[Thermal radiofrequency of the medial genicular nerves in chronic pain related to degenerative meniscopathy. A clinical case]. / Radiofrecuencia térmica de las ramas geniculares mediales para dolor crónico en contexto de meniscopatía degenerativa. A propósito de un caso.

Persistent knee pain in patients around the fifth decade of life is a frequent cause of attention in rehabilitation consultations. The most common cause of diagnosis is knee osteoarthritis, considering the existence of different degrees seen in simple radiographies. The advanced degrees present joint space reduction, osteophytosis and subchondral sclerosis; however, in the initial degrees, the findings are more subtle and sometimes nonexistent for conventional radiology. Clinical ultrasound has partly come to fill this «diagnostic gap¼, making it possible to detect meniscal extrusions and small osteophytes as signs of incipient osteoarthritis and to relate them as triggers of pain. In clinical practice we find a group of patients who, with little or no radiological alterations, present persistent and severe pain with medial predominance in most cases. These, until the appearance of the current evidence, were subsidiaries of meniscectomies. At this moment, when meniscectomies are not recommended, it is necessary to find a treatment for those cases in which conservative and non-ablative interventional treatment has failed. In this context, the possibility of using radiofrequency arises. Its use is widespread in the case of tricompartmental and advanced osteoarthritis. However, little data is available on its usefulness in cases of medial meniscal extrusion. It seems that thermal radiofrequency has greater effects than pulsed radiofrequency. We present a clinical case where thermal radiofrequency of the medial genicular nerves of the knee is proposed as a therapeutic alternative for chronic pain secondary to medial meniscal extrusion associated with incipient knee osteoarthritis, with the result of a decrease in pain (VAS 8 before treatment, VAS 1 after one year), subjective improvement of 80% and gait capacity.

Is the sustainability of exposure to non-ionizing electromagnetic radiation possible? / ¿Es posible la sostenibilidad de la exposición a las radiaciones electromagnéticas no ionizantes?

Technological advances imply an increase in artificially generating sources of electromagnetic fields (EMF), therefore, resulting in a permanent exposure of people and the environment (electromagnetic pollution). Inconsistent results have been published considering the evaluated health effects. The purpose of this study was to review scientific literature on EMF to provide a global and retrospective perspective, on the association between human exposure to non-ionizing radiation (NIR, mainly radiofrequency-EMF) and health and environmental effects. Studies on the health effects of 5G radiation exposure have not yet been performed with sufficient statistical power, as the exposure time is still relatively short and also the latency and intensity of exposure to 5G. The safety standards only consider thermal effects, do not contemplate non-thermal effects. We consider relevant to communicate this knowledge to the general public to improve education in this field, and to healthcare professionals to prevent diseases that may result from RF-EMF exposures. (AU)

Los avances tecnológicos implican un aumento de las fuentes artificiales que generan campos electromagnéticos (CEM), esto se traduce en una exposición permanente de las personas y el medio ambiente (contaminación electromagnética) a CEM. Se han publicado resultados contradictorios en cuanto a los efectos evaluados sobre la salud. El propósito de este estudio fue revisar la literatura científica sobre CEM para proporcionar una perspectiva global y retrospectiva, sobre la asociación entre la exposición humana a la radiación no ionizante (RNI, principalmente CEM en el rango de las radiofrecuencias) y los efectos sobre la salud y el medio ambiente. Aún no se han realizado estudios sobre los efectos en la salud de la exposición a la radiación 5G con suficiente potencia estadística, ya que el tiempo de exposición es todavía relativamente corto, igual que ocurre con la latencia y la intensidad de la exposición a la 5G. Las normas de seguridad solo consideran los efectos térmicos, no contemplan los efectos no térmicos. Consideramos relevante comunicar el conocimiento actual sobre este tema tanto al público en general para mejorar la educación en este campo, como a los profesionales sanitarios para prevenir las enfermedades que puedan derivarse de las exposiciones a RF-EMF. (AU)

Effect of turbinate surgery on mucociliary clearance. A systematic review and metanalysis / Efecto de la cirugía turbinal en el aclaramiento mucociliar. Revisión sistemática y metaanálisis

Despite the fact that turbinate surgery provides satisfactory results regarding nasal obstruction, most of these procedures are destructive, to some extent, for the respiratory epithelium. There are valid hypotheses suggesting either that turbinate surgery may improve mucociliary clearance (MCC) by improving rhinitis, as well hypotheses suggesting that these surgeries may impair it by damaging the nasal ciliated epithelia. This systematic review is designed with the objective of exploring the effect of turbinate surgery on MCC. Pubmed (Medline), the Cochrane Library, EMBASE, SciELO were analyzed. Four authors members of the YO-IFOS rhinology study group independently analyzed the articles. Extracted variables encompassed: sample size, age, indication for surgery, surgical technique, method used to measure mucociliary clearance, mucociliary transport time before and after surgery, and main outcome. 15 studies with a total population of 1936 participants (1618 patients excluding healthy controls) met the inclusion criteria. 9 studies could be combined in a metanalysis, wich revealed a non-statistically significant decrease of 3.86 min in MCTT after turbinate surgery (p = 0.06). The subgroup analysis of the 5 cohorts who underwent microdebrider turbinoplasty reached statistical significance under a random effect model, revealing a 7.02 min decrease in MCTT (p < 0.001). The laser turbinoplasty subgroup, composed of 4 cohorts, also reached significance, although the difference was lower than that for microdebrider turbinoplasty, 1.01 min (p < 0.001). This systematic review and meta-analysis suggests that turbinate surgery does not compromise mucociliary clearance. The available evidence also suggests that turbinate surgery with mucosa sparing techniques improves MCC, while with aggressive techniques it increases or remains the same. ... . (AU)

