Dolor pélvico en mujeres con episiotomía versus mujeres con desgarro perineal de segundo grado / Pelvic pain in women with episiotomy versus women with second-degree perineal tear

Introducción: El dolor pélvico es una de las disfunciones del suelo pélvico más comunes en el posparto, influyendo el grado de lesión y el momento en el que se valora. El grado de afección de una episiotomía medio-lateral es similar al desgarro perineal de segundo grado, por ello se decidió realizar un estudio que recogiera el grado de dolor referido mediante el Cuestionario de dolor de McGill. Material y métodos: Se realizó un estudio epidemiológico observacional, longitudinal prospectivo, de cohortes dinámicas, entre 384 mujeres, de las cuales 255 tuvieron un desgarro de segundo grado y a 129 se les practicó una episiotomía. Se realizó una valoración del suelo pélvico, junto con una recogida de datos (realización o no de masaje perineal, ejercicios musculares de suelo pélvico, presencia de Kristeller, tipo de sutura) así como el grado y tipo de dolor mediante el cuestionario de McGill, durante el puerperio inmediato, a las 6 semanas y a los 6 meses del posparto. Resultados: En el puerperio inmediato más del 50% de las mujeres refirieron algún tipo de sensación dolorosa, sin encontrar diferencias significativas entre ambas cohortes. Mientras que, a lo largo de la evolución del estudio, se produjo una disminución progresiva del dolor en ambas cohortes. Ya a las 6 semanas de posparto, menos del 33% de las mujeres refirieron alguna sensación dolorosa, considerándose como ausencia de dolor según los criterios del cuestionario de McGill. Conclusión:La presencia de episiotomía o desgarro perineal de segundo grado no ha tenido relación con el dolor perineal.(AU)

Introduction: Pelvic pain is one of the most common pelvic floor dysfunctions in the postpartum period, depending on the degree of injury and the time at which it is assessed. The degree of involvement of a mediolateral episiotomy is similar to that of a second degree perineal tear, therefore it was decided to conduct a study to collect the degree of pain reported using the McGill Pain Questionnaire. Material and methods: An observational, prospective longitudinal epidemiological study of dynamic cohorts was conducted among 384 women, of whom 255 had a second-degree tear and 129 had undergone an episiotomy. An assessment of the pelvic floor was carried out, together with data collection (performance or not of perineal massage, pelvic floor muscle exercises, presence of Kristeller, type of suture) as well as the degree and type of pain using the McGill Questionnaire, in the immediate puerperium, at six weeks, and six months of postpartum. Results: In the immediate puerperium more than 50% of women reported some type of painful sensation, without finding significant differences between both cohorts. However, as the study evolved, there was a progressive decrease in pain in both cohorts. By six weeks postpartum, less than 33% of women reported a painful sensation, considered as absence of pain according to the criteria of the McGill questionnaire. Conclusion: The presence of episiotomy or second degree perineal tear was not related to perineal pain.(AU)

Correlation Between PAPP-A Levels Determined During the First Trimester and Birth Weight at Full-Term.

Foetal birth weight is an important determinant of perinatal health. For this reason, various methods have been investigated for estimating this weight during pregnancy. The aim of this study is to evaluate the possible relationship between full-term birth weight and pregnancy-associated plasma protein-A (PAPP-A) levels determined during the first trimester as part of combined screening for aneuploidy carried out in pregnant women. We carried out a single-centre study including pregnant women who were being followed up by the Obstetrics Service Care Units of the XXI de Santiago de Compostela e Barbanza Foundation, who gave birth from March 1, 2015, to March 1, 2017, and who had undergone their first-trimester combined chromosomopathy screening. The sample included a total of 2794 women. We found a significant correlation between MoM PAPP-A and foetal birth weight. When MoM PAPP-A was measured at extremely low levels (< 0.3) during the first trimester, the OR for giving birth to a foetus with weight < p10, adjusting for gestational age and sex, was 2.74. For low levels of MoM PAPP-A (0.3-0.44), the OR was 1.52. With regard to the value of MOM PAPP-A levels as a predictor of foetal macrosomia, a correlation could be observed with elevated levels, although this was not statistically significant. PAPP-A determined during the first trimester acts as a predictor of foetal weight at term as well as for foetal growth disorders.

