Protocol of a clinical trial on the effectiveness of pudendal nerve block with and without neurostimulation in reducing posthemorroidectomy pain.

INTRODUCTION: Hemorrhoidal pathology is the most frequent proctological problem with a prevalence of 44% of the adult population. The most effective treatment is surgery but it also has the highest postoperative pain rate with moderate to severe pain rates of 30-40% during the first 24-48 hours. Here lies the importance of seeking measures to improve this situation, such as the pudendal nerve block with local anesthetic. However, the variability of the pudendal nerve sometimes makes its blockade ineffective and for this reason nerve location methods are sought to achieve a higher rate of success. The main aim of the study is to compare pain in the immediate postoperative period (24 h) after hemorrhoidectomy in patients with pudendal nerve block guided by anatomical references and guided by neurostimulation. METHODS: The present project proposes the performance of a single-center, triple-blind, randomized clinical trial of efficacy, carried out under conditions of routine clinical practice. Patients over 18 years old with hemorrhoids refractory to medical treatment, symptomatic grade III-IV and grade II hemorrhoids that do not respond to conservative procedures in a third level hospital in Spain and that are subsidiaries of surgery in major ambulatory surgery will be included. Demographic variables, variables on hemorrhoidal pathology, details of surgery, verbal numeric pain scale in the preoperative period and surgical complications will be collected. RESULTS: Not avaliable until the end of the study. CONCLUSIONS: The pudendal nerve block guided by anatomical landmarks has been shown to be useful in postoperative pain control after hemorrhoidectomy although the use of the neurostimulator has not been well studied and we believe it may improve outcom.

Fiabilidad y validez de la Escala de valoración del estilo de vida saludable adquirido (E-VEVSA) en adultos de Albacete y Murcia (España) / Reliability and validity of the Acquired healthy lifestyle assessment scale (E-VEVSA) in adults from Albacete and Murcia (Spain)

Fundamentos El estilo de vida es un constructo teórico que está formado por los hábitos de vida de un sujeto. El análisis y la cuantificación objetivable del estilo de vida, puede tener un gran impacto sobre la salud de las personas, así como en la evolución del estado de la misma con el transcurso de los años. El objetivo de la presente investigación ha sido la validación de la Escala de valoración del estilo de vida saludable adquirido (E-VEVSA) en adultos españoles. Métodos Sobre una muestra inicial para las pruebas exploratorias de 248 sujetos y final para las pruebas confirmatorias de 780 sujetos, de edades comprendidas entre los 22 y 72 años de edad, se realizaron pruebas psicométricas exploratorias y confirmatorias basadas en el estadístico alfa de Cronbach (fiabilidad) y análisis factorial exploratorio con rotación oblicua (oblimin) y confirmatorio con rotación varimax (validez de constructo), que dieron lugar a un instrumento definitivo formado por 52 ítems y estructurado en siete dimensiones: Responsabilidad individual en el cuidado de la salud (nueve ítems), hábitos de práctica físico-deportiva (seis ítems), hábitos de salud en las relaciones sociales (10 ítems), hábito de consumo de tabaco y alcohol (nueve ítems), hábito de alimentación saludable (siete ítems), hábito de salud psicológica (seis ítems) y hábito de descanso y sueño diario (cinco ítems). Resultados Todos los ítems explicaron una varianza total de 66,87% y un alfa de Cronbach de 0,894, estando por encima de 0,700 el alfa parcial de cada dimensión o factor. Conclusiones Los resultados arrojan pruebas psicométricas que confirman la validez de la escala E-VEVSA como un instrumento útil para medir el estilo de vida saludable adquirido en personas adultas (AU)

Background Lifestyle is a theoretical construct that is formed by the life habits of a subject. The analysis and objective quantification of lifestyle can have a great impact on people's health, as well as on the evolution of its status over the years. The objective of this research has been the validation of the Acquired Healthy Lifestyle Assessment Scale (E-VEVSA) in Spanish adults. Method On an initial sample for the exploratory tests of 248 subjects and a final sample for the confirmatory tests of 780 subjects, aged between 22 and 72 years of age. Exploratory and confirmatory psychometric tests were carried out based on the Cronbach's alpha statistic (reliability) and exploratory factorial analysis with oblique rotation (oblimin) and confirmatory with varimax rotation (construct validity), which resulted in an instrument made up of 52 items and structured in 7 dimensions: individual responsibility in health care (9 items), habits of physical-sports practice (6 items), health habits in social relationships (10 items), habit of tobacco and alcohol consumption (9 items), habit of healthy eating (7 items), psychological health habits (6 items) and daily rest and sleep habits (5 items). Results All the items explained a total variance of 66.87% and a Cronbach's alpha of .894, with the partial alpha of each dimension or factor being above .700. Conclusions The results show psychometric tests that confirm the validity of the E-VEVSA scale as a useful instrument to measure the healthy lifestyle acquired among adults (AU)

