Association between CACNG2 polymorphisms (rs4820242, rs2284015 and rs2284017) and chronic peripheral neuropathic pain risk in a Mexican population.

OBJECTIVE: In animal models and humans, mutations in voltage-dependent calcium channel gamma-2 subunit gene (CACNG2) have been associated with neuronal hyperexcitability, including neuropathic pain. The objective of this study was to determine the allelic and genotypic frequencies of CACNG2 polymorphisms (rs4820242, rs2284015 and rs2284017) and their association with the risk of chronic peripheral neuropathic pain (CPNP) in the Mexican population. PATIENTS AND METHODS: Single nucleotide polymorphisms (SNPs) were determined by real-time PCR, and allelic and genotypic frequencies were compared between healthy Mexican subjects and CPNP patients. The risk of association of CACNG2 SNPs with the presence of CPNP and its characteristics was evaluated. RESULTS: The allele G (OR 2.08, p = 0.01) of rs2284015 was observed as a risk factor for developing CPNP. The allele A of rs4820442 showed a risk of association with a history of surgery (OR 3.92, p = 0.04), radiculopathy (OR 4.29, p = 0.0001), bilateral presentation of pain (OR 3.15, p = 0.003), and neuropraxia (OR 0.36, p = 0.01). The allele C of rs2284015 was associated with an increased risk of burning and allodynia. In the analysis of the association of genotype frequencies and inheritance patterns, as well as in the analysis of interaction with sex, a modification of risk was observed. CONCLUSIONS: The allele G of rs2284015 and the AGC haplotype of CACNG2 rs4820242, rs2284015 and rs2284017, regardless of sex and etiology could contribute to the risk of CPNP. Certain alleles and genotypes could constitute severity markers in CPNP with sex-biased effects; however, further studies are required to confirm these observations.

[Prevalence of injury of the medial collateral ligament of the knee assessed by magnetic resonance]. / Prevalencia de lesión del ligamento colateral medial de la rodilla valorada por resonancia magnética.

INTRODUCTION: The medial collateral ligament (MCL) is one of the main stabilizers of the knee, but its injury occurs in conjunction with other ligaments. OBJECTIVE: To determine the prevalence of MCL lesions by magnetic resonance imaging, their degrees and associated lesions in our institution. MATERIAL AND METHODS: Retrospective study from January to April 2018 where KNEE MRIs were evaluated where the MCL lesion was presented to evaluate the degree and type of associated injuries. RESULTS: We included 368 studies, prevalence of isolated MCL lesion of 3.07%, grade I and grade II, prevalence of concomitant MCL lesions was 17.66% grade I (75%), grade II (15%) and grade III (3%). Associated injuries were medial meniscus injury (46.15%), anterior cruciate ligament injury (30.7%), isolated bone contusion (18.46%), chodral injuries (37.58%), medial vastus injury (14.51%), patellar medial retinacular injury (14.51%), vastus lateral injury (9.23%), posterior cruciate ligament injury (6.15%), lateral meniscus injury (4.61%), iliotibial band tenosynovitis (4.61%), medial facet avulsion fracture (3.07%), Pes Anserine tenosynovitis (3.07%). CONCLUSION: Prevalence of 17.66% of the MCL injuries in our hospital by magnetic resonance, the first 2 degrees predominate, with a wide spectrum of associated knee injuries.

INTRODUCCIÓN: El ligamento colateral medial (LCM) es uno de los principales estabilizadores de la rodilla, pero su lesión se presenta en conjunto con otras lesiones ligamentarias. OBJETIVO: Determinar la prevalencia de lesiones del LCM por resonancia magnética, sus grados y lesiones asociadas en nuestra institución. MATERIAL Y MÉTODOS: Estudio retrospectivo de Enero a Abril de 2018, se evaluaron resonancias magnéticas de rodilla donde se presentó lesión del LCM para evaluar grado y tipo de lesiones asociadas. RESULTADOS: Se incluyeron 368 estudios, prevalencia de lesión aislada del LCM de 3.07%, una grado I y una grado II, la prevalencia de lesiones de LCM concomitantes fue de 17.66%, grado I (75%), grado II (15%) y grado III (3%). Las lesiones asociadas fueron lesión del menisco medial (46.15%), lesión del ligamento cruzado anterior (30.7%), contusión ósea aislada (18.46%), lesiones condrales (37.58%), lesión de vasto medial (14.51%), lesión del retináculo medial patelar (14.51%), lesión del vasto lateral (9.23%), lesión del ligamento cruzado posterior (6.15%), lesión del menisco lateral (4.61%), tenosinovitis banda iliotibial (4.61%), fractura de avulsión de la faceta medial (3.07%), tenosinovitis de la Pes Anserinus (3.07%). CONCLUSIÓN: Prevalencia de 17.66% de lesiones del LCM en nuestro hospital por resonancia magnética, predominan los dos primeros grados con un espectro amplio de lesiones asociadas de la rodilla.

