ABSTRACT
The posterior femoral cutaneous nerve is a sensitive nerve that rises from S1-S3, usually giving off cutaneous branches for the gluteal region, perineum, the posterior region of the thigh and leg. The sciatic nerve is the largest nerve in the human body, rising from L4-S3, and divides into the tibial and common fibular nerves, innervating the muscles from the posterior compartment of the thigh. Anastomosis between the sciatic nerve and the posterior femoral cutaneous nerve is rare. During dissection of the right gluteal region on a male cadaver fixed with 10% formalin, we observed an anastomosis between both nerves, while the common fibular nerve perforated the piriformis muscle, dividing it in two muscle slips. Both nerves trajectories were within the regular pattern after this communication. Our aims were to describe this unusual case of anastomosis and perform a literature review on the variations of the sciatic nerve, while also discussing their clinical significance
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Subject(s)
Humans , Male , Sciatic Nerve/abnormalities , Femoral Nerve/abnormalities , Peroneal Nerve/abnormalities , Anatomic Variation , Nervous System Malformations/diagnosis , Piriformis Muscle Syndrome/diagnosisABSTRACT
Esta Guía de Práctica Clínica responde a preguntas clínicas sobre seguridad en la elección de fluido (cristaloide, coloide o Hidroxietilalmidón 130) en pacientes que precisan restauración volémica en el periodo perioperatorio de cirugía no cardiaca. A partir del resumen de la evidencia, se elaboraron las recomendaciones siguiendo la metodología GRADE. En esta población se sugiere la fluidoterapia basada en la administración de cristaloides, (recomendación débil, calidad de la evidencia baja). En las situaciones en las que la restauración volémica no se alcance sólo con cristaloides, se sugiere utilizar coloides sintéticos (Hidroxietilalmidón 130 o gelatina fluida modificada) en lugar de Albúmina 5% (recomendación débil, calidad de la evidencia baja). La elección y dosificación de coloide deberán basarse en las características del producto, comorbilidad del paciente y experiencia del anestesiólogo (AU)
The present Clinical practice guide responds to the clinical questions about security in the choice of fluid (crystalloid, colloid or hydroxyethyl starch 130) in patients who require volume replacement during perioperative period of non-cardiac surgeries. From the evidence summary, recommendations were made following the GRADE methodology. In this population fluid therapy based on crystalloids is suggested (weak recommendation, low quality evidence). In the events where volume replacement is not reached with crystalloids, the use of synthetic colloids (hydroxyethyl starch 130 or modified fluid gelatin) is suggested instead of 5% albumin (weak recommendation, low quality evidence). The choice and dosage of the colloid should be based in the product characteristics, patient comorbidity and anesthesiologist's experience (AU)
Subject(s)
Humans , Male , Female , Thoracic Surgery/methods , Colloids/administration & dosage , Fluid Therapy/methods , Pharmaceutical Preparations/administration & dosage , Communicable Diseases/pathology , Communicable Diseases/transmission , Anesthetics, Intravenous/administration & dosage , Anesthetics, Intravenous/metabolism , Polygeline/metabolism , Spain/ethnology , Thoracic Surgery/standards , Colloids/metabolism , Fluid Therapy , Pharmaceutical Preparations/metabolism , Communicable Diseases/genetics , Communicable Diseases/metabolism , Anesthetics, Intravenous/supply & distribution , Anesthetics, Intravenous/toxicity , PolygelineABSTRACT
La púrpura fulminante (PF) es una enferedad grave con una mortalidad y morbilidad elevadas. De forma característica se produce una coagulación intravasculardiseminada (CID) y shock séptico en relación con undescenso de los niveles de proteína C (PC). La proteínaC activada recombinante (PCAr) se ha utilizado con éxitopara detener este proceso. Las hemorragias intracranealesson el efecto adverso más importante y puedencondicionar el pronóstico.Presentamos tres casos de pacientes con púrpura fulminantemeningocócica que desarrollaron shock séptico y disfunción multiorgánica. Desde el ingreso fueron tratadoscon las medidas del protocolo de shock séptico,antibióticos y PCAr. En todos ellos se observó una mejoríade la disfunción hemodinámica durante las primerashoras. En todos ellos se trasfundieron plaquetas por plaquetopeniay en dos de los casos se hallaron hemorragiassubaracnoideas (HSA) como complicaciones. Uno de lospacientes falleció el quinto día, los otros dos fuerondados de alta de la Unidad de Reanimación y permanecían vivos a los 28 días (AU)
Purpura fulminans is a serious disease associated with high rates of morbidity and mortality. It usually leads to disseminated intravascular coagulation and septic shock related to reduced levels of protein C. Recombinant protein C (rPC) activator has been used successfully to inhibit this process. Intracranial hemorrhages are the most important, life-threatening adverse effects of treatment with rPC activator. We report 3 cases of patients with meningococcal purpura fulminans who developed septic shock and multiorgan dysfunction. They were treated with the protocol for septic shock, antibiotics and rPC activator from the time of admission, and improvement in hemodynamic dysfunction was observed within hours in all patients. All received platelet replacement transfusions. Subarachnoid bleeding complications occurred in 2 patients. One patient died 5 days after admission and 2 were discharged from the intensive recovery care unit 28 days after admission (AU)
