Movimientos involuntarios del muñón tras una amputación transtibial: síndrome del muñón saltarín / Involuntary movements of the stump after transtibial amputation: Jumping stump syndrome

Mujer de 45 años, con antecedente de cirugía de hallux valgus de evolución tórpida, derivando en amputación transtibial. A los 6 meses poscirugía comenzó con movimientos involuntarios del muñón tipo mioclonías desencadenados con el roce o extensión de la cadera, agravándose el dolor previo de muñón y de miembro fantasma. Durante el siguiente año, coincidiendo con el cambio de prótesis, empeoró la clínica progresivamente limitando la marcha. El abordaje terapéutico del dolor y de las mioclonías fue inicialmente farmacológico, sin respuesta. Ante la sospecha clínica y ecográfica de neuroma en el nervio ciático poplíteo externo, se infiltró el mismo con corticoide y anestésico y los gastrocnemios con toxina botulínica tipo A, sin éxito. Finalmente, las mioclonías desaparecieron y el dolor disminuyó tras el remodelado quirúrgico del muñón y la resección del neuroma. Este cuadro clínico es conocido como síndrome del muñón saltarín, y es una complicación rara que debe tenerse en cuenta tras una amputación.(AU)

45-year-old woman with history of hallux valgus surgery and torpid evolution, which led to transtibial amputation. Six months after surgery, she began to experience involuntary movements of the stump such as myoclonus, that were triggered by touch or hip extension, associating worsening of the previous stump and phantom limb pain. During the following year, concurring with change of prosthesis, symptoms progressively worsened, which limited walking. The therapeutic approach to pain and myoclonus was initially pharmacological, without response. Given the clinical and ultrasound suspicion of neuroma in the external popliteal sciatic nerve, it was infiltrated with corticosteroid and anesthetic, and the gastrocnemius with botulinum toxin type A, without success. Finally, the myoclonus disappeared, and the pain decreased after surgical remodeling of the stump and resection of the neuroma. This clinical picture is known as jumping stump syndrome and is a rare complication that must be considered after amputation.(AU)

[Involuntary movements of the stump after transtibial amputation: Jumping stump syndrome]. / Movimientos involuntarios del muñón tras una amputación transtibial: síndrome del muñón saltarín.

45-year-old woman with history of hallux valgus surgery and torpid evolution, which led to transtibial amputation. Six months after surgery, she began to experience involuntary movements of the stump such as myoclonus, that were triggered by touch or hip extension, associating worsening of the previous stump and phantom limb pain. During the following year, concurring with change of prosthesis, symptoms progressively worsened, which limited walking. The therapeutic approach to pain and myoclonus was initially pharmacological, without response. Given the clinical and ultrasound suspicion of neuroma in the external popliteal sciatic nerve, it was infiltrated with corticosteroid and anesthetic, and the gastrocnemius with botulinum toxin type A, without success. Finally, the myoclonus disappeared, and the pain decreased after surgical remodeling of the stump and resection of the neuroma. This clinical picture is known as jumping stump syndrome and is a rare complication that must be considered after amputation.

El paciente con cáncer en la unidad de vigilancia intensiva. Nuevas perspectivas / Patients with cancer in the intensive monitoring unit. New perspectives

Durante los últimos años, se ha evidenciado una mejoría significativa en la supervivencia de los pacientes con cáncer en las unidades de cuidados intensivos (UCI). Tanto el avance en el tratamiento médico y quirúrgico, como una mejor selección de pacientes, han influido en la mejoría de las expectativas vitales de estos enfermos. En la UCI una resucitación adecuada y precoz, sin limitaciones iniciales a técnicas de soporte vital, ha demostrado disminuir también la mortalidad en los pacientes con cáncer. Actualmente, no debemos denegar el ingreso en UCI solo por la enfermedad neoplásica de base. Aun así, la mortalidad del paciente con cáncer en la UCI, especialmente el hematológico, sigue siendo alta y en algunos casos es necesario realizar una prueba de ingreso en UCI (test de UCI) de, al menos, 3 días para diferenciar a los pacientes que se estén beneficiando de un tratamiento intensivo. Proponemos un algoritmo de decisión al ingreso en la UCI que nos ayude en una situación, a veces, compleja (AU)

