ABSTRACT
La neurofibromatosis tipo 1 o enfermedad de von Recklinghausen es una enfermedad genética, progresiva y multisistémica que afecta predominantemente a la piel y el sistema nervioso. La alteración vascular es poco frecuente pero puede tener resultados catastróficos. Las pacientes gestantes afectas de esta enfermedad necesitan un seguimiento exhaustivo y multidisciplinar con el objetivo de controlar las posibles alteraciones vasculares sobre todo renales por ser las más frecuentes. Presentamos el caso de una paciente diagnosticada de NF-1 que presentó un hemoperitoneo masivo espontáneo en el postoperatorio tardío de una cesárea electiva. El sangrado espontáneo de grandes vasos es una rara pero potencial complicación letal que puede producirse en pacientes afectos de neurofibromatosis I y que puede precisar de tratamiento quirúrgico urgente
Neurofibromatosis type 1 (NF-1) or von Recklinghausen's disease is a genetic, progressive, multi-system disease that predominantly affects the skin and nervous system. Vascular involvement is rare, but can have catastrophic results. Pregnant patients with this disease need careful, multidisciplinary follow up in order to control possible vascular alterations, which usually affect the kidneys. We present the case of a patient diagnosed with NF-1 who debuted with massive spontaneous hemoperitoneum in the late postoperative period of an elective Cesarean section. Spontaneous bleeding from large vessels is a rare but potentially lethal complication that can occur in patients with NF-1, and may require urgent surgical treatment
Subject(s)
Humans , Female , Pregnancy , Adult , Neurofibromatosis 1/complications , Hemoperitoneum/etiology , Cesarean Section , Neurofibromatosis 1/surgery , Hemoperitoneum/surgery , Pregnancy Complications , Postoperative Period , Postpartum Period , Fatal OutcomeABSTRACT
Neurofibromatosis type 1 (NF-1) or von Recklinghausen's disease is a genetic, progressive, multi-system disease that predominantly affects the skin and nervous system. Vascular involvement is rare, but can have catastrophic results. Pregnant patients with this disease need careful, multidisciplinary follow up in order to control possible vascular alterations, which usually affect the kidneys. We present the case of a patient diagnosed with NF-1 who debuted with massive spontaneous hemoperitoneum in the late postoperative period of an elective Cesarean section. Spontaneous bleeding from large vessels is a rare but potentially lethal complication that can occur in patients with NF-1, and may require urgent surgical treatment.
Subject(s)
Cesarean Section , Hemoperitoneum/etiology , Neurofibromatosis 1/complications , Postoperative Hemorrhage/etiology , Pregnancy Complications, Neoplastic , Adult , Elective Surgical Procedures , Fatal Outcome , Female , Humans , Postpartum Period , Pregnancy , RecurrenceABSTRACT
No disponible
Subject(s)
Humans , Female , Pregnancy , Adult , Analgesia, Epidural/instrumentation , Analgesia, Epidural/methods , Analgesia, Epidural , Labor, Obstetric , Polyneuropathies/drug therapy , Polyradiculoneuropathy/complications , Polyradiculoneuropathy/drug therapy , Pain Management/instrumentation , Pain Management/methods , Epidural Space , Anesthesia, Local/instrumentation , Anesthesia, Local/methods , Anesthesia, LocalABSTRACT
Objetivo. El presente estudio pretende establecer la eficacia y tolerabilidad de los opioides en el tratamiento del dolor en pacientes con úlceras cutáneas crónicas y dolor irruptivo incidental. Material y método. Estudio abierto, multicéntrico, prospectivo, no controlado, realizado en unidades del dolor y de úlceras de 5 hospitales de la Comunidad Valenciana. El criterio de inclusión fue dolor basal mayor o igual a 4 según la escala visual analógica o dolor irruptivo mayor o igual a 4 durante la cura. Los criterios de exclusión fueron alteraciones cognitivas, intolerancia a opioides y rechazo del paciente a dar el consentimiento. El protocolo estableció 5 momentos de evaluación: basal (primera visita), 15 días, un mes, 2 y 3 meses. La variable principal del estudio fue el dolor medido con la escala visual analógica en reposo, en movimiento y durante la cura. Se administraron opioides para el dolor basal y se administró fentanilo sublingual para el dolor irruptivo. Resultados. Treinta y dos pacientes (86,5%) completaron el estudio. El dolor basal experimentó una reducción media de 3,6 (DE 2,3) puntos en la escala visual analógica, el dolor en movimiento disminuyó 3,9 (DE 2,5), y el dolor durante la cura disminuyó 4,5 (DE 2,8), siendo en todos estadísticamente significativa (p < 0,001) desde el primer control. Catorce pacientes (43,8%) presentaron náuseas, 7 (21,9%), somnolencia y estreñimiento, 5 (15,6%), prurito, y uno (3,1%), vómitos. Conclusiones. Los resultados de nuestro estudio evidencian que el tratamiento con opioides en pacientes con úlceras cutáneas crónicas proporciona un alivio efectivo del dolor, tanto basalmente como durante la cura, con escasos efectos adversos (AU)
