Percepción subjetiva del dolor en cirugía local dermatologica / Subjective perception of pain in local dermatological surgery

Introducción. El dolor se mide difícilmente pues presenta un importante componente subjetivo. En Dermatología se ha estudiado poco este síntoma, en especial su componente psicoemocional (miedo previo a la intervención y sensación de liberación posterior a la misma). Se ha decidido evaluar cuantitativamente su percepción en intervenciones locales, en relación con diferentes momentos de la intervención y con la aplicación de una crema anestésica tópica como variable externa. Pacientes y métodos. Se documentó la percepción álgica con una escala de valoración verbal antes de y durante la infiltración anestésica y nada más finalizar la intervención quirúrgica, mediante tres preguntas: 1) ¿Cuánto cree que le va a doler?, 2) ¿cuánto le está doliendo? y 3) ¿cuánto le ha dolido?. Además se aleatorizó la aplicación de EMLA; (anestésico tópico en crema). Resultados. Se estudiaron 219 pacientes. Las puntuaciones en la pregunta 2 eran significativamente menores que las de la pregunta 1, y las de la pregunta 3 significativamente menores que las de las preguntas 1 y 2. Los pacientes tratados con EMLA puntuaron más bajo que los controles sólo en las preguntas 2 y 3. Discusión. Los pacientes piensan que les va a doler más la intervención que lo que en realidad les duele posteriormente y además borran “de inmediato” el recuerdo del dolor reciente. El uso de EMLA no modifica la idea del paciente de lo que le va a doler la intervención, pero sí percibe menos dolor que los que no lo utilizan. Es importante tranquilizar al paciente sobre la intervención para que éste no acumule ansiedad respecto al procedimiento y así se minimice su percepción álgica. Utilizar un anestésico local tópico en la zona de intervención podría ayudar a disminuir la sensación de dolor

Introduction. Pain is difficult to measure, as it has a significant subjective component. This symptom, and in particular its psycho-emotional component (fear prior to the operation and a feeling of release afterwards), has not been studied in extensively. We decided to quantitatively evaluate its perception in local surgery, in relation to different moments during the operation and using the application of a topical anesthetic cream as an external variable. Patients and methods. The perception of pain was documented with a verbal assessment scale before and during anesthesia infiltration and immediately at the end of the operation by means of three questions: 1) How much do you think it is going to hurt?, 2) How much does it hurt? and 3) How much did it hurt? In addition, the application of EMLA; (topical anesthetic cream) was randomized. Results. 219 patients were studied. The scores for question 2 were significantly lower than the ones for question 1, and the scores for question 3 were significantly lower than the ones for questions 1 and 2. The patients treated with EMLA only gave lower scores than the controls in questions 2 and 3. Discussion. Patients think that the surgery will hurt more than it really does, and they also immediately erase the memory of the recent pain. The use of EMLA does not modify the patient’s idea of how much the operation will hurt, but the patient does perceive less pain than those who do not use it. It is important to reassure patients about their operations so that they do not become overly anxious about the procedures, thus minimizing their perception of pain. The use of a topical local anesthetic in the area of the surgery could help decrease the sensation of pain

[Subjective perception of pain in local dermatological surgery]. / Percepción subjetiva del dolor en cirugía local dermatológica.

INTRODUCTION: Pain is difficult to measure, as it has a significant subjective component. This symptom, and in particular its psycho-emotional component (fear prior to the operation and a feeling of release afterwards), has not been studied extensively. We decided to quantitatively evaluate its perception in local surgery, in relation to different moments during the operation and using the application of a topical anesthetic cream as an external variable. PATIENTS AND METHODS: The perception of pain was documented with a verbal assessment scale before and during anesthesia infiltration and immediately at the end of the operation by means of three questions: 1) How much do you think it is going to hurt?, 2) How much does it hurt? and 3) How much did it hurt? In addition, the application of EMLA (topical anesthetic cream) was randomized. RESULTS: 219 patients were studied. The scores for question 2 were significantly lower than the ones for question 1, and the scores for question 3 were significantly lower than the ones for questions 1 and 2. The patients treated with EMLA only gave lower scores than the controls in questions 2 and 3. DISCUSSION: Patients think that the surgery will hurt more than it really does, and they also immediately erase the memory of the recent pain. The use of EMLA does not modify the patient's idea of how much the operation will hurt, but the patient does perceive less pain than those who do not use it. It is important to reassure patients about their operations so that they do not become overly anxious about the procedures, thus minimizing their perception of pain. The use of a topical local anesthetic in the area of the surgery could help decrease the sensation of pain.

Colgajos de avance con triángulo de Burow en la cara / Burow's wedge flap on the face

La cirugía oncológica dermatológica en la cara requiere unos conocimientos anatómicos y funcionales amplios y precisos. En la cara se encuentran estructuras con una función perfectamente delimitada, además de un componente estético muy importante. El colgajo de avance con triángulo de descarga o de Burow soluciona defectos de tamaños variables mediante una técnica sencilla con la que se obtienen resultados muy buenos. Las localizaciones ideales para el uso de este colgajo son el labio superior, la región preauricular y la región ciliar lateral. El uso del triángulo de descarga permite cerrar el defecto fácilmente sin tensión y evita la formación de orejas de perro. (AU)

Detection of hepatitis C virus RNA and core protein in keratinocytes from patients with cutaneous lichen planus and chronic hepatitis C.

Cutaneous lichen planus has been associated in patients with chronic hepatitis C virus infection. It is still unknown whether hepatitis C virus infects keratinocytes of lichen planus lesions. In this report we have analyzed the presence of genomic and anti-genomic hepatitis C virus RNA in skin biopsies from 26 patients with chronic hepatitis C and healthy skin and from 24 patients with cutaneous lichen planus (five with and 19 without hepatitis C virus infection) by in situ hybridization. Hepatitis C virus RNA was detected in the keratinocytes of 69% of the patients with healthy skin and chronic hepatitis C, in 100% of the patients with lichen planus and hepatitis C virus infection, and in none of lichen planus patients without hepatitis C virus infection. The percentage of keratinocytes showing genomic or anti-genomic hepatitis C virus RNA was statistically lower (p < 0.01 in all cases) in patients with healthy skin (mean +/- SD: 5.7 +/- 3.5% and 2.7 +/- 3.1% of keratinocytes with genomic or anti-genomic hepatitis C virus RNA, respectively) than in those with lichen planus lesions (31.7 +/- 7.9% and 18.8 +/- 7.4%, mean +/- SD) or the unaffected adjacent skin (24.8 +/- 6.9% and 14.3 +/- 3.8%, mean +/- SD). In conclusion, we have demonstrated that hepatitis C virus infects keratinocytes from patients with lichen planus and hepatitis C virus infection.

Meningococemia crónica / Chronic meningococcemia

La meningococemia crónica es una forma poco frecuente de infección meningocócica. Se ha descrito una mayor incidencia en pacientes con déficit del complemento. Presentamos un caso en un varón de 34 años, previamente sano y sin alteraciones del sistema inmune. El cuadro se complicó con una meningitis aguda (AU)