Los sistemas de descompresión vertebral tienen origen en los estudios realizados por los científicos de la NASA, quienes observaron que los astronautas que tenían dolor de espalda en tierra al subir al espacio, con la ingravidez, les desaparecía el dolor. [Editorial] / The vertebral decompression systems have their origin in the studies carried out by the NASA scientists, who observed that astronauts who had back pain on earth when going up into space, with weightlessness, the pain disappeared. [Editorial]

Los sistemas de descompresión vertebral tienen origen en los estudios realizados por los científicos de la NASA, quienes observaron que los astronautas que tenían dolor de espalda en tierra al subir al espacio, con la ingravidez, les desaparecía el dolor. Con estos antecedentes, el científico canadiense Dr. Alan E. Dyer (médico que inventó y patentó el desfibrilador cardiaco) consiguió recrear este escenario espacial en tierra, patentando una fórmula logarítmica que conseguía tratar aisladamente cada vértebra aplicando una secuencia de tracción controlada, progresiva e indolora sobre la columna vertebral. Estos sistemas de descompresión vertebral están basados en el método clásico de tracción, adaptado a la tecnología moderna. No tracciona, sino que descomprime los discos y las pequeñas articulaciones facetarias de forma progresiva e indolora, utilizando un software que aplica una fuerza de intensidad variable para cada tipo de paciente. Los ordenadores constituyen el "cerebro" que se encarga de controlar y ejecutar el software de la unidad de descompresión; siendo el "corazón" un dispositivo electromecánico que con el propio procesador acciona el servomotor que pone en marcha el sistema.

Neostigmine and glycopyrronium: a potential safe alternative for patients with pseudo-obstruction without access to conventional methods of decompression.

Intestinal pseudo-obstruction mimics bowel obstruction. However, on examination, no mechanical cause is identified. This condition will often resolve when managed conservatively, yet in some cases decompression is required to avoid the serious complications of bowel ischaemia and perforation. This is performed endoscopically, and due to the invasive nature and limited access to this service, an alternative treatment option is deemed appealing. Neostigmine has good efficacy in the decompression of pseudo-obstruction but is hindered by its wide side effect profile. In this context, neostigmine requires careful monitoring, which limits its appeal. This side effect profile is minimised when neostigmine is administered in conjunction with glycopyrronium.This case demonstrates the novel use of neostigmine and glycopyrronium in decompression of the bowel in a patient with pseudo-obstruction. Furthermore, it highlights its value, particularly when conventional techniques for decompression are not accessible.

Colonic volvulus in the United States: trends, outcomes, and predictors of mortality.

INTRODUCTION: Colonic volvulus is a rare entity associated with high mortality rates. Most studies come from areas of high endemicity and are limited by small numbers. No studies have investigated trends, outcomes, and predictors of mortality at the national level. METHODS: The Nationwide Inpatient Sample 2002-2010 was retrospectively reviewed for colonic volvulus cases admitted emergently. Patients' demographics, hospital factors, and outcomes of the different procedures were analyzed. The LASSO algorithm for logistic regression was used to build a predictive model for mortality in cases of sigmoid (SV) and cecal volvulus (CV) taking into account preoperative and operative variables. RESULTS: An estimated 3,351,152 cases of bowel obstruction were admitted in the United States over the study period. Colonic volvulus was found to be the cause in 63,749 cases (1.90%). The incidence of CV increased by 5.53% per year whereas the incidence of SV remained stable. SV was more common in elderly males (aged 70 years), African Americans, and patients with diabetes and neuropsychiatric disorders. In contrast, CV was more common in younger females. Nonsurgical decompression alone was used in 17% of cases. Among cases managed surgically, resective procedures were performed in 89% of cases, whereas operative detorsion with or without fixation procedures remained uncommon. Mortality rates were 9.44% for SV, 6.64% for CV, 17% for synchronous CV and SV, and 18% for transverse colon volvulus. The LASSO algorithm identified bowel gangrene and peritonitis, coagulopathy, age, the use of stoma, and chronic kidney disease as strong predictors of mortality. CONCLUSIONS: Colonic volvulus is a rare cause of bowel obstruction in the United States and is associated with high mortality rates. CV and SV affect different populations and the incidence of CV is on the rise. The presence of bowel gangrene and coagulopathy strongly predicts mortality, suggesting that prompt diagnosis and management are essential.