[Reliability and validity of the Acquired healthy lifestyle assessment scale (E-VEVSA) in adults from Albacete and Murcia (Spain)]. / Fiabilidad y validez de la Escala de valoración del estilo de vida saludable adquirido (E-VEVSA) en adultos de Albacete y Murcia (España).

BACKGROUND: Lifestyle is a theoretical construct that is formed by the life habits of a subject. The analysis and objective quantification of lifestyle can have a great impact on people's health, as well as on the evolution of its status over the years. The objective of this research has been the validation of the Acquired Healthy Lifestyle Assessment Scale (E-VEVSA) in Spanish adults. METHOD: On an initial sample for the exploratory tests of 248 subjects and a final sample for the confirmatory tests of 780 subjects, aged between 22 and 72 years of age. Exploratory and confirmatory psychometric tests were carried out based on the Cronbach's alpha statistic (reliability) and exploratory factorial analysis with oblique rotation (oblimin) and confirmatory with varimax rotation (construct validity), which resulted in an instrument made up of 52 items and structured in 7 dimensions: individual responsibility in health care (9 items), habits of physical-sports practice (6 items), health habits in social relationships (10 items), habit of tobacco and alcohol consumption (9 items), habit of healthy eating (7 items), psychological health habits (6 items) and daily rest and sleep habits (5 items). RESULTS: All the items explained a total variance of 66.87% and a Cronbach's alpha of .894, with the partial alpha of each dimension or factor being above .700. CONCLUSIONS: The results show psychometric tests that confirm the validity of the E-VEVSA scale as a useful instrument to measure the healthy lifestyle acquired among adults.

Spatiotemporal association between the mite Brevipalpus yothersi and Citrus leprosis virus C in orange orchards.

Citrus leprosis virus C (CiLV-C) is an economically important pathogen and the main causative agent of leprosis disease in citrus orchards. The main vector of this disease, the mite Brevipalpus yothersi, is widely distributed in Mexican orchards on a wide range of citrus species. Despite the importance of both the virus and the mite, field studies recording their occurrence and co-occurrence are practically non-existent. We systematically sampled orange orchards for both CiLV-C and B. yothersi throughout the year. The distribution of the CiLV-C and B. yothersi was evaluated on each sampling occasion and their spatiotemporal associations were determined. Specifically, 100-112 orange trees, distributed in 18 rows (five or six trees per row), were sampled monthly between March 2017 and February 2018 (11 sampling dates). Twenty leaves per tree were sampled on each occasion. The number of mites per tree and the percentage of leaves per tree with disease symptoms were recorded. On each sampling occasion, spatiotemporal associations between mites and disease were determined using the Spatial Analysis by Distance Indices (SADIE) method. CiLV-C and B. yothersi were identified using molecular methods. Throughout the study, the distribution of CiLV-C was aggregated and the distribution of B. yothersi was random. No association was found between the virus and the mite on any of the sampling dates. In total, 173 mites were collected, but only 43 mites were found to be carrying CiLV-C. The reason for this lack of association between the virus and the mite, as well as the impact of our findings on the epidemiology of the disease in orange orchards, are discussed.

[Influence of a programme of therapeutic exercise on different clinical indicators related to dyslipidaemia in adult subjects aged between 26 to 73 years with a cardiovascular risk factor]. / Influencia de un programa de ejercicio físico terapéutico en diferentes indicadores clínicos relacionados con la dislipidemia en sujetos adultos de 26 a 73 años con algún factor de riesgo cardiovascular.