Síndrome de web axilar secundario a la biopsia selectiva del ganglio centinela en cáncer de mama / Axillary web syndrome following sentinel node biopsy for breast cancer

Paciente de 49 años diagnosticada de carcinoma lobulillar infiltrante de mama derecha, intervenida mediante mastectomía y biopsia selectiva de ganglio centinela (BSGC). Los ganglios linfáticos centinela resecados fueron negativos para malignidad, motivo por el cual no fue necesaria la realización de linfadenectomía axilar. En el periodo posquirúrgico temprano la paciente presentó una sensación de tensión cutánea en el hueco axilar asociada a un cordón palpable doloroso, manifestación típica del síndrome de web axilar (SWA), una complicación poco conocida de las intervenciones quirúrgicas axilares, tanto invasivas como conservadoras. Mediante la presentación de este caso queremos centrar la atención en una entidad patológica cuya incidencia podemos estar infravalorando al no incluirla en estudios prospectivos de BSGC. Es importante que los médicos nucleares seamos conscientes de la existencia del SWA como una posible consecuencia de la BSGC, más frecuente que la infección, el seroma o el linfedema y de que debemos informar a los pacientes que firman el consentimiento (AU)

A 49 year-old woman diagnosed with infiltrating lobular breast carcinoma, underwent a right mastectomy and sentinel node biopsy (SLNB). The resected sentinel lymph nodes were negative for malignancy, with an axillary lymphadenectomy not being performed. In the early post-operative period, the patient reported an axillary skin tension sensation, associated with a painful palpable cord. These are typical manifestations of axillary web syndrome (AWS), a poorly known axillary surgery complication, from both invasive and conservative interventions. By presenting this case we want to focus the attention on a pathological condition, for which its incidence may be underestimated by not including it in SLNB studies. It is important for nuclear medicine physicians to be aware of AWS as a more common complication than infection, seroma, or lymphoedema, and to discuss this possible event with the patient who is consenting to the procedure (AU)

Axillary web syndrome following sentinel node biopsy for breast cancer. / Síndrome de web axilar secundario a la biopsia selectiva del ganglio centinela en cáncer de mama.

A 49 year-old woman diagnosed with infiltrating lobular breast carcinoma, underwent a right mastectomy and sentinel node biopsy (SLNB). The resected sentinel lymph nodes were negative for malignancy, with an axillary lymphadenectomy not being performed. In the early post-operative period, the patient reported an axillary skin tension sensation, associated with a painful palpable cord. These are typical manifestations of axillary web syndrome (AWS), a poorly known axillary surgery complication, from both invasive and conservative interventions. By presenting this case we want to focus the attention on a pathological condition, for which its incidence may be underestimated by not including it in SLNB studies. It is important for nuclear medicine physicians to be aware of AWS as a more common complication than infection, seroma, or lymphoedema, and to discuss this possible event with the patient who is consenting to the procedure.

Quantitative factors proposed to influence the prevalence of canine tick-borne disease agents in the United States.

The Companion Animal Parasite Council hosted a meeting to identify quantifiable factors that can influence the prevalence of tick-borne disease agents among dogs in North America. This report summarizes the approach used and the factors identified for further analysis with mathematical models of canine exposure to tick-borne pathogens.

Actitud ante las malformaciones congénitas pulmonares / Attitude facing congenital lung malformations

Introducción: Las malformaciones congénitas pulmonares (MCP) son infrecuentes y generalmente cursan de forma asintomática en el periodo neonatal. Actualmente, su detección se realiza mediante estudios antenatales, confirmándose en el momento del nacimiento mediante pruebas de imagen. Aunque puede mantenerse una actitud expectante en los pacientes asintomáticos, es recomendable realizar una cirugía programada a los 3-6 meses de vida, dadas las graves complicaciones que pueden presentar estos pacientes. Casos clínicos: Presentamos 4 casos de MCP detectados antenatalmente en nuestro centro en los últimos 6 años, valorando su diagnóstico, características y evolución posterior. Resultados: Los 4 casos fueron malformaciones unilaterales detectadas antenatalmente mediante la ecografía del segundo trimestre, y en 3 de ellos también por resonancia magnética. Uno de ellos es una lesión híbrida, malformación adenomatoidea pulmonar congénita asociada a un secuestro intralobar en el pulmón contralateral. En el momento del nacimiento sólo 1 paciente presentó dificultad respiratoria; los otros estaban asintomáticos. La radiografía simple y la tomografía computarizada (TC) realizadas posnatalmente confirmaron el diagnóstico en 3 pacientes, pero en 1 la radiografía fue normal y la TC posterior demuestra una lesión compatible con atresia bronquial. Se realizó una lobectomía del paciente con dificultad respiratoria neonatal y del paciente con MCP-secuestro, que había presentado una infección pulmonar a los 3 meses. Conclusiones: Nuestra serie aporta 4 casos de excepcional observación. Al tratarse de una patología potencialmente grave, es importante que la conozcan todos los pediatras, así como una implicación multidisciplinaria que permita unificar criterios para proporcionar el mejor manejo posible a nuestros pacientes (AU)