A pesar de que la cirugía turbinal tiene efectos positivos en la ventilación nasal, gran parte de estos procedimientos son agresivos con el epitelio respiratorio. Existen hipótesis que sugieren que la cirugía turbinal puede mejorar el aclaramiento mucociliar (AMC) al mejorar la rinitis, así como alterarlo al lesional el epitelio nasal. Esta revisión se diseña con el objetivo de explorar el efecto de la cirugía turbinal en el AMC. Se revisó Pubmed (Medline), the Cochrane Library, EMBASE, SciELO. 4 autores miembros de YO-IFOS grupo de estudio en rinología, analizaron de manera independiente los artículos. Las variables analizadas fueron tamaño muestral, edad, indicación quirúrgica, técnica quirúrgica, método de medición de AMC, AMC antes y después de la cirugía y resultado principal. Se incluyeron 15 estudios con 1936 participantes (1618 excluyendo controles sanos). 9 estudios fueron combinados en un metanálisis que demostró una diferencia no estadísticamente significativa de -3,86 minutos en AMC tras cirugía (p = 0,06). El análisis por subgrupos de las 5 cohortes sometidas a turbinoplastia con microdebridador si fueron estadísticamente significativas con una diferencia de -7,02 minutos (p < 0,001). El grupo sometido a laser (4 cohortes) también obtuvo diferencia estadística, aunque menor, -1,01 minutos (p < 0,001). Esta revision y metaanálisis sugiere que la cirugía turbinal no afecta al aclaramiento mucociliar. La evidencia disponible también sugiere que las técnicas menos agresivas con la mucosa mejoran el AMC, mientras que las agresivas podrían aumentarlo o no modificarlo. Este efecto beneficioso se observa desde el 1º al 3º mes postquirúrgico. Sin embargo, para poder obtener adecuadas conclusiones, debe existir un método estandarizado para medir el AMC, así como un método para describir adecuadamente la extensión quirúrgica. (AU)

Effect of turbinate surgery on mucociliary clearance. A systematic review and metanalysis.

Despite the fact that turbinate surgery provides satisfactory results regarding nasal obstruction, most of these procedures are destructive, to some extent, for the respiratory epithelium. There are valid hypotheses suggesting either that turbinate surgery may improve mucociliary clearance (MCC) by improving rhinitis, as well hypotheses suggesting that these surgeries may impair it by damaging the nasal ciliated epithelia. This systematic review is designed with the objective of exploring the effect of turbinate surgery on MCC. Pubmed (Medline), the Cochrane Library, EMBASE, SciELO were analyzed. Four authors members of the YO-IFOS rhinology study group independently analyzed the articles. Extracted variables encompassed: sample size, age, indication for surgery, surgical technique, method used to measure mucociliary clearance, mucociliary transport time before and after surgery, and main outcome. 15 studies with a total population of 1936 participants (1618 patients excluding healthy controls) met the inclusion criteria. 9 studies could be combined in a metanalysis, wich revealed a non-statistically significant decrease of 3.86 min in MCTT after turbinate surgery (p = 0.06). The subgroup analysis of the 5 cohorts who underwent microdebrider turbinoplasty reached statistical significance under a random effect model, revealing a 7.02 min decrease in MCTT (p < 0.001). The laser turbinoplasty subgroup, composed of 4 cohorts, also reached significance, although the difference was lower than that for microdebrider turbinoplasty, 1.01 min (p < 0.001). This systematic review and meta-analysis suggests that turbinate surgery does not compromise mucociliary clearance. The available evidence also suggests that turbinate surgery with mucosa sparing techniques improves MCC, while with aggressive techniques it increases or remains the same. This beneficial effect is evident since the first to third month after surgery. However, for solid conclusions, a standard way to measure MCTT should be stablished, as well as a method to appropriately describe the extension of the surgery.

Ablación por cateter de radiofrecuencia de extrasístoles ventriculares con origen en el seno coronario izquierdo

Las extrasístoles ventriculares (EEVV) son frecuentemente asintomáticas y no requieren de tratamiento antiarrítmico. Las EEVV de los tractos de salida son las EEVV idiopáticas más frecuentes en la práctica clínica. La anamnésis, el examen físico y el electrocardiograma son fundamentales en el diagnóstico. Aunque las EEVV de los tractos de salidas ventriculares son consideradas benignas, pueden producir diversos síntomas y desencadenar una cardiomiopatía inducida por las extrasístoles, que lleva a un deterioro de la función sistólica ventricular izquierda y en última instancia, insuficiencia cardiaca. Cuando el tratamiento farmacológico de las EEVV fracasa, nos queda la ablación de arritmias por catéter de radiofrecuencia como única alternativa eficaz. Este es el caso de la paciente de sexo femenino de 62 años, hipertensa, dislipidémica y tabaquista, que demuestra la seguridad de la ablación por catéter de radiofrecuencia, la eficacia terapéutica, y el restablecimiento integro de la función ventricular del corazón.