INTRODUCTION: A sedentary lifestyle is indicated in the international literature as one of the main causes for the onset of some cardiovascular risk factors. OBJECTIVE: To assess the effect of a therapeutic physical exercise programme on different clinical indicators related to dyslipidaemia (total cholesterol, HDL and LDL) in sedentary subjects with a cardiovascular risk factor. METHOD: Intervention study with before-and-after evaluation of a sample of 340 patients (132 males and 208 females) referred from the 2 primary care centres of the municipality of Molina de Segura (Murcia), and who participated in a 30-week programme of physical exercise combining muscle-conditioning work circuits with other cardio-respiratory resistance workouts. Regarding the clinical indicators, the health professionals collected in the medical history the health indicators corresponding to the biological evolution of the process for which the subjects studied had started the physical exercise programme. RESULTS: The statistical analyses showed a significant improvement (p<.005) in the LDL indicator and a non-significant improvement in total and HDL cholesterol indicators after a 3-month exercise programme of 3 weekly sessions. CONCLUSIONS: The prescription of physical exercise in dyslipidaemic subjects from primary care centre should be evaluated as a resource for improving the clinical indicators specific to their pathology.

The BET bromodomain inhibitor JQ1 suppresses growth of pancreatic ductal adenocarcinoma in patient-derived xenograft models.

The primary aim of this study was to evaluate the antitumor efficacy of the bromodomain inhibitor JQ1 in pancreatic ductal adenocarcinoma (PDAC) patient-derived xenograft (tumorgraft) models. A secondary aim of the study was to evaluate whether JQ1 decreases expression of the oncogene c-Myc in PDAC tumors, as has been reported for other tumor types. We used five PDAC tumorgraft models that retain specific characteristics of tumors of origin to evaluate the antitumor efficacy of JQ1. Tumor-bearing mice were treated with JQ1 (50 mg/kg daily for 21 or 28 days). Expression analyses were performed with tumors harvested from host mice after treatment with JQ1 or vehicle control. An nCounter PanCancer Pathways Panel (NanoString Technologies) of 230 cancer-related genes was used to identify gene products affected by JQ1. Quantitative RT-PCR, immunohistochemistry and immunoblots were carried out to confirm that changes in RNA expression reflected changes in protein expression. JQ1 inhibited the growth of all five tumorgraft models (P<0.05), each of which harbors a KRAS mutation; but induced no consistent change in expression of c-Myc protein. Expression profiling identified CDC25B, a regulator of cell cycle progression, as one of the three RNA species (TIMP3, LMO2 and CDC25B) downregulated by JQ1 (P<0.05). Inhibition of tumor progression was more closely related to decreased expression of nuclear CDC25B than to changes in c-Myc expression. JQ1 and other agents that inhibit the function of proteins with bromodomains merit further investigation for treating PDAC tumors. Work is ongoing in our laboratory to identify effective drug combinations that include JQ1.

Diagnosis of vascular cognitive impairment and its main categories.

OBJECTIVE: A review of current criteria for the diagnosis of categories related with vascular cognitive impairment, in particular the nomenclature, diagnostic criteria, and differential clinical-radiological findings. DEVELOPMENT: The criteria for the diagnosis of vascular cognitive impairment have evolved, but available criteria were designed basically for differentiating between vascular dementia and dementia due to Alzheimer disease, and for research purposes. Nevertheless, in clinical practice precise elements are required for: 1) Clinical diagnosis of dementia and mild cognitive impairment; 2) Clinical and neuroimaging criteria for identification of the various cerebrovascular lesions associated with cognitive dysfunction, and 3) A formulation of the aetiogenic-pathogenic relationship between cognitive impairment and cerebrovascular lesions. For this reason, a review was carried out on the diagnostic elements of vascular cognitive impairment categories, classification, and their most relevant characteristics. It highlights the characteristic for the diagnosis of multi-infarction dementia, strategic single infarct dementia, small vessel disease with dementia, mixed dementia, and vascular mild cognitive impairment. CONCLUSIONS: Standardisation is required, by a multidisciplinary expert team, as regards nomenclature and criteria for the diagnosis of the full spectrum associated with vascular cognitive impairment and especially for vascular dementia and its categories.

ICAM-2 confers a non-metastatic phenotype in neuroblastoma cells by interaction with α-actinin.

