Neuroapraxia del nervio hipogloso tras hemiartroplastia de hombro / Hypoglossal nerve neuropraxia after shoulder hemiarthroplasty

Se describe un caso de afectación del nervio hipogloso después de un recambio de hemiartroplastia de hombro con anestesia general con intubación orotraqueal sin complicaciones. Previamente se había realizado un bloqueo interescalénico guiado por ultrasonidos con el paciente despierto. La cirugía se llevó a cabo en posición de semisedestación. Tras la intervención, el paciente refirió clínica compatible con parálisis del nervio hipogloso derecho, iniciada de forma paulatina, que desapareció 4 semanas después. Varios mecanismos se han descrito como causantes de esta alteración neurológica, entre ellos la hiperextensión de la cabeza en el momento de la intubación, la presión ejercida por el neumotaponamiento, o la posición excesivamente hiperextendida o lateralizada de la cabeza durante la cirugía. Se discuten las posibles causas, los factores predisponentes y se sugieren medidas de prevención (AU)

We report a case of hypoglossal nerve damage after shoulder hemiarthroplasty with the patient in «beach chair» position, performed with general anesthesia with orotracheal intubation, and without complications. An ultrasound-guided interscalene block was previously performed in an alert patient. After the intervention, the patient showed clinical symptomatology compatible with paralysis of the right hypoglossal nerve that completely disappeared after 4 weeks. Mechanisms such as hyperextension of the neck during intubation, endotracheal tube cuff pressure, excessive hyperextension, or head lateralization during surgery have been described as causes of this neurological damage. We discuss the causes, the associated factors and suggest preventive measures (AU)

[Hypoglossal nerve neuropraxia after shoulder hemiarthroplasty]. / Neuroapraxia del nervio hipogloso tras hemiartroplastia de hombro.

We report a case of hypoglossal nerve damage after shoulder hemiarthroplasty with the patient in "beach chair" position, performed with general anesthesia with orotracheal intubation, and without complications. An ultrasound-guided interscalene block was previously performed in an alert patient. After the intervention, the patient showed clinical symptomatology compatible with paralysis of the right hypoglossal nerve that completely disappeared after 4 weeks. Mechanisms such as hyperextension of the neck during intubation, endotracheal tube cuff pressure, excessive hyperextension, or head lateralization during surgery have been described as causes of this neurological damage. We discuss the causes, the associated factors and suggest preventive measures.

Gender-specific pathways to intimacy in early adolescence.

As part of a larger longitudinal study of psychosocial development, 148 girls and 130 boys were administered a series of questions regarding a close friend during their eighth-grade school year. Scales corresponding to shared experience, self-disclosure, and intimacy (defined as emotional closeness) were developed from these items. Path-analytic models tested the relative strength of the self-disclosure and shared experience paths to emotional closeness for boys and girls separately. The results indicated that the self-disclosure path to emotional closeness is significant for both boys and girls. No relationship was found between shared experience and emotional closeness in girls when controlling for self-disclosure. The relationship between shared experience and feelings of closeness was, however, significant for boys even while controlling for the effects of self-disclosure. Covariance structure analysis (LISREL) indicated that the covariance matrices for the three scales were significantly different for boys and girls. The results are considered in relation to the gender socialization and friendship literature. The potential importance of defining intimacy as emotional closeness is also discussed.