[Supraspinatus tendon ruptures: correlation between MRI and surgical findings]. / Rupturas del tendón del supraespinoso: correlación entre RMN y hallazgos quirúrgicos.

INTRODUCTION: In rotator cuff rupture, the supraspinatus tendon ranks first in frequency. MRI is the study of choice for preoperative diagnosis and planning. The objective of this study was to assess the concordance between findings observed with MRI and transoperative in patients with supraspinatus tendon rupture. MATERIAL AND METHODS: A retrospective analysis was conducted from January 2014 to January 2020. Including patients over the age of 18, with MRI and supraspinatus tendon rupture report. A 2 analysis was performed for sensitivity, specificity, predictive values and diagnostic certainty using surgical findings as a reference. The kappa index was used to show the concordance between MRI and transoperative findings. RESULTS: A total of 79 patients were included in the study, 45 male and 34 female. The average age was 52.14 years. MRI correctly diagnosed 60.76% of supraspinatus ruptures, showing 74% sensitivity and 96% specificity for complete ruptures. For partial ruptures I show a sensitivity of 96%, a specificity of 33%. The kappa index showed a match of 0.90 for total ruptures and 0.53 for partial. CONCLUSIONS: MRI demonstrated good sensitivity and specificity for diagnosing complete ruptures, with good match to surgical findings. MRI proved to be a non-specific study for the identification of partial ruptures, which causes these lesions to be overdiagnosed.

INTRODUCCIÓN: En la ruptura del manguito de los rotadores, el tendón del supraespinoso ocupa el primer lugar en frecuencia. La resonancia magnética es el estudio de elección para el diagnóstico y planificación preoperatoria. El objetivo de este estudio fue evaluar la concordancia entre los hallazgos observados con la IRM y los hallazgos transoperatorios en pacientes con ruptura del tendón del supraespinoso. MATERIAL Y MÉTODOS: Se realizó un análisis retrospectivo de Enero de 2014 a Enero de 2020. Se incluyeron pacientes mayores de 18 años, con IRM y reporte de ruptura del tendón del supraespinoso. Se realizó un análisis de 2 para la sensibilidad, especificidad, valores predictivos y certeza diagnóstica utilizando los hallazgos quirúrgicos como referencia. Se utilizó el índice de Kappa para mostrar la concordancia entre IRM y hallazgos transoperatorios. RESULTADOS: Un total de 79 pacientes se incluyeron en el estudio, 45 masculinos y 34 femeninos. La edad promedio fue de 52.14 años. La IRM diagnosticó correctamente 60.76% de las rupturas del supraespinoso, mostró una sensibilidad de 74% y especificidad de 96% para rupturas completas. Para rupturas parciales mostró una sensibilidad de 96% y una especificidad de 33%. El índice de Kappa mostró una concordancia de 0.90 para rupturas totales y de 0.53 para rupturas parciales. CONCLUSIONES: La resonancia magnética demostró una buena sensibilidad y especificidad para el diagnóstico de rupturas completas, con una buena concordancia con los hallazgos quirúrgicos. La IRM demostró ser un estudio poco específico para la identificación de rupturas parciales, lo cual genera que estas lesiones estén sobrediagnosticadas.

[Diagnostic concordance of Magnetic Resonance Imaging of Adhesive Capsulitis, between Imaging Centers and a Shoulder Clinic, with surgical correlation]. / Concordancia diagnóstica de capsulitis adhesiva por resonancia magnética entre centros de imagenología y una clínica de reconstrucción articular con correlación quirúrgica.

INTRODUCTION: Despite the MRI findings present an adequate sensitivity and specificity for the diagnosis of adhesive capsulitis, there is a poor correlation between the imaging results in imaging centers and the diagnosis of a shoulder surgeon and the surgical findings. OBJECTIVE: To evaluate the correlation of the diagnosis of adhesive capsulitis by MRI between imaging centers and the shoulder and elbow surgery service, with subsequent surgical verification. MATERIAL AND METHODS: Retrospective, observational and comparative study in 41 patients with adhesive capsulitis diagnosis, the concordance among the MRI reports of different radiology cabinets and the Joint reconstruction clinic was calculated, in 10 cases the diagnosis was corroborated by surgery. The index was determinated between both interpretations and the surgical findings. RESULTS: The concordance among the reports analyzed by the shoulder surgeon of the Joint reconstruction clinic and the cabinets was low, with a index of 0.12, in all the surgical cases the presence of adhesive capsulitis was proved with a index of 0.10 with respect to the cabinets reports. CONCLUSION: The imaging findings described in the literature are reliable for the diagnosis of adhesive capsulitis. The low concordance with the imaging cabinets leads us to think that it is an underdiagnosed entity.