Premature ventricular complexes (PVC) are frequently asymptomatic and do not require antiarrhythmic treatment. Outflow tract PVC are the most common idiopathic PVC in clinical practice. The anamnesis, physical examination and electrocardiogram are essential in the diagnosis of these patients. Although PVC of the ventricular outflow tracts are considered benign, they can produce various symptoms such as dyspnea on exertion, asthenia, palpitations, dizziness, presyncope or syncope, and in those patients with very high arrhythmic burden (>24% on a 24-hour Holter monitoring), can trigger extrasystole-induced cardiomyopathy, leading to deterioration of left ventricular systolic function and ultimately heart failure. When pharmacological treatment of PVC fails, ablation of arrhythmias by radiofrequency catheter is the only effective alternative. This is the case of the 62-year-old female patient, hypertensive, dyslipidemic and a smoker, which demonstrates the safety of radiofrequency catheter ablation, the therapeutic efficacy, and the complete restoration of the ventricular function of the heart.

Is the sustainability of exposure to non-ionizing electromagnetic radiation possible?

Technological advances imply an increase in artificially generating sources of electromagnetic fields (EMF), therefore, resulting in a permanent exposure of people and the environment (electromagnetic pollution). Inconsistent results have been published considering the evaluated health effects. The purpose of this study was to review scientific literature on EMF to provide a global and retrospective perspective, on the association between human exposure to non-ionizing radiation (NIR, mainly radiofrequency-EMF) and health and environmental effects. Studies on the health effects of 5G radiation exposure have not yet been performed with sufficient statistical power, as the exposure time is still relatively short and also the latency and intensity of exposure to 5G. The safety standards only consider thermal effects, do not contemplate non-thermal effects. We consider relevant to communicate this knowledge to the general public to improve education in this field, and to healthcare professionals to prevent diseases that may result from RF-EMF exposures.

Resultados del aislamiento eléctrico de las venas pulmonares en pacientes menores y mayores de 70 años / Outcomes of pulmonary vein electrical isolation in patients younger than and older than 70 years

Resumen Introducción y objetivos: Comparar las características clínicas y los resultados de cohortes contemporáneas de pacientes menores y mayores de 70 años que han sido sometidos a ablación de fibrilación auricular (FA) mediante catéter. Métodos: Se llevó a cabo un estudio de cohortes retrospectivo en pacientes sometidos a ablación con catéter debido a la presencia de FA refractaria. Se realizó un seguimiento mínimo de 12 meses por paciente. Resultados: En el estudio se incluyeron un total de 239 pacientes sometidos a ablación de FA, de los cuales 171 (71,5%) pertenecían al grupo de edad < 70 años y 68 (28,5%) al grupo de edad > 70 años. La edad promedio de la población estudiada fue de 62,4 años (desviación estándar [DE] = 10,87). El grupo < 70 años presentó una edad promedio de 58,03 años (DE = 9,71), mientras que el grupo > 70 años tuvo una edad promedio de 73,4 años (DE = 3,05). Además, se observó una mayor prevalencia de FA paroxística en el grupo de pacientes menores de 70 años, mientras que en el grupo de pacientes mayores de 70 años se encontró una mayor prevalencia de FA persistente. Estas diferencias fueron estadísticamente significativas en ambos casos. Las tasas de recurrencia después del primer procedimiento de ablación fueron similares entre los dos grupos (21,43% en el grupo menor de 70 años frente a 23,53% en el grupo mayor de 70 años, p = 0,79). No se encontraron diferencias significativas en cuanto a complicaciones. El grupo menor de 70 años experimentó 18 complicaciones, mientras que el grupo mayor de 70 años tuvo 5 complicaciones, con un valor de p de 0,472. Conclusión: Los pacientes mayores de 70 años sometidos al primer procedimiento de ablación de FA por catéter presentan resultados clínicos similares a los pacientes menores de 70 años.

Abstract Introduction and objectives: The objective of this study is to compare the clinical characteristics and outcomes of contemporary cohorts of patients undergoing catheter ablation for atrial fibrillation (AF), stratified by age (< 70 years and ≥ 70 years). Methods: This retrospective cohort study included patients who underwent catheter ablation for refractory AF. The minimum follow-up duration per patient was 12 months. Results: A total of 239 patients were included in the study, with 171 (71.5%) in the < 70 years group and 68 (28.5%) in the ≥ 70 years group. The mean age of the study population was 62.4 years (SD 10.87). The < 70 years group had a mean age of 58.03 years (SD 9.71), while the ≥ 70 years group had a mean age of 73.4 years (SD 3.05). Furthermore, a higher proportion of paroxysmal AF was observed in patients < 70 years, whereas a higher proportion of persistent AF was found in patients ≥ 70 years. These differences were statistically significant. The recurrence rates after the initial ablation procedure were similar between the two groups (21.43% in the < 70 years group vs. 23.53% in the ≥ 70 years group, p = 0.79). Additionally, there were no significant differences in terms of complications. The < 70 years group experienced 18 complications, while the ≥ 70 years group had 5 complications (p = 0.472). Conclusion: The findings of this study suggest that patients aged 70 years and older who undergo their first catheter ablation procedure for AF demonstrate similar clinical outcomes compared to patients younger than 70 years.