Temporal trends, practice patterns, and treatment outcomes for infected upper urinary tract stones in the United States.

BACKGROUND: The incidence of infected urolithiasis is unknown, and evidence describing the optimal management strategy for obstruction is equivocal. OBJECTIVE: To examine the trends of infected urolithiasis in the United States, the practice patterns of competing treatment modalities, and to compare adverse outcomes. DESIGN, SETTING, AND PARTICIPANTS: A weighted estimate of 396385 adult patients hospitalized with infected urolithiasis was extracted from the Nationwide Inpatient Sample, 1999-2009. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Time trend analysis examined the incidence of infected urolithiasis and associated sepsis, as well as rates of retrograde ureteral catheterization and percutaneous nephrostomy (PCN) for urgent/emergent decompression. Propensity-score matching compared the rates of adverse outcomes between approaches. RESULTS AND LIMITATIONS: Between 1999 and 2009, the incidence of infected urolithiasis in women increased from 15.5 (95% confidence interval [CI], 15.3-15.6) to 27.6 (27.4-27.8)/100 000); men increased from 7.8 (7.7-7.9) to 12.1 (12.0-12.3)/100000. Rates of associated sepsis increased from 6.9% to 8.5% (p=0.013), and severe sepsis increased from 1.7% to 3.2% (p<0.001); mortality rates remained stable at 0.25-0.20% (p=0.150). Among those undergoing immediate decompression, 113 459 (28.6%), PCN utilization decreased from 16.1% to 11.2% (p=0.001), with significant regional variability. In matched analysis, PCN showed higher rates of sepsis (odds ratio [OR]: 1.63; 95% CI, 1.52-1.74), severe sepsis (OR: 2.28; 95% CI, 2.06-2.52), prolonged length of stay (OR: 3.18; 95% CI, 3.01-3.34), elevated hospital charges (OR: 2.71; 95%CI, 2.57-2.85), and mortality (OR: 3.14; 95%CI, 13-4.63). However, observational data preclude the assessment of timing between outcome and intervention, and disease severity. CONCLUSIONS: Between 1999 and 2009, women were twice as likely to have infected urolithiasis. Rates of associated sepsis and severe sepsis increased, but mortality rates remained stable. Analysis of competing treatment strategies for immediate decompression demonstrates decreasing utilization of PCN, which showed higher rates of adverse outcomes. These findings should be viewed as preliminary and hypothesis generating, demonstrating the pressing need for further study.

Síndrome del túnel carpiano en pacientes con nervio mediano bífido / Carpal tunnel syndrome in patients with a bifid median nerve

Introducción: La neuropatía por atrapamiento más frecuente es el síndrome del túnel del carpo. De diagnóstico habitualmente clínico y electromiográfico, los estudios realizados mediante ecografía, además de permitir el diagnóstico por la detección de cambios morfológicos típicos en el nervio mediano, logran identificar posibles anomalías anatómicas previamente a la cirugía de descompresión, lo que supone una inestimable ayuda al cirujano y augura mejores resultados. Casos clínicos: Presentamos cuatro casos clínicos de nervio mediano bífido diagnosticados prequirúrgicamente mediante estudio ecográfico, y valoramos este hallazgo con las peculiaridades clínicas de los pacientes, así como el buen resultado quirúrgico, con el conocimiento previo de su anatomía y la descompresión de ambas ramas. Conclusiones: La existencia de esta anomalía y otras posibles enfermedades intracanal orientan hacia la preferencia de los abordajes abiertos del túnel del carpo sobre la cirugía endoscópica, para conseguir la resolución de los cuadros clínicos (AU)

Introduction: The most frequent type of entrapment neuropathy is carpal tunnel syndrome. Diagnosis is often clinical and electromyographic. Ultrasound studies not only permit diagnosis through the detection of median nerve morphological changes but also make it possible to identify potential anatomic abnormalities prior to decompressive surgery, thus constituting an invaluable tool for the surgeon who can in this way obtain better results. Case reports: We present 4 cases of a bifid median nerve diagnosed preoperatively by means of ultrasound and we evaluated this finding taking into account the patients’ clinical specificities and the good surgical outcome, with previous knowledge of the anatomy and decompression of both branches. Conclusions: The existence of this abnormality and other possible intracanal pathologies make us prefer open approaches to the carpal tunnel over endoscopic surgery, if genuine resolution of the condition is to be achieved (AU)