In recent years, there has been a significant improvement in the survival of patients with cancer in intensive care units (ICUs). Advances in medical and surgical treatments and better selection of patients has helped improve the life expectancy of this type of patient. An appropriate and early resuscitation in the ICU, without initial limitations on the life support techniques, has been shown to also decrease the mortality of patients with cancer. At present, we should not deny admission to the ICU based only on the underlying neoplastic disease. However, the mortality rate for patients with cancer in the ICU, especially those with hematologic disease, remains high. In some cases, an ICU admission test (ICU test) is required for at least 3 days to identify patients who can benefit from intensive treatment. We would like to propose a decision algorithm for ICU admission that will help in making decisions in an often complex situation (AU)

Patients with cancer in the intensive monitoring unit. New perspectives. / El paciente con cáncer en la unidad de vigilancia intensiva. Nuevas perspectivas.

In recent years, there has been a significant improvement in the survival of patients with cancer in intensive care units (ICUs). Advances in medical and surgical treatments and better selection of patients has helped improve the life expectancy of this type of patient. An appropriate and early resuscitation in the ICU, without initial limitations on the life support techniques, has been shown to also decrease the mortality of patients with cancer. At present, we should not deny admission to the ICU based only on the underlying neoplastic disease. However, the mortality rate for patients with cancer in the ICU, especially those with hematologic disease, remains high. In some cases, an ICU admission test (ICU test) is required for at least 3 days to identify patients who can benefit from intensive treatment. We would like to propose a decision algorithm for ICU admission that will help in making decisions in an often complex situation.

A Kinect-based system for cognitive rehabilitation exercises monitoring.

In this paper, a 3D computer vision system for cognitive assessment and rehabilitation based on the Kinect device is presented. It is intended for individuals with body scheme dysfunctions and left-right confusion. The system processes depth information to overcome the shortcomings of a previously presented 2D vision system for the same application. It achieves left and right-hand tracking, and face and facial feature detection (eye, nose, and ears) detection. The system is easily implemented with a consumer-grade computer and an affordable Kinect device and is robust to drastic background and illumination changes. The system was tested and achieved a successful monitoring percentage of 96.28%. The automation of the human body parts motion monitoring, its analysis in relation to the psychomotor exercise indicated to the patient, and the storage of the result of the realization of a set of exercises free the rehabilitation experts of doing such demanding tasks. The vision-based system is potentially applicable to other tasks with minor changes.

Tratamiento de la tendinopatía calcificante de hombro: ¿iontoforesis con ácido acético u onda corta? / Treatment of calcifying tendinitis of the shoulder: iontophoresis with acetic acid or shortwave?

Introducción. La tendinopatía calcificante de hombro (TCH) es una patología invalidante, dolorosa, frecuente y con alto impacto socioeconómico. El objetivo de este estudio es comparar la eficacia de la iontoforesis con ácido acético (IAA) con la onda corta (OC), asociadas ambas a ultrasonidos (US) y a un programa de cinesiterapia domiciliaria en dos grupos de pacientes con TCH. Material y método. Se estudia una muestra de 23 pacientes, aleatorizados en dos grupos de tratamiento: en el grupo I (GI) se emplea IAA al 2 % y en el grupo II (GII) OC. En ambos grupos se utilizaron los US y un programa estandarizado de ejercicios de hombro. Se aplicaron 15 sesiones de tratamiento y se valoraron las diferencias estadísticamente significativas en la escala visual analógica, índice de Constant (IC) y tamaño de la calcificación del hombro afecto. Resultados. Se encontró mejoría estadísticamente significativa en ambos grupos en el dolor (GI p = 0,002; GII p = 0,003) y en el apartado nivel de actividad del IC para el GII (p = 0,01). No se detectaron diferencias en la fuerza, movilidad y tamaño de la calcificación. Conclusiones. La asociación de IAA al 2 %, US y ejercicios no ha demostrado ser mejor en la TCH que la combinación de OC, US y ejercicios en lo referente a la mejoría del dolor, el IC y el tamaño de la calcificación. Son precisos más estudios con mayor número de pacientes y apoyados en técnicas de imagen que permitan mejores correlaciones clínico-patológicas para llegar a resultados más concluyentes