Objective. The aim of the study was to assess the efficacy and safety of opioids in the management of pain in those patients with chronic cutaneous ulcers and breakthrough/incidental pain. Material and method. An open-label, multicentre, prospective, uncontrolled study was conducted in the pain and ulcer units of 5 hospitals across the Comunidad Valenciana. Eligibility criteria were baseline pain 4 in the visual analogue scale or breakthrough procedural pain 4. Exclusion criteria were cognitive impairment, opioid intolerance, or patient refusal to provide informed consent. The protocol scheduled 5 controls: baseline (enrolment), 15 days, one month, 2 months, and 3 months. The main outcome measure of the study was the visual analogue scale score during rest, movement and procedures. Opioids were administered for release of the baseline pain, and sublingual fentanyl for breakthrough pain. Results. A total of 32 patients (86.5%) completed the study. Baseline pain achieved a mean improvement of 3.6 visual analogue scale points (SD 2.3), movement pain improved by 3.9 points (SD 2.5) and procedural pain improved by 4.5 points (SD 2.8), and the mean pain intensity improvement was statistically significant from the first control and at all controls thereafter (P < .001). Nausea was reported by 14 patients (43.8%), drowsiness and constipation by 7 (21.9%), itching by 5 (15.6%), and one (3.1%) reported vomiting. Conclusions. Structured assessment of pain is a key concept in the management of patient with chronic cutaneous ulcers. The results of this study suggest that opioid therapy provides clinically significant pain relief with few adverse effects (AU)
Subject(s)
Humans , Male , Female , Pain Management/methods , Fentanyl/therapeutic use , Administration, Sublingual , Skin Ulcer/diagnosis , Skin Ulcer/drug therapy , Chronic Pain/drug therapy , Fentanyl/metabolism , Skin Ulcer/metabolism , Treatment Outcome , Evaluation of the Efficacy-Effectiveness of Interventions , Analgesics, Opioid/therapeutic use , Pain/complications , Pain/drug therapy , Pain/etiologyABSTRACT
La miocardiopatía no compactada es una miocardiopatía primaria de origen genético. Las pacientes embarazas con miocardiopatía no compactada son más susceptibles a presentar complicaciones, como insuficiencia cardíaca, arritmias y fenómenos embólicos. Presentamos el caso de una embarazada a término con miocardiopatía no compactada asintomática y en tratamiento con bisoprolol a la que se le realizó analgesia epidural para el parto evolucionando de manera favorable. Se describe el curso clínico y se realiza una somera revisión (AU)
Non-compaction cardiomyopathy, a genetic primary cardiomyopathy, is being increasingly diagnosed. Pregnant women with non-compaction cardiomyopathy are more susceptible to complications, such as heart failure, arrhythmias and embolic events. This paper reports the case of a pregnant woman with non-compaction cardiomyopathy under treatment and asymptomatic, who received epidural analgesia during labor and delivery. The clinical course is described and a brief review is presented (AU)
Subject(s)
Humans , Female , Pregnancy , Adult , Cardiomyopathies/complications , Cardiomyopathies/drug therapy , Anesthesia, Epidural , Bisoprolol/therapeutic use , Pregnancy Complications/drug therapy , Risk Factors , Critical Pathways/trendsABSTRACT
OBJECTIVE: The aim of the study was to assess the efficacy and safety of opioids in the management of pain in those patients with chronic cutaneous ulcers and breakthrough/incidental pain. MATERIAL AND METHOD: An open-label, multicentre, prospective, uncontrolled study was conducted in the pain and ulcer units of 5 hospitals across the Comunidad Valenciana. Eligibility criteria were baseline pain 4 in the visual analogue scale or breakthrough procedural pain 4. Exclusion criteria were cognitive impairment, opioid intolerance, or patient refusal to provide informed consent. The protocol scheduled 5 controls: baseline (enrolment), 15 days, one month, 2 months, and 3 months. The main outcome measure of the study was the visual analogue scale score during rest, movement and procedures. Opioids were administered for release of the baseline pain, and sublingual fentanyl for breakthrough pain. RESULTS: A total of 32 patients (86.5%) completed the study. Baseline pain achieved a mean improvement of 3.6 visual analogue scale points (SD 2.3), movement pain improved by 3.9 points (SD 2.5) and procedural pain improved by 4.5 points (SD 2.8), and the mean pain intensity improvement was statistically significant from the first control and at all controls thereafter (P<.001). Nausea was reported by 14 patients (43.8%), drowsiness and constipation by 7 (21.9%), itching by 5 (15.6%), and one (3.1%) reported vomiting. CONCLUSIONS: Structured assessment of pain is a key concept in the management of patient with chronic cutaneous ulcers. The results of this study suggest that opioid therapy provides clinically significant pain relief with few adverse effects.
