ABSTRACT
INTRODUCTION: Hidradenitis suppurativa (HS) is a recurrent, debilitating, chronic disorder of the pilosebaceous unit. Although advances in HS treatment have been made, more than 45% of patients remain dissatisfied with systemic treatment, and more than one-third are dissatisfied with surgical procedures. OBJECTIVES: A prospective, observational study on the deroofing procedures in HS with special attention paid to patient satisfaction and complications. METHODS: HS lesions were assessed clinically and by the use of ultrasound. Patients reported outcomes, including pain, itch and satisfaction, were measured at 24 h post-surgery by a numeric rating scale (NRS) ranging from 0 to 10. Additionally, the timeline of objective wound closure reported by patients in (weeks), in addition to the need for any analgesics use, were both evaluated. RESULTS: The mean closure time of the post-deroofing wound was assessed as 4.4 ± 1.9 weeks. A statistically longer time was necessary for complete closure in males than in females (4.9 ± 2.2 weeks and 3.9 ± 1.6 weeks, respectively; p = 0.046). The closure time correlated positively yet weakly with the HS tunnel's width (r = 0.27, p = 0.016) and length (r = 0.228, p = 0.044). Patients assessed mean pain at 24 h post-op as mild with 0.7 ± 1.2 points according to NRS, with no differences between sexes. Similarly, itch in the first 24 h was assessed as mild with 1.8 ± 1.1 points, without differences between sexes. No pain, itch or adverse events were reported after 1 week following deroofing. Moreover, no cases of wound infection were reported. An overall patient satisfaction was assessed as 9.9 ± 0.4 points (range 9-10 points). CONCLUSION: Deroofing is an easy, effective and safe dermatosurgical procedure that does not require surgical experience or operating theatre. It is associated with no complications and very low post-op pain and should be part of holistic HS management.
Subject(s)
Hidradenitis Suppurativa , Patient Satisfaction , Humans , Hidradenitis Suppurativa/surgery , Hidradenitis Suppurativa/complications , Male , Female , Adult , Prospective Studies , Middle Aged , Young AdultABSTRACT
Una parte importante del dolor abdominal recurrentela constituyen los trastornos funcionales recogidosen los criterios de Roma. El objetivo de esteartículo es comentar las modificaciones más destacablesrealizadas en la última actualización, es decir,del Roma II de 1999 al Roma III del 2006. Sontres las modificaciones globales más destacables: a)se excluye a la aerofagia; b) se acorta el tiempo deduración de los síntomas necesario para el diagnóstico,pasando de tres a dos meses y c) exclusión delgrado de madurez en el desarrollo cognitivo del niñocomo criterio diagnóstico, incluyéndose niños a partirde los 4 años. Las modificaciones específicas paracada grupo más destacables son: a) dispepsiafuncional: se elimina la necesidad de realizar unaendoscopia digestiva alta para el diagnóstico; b) migrañaabdominal: se reduce la frecuencia y duraciónde los síntomas que deben afectar la actividad habitual.Los antecedentes familiares de migraña soncriterio de apoyo, no de diagnóstico; c) dolor abdominalfuncional: reducción de la frecuencia de la sintomatologíay la posibilidad de relacionarse coneventos psicosociales, pudiendo o no afectar a laactividad habitual del niño y c) no existen modificacionespara el síndrome de intestino irritable
Functional disorders, gathered in Rome criteria,constitute an important part of recurrent abdominalpain. The aim of this article is to comment the mostremarkable modifications made in the last update,that is, from the 1996 Rome II criteria to 2006 RomeIII criteria. Three are the most remarkable global modifications:a) aerophagia is excluded; b) durationterm of symptoms is reduced from three to twomonths and c) children cognitive mature degree isexcluded, including children older than 4 years. Themore remarkable modifications made in each specificgroup are: a) functional dyspepsia: the necessityof making an upper digestive endoscopy for thediagnosis is eliminated; b) abdominal migraine: frequencyand duration of symptoms that affect thenormal activity are reduced. Familiar antecedents ofmigraine are support criterion, they are not diagnosiscriterion; c) functional abdominal pain: reduction ofthe symptoms frequency, and the possibility to relatewith psycho social events, that may affect the childrenhabitual activity, or may not; and d) there areno modifications about the irritable bowel syndrome
Subject(s)
Humans , Male , Female , Child , Abdominal Pain/etiology , Abdominal Pain/classification , Dyspepsia/diagnosis , Migraine Disorders/diagnosis , Irritable Bowel Syndrome/diagnosis , International Classification of Diseases/trendsABSTRACT
La prevalencia del dolor abdominal de larga duraciónen niños es desconocida. Supone el 2-4% delas consultas pediátricas. Un dolor cuya duraciónsupere las 2-6 semanas se denomina dolor abdominalcrónico y si persiste más de 3 meses se denominadolor abdominal recurrente. Puede ser orgánico,somatomorfo o funcional En los menores de 4 añosel dolor abdominal recurrente se establece como undiagnóstico, no pudiéndose establecer el diagnósticode funcional. En los mayores de 4 años el dolorabdominal recurrente es un síntoma y se estableceel diagnóstico de funcional según los criterios deRoma III, basados en un conjunto de síntomas.Un interrogatorio y un examen físico completosson los componentes de mayor importancia en lavaloración de cualquier enfermo con dolor abdominalcrónico o recurrente. La causa orgánica se debeconsiderar siempre en primer lugar, principalmenteen menores de 4 años. La presencia de síntomas osignos de alarma constituye una indicación parapracticar pruebas diagnósticas. Una vez descartadaenfermedad orgánica o trastorno por somatización,podemos establecer el diagnóstico de dolor abdominalfuncional, en base a los criterios de Roma III queestablece las siguientes categorías: dispepsia funcional,síndrome de intestino irritable, migraña abdominaly dolor abdominal funcional.El niño con dolor abdominal crónico o recurrentese debe tratar en el contexto de un modelo asistencialbiopsicosocial
Prevalence of long term abdominal pain is unknown.It supposes about 2-4% of the pediatric consultations.Pain that lasts more than 2-6 weeks is calledchronic abdominal pain, and if it lasts more than3 months, it is called recurrent abdominal pain. Itcan be an organic disorder, a somatization disorderor a functional disorder. In children younger than 4years recurrent abdominal pain sets up as a diagnosis,as it cant be established as a functional disorder.In older children, recurrent abdominal pain isa symptom, and the diagnosis of functional disorderis established according to Rome III criteria, thatare based upon a set of symptoms.Complete examination and physical exploration arethe main components in the valuation of any patientwith chronic or recurrent abdominal pain. Organiccause should be always considered in first place, moreoverin children younger than 4 years. Presence ofalarm symptoms or signs constitutes and indication toperform diagnostic tests. Once discarded organic diseaseor somatization disorder, we can establish thefunctional abdominal pain diagnosis, based upon theRome III criteria, that sets up the following categories:functional dyspepsia, irritable bowel syndrome, abdominalmigraine and abdominal functional pain.Children with chronic or recurrent abdominal painshould be treated in the context of a biopsicosocial assistant model (AU)
