Continuous thoracic paravertebral analgesia after minimally invasive atrial septal defect closure surgery in pediatric population: Effectiveness and safety analysis.

INTRODUCTION: Lateral thoracotomy is replacing traditional median sternotomy for atrial septal defect (ASD) closure in children in order to improve cosmetic outcomes. Continuous paravertebral block has been described as an effective and safe analgesic technique in children. The aim of this study is to assess pain management by continuous perfusion of local anesthetic through a thoracic paravertebral catheter (PVC) in a pediatric population after thoracotomy closure of ASD, and its effectiveness in a fast-track program. METHODS: Descriptive cross-sectional study. Analgesic effectiveness, perioperative and safety-related data were analyzed in 21 patients who underwent thoracotomy closure of ASD with PVC. In the postoperative period, patients received continuous perfusion of bupivacaine 0.125% and fentanyl (1 mcg.ml-1) at 0.2 ml.kg-1.h-1 through the PVC. RESULTS: The median of mean pain scale score for each patient was 1.5. All patients were extubated in the operating theatre. No patient with PVC required opioid rescue. The median length of stay in the Pediatric Intensive Care Unit was 48 hours. There were 3 adverse events related to PVC: 1 due to malposition and 2 due to accidental removal. No other complications or cases of local anesthetic toxicity were recorded. CONCLUSIONS: PVC provides effective, safe, opioid-saving analgesia in the postoperative period of ASD closure by thoracotomy in the context of a fast-track protocol.

Analgesia paravertebral torácica continua tras cirugía mínimamente invasiva de cierre de comunicación interauricular en población pediátrica: análisis de eficacia y seguridad / Continuous thoracic paravertebral analgesia after minimally invasive atrial septal defect closure surgery in pediatric population: Effectiveness and safety analysis

Introducción: La toracotomía lateral está sustituyendo la esternotomía media clásica para el cierre de la comunicación interauricular (CIA) en niños con objetivo de obtener un menor impacto estético. El bloqueo paravertebral continuo se ha descrito como una técnica analgésica efectiva y segura en niños. El objetivo del estudio es valorar el control analgésico tras el cierre de CIA por toracotomía, mediante la administración de anestésico local en perfusión continua a través de un catéter paravertebral torácico (CPV) en población pediátrica, y su efectividad en un programa fast-track. Métodos: Estudio transversal descriptivo. Se analizaron datos de efectividad analgésica, datos perioperatorios y relacionados con la seguridad en 21 pacientes intervenidos de cierre de CIA mediante toracotomía con CPV. En el periodo postoperatorio se empleó una perfusión continua a través del CPV de bupivacaína al 0,125% y fentanilo (1μg.ml-1) a 0,2ml.kg-1.h-1. Resultados: La mediana de las puntuaciones medias en las escalas de dolor de cada paciente fue 1,5. Todos los pacientes se extubaron en quirófano. Ningún paciente con CPV requirió rescate con opioides. La mediana de tiempo de estancia en la unidad de cuidados intensivos pediátricos fue de 48h. Se objetivaron 3 eventos adversos relacionados con el CPV: uno debido a mala posición y 2 por salida accidental. No se registraron otras complicaciones ni casos de toxicidad por anestésicos locales. Conclusiones: El CPV proporciona una analgesia efectiva y segura en el postoperatorio de cierre de CIA mediante toracotomía en el contexto de un protocolo fast-track disminuyendo el consumo postoperatorio de opioides.(AU)

