypical presentation as a cause of Henoch-Schönlein purpura

Resumen: Introducción: en la literatura existen escasos reportes de caso del desarrollo de síndrome compartimental como una potencial complicación de la púrpura de Henoch-Schönlein. Caso clínico: se presenta el caso clínico de una paciente de 17 años con un cuadro de síndrome compartimental bilateral en pies como presentación atípica de la púrpura de Henoch-Schönlein, nunca antes descrita en la literatura. Conclusión: con una rápida sospecha diagnóstica y un tratamiento quirúrgico con fasciotomías, se consiguió preservar la viabilidad de las extremidades y su funcionalidad a los seis meses de seguimiento, a pesar de tratarse de una presentación sumamente atípica de la patología en cuestión.

Abstract: Introduction: there are few case reports available that describe compartment syndrome as a complication of Henoch-Schönlein purpura. Case report: we report the case of a 17-year-old patient with bilateral compartment syndrome of the foot as an atypical presentation of Henoch-Schönlein purpura. A case like this has not been reported before. Conclusion: although the patient had an extremely rare clinical presentation, the viability and functionality of the limbs was preserved even after six months of follow-up thanks to an early diagnosis and surgical treatment.

Evolución temporal de una línea celular leucémica que compite con la hematopoyesis saludable / Temporal evolution of a leukemic line that competes with healthy hematopoiesis

Introducción: La hipótesis del cáncer de las células madre se ha convertido en uno de los paradigmas más importantes en la investigación biomédica. Durante los últimos años se ha ido acumulando evidencia de la existencia de poblaciones similares a células madre en diferentes tipos de cáncer, especialmente en las leucemias. Objetivos: Mostrar mediante la modelación matemática y la simulación computacional cómo los cambios en los parámetros que describen las tasas de proliferación y las propiedades de autorrenovación pueden influir en la dinámica de las poblaciones de células sanas y leucémicas. Métodos: Se utilizó un modelo matemático que es una extensión de los modelos de hematopoyesis sana. Se resolvió el modelo mediante herramientas computacionales basadas en métodos numéricos, lo que permitió realizar simulaciones con diferentes parámetros e intervalos de tiempo. Resultados: Al imponer ciertas condiciones iniciales y resolver matemáticamente el modelo se obtuvo la evolución temporal de las variables de estado del sistema hematopoyético. Partiendo de un estado conocido del sistema hematopoyético se predijo el comportamiento en el tiempo de las variables de estado. Se particularizó para cuatro escenarios clínicamente relevantes. Conclusiones: El análisis del modelo dio como resultado diferentes escenarios de crecimiento de células leucémicas, entre los cuales la proliferación aumentada de células malignas es el más prominente. Sin embargo, diferentes escenarios son posibles, como la inducción de apoptosis o la autorrenovación mejorada(AU)

Introduction: The stem cell cancer hypothesis has become one of the most important paradigms in biomedical research. In recent years, evidence has accumulated for the existence of stem cell-like populations in different types of cancer, especially in leukemias. Objectives: To show, through mathematical modeling and computational simulation, how changes in the parameters that describe proliferation rates and self-renewal properties can influence the dynamics of healthy and leukemic cell populations. Methods: A mathematical model was used which is an extension of the healthy hematopoiesis models. The model was solved using computational tools based on numerical methods, this allowed to carry out countless simulations with different parameters and time intervals. Results: By imposing certain initial conditions and mathematically solving the model, the temporal evolution of the state variables of the hematopoietic system was obtained, that is, starting from a known state of the hematopoietic system, the behavior over time of the state variables of the system was predicted. It was particularized for four clinically relevant scenarios. Conclusions: The analysis of the model results in different growth scenarios of leukemic cells, among which the increased proliferation of malignant cells is the most prominent. However, different scenarios are possible, such as apoptosis induction or enhanced self-renewal(AU)

Abordaje transcervical en el síndrome de Eagle. Reporte de caso clínico / Transcervical Approach in Eagle Syndrome. Clinical Case Report