Progressive metastatic disease is a major cause of mortality for patients diagnosed with multiple types of solid tumors. One of the long-term goals of our laboratory is to identify  molecular interactions that regulate metastasis, as a basis for developing agents that inhibit this process. Toward this goal, we recently demonstrated that intercellular adhesion molecule-2 (ICAM-2) converted neuroblastoma (NB) cells from a metastatic to a non-metastatic phenotype, a previously unknown function for ICAM-2. Interestingly, ICAM-2 suppressed metastatic but not tumorigenic potential in preclinical models, supporting a novel mechanism of regulating metastasis. We hypothesized that the effects of ICAM-2 on NB cell phenotype depend on the interaction of ICAM-2 with the cytoskeletal linker protein α-actinin. The goal of the study presented here was to evaluate the impact of α-actinin binding to ICAM-2 on the phenotype of NB tumor cells. We used in silico approaches to examine the likelihood that the cytoplasmic domain of ICAM-2 binds directly to α-actinin. We then expressed variants of ICAM-2 with mutated α-actinin-binding domains, and compared the impact of ICAM-2 and each variant on NB cell adhesion, migration, anchorage-independent growth, co-precipitation with α-actinin and production of localized and disseminated tumors in vivo. The in vitro and in vivo characteristics of cells expressing ICAM-2 variants with modified α-actinin-binding domains differed from cells expressing ICAM-2 wild type (WT) and also from cells that expressed no detectable ICAM-2. Like the WT protein, ICAM-2 variants inhibited cell adhesion, migration and colony growth in vitro. However, unlike the WT protein, ICAM-2 variants did not completely suppress development of disseminated NB tumors in vivo. The data suggest the presence of α-actinin-dependent and α-actinin-independent mechanisms, and indicate that the interaction of ICAM-2 with α-actinin is critical to conferring an ICAM-2-mediated non-metastatic phenotype in NB cells.

Consulta de preanestesia en cirugía mayor ambulatoria / No disponible

La consulta de preanestesia en la unidad de cirugía mayor ambulatoria, es un elemento muy importante desde el punto de vista organizativo, ya que gracias a un buen planteamiento de la misma podemos obtener un mayor rendimiento así como mejorar la seguridad del paciente. En este trabajo se presenta de manera descriptiva el modo en el que estamos organizados, que se divide fundamentalmente en tres aspectos: a) el cuestionario de salud, que es rellenado por el paciente, consiguiendo así que participen en su salud; b) los algoritmos o flujo gramas que en base a la edad, estado físico, comorbilidades y tipo de cirugía orientan a la hora de pedir pruebas complementarias, consiguiendo así una indicación más precisa de las mismas; y por último c) la clasificación del tipo de cirugía, realizada en base a la experiencia acumulada en nuestro centro y el tipo de cirugía. Este diseño de entre muchos válidos es muy dinámico, permitiendo su adaptación a las necesidades de cada centro, mejorando así el rendimiento y la seguridad del paciente (AU)

Pre-anaesthetic evaluation constitutes an important organizational component in a day surgery unit. A careful set up may lead to major efficiency and improved patient safety. This work presents a description of the organizational model of our unit, which consists of three fundamental elements: a) the health questionnaire, filled in by the patient, thus achieving implication in her/his health related questions; b)the algorithms or flow-charts which, based on patients’ age, ASA, comorbidities, and type of surgery, indicate more precisely the complementary analyses to be done; and c) finally classification of the surgery to be carried out, based on the body of experience accumulated in our centre. This design is, among many other valid ones, very dynamic and permits being adapted to the necessities of varying centres obtaining better efficiency and patient safety (AU)

[Teaching experience of the anesthesiology training unit at Hospital Universitario Nuestra Señora de Candelaria]. / Experiencia de la unidad docente de Anestesiología y Reanimación del Hospital Universitario Nuestra Señora de Candelaria.

BACKGROUND: Health care in Spain has improved progressively and professionals are now required to meet competency levels that safeguard the citizen's right to health protection. To achieve this, instructors in residency training programs and resident physicians themselves are calling for a common framework for training to ensure quality and consistency. Given the scarcity of articles related to training in our journal and following the First Meeting of Residency Program Instructors of the Sociedad Española de Anestesiologia y Reanimación (SEDAR), there has arisen a need to explain how SEDAR's training unit is organized. METHODS: In order to facilitate the sharing of experiences of those involved in training anesthesiology medical residents, we undertook a descriptive analysis of our hospital's curriculum. RESULTS: The structure and operation of the department are described in this report. The results of anonymous surveys completed annually show the satisfaction of residents (9.4 out of 10) and physicians (8.7 out of 10). An audit by the Ministry of Health showed that the curriculum met 100% of the required criteria.

