ABSTRACT
La meralgia parestésica es una entidad nosológica caracterizada por la presencia de parestesias, hipoestesia y disestesias en la región ántero-lateral del muslo. Su origen es la compresión del nervio fémorocutáneo lateral, bien en su trayecto intrapelviano, a su paso a través del ligamento inguinal, o bien por causas extrínsecas. Aunque la sintomatología puede considerarse banal y la causa en muchas ocasiones idiopática, es preciso protocolizar su diagnóstico y terapéutica, no sólo para descartar afecciones más graves sino para lograr un tratamiento eficaz. Presentamos una serie de 25 casos de meralgia parestésica y exponemos el protocolo diagnóstico y terapéutico. El diagnóstico se basa en la exploración clínica, la ecografía abdómino-pélvica y el estudio electrofisiológico. Este último consta de electromiografía, electroneurografía y potenciales evocados somatosensoriales. Se exponen los límites de normalidad de estas pruebas. El tratamiento comienza con la instauración de medidas higiénico-dietéticas (evitar prendas compresivas, reeducación postural, pérdida de peso), lo que logró la desaparición de los síntomas en el 40% de los casos. Si estas medidas no son eficaces se instaura tratamiento farmacológico, primero con anticomiciales y posteriormente con ansiolíticos o antidepresivos, lo que logró la curación del 52% de los pacientes. El 8% restante fue sometido a descompresión quirúrgica del nervio fémorocutáneo lateral al nivel del ligamento inguinal, que resolvió el cuadro de alteración de la sensibilidad. Concluímos que, la meralgia parestésica debe ser diagnosticada por neurofisiología y tratada secuencialmente mediante medidas higiénico-dietéticas, farmacológicas y neurolisis quirúrgica (AU)
The meralgia paresthetica is an entity characterized by the presence of parestesias, hipoestesia and disestesias in the ántero-lateral region of the thigh. It is caused by the compression of the lateral femorocutaneous nerve, well in its intrapelvic course, its passing through the inguinal ligament, or for extrinsic causes. Although the sintomatology can be considered banal and the ethiology in many occasions idiopatic, is necessary to protocolize its diagnosis and therapeutic, not only to discard more serious affections but to achieve an effective treatment. A series of 25 cases of meralgia paresthetica is presented and the diagnostic and therapeutic protocol is exposed. The diagnosis is based on the clinical exploration, abdomino-pelvic ecography and electrophisiologic study. This last one consists of electromiography, electroneurography and somatosensorial evoked potentials. The limits of normality of these tests are exposed. The treatment begins with the setting-up of hygienic-dietary measures (evitación of compresive garments, postural reeducation, loss of weight), with what the disappearance of the symptoms was achieved in 40% of the cases. If these measures are not effective pharmacological treatment is established, first with anticonvulsivants and later on with ansiolytic or antidepressants, with what the cure of 52% of the patients was achieved. The remaining 8% was subjected to surgical decompression of the nerve at the level of the inguinal ligament, with what were solved the sensibility disturbances. It is concluded that the meralgia paresthetica should be diagnosed by neurophysiologic study and treated sequentially by means of hygienicdietary, pharmacological measures and surgical neurolisis (AU)
Subject(s)
Humans , Nerve Compression Syndromes/complications , Paresthesia/complications , Thigh/physiopathology , Hypesthesia/physiopathology , Nerve Compression Syndromes/therapy , Paresthesia/therapy , Hypesthesia/therapy , Decompression, SurgicalABSTRACT
By means of an "in vitro" method using pig skin, the authors determine the penetration power of some antiseptic creams in order out the most effective one from this point of view in the treatment of subscar-located infections. The following antiseptic creams were studied: 1% Silver Sulfadiazine, 1% Silver Sulfadiazine with 2.2% Cerium Nitrate, 2.2% Cerium Nitrate, 10% Iodine Povidone, 0.2% Nitrofurazone 0.1%, 0.5% and 1% Chlorhexidine. These products were faced with 17 microorganisms isolated from burn wounds and a control one. The minimal inhibitory concentrations (MIC) obtained after passing through the penetration power of some antiseptic creams in order to find out the most effective one from this point of view in the treatment of subscar-located infections.