INTRODUCCIÓN: Los hallazgos en resonancia magnética (IRM) presentan una adecuada sensibilidad y especificidad para el diagnóstico de capsulitis adhesiva; sin embargo, existe una baja correlación diagnóstica entre la interpretación realizada en los centros de imagenología y la de la clínica de reconstrucción articular y los hallazgos quirúrgicos. OBJETIVO: Conocer la correlación del diagnóstico de capsulitis adhesiva por IRM entre centros de imagenología y la clínica de reconstrucción articular con posterior comprobación quirúrgica. MATERIAL Y MÉTODOS: Estudio retrospectivo, observacional y comparativo en un grupo de 41 pacientes con diagnóstico de capsulitis adhesiva, comparando la concordancia de los reportes de IRM de distintos centros de imagenología y la clínica de reconstrucción articular, se corroboró quirúrgicamente en 10 casos. Se determinó el índice entre ambas interpretaciones y los hallazgos quirúrgicos. RESULTADOS: La concordancia de los reportes analizados por el cirujano de hombro de la clínica de reconstrucción articular y los reportes de los centros de imagenología fue baja con un índice de 0.12, en todos los casos quirúrgicos se corroboró la presencia de capsulitis adhesiva, el índice con los reportes de los centros de imagenología fue de 0.10. CONCLUSIÓN: Los hallazgos en la IRM descritos en la literatura son confiables para el diagnóstico capsulitis adhesiva. La baja concordancia con los centros de imagenología nos orienta a pensar que es una entidad subdiagnosticada por esas instituciones.

Postoperative analgesia with dexmedetomidine in interscalene block. Comparative study. / Analgesia postoperatoria con dexmedetomidina en bloqueo interescalénico. Estudio comparativo.

INTRODUCTION: Dexmedetomidine prolongs sensory block of ropivacaine. Our objective was to study whether this extension would produce better postoperative pain control compared to that produced by clonidine in patients undergoing arthroscopic shoulder. MATERIALS AND METHODS: Study comparative, longitudinal, controlled, randomized into 3 groups. Control group I: ropivacaine 0.75% clonidine group II: 0.75% ropivacaine plus clonidine 1mg/kg group iiidexmedetomidine: 0.75% ropivacaine more dexmedetomidine 1mg/kg. Interscalene block single dose ultrasound-guided. Sensory and motor blockade, pain intensity, sedation level, heart rate, respiratory rate, blood pressure at 6, 12 and 24hours was measured. RESULTS: Pain intensity at 6hours in groups I and II moderate to severe pain, mild pain group iii. At 12hours the groups IIand II showed moderate to severe pain by more than 60% of patients, and in group iiionly 10%. At 24hours I and II group 20% of patients they continued to moderate pain. CONCLUSION: The prolonged interscalene block produced by dexmedetomidine provided better postoperative pain control during the first 24hours.

[Total shoulder arthroplasty under monitoring of cerebral perfusion. Report of the first case in Mexico]. / Artroplastía total de hombro bajo monitoreo de la perfusión cerebral. Reporte del primer caso en México.

INTRODUCTION: The maintenance of cerebral perfusion during shoulder surgery performed in the beach chair position is controversial. The aim of this report is to present the first case in Mexico of a total shoulder arthroplasty performed with interscalene block and monitoring of the cerebral oxygen saturation. This monitoring was described in 1977, but only until the last decade has it reached relevance from the clinical point of view. CLINICAL CASE: We present an 84-year-old patient scheduled for total shoulder arthroplasty in beach chair position under regional anesthesia (ultrasound-guided interscalene block) in which the regional oxygen saturation (CrSO2) was monitored. DISCUSSION: Monitoring of cerebral oximetry is a suitable tool that allows us to have a continuous assessment throughout the transanesthetic, so we can make decisions more expeditiously. On this basis, we believe that this type of monitoring should be fundamental in patients placed in a beach chair position, as well as predominantly use regional anesthesia. In cases where it cannot be used, this monitor is absolutely essential.