Comparison of bipolar radiofrequency thermotherapy and transurethral prostate resection in treatment of benign prostate hyperplasia.

OBJECTIVES: Lower urinary tract symptoms due to benign prostatic hyperplasia in men increase with aging. Risks related to anesthesia and surgery have led a search for alternative treatments. Bipolar radiofrequency (RF) thermotherapy is one of the methods adopted in patients with high surgical risks. The aim of this study is to compare the effect of bipolar RF thermotherapy and transurethral resection of the prostate (TURP) methods on voiding symptoms and on post-operative complication rates especially in patients carrying high surgical risks. METHODS: Pre-operative, post-operative 1st and 6th month International Prostate Symptom Score (IPSS), Qmax, quality of life, prostate volumes, and postoperative complications of the patients underwent TURP and RF for benign prostatic hyperplasia (BPH) were compared. RESULTS: In the RF group, the pre-operative median IPSS was 30, prostate volume 41.5 cc, post-void residual (PVR) 80 ml, and Qmax is 5.85 ml/s.; In the TURP group, these were 29, 40 cc, 85 ml, and 5.3 ml/sec, respectively. In the Bipolar RF group, post-operative 1st- and 6th-month median values were IPSS 18, 21; prostate volume 40, 40; PVR 40, 35; Qmax 10.9, 9.15 and in the TURP group IPSS 9, 8; prostate volume 20, 20; PVR 30, 10; Qmax 17.25, 19.1, respectively. CONCLUSION: Bipolar RF thermotherapy is an applicable treatment method for BPH patients with high surgical risks.

OBJETIVOS: La termoterapia bipolar por radiofrecuencia es uno de los métodos adoptados en pacientes con alto riesgo quirúrgico. El objetivo de este estudio es comparar el efecto de la termoterapia de radiofrecuencia bipolar y los métodos de RTUP en los síntomas de vaciado y en las tasas de complicaciones posoperatorias, especialmente en pacientes con alto riesgo quirúrgico. MÉTODOS: Se compararon el IPSS, el Qmax, la calidad de vida, los volúmenes de próstata y las complicaciones posoperatorias de los pacientes sometidos a RTUP y RF para la HBP preoperatorios, posoperatorios al primer y sexto mes. RESULTADOS: En el grupo de RF, la mediana preoperatoria del IPSS fue de 30, el volumen prostático de 41.5 cc, el PVR de 80 ml y el Qmax de 5.85 ml/seg.; En el grupo RTUP estos fueron 29, 40 cc, 85 ml y 5.3 ml/seg, respectivamente. En el grupo de RF bipolar, los valores medianos postoperatorios del primer y sexto mes fueron IPSS 18, 21; volumen de próstata 40, 40; PVR 40, 35; Qmax 10.9, 9.15 y en el grupo TURP IPSS 9, 8; volumen de próstata 20, 20; PVR 30, 10; Qmax 17.25, 19.1, respectivamente. CONCLUSIÓN: La termoterapia de RF bipolar es un método de tratamiento aplicable para pacientes con HPB con alto riesgo quirúrgico.

Ablación tumoral y cementación en el tratamiento de las metástasis vertebrales. Estudio multicéntrico / Tumor ablation and vertebral augmentation in the treatment of vertebral metastases: A multicenter study

Introducción: El tratamiento de las fracturas vertebrales metastásicas sin compresión neural se realiza con técnicas percutáneas de cementación. El aumento de presión intratumoral por estas técnicas puede enviar células tumorales al torrente sanguíneo. Para evitar esa diseminación y mejorar el tratamiento del dolor se han introducido las técnicas de ablación que permitirían crear una cavidad en el tumor previo a la cementación o directamente necrosar la metástasis cuando el tamaño es pequeño. Material: Presentamos la experiencia con la ablación de dos hospitales y dos técnicas de ablación distintas. El primer grupo usó la ablación por radiofrecuencia (ARF) en 14 pacientes (26 vértebras) de los cuales en cuatro se asoció una artrodesis vertebral. El segundo grupo usó la ablación por microondas (AMO); 93 pacientes (129 lesiones) sin asociar instrumentación vertebral. Resultados: En el grupo de ARF la mejoría del dolor en la escala visual analógica (EVA) fue de 7,7 a 2,6 a las seis semanas. No hubo complicaciones derivadas de la ablación. En la mayoría de los casos se asoció la cementación. En el grupo de AMO la mejoría del dolor en EVA pasó de 6,8 a 1,7 a las seis semanas. En todos los casos se asoció la cementación. No hubo complicaciones derivadas de la ablación. Conclusiones: La asociación de las técnicas de ablación a la cementación vertebral es una técnica segura, que permite mejorar notablemente el dolor del paciente y puede ayudar al control de la enfermedad.(AU)