Experiencia de la unidad docente de Anestesiología y Reanimación del Hospital Universitario Nuestra Señora de Candelaria / Teaching experience of the anesthesiology training unit at Hospital

Objetivos: La sanidad en España ha evolucionado hacia una mejora de la calidad, exigiendo a los profesionales que cumplan los niveles de competencia necesarios para salvaguardar el derecho a la protección de la salud de los ciudadanos. Para alcanzarlos, las Unidades Docentes y los Médicos Residentes demandan un marco común de formación que garantice la calidad y la uniformidad de la docencia. Dado el escaso número de publicaciones en nuestra revista relacionadas con la docencia y tras la Primera Reunión de Tutores de Anestesiología y Reanimación de la SEDAR, surgió la inquietud por dar a conocer cómo tenemos organizada nuestra Unidad Docente. Métodos: Con el objetivo de facilitar el intercambio de experiencia de los implicados en la formación de los Médicos Internos Residentes de Anestesiología, Reanimación y Terapéutica del Dolor realizaremos un análisis descriptivo de la formación en nuestro hospital. Resultados: Se describe la estructura y funcionamiento. Las encuestas anónimas realizadas anualmente por los residentes (9,4 puntos sobre 10) y facultativos (8,7 sobre 10) muestran la aceptación del sistema. Además en una auditoría docente del Ministerio de Sanidad se ha cumplido el 100% de los criterios exigidos(AU)

Background: Health care in Spain has improved progressively and professionals are now required to meet competency levels that safeguard the citizen’s right to health protection. To achieve this, instructors in residency training programs and resident physicians themselves are calling for a common framework for training to ensure quality and consistency. Given the scarcity of articles related to training in our journal and following the First Meeting of Residency Program Instructors of the Sociedad Española de Anestesiología y Reanimación (SEDAR), there has arisen a need to explain how SEDAR’s training unit is organized. Methods: In order to facilitate the sharing of experiences of those involved in training anesthesiology medical residents, we undertook a descriptive analysis of our hospital’s curriculum. Results: The structure and operation of the department are described in this report. The results of anonymous surveys completed annually show the satisfaction of residents (9.4 out of 10) and physicians (8.7 out of 10). An audit by the Ministry of Health showed that the curriculum met 100% of the required criteria(AU)

[Diagnosis of delayed cerebral ischaemia and cerebral vasospasm in subarachnoid haemorrhage]. / Diagnóstico de la isquemia cerebral tardía y el vasospasmo cerebral en la hemorragia subaracnoidea.

OBJECTIVE: A review of current foundations for the medical diagnosis of vasospam and delayed cerebral ischaemia due to spontaneous subarachnoid haemorrhage. DEVELOPMENT: A review of available tests for the investigation of vasospasm (transcraneal Doppler, angiographic methods) and delayed cerebral ischaemia (clinical exam, computerised tomography by X rays, magnetic resonance, emission computerised tomography, electroencephalography, microdialysis) based on type and quality of information, advantages and limitations. Grading and trends for application were also considered for differential diagnosis. CONCLUSIONS: In current clinical practice the most advisable guideline for screening and diagnosis monitoring of vasospasm and delayed cerebral ischaemia is in the first place, based on clinical examination and transcraneal Doppler. The electroencephalographic monitoring, computerised tomography techniques and multi-modal magnetic resonance are justified in specific situations. Digital subtraction angiography is the current gold standard for diagnosis of cerebral vasospasm. There is a need for more and higher quality articles about the utility of diagnostic tests in this context.

Diagnóstico de la isquemia cerebral tardía y el vasospasmo cerebral en la hemorragia subaracnoidea / Diagnosis of delayed cerebral ischaemia and cerebral vasospasm in subarachnoid haemorrhage

Objetivo: Revisar los fundamentos actuales para el diagnóstico, en la práctica médica, del vasospasmo y la isquemia cerebral tardía por hemorragia subaracnoidea espontánea.Desarrollo: Se revisan las pruebas disponibles para investigar el vasospasmo (Doppler transcraneal, métodos angiográficos) y la isquemia cerebral tardía (examen clínico, tomografía computarizada convencional, resonancia magnética, tomografía computarizada de emisión, electroencefalografía, microdiálisis) en cuanto al tipo y calidad de la información que brindan, además de sus ventajas y limitaciones. Se aborda el diagnóstico diferencial, graduación y pautas de aplicación. Conclusiones: En la práctica clínica actual la pauta más recomendable para el diagnóstico y la monitorización del vasospasmo y la isquemia cerebral tardía consiste, en primer lugar, en el examen clínico y por Doppler transcraneal. La monitorización electroencefalográfica, las técnicas de tomografía computarizada y resonancia magnética multimodal son apropiadas en situaciones específicas. La angiografía por sustracción digital es el estándar para el diagnóstico del vasospasmo cerebral. Se insiste en la necesidad de mejorar la calidad de los futuros artículos sobre la utilidad de las pruebas diagnósticas señaladas (AU)