INTRODUCCIÓN: Desde hace algún tiempo es tema de controversia el mantenimiento de la perfusión cerebral durante la cirugía de hombro realizada en posición de silla de playa. El objetivo de este reporte es presentar el primer caso en México de una artroplastía total de hombro realizada con bloqueo interescalénico y monitoreo de la saturación cerebral de oxígeno. Este monitoreo se describió en 1977, pero sólo hasta la última década ha alcanzado relevancia desde el punto de vista clínico. CASO CLÍNICO: Paciente de 84 años programado para artroplastía total de hombro en posición de silla de playa bajo anestesia regional tipo bloqueo interescalénico guiado por ultrasonido, en la cual se monitoreó la saturación regional de oxígeno (CrSO2). DISCUSIÓN: El monitoreo de la oximetría cerebral es una herramienta adecuada que nos permite tener una valoración continua durante todo el transanestésico, con lo que podemos tomar decisiones de forma más expedita. Con base en esto consideramos que este tipo de monitoreo debe ser básico en pacientes colocados en posición de silla de playa, así como el uso preponderante de anestesia regional; en los casos donde ésta no se pueda utilizar, este monitor es primordial.

[Spinal cord stimulation in teenager with complex regional pain syndrome for Lyme’s disease. Case report and review of the literature]. / Estimulación de cordones posteriores en adolescente con síndrome de dolor regional complejo por enfermedad de Lyme. Reporte de un caso.

Lyme disease is an emerging pathology in Mexico, producer of painful muscle skeletal either neurotic pain difficult to control. We present the case of a teenager girl who has complex regional pain type II of pelvic limb secondary to it, where it established a multidisciplinary management that finally was controlled with the placement of a spinal cord stimulator. We consider this as an unusual situation in an adolescent, as well as its evolution by 60 months where the literature only was reported in a few cases.

La enfermedad de Lyme es una enfermedad emergente presente en México, productora de cuadros de dolor musculoesquelético o bien neurótico de difícil control. Se presenta el caso de una adolescente con síndrome de dolor regional complejo secundario a la misma de miembro pélvico donde se instauró un manejo multidisciplinario que finalmente se controló con la colocación de un estimulador de cordones posteriores, situación inusual en un adolescente, así como su evolución por 60 meses, ya que en la literatura sólo se encuentra reportada en pocos casos.

[Postoperative analgesia in joint replacement surgery]. / Analgesia postoperatoria en cirugía de reemplazo articular.

Patients undergoing joint replacement surgery may experience intense and sustained postoperative pain due to inappropriate analgesia that delays recovery and hospital discharge. Traditionally, postoperative analgesia following arthroplasty is achieved with scheduled analgesia, either patient-controlled or with epidural spinal blocks. The former techniques have advantages and disadvantages. Recently, peripheral nerve block has emerged as an appropriate alternative for postoperative pain. Numerous trials report that the use of multimodal analgesia based on peripheral nerve blocks may control pain and offer functional results similar to those obtained with continuous epidural blocks or systemic opioids, but without their unwanted systemic effects. This review discusses the indications, benefits and adverse effects associated with standard and new analgesic techniques.

[Total shoulder arthroplasty with interscalene block. Feasibility study]. / Artroplastía total de hombro con bloqueo interescalénico. Estudio de factibilidad.

INTRODUCTION: General anesthesia is considered as the technique of choice for shoulder surgery, either alone or combined. We propose to show the feasibility of using guided interscalene block as the single anesthetic technique for total shoulder arthroplasty. MATERIAL AND METHODS: Neurostimulation-guided interscalene block plus sedation with dexmedetomidine were used. The following were measured intraoperatively: latency time, intraoperative analgesia, motor block according to Monzo's scale, success rate, adverse events and complications. The following were measured postoperatively: duration of postoperative analgesia and pain intensity with a visual analogue scale at 6, 12 and 24 hours. Patient satisfaction was also measured. RESULTS: Intraoperative analgesia was appropriate in 100% of patients. Motor block was grade 0 in 76.4% and grade 1 in 23.6%, which is appropriate for surgery. The success rate was 100%. Mean postoperative pain at 6 hours was 0.13 +/- 0.54 points in the visual analogue scale; 1.67 +/- 1.15 at 12 hours, and 3.15 +/- 1.66 points at 24 hours. 54.5% of patients were very satisfied and 45.5% were satisfied. Complications occurred in 8.18%. CONCLUSION: This type of surgery is feasible with interscalene block plus sedation; it is a safe and efficacious technique.