ABSTRACT
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Subject(s)
Humans , Female , Aged , Fibromyalgia/diagnosis , Myalgia/diagnosis , Distal Myopathies/diagnosis , Chronic Pain/etiology , Diagnosis, Differential , Pain Management/methodsABSTRACT
Introducción: La neuromodulación de las raíces sacras se ha mostrado eficaz en el tratamiento del dolor pélvico crónico (DPC) refractario a tratamiento farmacológico. En estos pacientes y parece existir un importante grado de sensibilización central. La radiofrecuencia pulsada ha demostrado su utilidad en múltiples cuadros de dolor neuropático. Una modificación de la técnica de radiofrecuencia pulsada (RFP) vía caudal, propuesta por Rohof para el tratamiento de pacientes con sensibilización central, intentando concentrar los impulsos electromagnéticos sobre las vías nerviosas aferentes y eferentes que inervan las distintas estructuras pélvicas, quizá pudiera ser efectiva en el tratamiento de estos pacientes. En este artículo se presentan dos pacientes con DPC refractario a otros tratamientos previos que han respondido adecuadamente a la RFP vía caudal de raíces sacras. Material y métodos: Se presentan dos casos de pacientes con DPC con escasa respuesta previa a distintos tratamientos conservadores e intervencionistas clásicos. Se realiza RFP vía caudal de raíces sacras, con una cánula recta, con control de temperatura (electrodo extraíble Cosman(R) modelo CC152020) situando su punta, mediante control radiológico, a nivel S3 y colocando la placa dispersiva sobre la unión sacro lumbar. Tras la RFP se realiza inyección posterior de anestésico local y corticoide a través de la cánula. Se evalúa a los pacientes cada tres meses hasta el momento actual. Resultados: Tras la aplicación de esta técnica, ambos pacientes refieren disminución de la intensidad del dolor en la escala NRS (de 8-9/10 a 2-3/10), así como un grado de alivio de hasta el 80 %, afirmando haber obtenido con esta técnica el mayor grado de satisfacción logrado hasta el momento con una mayor duración del mismo. Conclusión: La RFP de raíces sacras vía caudal puede suponer una nueva, sencilla, útil y segura alternativa terapéutica en pacientes con DPC (AU)
Introduction: Sacral root neuromodulation has been known as a well-established method of managing intractable chronic pelvic pain (CPP), where it seems to exist an important degree of central sensitization. Pulsed radiofrequency (PRF) offers applicability to pathological conditions such as neuropathic pain. A modified caudal PRF proposed by Rohof for the treatment of patients with central sensitization, attempting to concentrate the electromagnetic impulses on the afferent and efferent nerve pathways innervating the different pelvic structures, could be an effective treatment. In this paper, we present two patients with refractory CPP and a remarkable pain relief after being treated with this novel technique. Materials and methods: We present the history of two patients with CPP and refractory to both conservative and interventional classic treatments. Caudal PRF is carried out, with a straight temperature-control cannula (Cosman(R) removable electrode CC152020 model), with radiological control, no further than the S3 level and applying the ground pad on the lumbosacral junction. Then, local anesthesia and corticoids are injected through the cannula. Patients are evaluated every three months until the present time. Results: After the application of this technique, both patients reported decreased pain intensity on the NRS scale (from 8-9/10 to 2-3/10), as well as a degree of pain relief up to 80 %, claiming to have obtained the greater degree of satisfaction and prolong effect achieved so far. Conclusion: Caudal PRF of the sacral roots might be used as a new, simple, useful and safe therapeutic alternative in patients with CPP (AU)
Subject(s)
Humans , Female , Middle Aged , Aged , Pelvic Pain/rehabilitation , Chronic Pain/rehabilitation , Pulsed Radiofrequency Treatment/methods , Pain Management/methods , Neurotransmitter Agents/therapeutic use , Injections, EpiduralSubject(s)
Ambulatory Surgical Procedures , Anesthesia, Spinal , Hernia, Inguinal/surgery , Laparoscopy , HumansABSTRACT
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Subject(s)
Humans , Laparoscopy , Ambulatory Surgical Procedures , Anesthesia, Spinal , Hernia, InguinalABSTRACT
Colorectal cancer usually appears in patients over 60 years-old. However, all the series communicate a small percentage of cases in young patients, ranging from 2 to 10% of the total. We have found important discrepancies between authors who have worked on the possible distinctive characteristics of colorectal cancer of the young over the last decade. This motivated us to examine more closely the clinical, follow-up and prognostic features of colorectal cancerous disease in the young as compared to that occurring in the general population. We analyzed retrospectively the clinical histories of our patients with special reference to the following parameters: sex, diagnostic delay (time from the appearance of the first symptom to diagnosis), index symptom, site, Dukes' grade, type of surgical treatment, complications, recurrence and survival. We found that 4.9% of our patients with colorectal cancer were as old as 40 years. The clinical presentation, tumoral site and Dukes grade were similar in the young adult and in the general population. In spite of the fact that there were no differences in these parameters, in younger patients the surgeon was more aggressive, more often performing a radical operation. Perhaps for this reason, this age group had a higher percentage of complications and recurrences. We found no differences in the 4-year survival or in the time survived after surgery.