Objective: A review of current foundations for the medical diagnosis of vasospam and delayed cerebral ischaemia due to spontaneous subarachnoid haemorrhage.Development: A review of available tests for the investigation of vasospasm (transcraneal Doppler, angiographic methods) and delayed cerebral ischaemia (clinical exam, computerised tomography by X rays, magnetic resonance, emission computerised tomography, electroencephalography, microdialysis) based on type and quality of information, advantages and limitations. Grading and trends for application were also considered for differential diagnosis. Conclusions:In current clinical practice the most advisable guideline for screening and diagnosis monitoring of vasospasm and delayed cerebral ischaemia is in the first place, based on clinical examination and transcraneal Doppler. The electroencephalographic monitoring, computerised tomography techniques and multi-modal magnetic resonance are justified in specific situations. Digital subtraction angiography is the current gold standard for diagnosis of cerebral vasospasm. There is a need for more and higher quality articles about the utility of diagnostic tests in this context (AU)

Effects of frequency of static stretching on straight-leg raise in elementary school children.

AIM: The aim of this study was to evaluate the efficacy of different frequencies of a stretching exercise program on lower extremity range of motion (ROM) in prepubertal schoolchildren. METHODS: A total of 62 children were divided into 3 groups (experimental groups: A, B; control group: C). Experimental group A performed hamstring stretches for 5 min during the Physical Education classes over a full school term (9 months), 2 sessions per week (31 weeks, 62 sessions of Physical Education). Experimental group B performed hamstring stretches for 5 min during the Physical Education classes and during a specific extracurricular physical activity, over a full school term (9 months), 4 sessions per week (31 weeks, 62 sessions of Physical Education and 62 sessions of after-school physical activities). Control group followed the standard class program of Physical Education classes. Hamstring flexibility was measured using the straight leg raise test before and after the program. RESULTS: No significant differences were revealed in ROM before and after the Physical Education classes for the control group. However, significant improvements in ROM were shown in the two experimental groups (P<0.001). Four days per week produced a greater rate of gains in ROM (16.9 degrees) than 2 days per week (9.3 degrees). For all groups, the initial and the final ROM between the right and left sides were similar. CONCLUSION: This study indicates that a full school term (9 months) incorporating static stretching as part of the Physical Education classes and the extracurricular physical activities significantly increases the ROM of the hamstrings in prepubertal schoolchildren. The study also suggests that the increase of the frequency of stretching is effective for increasing ROM.

Enfermedades cerebrovasculares agudas: un reto actual para los sistemas sanitarios / Acute cerebrovascular diseases: a challenge for today's health care systems

No disponible

[Clinical techniques for use in neurological physical examinations. III. Sensory functions]. / Técnicas clínicas para el examen físico neurológico. III. Función sensitiva.

AIMS: The purpose of this work is to focus on the main practical aspects of the techniques used for the neurological physical examination of the sensory functions and to present an approach for the practice of this study. DEVELOPMENT: Despite the difficulty often involved in interpreting its results, today the formal examination of sensation is still an important part of a complete neurological evaluation and remains valid in the search for a correct diagnosis and suitable treatment. We recommend clinicians to carry out a brief but consistent and effective exploration in a systematic, flexible and orderly manner to check for abnormalities in the sensory functions. Should any anomalies be detected, then a more detailed and thorough neurological exploration must be performed selectively. We present a detailed review of the practical aspects of the main techniques used in the physical examination of this neurological category. In addition to the tests used to examine the peripheral and cortical sensory systems, we also describe other techniques designed to trigger pain or other sensory symptoms due to radicular lesions or injury to the median nerve. CONCLUSIONS: We present a detailed description of the main clinical techniques used in the neurological physical examination of the sensory functions, as well as an approach that allows them to be performed on adult patients. In addition, we underline the importance of physically examining the sensory functions in contemporary medicine and the need to continually perfect the way these techniques are performed in order to achieve an efficient clinical practice.