Introduction: Lateral thoracotomy is replacing traditional median sternotomy for atrial septal defect (ASD) closure in children in order to improve cosmetic outcomes. Continuous paravertebral block has been described as an effective and safe analgesic technique in children. The aim of this study is to assess pain management by continuous perfusion of local anesthetic through a thoracic paravertebral catheter (PVC) in a pediatric population after thoracotomy closure of ASD, and its effectiveness in a fast-track program. Methods: Descriptive cross-sectional study. Analgesic effectiveness, perioperative and safety-related data were analyzed in 21 patients who underwent thoracotomy closure of ASD with PVC. In the postoperative period, patients received continuous perfusion of bupivacaine 0.125% and fentanyl (1 μg.ml-1) at 0.2ml.kg-1.h-1 through the PVC. Results: The median of mean pain scale score for each patient was 1.5. All patients were extubated in the operating theatre. No patient with PVC required opioid rescue. The median length of stay in the Pediatric Intensive Care Unit was 48hours. There were 3 adverse events related to PVC: 1 due to malposition and 2 due to accidental removal. No other complications or cases of local anesthetic toxicity were recorded. Conclusions: PVC provides effective, safe, opioid-saving analgesia in the postoperative period of ASD closure by thoracotomy in the context of a fast-track protocol.(AU)

Reducción amigdalar por radiofrecuencia en pediatría / No disponible

Introducción: Se ha realizado un estudio preliminar donde se evalúa la radiofrecuencia como nueva técnica disponible para tratar casos seleccionados de hipertrofia amigdalar. Objetivos: El objetivo principal es determinar los beneficios y seguridad de la reducción amigdalar por radiofrecuencia mediante punción en pacientes pediátricos. Como objetivos secundarios se expondrán las implicaciones quirúrgicas y anestésicas de la técnica. Material y métodos: Estudio retrospectivo y descriptivo de todos los pacientes pediátricos intervenidos de hipertrofia amigdalar mediante radiofrecuencia por punción durante el periodo junio2010-febrero 2011 en nuestra Unidad. Los pacientes seleccionados se incluyeron dentro de un protocolo de actuación. Se ha estudiado: edad, sexo, sintomatología previa, dispositivo mantenimiento vía aérea, tiempo quirúrgico, asociación de adenoidectomía,complicaciones, estancia hospitalaria, dolor postoperatorio, recuperación actividad normal y resultado final. Resultados: Durante el periodo señalado 15 pacientes han sido sometidos a dicha técnica, nueve niñas (60%) y seis niños(40%), con edad media de 3,9 años. Los síntomas de indicación quirúrgica más frecuentes fueron mala respiración, ronquido y alteraciones de deglución. En todos los casos se utilizó mascarilla laríngea reforzada como único dispositivo de mantenimiento de la vía aérea. Se asoció adenoidectomía en el 80% de los pacientes. El tiempo medio de la intervención fue de 14 minutos. No se constataron complicaciones intraoperatorias ni postoperatorias. Como tratamiento del dolor postoperatorio inmediato se emplearon antiinflamatorios no esteroideos y paracetamol y tras el alta hospitalaria sólo requirieron paracetamol. La (..) (AU)

Introduction: We performed a preliminary study where puncture radiofrequency was evaluated as a new technique, available to treat selected cases of tonsillar hypertrophy. Objectives: The main objective is to determine the benefits and safety of puncture radiofrequency tonsil reduction in pediatric patients. Secondary we evaluated the implications of surgical and anesthetic techniques. Material and methods: Retrospective and descriptive study of all pediatric patients who underwent radiofrequency tonsil hypertrophypuncture during June 2010-February 2011 in our unit. The selected patients were included in a protocol including: age, sex, previous symptoms, airway maintenance device, surgical time, adenoidectomy association, complications, hospital stay, postoperative pain, recovery and outcome. Results: During the reported period 15 children have undergone this technique, nine girls (60%) and six boys (40%), with a mean age of 3.9 years. The most frequent symptoms for surgery were breathing difficulties, snoring and swallowing disorders. In allcases reinforced laryngeal mask was used as the sole device for airway maintenance. Adenoidectomy was associated in 80% of patients. The average time for surgery was 14 minutes. There were neither intraoperative nor postoperative complications. NSAIDs and acetaminophen were used as postoperative analgesia. At home, patients only used acetaminophen for pain control. Hospital stay was less than 24 hours, with 48-72 hours of recovery time. No patient came back to our emergency units. After two months, there was tonsillar reduction demonstrated in 14 of the 15 cases (93%).Conclusions: Puncture Radio frequency tonsils reduction, inpediatric selected cases can be a safe, effective and a low morbidity technique (AU)