Introduction: Treatment of metastatic vertebral fractures without neural compression is performed with percutaneous cementation techniques. The increase in intratumoral pressure by these techniques can send tumor cells into the bloodstream. To prevent this dissemination and improve pain treatment, ablation techniques have been introduced that would allow the creation of a cavity in the tumor prior to cementation or directly necrosing the metastasis when its size is small. Material: We present the experience with ablation of two hospitals and two different ablation techniques. The first group used radiofrequency ablation (A) in 14 patients (26 vertebrae), 4 of whom underwent vertebral arthrodesis. The second group used microwave ablation (B) in 93 patients (129 lesions) without associated vertebral instrumentation. Results: In group A pain improvement in VAS was 7.7–2.6 at 6 weeks. There were no complications derived from the ablation. In most cases cementation was associated. In the group B pain improvement in VAS went from 6.8–1.7 at 6 weeks. Cementation was associated in all cases. There were no complications derived from the ablation. Conclusion: The association of ablation techniques with vertebral cementation is a safe technique that significantly improves the patient's pain and can help control the disease.(AU)

[Translated article] Tumor ablation and vertebral augmentation in the treatment of vertebral metastases: A multicenter study / Ablación tumoral y cementación en el tratamiento de las metástasis vertebrales. Estudio multicéntrico

Introducción: El tratamiento de las fracturas vertebrales metastásicas sin compresión neural se realiza con técnicas percutáneas de cementación. El aumento de presión intratumoral por estas técnicas puede enviar células tumorales al torrente sanguíneo. Para evitar esa diseminación y mejorar el tratamiento del dolor se han introducido las técnicas de ablación que permitirían crear una cavidad en el tumor previo a la cementación o directamente necrosar la metástasis cuando el tamaño es pequeño. Material: Presentamos la experiencia con la ablación de dos hospitales y dos técnicas de ablación distintas. El primer grupo usó la ablación por radiofrecuencia (ARF) en 14 pacientes (26 vértebras) de los cuales en cuatro se asoció una artrodesis vertebral. El segundo grupo usó la ablación por microondas (AMO); 93 pacientes (129 lesiones) sin asociar instrumentación vertebral. Resultados: En el grupo de ARF la mejoría del dolor en la escala visual analógica (EVA) fue de 7,7 a 2,6 a las seis semanas. No hubo complicaciones derivadas de la ablación. En la mayoría de los casos se asoció la cementación. En el grupo de AMO la mejoría del dolor en EVA pasó de 6,8 a 1,7 a las seis semanas. En todos los casos se asoció la cementación. No hubo complicaciones derivadas de la ablación. Conclusiones: La asociación de las técnicas de ablación a la cementación vertebral es una técnica segura, que permite mejorar notablemente el dolor del paciente y puede ayudar al control de la enfermedad.(AU)

Introduction: Treatment of metastatic vertebral fractures without neural compression is performed with percutaneous cementation techniques. The increase in intratumoral pressure by these techniques can send tumor cells into the bloodstream. To prevent this dissemination and improve pain treatment, ablation techniques have been introduced that would allow the creation of a cavity in the tumor prior to cementation or directly necrosing the metastasis when its size is small. Material: We present the experience with ablation of two hospitals and two different ablation techniques. The first group used radiofrequency ablation (A) in 14 patients (26 vertebrae), 4 of whom underwent vertebral arthrodesis. The second group used microwave ablation (B) in 93 patients (129 lesions) without associated vertebral instrumentation. Results: In group A pain improvement in VAS was 7.7–2.6 at 6 weeks. There were no complications derived from the ablation. In most cases cementation was associated. In the group B pain improvement in VAS went from 6.8–1.7 at 6 weeks. Cementation was associated in all cases. There were no complications derived from the ablation. Conclusion: The association of ablation techniques with vertebral cementation is a safe technique that significantly improves the patient's pain and can help control the disease.(AU)

Therapeutic effects of melatonin in long-term exposure to 2100MHz radiofrequency radiation on rat sperm characteristics / Efectos terapéuticos de la melatonina en la exposición a largo plazo a la radiación de radiofrecuencia de 2100MHz en las características del esperma de rata

Introduction: Radiofrequency electromagnetic fields (RF-EMFs) are one of the risk factors for male reproductive health and melatonin can be an ideal candidate for therapeutic development against RF-induced male fertility problems due to its antioxidant properties. The possible therapeutic role of melatonin in the destructive effects of 2100MHz RF radiation on rat sperm characteristics is investigated in the present study. Methods: Wistar albino rats were divided into four groups and the experiment continued for ninety consecutive days; Control, Melatonin (10mg/kg, subcutaneously), RF (2100MHz, thirty minutes per day, whole-body), and RF+Melatonin groups. Left caudal epididymis and ductus deferens tissues were placed in sperm wash solution (at 37°C) and dissected. The sperms were counted and stained. Measurements of the perinuclear ring of the manchette and posterior portion of the nucleus (ARC) were performed and the sperms were examined at an ultrastructural level. All of the parameters were evaluated statistically. Results: The percentages of abnormal sperm morphology were significantly increased with RF exposure, while the total sperm count was significantly decreased. RF exposure also showed harmful effects on acrosome, axoneme, mitochondrial sheath, and outer dense fibers at the ultrastructural level. The number of total sperms, sperms with normal morphology increased, and ultrastructural appearance returned to normal by melatonin administration. Discussion: The data showed that melatonin may be a beneficial therapeutic agent for long-term exposure of 2100MHz RF radiation-related reproductive impairments. (AU)

