Estudio de la influencia del ejercicio con levantamiento de pesos en pacientes con disección axilar / Effects of weightlifting exercise in patients with axillary dissection

Introducción. Los pacientes intervenidos quirúrgicamente con disección axilar supervivientes de cáncer de mama, a partir de las recomendaciones actuales, restringen su actividad física por miedo e incertidumbre a padecer linfedema secundario, lo que puede limitar su recuperación física y psicosocial. En este estudio, observamos los efectos de un programa de entrenamiento controlado, que incluyó ejercicios con levantamiento de pesos. Material y métodos. Ensayo clínico prospectivo abierto y controlado. Se seleccionaron 22 pacientes diagnosticados de cáncer de mama, con disección axilar de, al menos, un nódulo linfático, con o sin diagnóstico de linfedema. El grupo intervención (grupo de actividad física con pesas, GAFP, n=11) mantuvo su estilo de vida habitual, incorporando un protocolo terapéutico de ejercicios bisemanal diseñado por fisioterapeutas, que incluyó levantamiento de pesos de forma controlada y progresiva, realizado siempre bajo su supervisión. El grupo control (GC, n=11) mantuvo su estilo de vida sin cambios durante las 6 semanas de duración del estudio (febrero-marzo de 2013). Se valoraron el volumen del brazo (midiendo la circunferencia de cada brazo), las sensaciones de dolor y pesadez del brazo mediante la Escala Visual Analógica (EVA), el índice de masa corporal (BMI) y la calidad de vida (FACT-B+4), Resultados. Ninguna de las participantes en el grupo de intervención experimentó un aumento de los síntomas. No hubo diferencias significativas entre ambos grupos, aunque se advirtió una tendencia (p = 0,341) hacia el descenso del volumen del brazo afecto en los pacientes del grupo GAFP. Conclusiones. De acuerdo con estudios previos, es segura la realización de un protocolo de ejercicios que incluya levantamiento de pesos, en un entorno controlado y progresivo (AU)

Introduction. In breast cancer survivors who have undergone axillary dissection, current recommendations advise restricting physical activity due to the risk of secondary lymphedema, which may limit these patients’ physical and psychosocial recovery. In this study, we examined the effects of a controlled training program that included weightlifting exercises. Material and methods. An open, prospective, controlled clinical trial was carried out that included a control and an intervention group. We selected 22 patients with a diagnosis of breast cancer and dissection of at least one axillary lymph node, with or without a diagnosis of lymphedema. An intervention group (group of physical activity weights, n=11) maintained their usual lifestyle, incorporating a therapeutic protocol designed by physiotherapists, consisting of twice-weekly exercises that included weightlifting in controlled and progressive sessions, always under supervision. A control group (n=11) maintained their lifestyle unchanged for the 6-week study (February-March 2013). We also assessed arm volume (measurement of the circumference of each arm, sensations of pain and heaviness [Visual Analog Scale], body mass index [BMI], and quality of life [FACT-B +4]). Results. None of the participants in the intervention group had symptom exacerbation or a diagnosis of lymphedema. There were no significant differences between the 2 groups, although a trend (P=.341) toward a decrease in the volume of the affected arm was noted in patients in the intervention group. Conclusions. Consistent with previous studies, this study confirms the safety of an exercise protocol that included weight lifting in a progressive and controlled environment (AU)

The use of negative-pressure wound therapy in pilonidal sinus disease: a randomized controlled trial comparing negative-pressure wound therapy versus standard open wound care after surgical excision.

BACKGROUND: Pilonidal sinus disease is associated with significant morbidity after surgical treatment with regard to wound healing. Recent case studies suggested that negative-pressure wound therapy as primary treatment following surgical excision may shorten the duration of wound healing. OBJECTIVE: The purpose of this randomized controlled trial was to evaluate the role of vacuum therapy in pilonidal sinus disease: negative-pressure wound therapy versus standard open wound care after surgical excision. METHODS: Patients were randomly assigned to either negative-pressure wound therapy for 2 weeks or standard open wound healing. The primary end point of the study was the time to complete wound healing. Secondary end points were visual analog scale score, wound size ratio at day 14 (ie, wound healing rate), time to resume daily activities, and recurrence within 6 months after wound closure. RESULTS: Forty-nine patients were included in the study: 24 patients were treated with vacuum therapy, and 25 patients underwent standard open wound care. Complete wound healing was achieved at a median of 84 days in the vacuum therapy group versus 93 days in control patients (p = 0.44). The wound size ratio was significantly lower in the vacuum therapy group (0.30 versus 0.57, p = 0.02), ie, higher wound healing rate in the first 2 weeks. There was no difference in visual analog scale scores and disease recurrence between both groups. The time to resume full daily activities after surgery was 27 days in the patients undergoing vacuum therapy and 29 days in the control patients (p = 0.92). LIMITATIONS: This study is limited by the small number of patients, the lack of blinding to patients and doctors, and the absence of patient quality-of-life evaluation. CONCLUSION: It is feasible to apply vacuum therapy in the treatment of pilonidal sinus disease, and it has a positive effect on wound size reduction in the first 2 weeks. However, there is no difference in time to complete wound healing and time to resume daily life activities.

Craniofacial resection and its role in the management of sinonasal malignancies.

Sinonasal malignancy is rare, and its presentation is commonly late. There is a wide variety of pathologies with varying natural histories and survival rates. Anatomy of the skull base is extremely complex and tumors are closely related to orbits, frontal lobes and cavernous sinus. Anatomical detail and the late presentation render surgical management a challenging task. A thorough understanding of anatomy and pathology combined with modern neuroimaging and reliable reconstruction within a multidisciplinary team is imperative to carry out skull base surgery effectively. While endoscopic approaches are gaining credibility, clearly, it will be some time before meaningful comparisons with craniofacial resection can be made. Until then, craniofacial resection will remain the gold standard for managing the sinonasal malignancies of the anterior skull base, as it has proved to be safe and effective.

Is inferior dissection of the rectus sheath necessary during Pfannenstiel incision for lower segment Caesarean section? A randomised controlled trial.

OBJECTIVE: The objective was to determine the benefit of non-dissection of the rectus sheath inferiorly in a Pfannenstiel incision during an elective Caesarean section with regard to operative blood loss and post-operative pain. DESIGN: A randomised controlled trial. SETTING: The Royal Free Teaching Hospital in London. POPULATION: One hundred and twenty women who underwent elective Caesarean section delivery. METHOD: Women were randomised to have dissection or non-dissection of the rectus sheath inferiorly during an elective Caesarean section. MAIN OUTCOME MEASURES: Estimated blood loss during the operation, as well as the difference between pre- and post-operative haemoglobin levels. Post-operative pain was assessed by the visual analogue scale, a verbal rating scale and the use of post-operative analgesia. Patient satisfaction was assessed by a verbal rating scale. RESULTS: There was no significant difference in the estimated blood loss during the procedure between the two groups; however, the mean difference between the pre-operative and post-operative haemoglobin was significantly smaller in the study group (p=0.05). There was a statistically significant difference in both the visual analogue scale (p-value=0.03) and the verbal rating scale scores (p-value=0.02) for pain between the two groups, with lower scores for the study group. There was no overall difference in the verbal rating scale scores for patient satisfaction. CONCLUSION: Non-dissection of the rectus sheath inferiorly in Pfannenstiel incisions during Caesarean section procedures is associated with a significant reduction in the post-operative pain as well as a smaller drop in post-operative haemoglobin.