Relación entre el test de elevación de pierna recta y el test ángulo poplíteo en la medición de la extensibilidad isquiosural / Relationship between straight leg raise (SLR) and active knee extension (AKE) test measurements in hamstrings flexibility

Objetivos Establecer la relación entre los test de elevación de pierna recta (EPR) y active knee extension (AKE, «ángulo poplíteo») en la medición de la extensibilidad isquiosural, determinar el grado de fiabilidad de cada test, determinar la influencia ejercida de un test sobre otro y establecer el grado de extensibilidad isquiosural en los universitarios, así como las diferencias entre géneros.Material y método Se ha llevado a cabo un diseño experimental aleatorio transversal. 19 sujetos, 11 mujeres y 8 hombres, se presentaron voluntariamente al estudio. De ellos, 2 mujeres fueron excluidas por haber padecido dolor lumbar en el último mes. Fueron repartidos en dos grupos de forma aleatoria, un grupo fue sometido al test EPR seguido del AKE, mientras que el grupo 2 fue sometido al test AKE seguido del EPR, con 6 min entre test y test, con dos intentos para cada test con 1min entre ensayo y ensayo. Resultados No encontramos una relación estadísticamente significativa entre AKE y EPR, medida por un coeficiente de determinación del 0,420. En cuanto a fiabilidad, los resultados fueron 0,866 en AKE y de 0,741 en EPR. La realización de un test no condicionó el resultado del siguiente test y se hallaron resultados más altos en el hombre con respecto a la mujer.ConclusiónEPR y AKE no miden por igual la extensibilidad isquiosural, siendo AKE más fiable que EPR. Un test no influyó en la realización posterior del otro y se encontraron datos más altos de extensibilidad en hombres que mujeres, siendo necesaria más investigación para poder concluir sobre este aspecto (AU)

Objective To determine the relationship between straight leg raise (SLR) test and active knee extension (AKE) in hamstrings flexibility measurement, reliability of each test, influence of one test over the other and establish the differences between the university students and gender in hamstrings range of motion. Materials and methods A randomized, cross-sectional, experimental design study was conducted. Nineteen healthy subjects (11 women, 8 men) voluntarily participated in the study. Two women were excluded to de having had low back pain in the last month. The subjects were randomly assigned to groups 1 and 2. Group 1 performed the SLR first and then the KEA and Group 2 performed the KEA first and then the SLR. The subjects had 6 min between the two test, with two attempts for each test with a one-minute rest period SLR1 and SLR2 and AKE1 and AKE2, respectively.Results There was no statistically significant relationship between AKE and SLR measurements, with a coefficient of determination of 0.421. Reliability of SLR was 0.741 and 0.866 in AKE. No influence was found between both test and we found a higher range of movement in the male than in female.Conclusions SLR and AKE does not measure hamstrings flexibility equally. We obtained more reliable results with the AKE. One test did not influence the subsequent performance of the other and higher data on extensibility were found in men than in women. However, future research is needed to make a conclusion on this aspect (AU)

Efectos de la hidroterapia en el dolor lumbar crónico: fisioterapia basada en la evidencia / Effects of hydrotherapy on the chronic lumbar pain: evidence based phisiotherapy