Introducción: Los campos electromagnéticos de radiofrecuencia (RF-EMF) son uno de los factores de riesgo para la salud reproductiva masculina y la melatonina puede ser un candidato ideal para el desarrollo terapéutico contra los problemas de fertilidad masculina inducidos por RF debido a sus propiedades antioxidantes. En el presente estudio se investiga el posible papel terapéutico de la melatonina en los efectos destructivos de la radiación RF de 2100MHz en las características del esperma de rata. Métodos: Se dividieron ratas albinas Wistar en 4 grupos y se continuó el experimento durante 90 días consecutivos: grupos control, melatonina (10mg/kg, por vía subcutánea), RF (2100MHz, 30min por día, cuerpo entero) y RF+melatonina. Los tejidos del epidídimo caudal izquierdo y del conducto deferente se colocaron en una solución de lavado de esperma (a 37°C) y se diseccionaron. Los espermatozoides fueron contados y teñidos. Se realizaron mediciones del anillo perinuclear del manchette y de la porción posterior del núcleo (ARC) y se examinaron los espermatozoides a nivel ultraestructural. Todos los parámetros fueron evaluados estadísticamente. Resultados: Los porcentajes de morfología anormal de los espermatozoides aumentaron significativamente con la exposición a RF, mientras que el recuento total de espermatozoides disminuyó significativamente. La exposición a RF también mostró efectos nocivos en el acrosoma, el axonema, la vaina mitocondrial y las fibras densas externas a nivel ultraestructural. El número total de espermatozoides, los espermatozoides con morfología normal aumentaron y la apariencia ultraestructural volvió a la normalidad mediante la administración de melatonina. Discusión: Los datos mostraron que la melatonina puede ser un agente terapéutico beneficioso para la exposición a largo plazo de las deficiencias reproductivas relacionadas con la radiación de RF de 2100MHz. (AU)

Percutaneous ethanol injection in thyroid nodular pathology and metastatic cervical adenopathies: A systematic review, meta-analysis and economic evaluation.

BACKGROUND: Percutaneous ethanol injection (PEI) has been shown to be a valuable treatment for thyroid nodular pathology and metastatic cervical adenopathies. OBJECTIVE: To evaluate the effectiveness, safety, and cost-effectiveness of PEI in thyroid nodular pathology and metastatic cervical adenopathies. METHODS: A systematic review (SR) using meta-analysis was conducted on the effectiveness and safety of PEI. A SR on cost-effectiveness was also performed. The SRs were conducted according to the methodology developed by the Cochrane Collaboration with reporting in accordance with the PRISMA statement. A cost-minimization analysis was carried out using a decision tree model. Assuming equal effectiveness between two minimally invasive techniques (PEI and radiofrequency ablation (RFA)), the model compared the costs of the alternatives with a horizon of six months and from the perspective of the Spanish National Health System. RESULTS: The search identified three RCTs (n=157) that evaluated PEI versus RFA in patients diagnosed with benign thyroid nodules: ninety-six patients with predominantly cystic nodules and sixty-one patients with solid nodules. No evidence was found on other techniques or thyroid nodular pathology. No statistically significant differences were observed between PEI and RFA in volume reduction (%), symptom score, cosmetic score, therapeutic success and major complications. No economic evaluations were identified. The cost-minimization analysis estimated the cost per patient of the PEI procedure at €326 compared to €4781 for RFA, which means an incremental difference of -€4455. CONCLUSIONS: There are no differences between PEI and RFA regarding their safety and effectiveness, but the economic evaluation determined that the former option is cheaper.

Ambulatory surgery for chronic venous insufficiency using radiofrequency thermoablation: quality and satisfaction.

BACKGROUND: Chronic venous disease is a frequent and prevalent pathology. Its surgical treatment has been shown to be cost-effective. Thermal endoablation performed as major outpatient surgery (MAS) is the technique of choice. OBJECTIVE: To know the satisfaction of patients after MAS and the quality of care provided. METHOD: Observational, descriptive, cross-sectional study, carried out between January 2019 and March 2020. A survey was carried out on patients who underwent endovascular radiofrequency thermoablation in two hospitals in Spain, consisting of two questionnaires: one ad hoc and one another of satisfaction (SERCAL). Quality indices for MAS were measured. RESULTS: We analyzed 156 episodes. 145 interventions were carried out. We found 4 (2.8%) unscheduled admissions. 3 patients (2.1%) attended the emergency department. There was a 99.3% success rate. 100% of the patients had pre-surgical recommendations and informed consent. We obtained 48 surveys (response rate: 33.1%). All the patients gave a rating greater ≥ 8 in quality of care (x = 9.83) and would recommend this procedure to their relatives (x = 9.71). CONCLUSIONS: Endovascular radiofrequency thermoablation performed in MAS has a high success rate and a very low rate of admission and visit to the emergency room. Patient satisfaction is high.

