ABSTRACT
La sinostosis radiocubital es una anomalía congénita poco frecuente, a menudo bilateral, que produce una limitación de la supinación del antebrazo. El origen de esta alteración tiene lugar al producirse una detención en la diferenciación de los esbozos cartilaginosos del radio y el cúbito durante el periodo embrionario. Existen diferentes tipos de sinostosis. En muchos casos la clínica es leve, pues compensan su limitación en la pronosupinación con hipermovilidad de las demás articulaciones del miembro superior. La radiografía de miembros superiores es diagnóstica. El tratamiento depende del grado de funcionalidad del antebrazo. Estaría indicado tratamiento quirúrgico si existe una grave deformación en pronación que ocasione graves déficits funcionales. En cualquier otro caso, el manejo será conservador
Radioulnar synostosis is an uncommon congenital anomaly, often bilateral, that produces a limitation of the forearm supination. The origin of this anomaly takes place when a stop is being produced in the differentiation of the cartilaginous outline of the radius and ulna during the embryonic period. There are different types of synostosis. In many cases, the symptoms are mild because it compensates its limitation in pronosupination with hypermobility of other joints of the upper limb. X-ray of upper limbs is diagnostic. The treatment depends on the degree of functionality of the forearm. Surgical treatment would be indicated if there is a severe deformation in pronation that causes serious functional deficits. In any other case, the management will be conservative
Subject(s)
Humans , Male , Child, Preschool , Synostosis/diagnostic imaging , Radius/abnormalities , Radius/diagnostic imaging , Ulna/abnormalities , Ulna/diagnostic imaging , Primary Health Care , Upper Extremity Deformities, Congenital/diagnostic imagingABSTRACT
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Subject(s)
Humans , Herpes Zoster/drug therapy , Antiviral Agents/administration & dosage , Herpes Zoster/prevention & control , Immunocompromised Host , Neuralgia/drug therapy , Neuralgia/etiologyABSTRACT
BACKGROUND: The authors sought to confirm a chance observation that intravenous lipid treatment increases the dose of bupivacaine required to produce asystole in rats. The authors also measured the partitioning of bupivacaine between the lipid and aqueous phases of a plasma-lipid emulsion mixture. METHODS: Anesthetized Sprague-Dawley rats were used in pretreatment (protocol 1) and resuscitation (protocol 2) experiments. In protocol 1, animals were pretreated with saline or 10%, 20%, or 30% Intralipid (n = 6 for all groups), then received 0.75% bupivacaine hydrochloride at a rate of 10 ml x kg x min(-1) to asystole. In protocol 2, mortality was compared over a range of bolus doses of bupivacaine after resuscitation with either saline or 30% Intralipid (n = 6 for all groups). The lipid:aqueous partitioning of bupivacaine in a mixture of plasma and Intralipid was measured using radiolabeled bupivacaine. RESULTS: Median doses of bupivacaine (in milligrams per kilogram) producing asystole in protocol 1 were for 17.7 for saline, 27.6 for 10% Intralipid, 49.7 for 20% Intralipid, and 82.0 for 30% Intralipid (P < 0.001 for differences between all groups). Differences in mean +/- SE concentrations of bupivacaine in plasma (in micrograms per milliliter) were significant (P < 0.05) for the difference between saline (93.3 +/- 7.6) and 30% Intralipid (212 +/- 45). In protocol 2, lipid infusion increased the dose of bupivacaine required to cause death in 50% of animals by 48%, from 12.5 to 18.5 mg/kg. The mean lipid:aqueous ratio of concentrations of bupivacaine in a plasma-Intralipid mixture was 11.9 +/- 1.77 (n = 3). CONCLUSIONS: Lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats. Partitioning of bupivacaine into the newly created lipid phase may partially explain this effect. These results suggest a potential application for lipid infusion in treating cardiotoxicity resulting from bupivacaine.