Subject(s)
Fentanyl/therapeutic use , Narcotics/therapeutic use , Pain/drug therapy , Skin Ulcer/complications , Administration, Sublingual , Aged , Chronic Disease , Constipation/chemically induced , Female , Fentanyl/administration & dosage , Fentanyl/adverse effects , Humans , Male , Middle Aged , Narcotics/administration & dosage , Narcotics/adverse effects , Pain/etiology , Postoperative Nausea and Vomiting/chemically induced , Prospective Studies , Pruritus/chemically induced , Visual Analog ScaleABSTRACT
Non-compaction cardiomyopathy, a genetic primary cardiomyopathy, is being increasingly diagnosed. Pregnant women with non-compaction cardiomyopathy are more susceptible to complications, such as heart failure, arrhythmias and embolic events. This paper reports the case of a pregnant woman with non-compaction cardiomyopathy under treatment and asymptomatic, who received epidural analgesia during labor and delivery. The clinical course is described and a brief review is presented.
Subject(s)
Analgesia, Epidural/methods , Analgesia, Obstetrical/methods , Heart Defects, Congenital , Pregnancy Complications, Cardiovascular , Adult , Delivery, Obstetric , Female , Heart Defects, Congenital/genetics , Heart Defects, Congenital/pathology , Hemodynamics , Humans , Infant, Newborn , Pregnancy , Pregnancy Complications, Cardiovascular/genetics , Pregnancy Complications, Cardiovascular/pathologySubject(s)
Catheterization, Central Venous/adverse effects , Hydrothorax/etiology , Intraoperative Complications/etiology , Jugular Veins/injuries , Wounds, Penetrating/etiology , Delayed Diagnosis , Female , Humans , Jejunostomy , Middle Aged , Oliguria/etiology , Pancreatic Neoplasms/surgery , Pleural Effusion/etiologyABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Hydrothorax/etiology , Catheterization, Central Venous/adverse effects , Jugular Veins , Jejunostomy/methods , Pancreatic Neoplasms/surgerySubject(s)
Nerve Block/methods , Sciatic Nerve/diagnostic imaging , Female , Humans , Middle Aged , Punctures , UltrasonographyABSTRACT
No disponible
Subject(s)
Female , Middle Aged , Humans , Sciatic Nerve , Nerve Block/methods , PuncturesABSTRACT
AIMS: To compare the efficacy and feasibility of the sciatic nerve block performed using either a posterior or a lateral approach to the popliteal fossa, taking into consideration patient comfort during puncture and postoperative analgesia. PATIENTS AND METHODS: Sixty patients scheduled for foot surgery were randomly assigned to 2 groups: a posterior approach was used in performing the sciatic nerve block in 1 group (n = 30) and a lateral approach was in the other group (n = 30). The local anesthetic employed was mepivacaine 1%. RESULTS: Duration of sensory block was used significantly longer with the lateral approach (5.4 hours, range 3.3-8 hours) than with the posterior approach (4.4 hours, range 1.5-7 hours) (P < 0.001). Time to onset of the block was significantly shorter with the lateral approach (10 minutes, range 5-25 minutes) than with the posterior approach (17 minutes, range 4-45 minutes) (P < 0.01). Quality of the blockade was similar with both approaches. CONCLUSIONS: The lateral approach to the block of the sciatic nerve in the popliteal fossa provides analgesia comparable to that obtained with the posterior approach, with a faster onset and longer postoperative duration.
Subject(s)
Anesthetics, Local/administration & dosage , Mepivacaine/administration & dosage , Nerve Block/methods , Sciatic Nerve , Adult , Aged , Aged, 80 and over , Feasibility Studies , Female , Foot/surgery , Humans , Leg , Male , Middle AgedABSTRACT
We review the use of urapidil to manage hypertension in two patients undergoing adrenalectomy for pheochromocytoma and aldosterone producing adenoma. Bolus administration (25 mg/i.v.) of urapidil provided good control of blood pressure during surgical manipulation of the tumor, although continuous perfusion of the drug was required by one patient before complete excision was achieved. No changes in heart rate or sudden decrease in blood pressure were observed. We believe that urapidil may be useful for treating hypertension during tumor adrenalectomy.