ANTECEDENTES: La enfermedad venosa crónica es una patología frecuente y prevalente. Su tratamiento quirúrgico ha mostrado ser coste-efectivo. La endoablación térmica realizada como cirugía mayor ambulatoria (CMA) es la técnica de elección. OBJETIVO: Conocer la satisfacción de los pacientes tras CMA y la calidad de la atención brindada. MÉTODO: Estudio observacional, descriptivo y transversal, realizado entre enero de 2019 y marzo de 2020. Se realizó una encuesta a los pacientes intervenidos mediante termoablación endovascular por radiofrecuencia en dos hospitales de España, con dos cuestionarios: uno ad hoc y otro de satisfacción (SERCAL). Se midieron índices de calidad para CMA. RESULTADOS: Analizamos 156 episodios. Se realizaron 145 intervenciones. Encontramos 4 (2.8%) ingresos no programados. Tres pacientes (2.1%) acudieron a urgencias. Hubo una tasa de éxito del 99.3%. El 100% de los pacientes contaban con recomendaciones prequirúrgicas y consentimiento informado. Obtuvimos 48 encuestas (índice de respuesta: 33.1%). Todos los pacientes otorgaron una calificación ≥ 8 en calidad de atención (x = 9.83) y recomendarían este procedimiento a sus familiares (x = 9.71). CONCLUSIONES: La termoablación endovascular por radiofrecuencia realizada en CMA tiene una alta tasa de éxito y unas tasas de ingreso y visita a urgencias muy bajas. La satisfacción de los pacientes es elevada.

Técnica de radiofrecuencia ablativa ecoguiada del nervio sural para el dolor crónico de tobillo. A propósito de un caso / Ultrasound-guided radiofrequency ablation of the sural nerve for chronic ankle pain: A case report

El dolor crónico en la cara lateral del tobillo relacionado con la neuralgia sural es una patología poco frecuente. El nervio sural inerva la sensibilidad del borde posterolateral de la pierna, así como del borde dorsolateral del pie. En ocasiones la neuralgia sural es resistente al tratamiento conservador, pudiendo afectar a la esfera psicoemocional y social del paciente. Describimos el caso de un paciente de 54años con dolor neuropático en territorio del sural y con el antecedente de varias cirugías de tobillo. Tras tratamiento conservador sin éxito, se realiza radiofrecuencia ablativa ecoguiada en nervio sural con posterior cese completo del dolor sin efectos secundarios. Nos proponemos dar importancia a la ecopalpación en consulta de un médico rehabilitador, así como describir la radiofrecuencia ablativa ecoguiada como una técnica segura y eficaz para la neuralgia sural que no responde a tratamiento conservador. Sin embargo, se necesitan más estudios de calidad para corroborar estos resultados.(AU)

Chronic lateral ankle pain related to sural neuralgia is a rare pathology. The sural nerve innervates the sensitivity of the posterolateral border of the leg, as well as the dorsolateral border of the foot. On occasions, sural neuralgia is resistant to conservative treatment and can affect the patient's psycho-emotional and social sphere. We describe the case of a 54-year-old patient with neuropathic pain in the sural territory and a history of several ankle surgeries. After unsuccessful conservative treatment, ultrasound-guided ablative radiofrequency is performed in the sural nerve with subsequent complete cessation of pain without side effects. We propose to give importance to ecopalpation in the consultation of a rehabilitation physician, as well as to describe ultrasound-guided ablative radiofrequency as a safe and effective technique for sural neuralgia that does not respond to conservative treatment. However, more quality studies are needed to corroborate these results.(AU)

Controversias en el tratamiento de los miomas / Controversy in the treatment of uterine fibroids

El mioma uterino representa el tumor más frecuente en la mujer de edad reproductiva, aunque solo un 25% de mujeres precisarán tratamiento debido a la presencia de síntomas. Disponemos de pocos estudios aleatorizados que hayan comparado las distintas opciones de tratamiento para el mioma uterino entre ellas; por ahora, la cirugía sigue siendo la opción que ha ofrecido mejores tasas de resolución sintomática, mejoría en calidad de vida y menor tasa de recurrencia. A pesar de la amplia difusión de la cirugía, sí que parece razonable pensar que, disminuyendo los tratamientos quirúrgicos, ya sea con terapias menos invasivas o con nuevos tratamientos médicos, se podría disminuir por un lado la morbilidad asociada a la cirugía y, por otro lado, los costes asociados. En este sentido, las técnicas ablativas para el tratamiento del mioma, la EAU, el HIFU y la radiofrecuencia, han demostrado resultados en cuanto a control sintomático y calidad de vida equiparables a la cirugía, con una baja tasa de complicaciones graves. El mayor problema sería las tasas de recurrencia y el impacto que pueden tener sobre la fertilidad futura de las pacientes. Será necesario disponer de mayor evidencia y estudios comparativos a largo plazo respecto a nuevas técnicas ablativas alternativas a los abordajes quirúrgicos.(AU)

Uterine fibroids are the most common tumours in women of reproductive age, but only 25% of women will require treatment due to the presence of symptoms. There are few randomised studies that have compared the different treatment options for uterine myoma; for the moment, surgery remains the option that offers the best rates of symptomatic resolution, improved quality of life, and a lower recurrence rate. Despite the widespread use of myoma surgery, it seems reasonable to believe that by reducing surgical treatments, either with less invasive therapies or with new medical treatments, both associated morbidity and costs would be reduced. In this sense, ablative techniques for myoma treatment, UAE, HIFU, and radiofrequency, have demonstrated results in terms of symptomatic control and quality of life comparable to surgery, with a low rate of major complications. Recurrence rates and the impact on patients’ future fertility would be the main concern. Future long-term comparative studies of ablative techniques and surgical approaches are needed.(AU)