Introduction. Calcifying tendinitis of the shoulder (TCH) is a crippling, painful and common disease with high socio-economic impact. This study has aimed to compare iontophoresis with acetic acid (IAA) with shortwave (SW), both associated with ultrasound (US) and a physiotherapy home shoulder program in two groups of patients with TCH. Materials and methods. We studied a sample of 23 patients, randomized into two treatment groups. Group I uses IAA 2 % and the group II uses SW. US and an exercise shoulder program were used in both groups. Fifteen treatment sessions were applied and the statistically significant differences on the EVA, Constant index (CI) and size of the calcification were evaluated. Results. Statistically significant improvement for both groups regarding pain (GI, p = 0.002; GII, p = 0.003) and in the CI (p = 0.01) was found. No differences were detected in force, mobility and size of the calcification. Conclusions. It has not proven that the association of IAA at 2 %, US and exercises is better than the association of SW, US and exercises, in terms of improvement in pain, CI and size of calcification. Further studies with a larger sample population and complementary imaging techniques that can better define the clinical pathological correlations are needed

The oral combination of thalidomide, cyclophosphamide and dexamethasone (ThaCyDex) is effective in relapsed/refractory multiple myeloma.

We evaluate the efficacy of the oral combination of thalidomide, cyclophosphamide and dexamethasone (ThaCyDex) in 71 refractory/relapsed multiple myeloma patients, including a prognostic analysis to predict both response and survival. Patients received thalidomide at escalating doses (200-800 mg/day), daily cyclophosphamide (50 mg/day) and pulsed dexamethasone (40 mg/day, 4 days every 3 weeks). On an intention-to-treat basis and using the EBMT response criteria, 2% patients reached complete response (CR), 55% partial response (PR) and 26% minor response (MR) yielding a total response (CR+PR+MR) rate of 83% after 3 months of therapy. After 6 months of therapy, responses were maintained including a 10% CR. The 2-year progression free and overall survival were 57 and 66%, respectively. A favorable response was associated with beta2 microglobulin < or =4 mg/dl, platelets >80 x 10(9)/l and nonrefractory disease. Regarding survival, low beta2 microglobulin (< or =4 mg/dl), age (< or =65 years) and absence of extramedullary myelomatous lesion were associated with a longer survival. Major adverse effects included constipation (24%), somnolence (18%), fatigue (17%) and infection (13%). Only 7% of patients developed a thrombo-embolic event. ThaCyDex is an oral regimen that induces a high response rate and long remissions, particularly in relapsing patients with beta2 microglobulin < or =4 mg/dl and < or =65 years.

Evolution and factors associated with biological-risk accidents reported in a university hospital in Spain, 1989 to 1995.

BACKGROUND: The objective of this study was to describe the profile and evolution of accidents involving risk of transmission of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) reported in a large Spanish hospital, together with the preventive measures administered and the factors associated with high-risk accidents. METHODS: Data used were the accidents recorded in the hospital during the period from January 1989 to December 1995. A logistic model, using age, gender, service, occupation, and year of accident as independent variables was constructed to study the factors associated with these accidents. RESULTS: The study included 1,009 accidents. Accidents were more common among nurses, female doctors, younger workers, and persons who worked in surgical settings. Of the total sources of infection studied, 11.6% were positive for HBV, 28.2% for HCV, and 24.4% for HIV. No seroconversions were detected in the partial follow-ups conducted. The factors associated with high-risk accidents were gender (relative risk [RR], 2.01; 95% confidence interval [CI95], 1.24-3.60); occupation as physician (RR, 2.57; CI95, 1.54-4.29) or as nursing staff (RR, 1.80; CI95, 1.12-2.89); and working in a surgical service (RR, 2.01; CI95, 1.27-3.18). Younger workers had more accidents overall, but older workers were more likely to have high-risk exposure. In the multivariate analysis, the occupation (physician and nursing staff) was the most important variable when adjusted by the other factors. CONCLUSIONS: Our results suggest that a greater effort still is required in the application and evaluation of preventive measures. New safety systems, with clearly proven cost-effectiveness, should be developed and applied.