Introducción. El concepto de que los efectosantigravitatorios propios de los ejercicios en el aguamejoran las dolencias lumbares está bien extendido,por lo que, basándose en este precepto, son muyrecomendados.Objetivos. Se pretende determinar la evidenciacientífica acerca del efecto de la hidroterapia sobreel dolor lumbar crónico, definiendo sus indicacionesy comparando su efectividad con la conseguida porlos ejercicios terapéuticos realizados fuera del agua.Metodología. Se efectuó una búsqueda bibliográficaen las principales bases de datos de interés médicosanitario(Pubmed, The Cochrane Library y PEDro)centrada en los efectos de la hidroterapia sobre el dolorlumbar crónico. Además, se consultaron otras fuentesbibliográficas que aportan datos de interés parael tema que se está tratando.Resultados y discusión. Evidencia limitada dela hidroterapia en el dolor lumbar crónico. No se encontraron diferencias significativas entre terapiasefectuadas dentro y fuera de la piscina.Conclusiones. Existe una clara necesidad de másestudios que determinen con exactitud los beneficiosde la hidroterapia sobre la lumbalgia crónica(AU)

Introduction. The concept that the anti-gravitationaleffects typical of the aquatic exercises improve lumbartrouble is wide spread, being their recommendationoften justified.Objectives. It is intended to determine scientificevidence of the effect of hydrotherapy on the chroniclumbar pain, to define its indications and to compare itseffectiveness with a therapy of out-of-the-water exercises.Methodology. It was performed a bibliographicresearch on the main healthcare Data Bases (Pubmed,The Cochrane Library and PEDro) about the effects ofhydrotherapy on the chronic lumbar pain. In addition,other bibliographic sources were consulted whichsupplied information of interest for the subject underdiscussion.Results and Discussion. Limited evidenceon hydrotherapy for the chronic lumbar pain.No significant differences were found betweeninside and outside the swimming pool therapies. Conclusions. There is an obvious need for more studiesto exactly determine the benefits of hydrotherapy for thechronic lumbar pain(AU)

Los efectos de los estiramientos musculares: ¿qué sabemos realmente? / The effects of muscular stretching: what do we really now?

Los estiramientos musculares son una parte esencial en los programas de fisioterapia y planificaciones deportivas. Los argumentos para su inclusión son diversos: a) mejora de la amplitud de movimiento articular; b) disminución del tono muscular; c) mejora de los niveles de actividad físico-deportiva, y d) prevención de lesiones musculares, etc. Sin embargo, los beneficios antedichos no se corresponden con un aceptable nivel de evidencia experimental. A partir de algunas de las conclusiones de los estudios consultados al respecto, parece existir suficientes evidencias para una revisión crítica de algunos de los componentes teórico-prácticos relacionados con los estiramientos

Muscular stretching is an essential part within physiotherapy programs and sport plans. Arguments for inclusion are various: a) improvement of join movement ampleness; b) decrease of muscular tone; c) improvement of sport-physical activity practice, and d) prevention of muscular injuries, etc. Nevertheless, these benefits do not keep up a correspondence with an acceptable evidence based level. From some conclusions of the revised studies, it seems to exist enough evidence for a critic review of some of the theoretic-practical components related to stretching

[Diagnostic strategy for mitochondrial diseases]. / Estrategia diagnóstica de las enfermedades mitocondriales.

OBJECTIVE: The variability of both phenotypic and genotypic expression in mitochondrial diseases makes clinical diagnosis difficult, which is essential to establish therapy, aid in genetic counselling or for performing prenatal diagnosis. We have therefore proposed a strategy to help determine correct diagnosis of these alterations, in an attempt to rationalize the number of tests and, whenever possible, avoid tissue biopsy and minimize the size of the biopsy when indicated. DEVELOPMENT: Based on mitochondrial metabolism and molecular bases, as well as their alterations, a preliminary metabolic examination is carried out including at least one study of cytoplasmatic (lactate/pyruvate) and mitochondrial oxide reduction (hydroxibutirate/acetoacetate) in basal conditions or, if required, following glucose overload or an effort test. Metabolic study, in addition to clinical exploration, are the screening tests used to determine the need for tissue biopsy in which biochemical (pyruvate dehydrogenase, free and total carnitine, beta oxidation enzymes and respiratory chain complexes), genetic (mitochondrial DNA or nuclear alterations) and histologic tests are carried out to confirm diagnosis. CONCLUSIONS: a) Metabolic exploration may discard mitochondrial disease and many cases, avoid the use of an invasive procedure such as tissue biopsy. b) Biochemical study of tissue biopsy is the only useful key in the confirming of the diagnosis when no mitochondrial and/or nuclear DNA are observed.