Implicación ocular en el tratamiento con radiofrecuencia pulsada del ganglio esfenopalatino / Ocular involvement in sphenopalatine ganglion pulsed radiofrequency

El tratamiento con radiofrecuencia pulsada del ganglio esfenopalatino es una opción importante a tener en cuenta respecto al tratamiento intervencionista en casos refractarios de neuralgia del trigémino o dolores faciales atípicos, dado el fácil acceso a su localización. A pesar de que las complicaciones de esta técnica son raras y es un procedimiento bastante seguro, a nivel oftalmológico cabe reseñar su importancia por las relaciones anatómicas de este ganglio (AU)

Pulsed radiofrequency treatment of the sphenopalatine ganglion is an important interventional treatment in refractory cases of trigeminal neuralgia or atypical facial pain, given the easy access to its location. Despite the fact that complications from this technique are rare and it is a fairly safe procedure, ophthalmologists should know about it due to the anatomical relations of this ganglion (AU)

[Translated article] Tumor ablation and vertebral augmentation in the treatment of vertebral metastases: A multicenter study.

INTRODUCTION: Treatment of metastatic vertebral fractures without neural compression is performed with percutaneous cementation techniques. The increase in intratumoral pressure by these techniques can send tumor cells into the bloodstream. To prevent this dissemination and improve pain treatment, ablation techniques have been introduced that would allow the creation of a cavity in the tumor prior to cementation or directly necrosing the metastasis when its size is small. MATERIAL: We present the experience with ablation of two hospitals and two different ablation techniques. The first group used radiofrequency ablation (A) in 14 patients (26 vertebrae), 4 of whom underwent vertebral arthrodesis. The second group used microwave ablation (B) in 93 patients (129 lesions) without associated vertebral instrumentation. RESULTS: In group A pain improvement in VAS was 7.7-2.6 at 6 weeks. There were no complications derived from the ablation. In most cases cementation was associated. In the group B pain improvement in VAS went from 6.8 to 1.7 at 6 weeks. Cementation was associated in all cases. There were no complications derived from the ablation. CONCLUSION: The association of ablation techniques with vertebral cementation is a safe technique that significantly improves the patient's pain and can help control the disease.

Therapeutic effects of melatonin in long-term exposure to 2100MHz radiofrequency radiation on rat sperm characteristics.

INTRODUCTION: Radiofrequency electromagnetic fields (RF-EMFs) are one of the risk factors for male reproductive health and melatonin can be an ideal candidate for therapeutic development against RF-induced male fertility problems due to its antioxidant properties. The possible therapeutic role of melatonin in the destructive effects of 2100MHz RF radiation on rat sperm characteristics is investigated in the present study. METHODS: Wistar albino rats were divided into four groups and the experiment continued for ninety consecutive days; Control, Melatonin (10mg/kg, subcutaneously), RF (2100MHz, thirty minutes per day, whole-body), and RF+Melatonin groups. Left caudal epididymis and ductus deferens tissues were placed in sperm wash solution (at 37°C) and dissected. The sperms were counted and stained. Measurements of the perinuclear ring of the manchette and posterior portion of the nucleus (ARC) were performed and the sperms were examined at an ultrastructural level. All of the parameters were evaluated statistically. RESULTS: The percentages of abnormal sperm morphology were significantly increased with RF exposure, while the total sperm count was significantly decreased. RF exposure also showed harmful effects on acrosome, axoneme, mitochondrial sheath, and outer dense fibers at the ultrastructural level. The number of total sperms, sperms with normal morphology increased, and ultrastructural appearance returned to normal by melatonin administration. DISCUSSION: The data showed that melatonin may be a beneficial therapeutic agent for long-term exposure of 2100MHz RF radiation-related reproductive impairments.

[Ultrasound-guided radiofrequency ablation of the sural nerve for chronic ankle pain: A case report]. / Técnica de radiofrecuencia ablativa ecoguiada del nervio sural para el dolor crónico de tobillo. A propósito de un caso.

Chronic lateral ankle pain related to sural neuralgia is a rare pathology. The sural nerve innervates the sensitivity of the posterolateral border of the leg, as well as the dorsolateral border of the foot. On occasions, sural neuralgia is resistant to conservative treatment and can affect the patient's psycho-emotional and social sphere. We describe the case of a 54-year-old patient with neuropathic pain in the sural territory and a history of several ankle surgeries. After unsuccessful conservative treatment, ultrasound-guided ablative radiofrequency is performed in the sural nerve with subsequent complete cessation of pain without side effects. We propose to give importance to ecopalpation in the consultation of a rehabilitation physician, as well as to describe ultrasound-guided ablative radiofrequency as a safe and effective technique for sural neuralgia that does not respond to conservative treatment. However, more quality studies are needed to corroborate these results.

Ocular involvement in sphenopalatin ganglion pulsed radiofrequency.

Pulsed radiofrequency (PRF) treatment of the sphenopalatine ganglion is an important interventional treatment in refractory cases of trigeminal neuralgia (TN) or atypical facial pain, given the easy access to its location. Despite the fact that complications from this technique are rare and it is a fairly safe procedure, ophthalmologists should know about it due to the anatomical relations of this ganglion.