Resumen El síndrome de Eagle es una enfermedad rara responsable de múltiples síntomas de cabeza y cuello, resultado de un alargamiento del proceso estiloideo u osificación del ligamento estilohioideo comprimiendo estructuras neurovasculares adyacentes, hay dos variantes, el clásico caracterizado principalmente por dolor y disfagia y la variante carotídea distinguido con dolor y en ocasiones isquemia cerebral. Describimos un reporte de caso clínico de un paciente femenino de 45 años, quien experimentaba dolor cervical de lado izquierdo, realizando el protocolo completo de dolor miofascial del Hospital Regional General Ignacio Zaragoza ISSSTE de la Ciudad de México, el estudio de tomografía computada evidenció una elongación de 50mm del proceso estiloideo, confirmando el diagnóstico, enfocando el artículo en la descripción anatómico-quirúrgica.

Abstract Eagle syndrome is a rare disease responsible for multiple head and neck symptoms, resulting from an elongation of the styloid process or ossification of the stylohyoid ligament compressing adjacent neurovascular structures. There are two variants, the classic one characterized mainly by pain and dysphagia and the carotid variant distinguished with pain and sometimes cerebral ischemia. We describe a clinical case report of a 45-year-old female patient, who experienced left cervical pain, performing the complete myofascial pain protocol of the Regional Hospital "General Ignacio Zaragoza" ISSSTE in Mexico City, resulting in a 50mm elongation of the styloid process in the CT scan, confirming the diagnosis, and focusing the article on the anatomical-surgical description.

Manifestaciones cardiovasculares y síndrome compartimental asociado a mordedura por Phoneutria spp: Reporte de un caso / Cardiovascular manifestations and compartment syndrome associated with bite by Phoneutria spp: case report / Manifestações cardiovasculares e síndrome compartimental associadas à mordida de Phoneutria spp: Relato de caso

Se describen las características sobre el phoneutrismo a propósito de un caso. El phoneutrismo es el término con el que se conoce al accidente ocasionado por la mordedura de la araña phoneutria spp, la cual tiene una relevancia clínica dada por las características tóxicas de su veneno. Se presenta un caso de mordedura de la araña phoneutria spp de un paciente atendido en un hospital de alta complejidad de la ciudad de Medellín, Colombia, con manifestaciones cardiovasculares y hallazgos compatibles con un síndrome compartimental, lo cual es inusual en este tipo de arañas, por lo que se necesitó vigilancia en unidad de alta dependencia y fasciotomía cutánea. En Colombia este tipo de accidentes no son de reporte obligatorio, por tanto existe un alto riesgo de subregistro. Lo llamativo de este caso está en las manifestaciones cardiovasculares y la presencia de síndrome compartimental que no se ha descrito en la literatura con este subespecie de arañas.

The characteristics of phoneutrism are described in relation to a case. Phoneutrism is the term with which the accident caused by the bite of the phoneutria spp spider is known, which has clinical relevance given by the toxic characteristics of its venom. We present a case of a bite by the phoneutria spp spider in a patient treated at a high-complexity hospital in the city of Medellín, Colombia, with cardiovascular manifestations and findings compatible with compartment syndrome, which is unusual in this type of spiders, and required surveillance in a high dependency unit and cutaneous fasciotomy. In Colombia reporting this type of accident is not mandatory; therefore, there is a high risk of underreporting. What is striking about this case is the cardiovascular manifestations and the presence of compartment syndrome that has not been described in the literatura with this genre of spiders.

As características do fonutrismo são descritas em um relatório de um caso. Fonutrismo é o termo usado para descrever o acidente causado pela mordida da aranha Phoneutria spp, que é clinicamente relevante devido às características tóxicas de seu veneno. Apresentamos um caso de mordida de aranha por uma aranha Phoneutria em um paciente tratado em um hospital de alta complexidade na cidade de Medellín, Colômbia, com manifestações cardiovasculares e achados compatíveis com a síndrome compartimental, o que é incomum neste tipo de aranha, exigindo vigilância em uma unidade de alta de-pendência e fasciotomia cutânea. Na Colômbia, este tipo de acidente não é obrigatório, portanto, há um alto risco de subnotificação. O que é impressionante neste caso são as manifestações cardiovasculares e a presença da síndrome compartimental, que não foi descrita na literatura com esta subespécie de aranha.

