[Giant loss of domain hernia: Preoperative treatment with botulinum toxin of the abdominal oblique muscles]. / Hernia abdominal con pérdida del domicilio: tratamiento preoperatorio con toxina botulínica de la musculatura oblicua abdominal.

In giant loss of domain hernia there is a high risk of abdominal compartment syndrome and restrictive lung disease after complete surgical repair of the fascial defect. We report the case of a 54-year-old man with a late-stage right giant mesogastric loss of domain hernia who began preoperative treatment with progressive pneumoperitoneum. After evaluation of the muscles and skin, ultrasound and electromyographic-guided infiltration of botulinum toxin type A was performed in the abdominal oblique muscles. It caused a flaccid paralysis of the wall and allowed advancement of the lateral flaps without weakening them. The patient underwent surgery one month later with complete closure of the defect and with no signs of respiratory failure or compartment syndrome. The use of botulinum toxin in the preoperative treatment of patients with loss of domain hernias seems a safe and effective therapeutic option.

Hernia abdominal con pérdida del domicilio: tratamiento preoperatorio con toxina botulínica de la musculatura oblicua abdominal / Giant loss of domain hernia: Preoperative treatment with botulinum toxin of the abdominal oblique muscles

En las hernias gigantes con pérdida del domicilio existe un alto riesgo de síndrome compartimental abdominal y de enfermedad respiratoria restrictiva tras la reparación quirúrgica completa del defecto fascial. Presentamos el caso de un paciente de 54 años con una eventración gigante mesogástrica con pérdida del derecho al domicilio de años de evolución, que ha iniciado tratamiento preoperatorio con neumoperitoneo progresivo. Tras valoración de la pared abdominal y del estado dérmico, se realiza infiltración bajo guía ecográfica y electromiográfica de musculatura oblicua de toxina botulínica tipo A. Provoca una parálisis flácida de la pared y permite el avance de los colgajos laterales sin debilitarlos. Posteriormente se interviene sin presentar signos de insuficiencia respiratoria y con un cierre completo del defecto sin signos de síndrome compartimental. El uso de toxina botulínica en el tratamiento preoperatorio de las hernias gigantes con pérdida del domicilio parece una alternativa terapéutica efectiva y segura

In giant loss of domain hernia there is a high risk of abdominal compartment syndrome and restrictive lung disease after complete surgical repair of the fascial defect. We report the case of a 54-year-old man with a late-stage right giant mesogastric loss of domain hernia who began preoperative treatment with progressive pneumoperitoneum. After evaluation of the muscles and skin, ultrasound and electromyographic-guided infiltration of botulinum toxin type A was performed in the abdominal oblique muscles. It caused a flaccid paralysis of the wall and allowed advancement of the lateral flaps without weakening them. The patient underwent surgery one month later with complete closure of the defect and with no signs of respiratory failure or compartment syndrome. The use of botulinum toxin in the preoperative treatment of patients with loss of domain hernias seems a safe and effective therapeutic option

[Measurement of the outcomes in acquired brain injury in a neurorehabilitation unit. A long-term study]. / Medicion de resultados en el daño cerebral adquirido en una unidad de neurorrehabilitacion. Estudio a largo plazo.

INTRODUCTION: Following sudden brain damage, there is a loss of capabilities that affects the person's autonomy. Recovery from the physical, psychic and cognitive sequelae requires the application of multiple therapies, the outcomes of which need to be measured objectively. Our aim is to analyse the application of standardised instruments in determining the therapeutic outcomes in acquired brain injury. PATIENTS AND METHODS: We conducted a retrospective descriptive observational study lasting 13 months. Both epidemiological and clinical data were analysed: elapsed time since onset, degree of independence (Barthel index), presence of spasticity and treatment with botulinum toxin. Outcomes were measured using Goal Attainment Scaling and the Rehabilitation Complexity Scale, pre- and post-treatment. RESULTS: We reviewed a total of 45 patients, 60% of them having suffered a stroke. Spasticity was present in 19 patients, and 42% were treated with botulinum toxin infiltration. All of them underwent goal-setting treatment; in 84% of the cases more than one goal was planned, and the most prevalent was gait re-education. With the use of the scales it was observed that the patients with the greatest initial complexity had more difficulty to achieve the goals that had been set, although there was a higher degree of improvement in comparison to their prior status. CONCLUSION: The initial situation in terms of dependence and the degree of complexity of the needs of patients with brain damage correlate with the final situation after a programme of neurorehabilitation therapy. This reflects the importance of using scales like Goal Attainment Scaling and the Rehabilitation Complexity Scale, pre- and post-treatment.

TITLE: Medicion de resultados en el daño cerebral adquirido en una unidad de neurorrehabilitacion. Estudio a largo plazo.Introduccion. Tras un daño cerebral brusco se produce una perdida de capacidades que afectan a la autonomia de la persona. La recuperacion de las secuelas fisicas, psiquicas y cognitivas requiere la aplicacion de multiples terapias cuyos resultados precisan una medicion objetiva. Nuestro objetivo es analizar la aplicacion de instrumentos estandarizados en la determinacion de resultados terapeuticos en el daño cerebral adquirido. Pacientes y metodos. Estudio observacional descriptivo retrospectivo de 13 meses de duracion. Analizamos datos epidemiologicos y clinicos: tiempo de evolucion, grado de independencia (indice de Barthel), presencia de espasticidad y tratamiento con toxina botulinica. Como medida de resultados se uso la Goal Attainment Scaling y la Rehabilitation Complexity Scale, pre y postratamiento. Resultados. Revisamos un total de 45 pacientes, el 60% debido a un ictus. La espasticidad estaba presente en 19 pacientes, y el 42% fue tratado con infiltracion de toxina botulinica. Todos realizaron tratamiento con planificacion de objetivos; en el 84% de los casos se planifico mas de un objetivo terapeutico, y el mas prevalente fue la reeducacion de la marcha. Con el uso de las escalas se observo que los pacientes con mayor complejidad inicial presentaban una mayor dificultad para lograr los objetivos establecidos, aunque existia un mayor grado de mejora en comparacion con su estado previo. Conclusion. La situacion de dependencia inicial y el grado de complejidad en las necesidades del paciente con daño cerebral se correlaciona con la situacion final tras un programa de tratamiento neurorrehabilitador, de ahi la importancia del uso de escalas como la Goal Attainment Scaling y la Rehabilitation Complexity Scale pre y postratamiento.