[Clinical techniques for use in neurological physical examinations. II. Motor and reflex functions]. / Técnicas clínicas para el examen físico neurológico. II. Función motora y refleja.

AIMS: The aim of this study is to highlight the chief practical aspects of the techniques used in the neurological physical examination of the motor and reflex functions. DEVELOPMENT: We recommend clinicians to carry out a brief but consistent and effective exploration in a systematic, flexible and orderly manner to check for abnormalities in the motor and reflex functions of the nervous system. Should any anomalies be detected, then a more detailed and thorough neurological exploration must be performed selectively. We present a detailed review of the practical aspects of the main techniques used in the physical examination of these neurological categories. The motor function is explored using techniques that examine muscle tone, muscle strength, muscle fatigability, hypokinesia, tremor, coordination and gait. Lastly, in this category several manoeuvres that are useful in hysterical or mimicking paralyses are also dealt with. Reflexes to examination are usually divided into: 1. Myotatic reflexes; 2. Cutaneomucous reflexes; 3. Spinal cord or defence automatism reflexes; 4. Posture and attitude reflexes. We also add the study of primitive pathological reflexes, remote reflexes, synkinesias and signs of meningeal irritation. CONCLUSIONS: We present a detailed description of the main clinical techniques used in the neurological physical examination of motility and reflexes, as well as an approach that allows them to be performed on adult patients. In addition, we underline the importance of physically examining the nervous system in contemporary medicine and the need to continually perfect the way these techniques are performed in order to achieve an efficient clinical practice.

Técnicas clínicas para el examen físico neurológico, III: función sensitiva / Clinical techniques for use in neurological physical examinations, III: sensory functions

Objetivo. Poner énfasis en los principales aspectos prácticos de las técnicas para el examen físico neurológico de la función sensitiva y presentar un enfoque para la práctica de este estudio. Desarrollo. A pesar de lo difícil que puede resultar su interpretación, el examen formal de la sensación es todavía una parte importante de la evaluación neurológica completa y mantiene su vigencia para el diagnóstico y el tratamiento apropiado. Se recomienda que los médicos apliquen, de forma sistemática, flexible y ordenada, una exploración breve, pero consistente y eficiente, a fin de detectar alteraciones de la función sensitiva. En caso de presentarse anormalidades se indica la ejecución selectiva de una exploración neurológica más detallada e integral. Se revisan detalladamente los aspectos prácticos de las principales técnicas del examen físico de esta categoría neurológica. Además de las pruebas para el examen del sistema sensitivo periférico y cortical, se describen otras técnicas diseñadas para desencadenar dolor u otros síntomas sensitivos por lesión radicular o del nervio mediano. Conclusiones. Se detallan las principales técnicas clínicas del examen físico neurológico de la función sensitiva y se presenta un enfoque para su ejecución en el paciente adulto. Además, se subraya el valor que posee el examen físico de la función sensitiva en la medicina contemporánea y la necesidad de un perfeccionamiento continuo en la ejecución de sus técnicas para lograr una práctica clínica eficiente(AU)

AIMS: The purpose of this work is to focus on the main practical aspects of the techniques used for the neurological physical examination of the sensory functions and to present an approach for the practice of this study. DEVELOPMENT: Despite the difficulty often involved in interpreting its results, today the formal examination of sensation is still an important part of a complete neurological evaluation and remains valid in the search for a correct diagnosis and suitable treatment. We recommend clinicians to carry out a brief but consistent and effective exploration in a systematic, flexible and orderly manner to check for abnormalities in the sensory functions. Should any anomalies be detected, then a more detailed and thorough neurological exploration must be performed selectively. We present a detailed review of the practical aspects of the main techniques used in the physical examination of this neurological category. In addition to the tests used to examine the peripheral and cortical sensory systems, we also describe other techniques designed to trigger pain or other sensory symptoms due to radicular lesions or injury to the median nerve. CONCLUSIONS: We present a detailed description of the main clinical techniques used in the neurological physical examination of the sensory functions, as well as an approach that allows them to be performed on adult patients. In addition, we underline the importance of physically examining the sensory functions in contemporary medicine and the need to continually perfect the way these techniques are performed in order to achieve an efficient clinical practice(AU)