0.25% Bupivacaine with 8 mg Dexamethasone and 50 mcg Clonidine as adjuvant on fascia iliaca compartment block in open reduction and internal fixation surgeries to femoral fractures-a prospective randomized study

Background: Fascia iliaca compartment nerve block (FICB) is commonly preferred pain management technique in femoral fractures. Dexamethasone and clonidine as adjuvants to local anesthetics have good analgesic effect with limited adverse effect. Aim and Objectives: To assess the efficacy of bupivacaine with clonidine, bupivacaine with dexamethasone, and bupivacaine alone in fascia iliaca compartment block in cases with femoral fractures. Materials and Methods: The present prospective randomized study included a total of 120 cases undergoing proximal femoral surgeries under subarachnoid block above 21 years. The study cases were randomly divided into three study groups, i.e. 40 participants in each group. Group 1 received 0.25% bupivacaine with 2 ml normal saline, Group 2 received 0.25% bupivacaine with 50mcg clonidine, and Group 3 received with 0.25% bupivacaine with 8mg dexamethasone. Parameters such as heart rate (HR), mean arterial pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), oxygen saturation levels, and visual analog scale (VAS) score was monitored and recorded. Results: The mean difference of HR between the study groups was statistically not significant (P > 0.005). The mean SBP, DBP, and VAS score was comparable between study groups. The mean analgesic duration in Group 1 was 6.01 h, in Group 2 was 13.58 h, and in Group 3 was 14.44 h. The mean difference of rescue analgesia requirement and duration of rescue analgesia was statistically significant. No adverse effects toward drugs were noticed. Conclusion: About 0.25% bupivacaine with 8 mg Dexamethasone had better analgesic duration and require minimal rescue analgesia in the first postoperative day than 0.25% bupivacaine with 50 mcg clonidine in cases undergoing femoral surgeries under FICB.

Regional anesthesia for compartment syndrome as a complication of ECMO. Case report / Anestesia regional para síndrome compartimental como complicación de ECMO. Reporte de caso

Abstract We present the case of a patient intervened for mechanical mitral replacement, tricuspid annuloplasty, and correction of a total anomalous pulmonary venous return, which required Extracorporeal Membrane Oxygenation (ECMO) in the immediate postoperative period because of refractory cardiogenic shock. After withdrawal of the arterial cannula, the patient developed compartment syndrome of the right lower limb, requiring urgent intervention. Also, the patient went into respiratory failure, requiring support with high flow oxygen cannula. Given the patient's condition, general anesthesia was discarded. An ultrasound-guided popliteal block and sedation with dexmedetomidine and ketamine was performed instead, maintaining the high flow nasal cannula. Regional anesthesia along with dexmedetomidine and ketamine could be an alternative for a surgical procedure in patients with high risk of cardiovascular and respiratory complications.

Resumen Presentamos el caso de una paciente femenina sometida a remplazo de válvula mitral mecánica, anuloplastia y corrección de retorno venoso pulmonar anómalo total, quien requirió oxigenación con membrana extracorpórea (ECMO) en el postoperatorio inmediato debido a shock cardiogénico refractario. Una vez retirada la cánula arterial, la paciente desarrolló síndrome compartimental de la extremidad inferior derecha, requiriendo intervención urgente. Adicionalmente, presentó insuficiencia respiratoria que requirió soporte de oxígeno por cánula de alto flujo. En vista de la condición de la paciente se descartó la anestesia general, optando a cambio por un bloqueo poplíteo guiado por ultrasonido más sedación con dexmedetomidina y ketamina, manteniendo la cánula nasal de alto flujo. La anestesia regional junto con dexmedetomidina y ketamina puede ser una alternativa para procedimientos quirúrgicos en pacientes de alto riesgo cardiovascular y complicaciones respiratorias.