Purkinje cell impairment induced by early movement restriction.

In the present work the effects of movement restriction imposed during the early postweaning period on both Purkinje cell dendritic development and exploratory behavior were analyzed. Male and female Sprague-Dawley albino rats were reared either in isolated-restricted or social-standard environments from postnatal day 18 to 30. On the 31st postnatal day, all rats were behaviorally evaluated by the open-field test and then sacrificed under deep ether anesthesia. Vermian cerebellar sections were later stained with the Golgi-Cox-Sholl method and the Purkinje cell dendritic morphology was quantified under light microscopy. The results indicate that early somatomotor restriction severely impairs both exploratory behavior and Purkinje cell dendritic growth.

[Glomus jugulare tumor: perioperative management]. / Tumor glómico yugular: manejo perioperatorio.

Surgical treatment of glomus jugulare tumors yields high rates of perioperative morbidity and mortality for several reasons, among them neuroendocrine secretory activity, a high degree of vascularization, intracranial extension, duration of surgery and cranial nerve lesion. Secretory activity (e.g. catecholamines and serotonin) should be investigated before surgery and treated appropriately. Carotid arteriography (and ball occlusion) are useful to assess vascularization of the tumor and determine the need to clamp the carotid artery during the procedure. Potential complications such as hemodynamic alterations (bleeding or endocrine response), pulmonary embolism (air or thrombotic), hypothermia, facial nerve lesion, should be monitored for during surgery. After surgery cranial nerve involvement, which can lead to dysphagia and bronchoaspiration, must be looked for; the risk of cerebro-spinal fluid fistula is also high. We report the case of a woman who underwent surgery for a non secreting glomus jugulare tumor with extradural intracranial invasion. The main complications during surgery were bleeding with hemodynamic repercussions, pulmonary embolism, lesions in the VII, VIII and X cranial nerves, and opening of the dura mater (which required insertion of an intradural drain to prevent formation of a fistula). After surgery oral intake was delayed until intestinal function was established and glottic sphincter competence was verified by fiberoptic laryngoscopy. The only complication presenting at this time was cephalea, which disappeared upon removal of the drain on day 4. The patient was released on day 10.

Effects of preweaning environmental stimulation on neuronal and behavioral impairment produced by undernutrition.

The present study investigates the effects of sensorimotor stimulation on the basal dendrogenesis of superficial cerebrocortical neurons and the accomplishment in the associated exploratory behavior in rats simultaneously exposed to nutritional deprivation. Sprague-Dawley albino rats were submitted to nutritional-environmental influences from birth to the 21st postnatal day. Exploratory behavior was assessed by the evaluation of locomotor activity in the open-field apparatus. In order to evaluate changes in neuronal morphology induced by nutritional-environmental variables, brains were stained according to the Golgi-Cox-Sholl procedure. Dendritic development was assessed under camera lucida by measuring basal dendritic branching of layer II and III pyramidal neurons, located in the dorsomedial region of the visual cortex of the rat. Morphometrical analysis revealed that both basal dendritic length and branching were significantly reduced by undernutrition. In contrast, environmental stimulation during the suckling period compensated for the neuronal impairment produced by protein-calorie deprivation. An improvement was also observed in exploratory behavior although to a lesser degree, as shown by the open field test data. In conclusion, the present results indicate that sensorimotor stimulation applied during the period of fastest rate of cortical cytodifferentiation compensates for neuronal and behavioral impairment produced by undernutrition.