Introduction: Congenital lung malformations are rare and generally have an asymptomatic development in the neonatal period. The detection of this condition is done by antenatal studies and it is later confirmed at birth with imaging tests. Although an expectant attitude towards asymptomatic patients may be adopted, the recommendation is to perform a surgical resection programmed between 3-6 months of life, given the serious complications these patients can suffer. Clinical cases: This study presents 4 cases of congenital lung malformations –detected antenatally in our center in the last 6 years– focusing on their diagnosis, characteristics and further development. Results: All four cases were unilateral malformations detected antenatally by the second quarter ultrasound, of which three were also detected by nuclear magnetic resonance. One of them was a hybrid lesion (congenital malformation of the lung-pulmonary sequestration) associated with an intralobar sequestration in the contralateral lung. Only one of the cases presented respiratory distress at birth, the others being asymptomatic. The chest-X-ray and axial tomography (CT) done postnatally confirmed the diagnosis in three of the patients; the fourth patient was diagnosed after a CT showed bronchial atresia, despite having a normal chest-X-ray. Lobectomy was performed on the patient with neonatal distress and the patient with the hybrid lesion, who had had a pulmonary infection at 3 months of life. Conclusions: This study provides 4 cases of exceptional observation. Congenital lung malformation is a potentially serious pathology, so it is important for all pediatricians to know about it. Thus, a multidisciplinary involvement is needed so as to unify criteria in order to provide patients with the best specialised care (AU)

Eficacia del bloqueo del ganglio impar en dolor pélvico y perineal de etiología ginecológica rebelde a tratamiento médico-quirúrgico / Efficiency of ganglion impar blockade in perineal and pelvic pain of gynecological etiology refractory to medical-surgical treatment

El dolor visceral vehiculizado por las fibras del sistema nervioso simpático en el área perineal y pélvica, tanto de etiología benigna como maligna, puede tratarse de forma eficaz con la neurolisis del ganglio de Walter, impar o sacroccocígeo. Otras posibles indicaciones de esta técnica son la proctalgia fugaz y la enteritis. Este bloqueo raramente puede eliminar el dolor de características somáticas y neuropáticas. Tras su realización habitualmente obtenemos una importante disminución de la dosis necesaria de los agentes analgésicos opioides y no opioides, lo que conlleva un alivio de los efectos secundarios desfavorables y una maximización de su efecto analgésico. La realización de esta técnica percutánea se puede considerar de baja complejidad y con escasos efectos secundarios.Se exponen cinco casos de dolor pélvico, perineal y coccígeo de diferente etiología con mala respuesta al tratamiento farmacológico convencional y la respuesta y evolución de éstos tras realización de bloqueo del ganglio impar con radiofrecuencia, anestésicos locales y neurolisis con fenol (AU)

Visceral pain transmitted by fibers of the sympathetic nervous system in the perineal and pelvic area, whether of benign or malignant etiology, can be effectively treated with neurolysis of the ganglion of Walther, also known as the ganglion impar or sacrococcygeus ganglion. Other possible indications for this technique are shooting anal pain and enteritis. This blockade can rarely eliminate somatic pain or neuropathic features. After this technique has been performed, the required dose of opioid and non-opioid analgesic agents is usually substantially reduced, leading to relief of adverse effects and maximizing analgesic action. The performance of this percutaneous technique can be considered to be of low complexity and with minimal side effects.We describe five cases of pelvic, perineal and coccygeal pain of different etiologies and poor response to conventional drug treatment, as well as the response and clinical course of these patients after completion of ganglion impar blockade with radiofrequency, local anesthetics and phenol neurolysis (AU)

[Oral ketamine-midazolam premedication of uncooperative patients in major outpatient surgery]. / Premedicación con ketamina-midazolam oral en pacientes no colaboradores en cirugía mayor ambulatoria.

BACKGROUND: Currently, ketamine is not often used as an anesthetic. Its clinical characteristics and mechanism of action largely depend on antagonism of the N-methyl-D-aspartate receptor. OBJECTIVE: To evaluate the utility of oral ketamine as a preanesthetic agent to lower surgical stress for patients with mental disability. MATERIAL AND METHODS: Observational, retrospective study of 112 mentally disabled patients undergoing major dental surgery on an outpatient basis. The study group received oral midazolam, ibuprofen, and 6 mg/kg of ketamine; the control group received only midazolam and ibuprofen. We recorded data concerning demographics, anesthesia, surgery, physiologic variables, Glasgow score, time of onset of anxiolysis, duration of stay in the recovery ward, and adverse events. RESULTS: Conservative odontologic treatment was provided in 66.3% of the cases. Seventy-one patients (64.4%) were in the control group and 41 patients (36.6%) in the study group. Hemodynamic, respiratory, and neurologic changes were minimal and there were no significant between-group differences. Level of sedation differed significantly between groups (P = .001) at 15 and 30 minutes; differences were also observed within the study group. Mean (SD) duration of surgery was 72.6 (29.7) minutes. Mean duration of stay in the postoperative recovery ward was 140.9 (52.1) minutes (135.8 [54.89] minutes in the study group and 144.2 [50.5] minutes in the control group). The incidence of adverse events did not differ significantly between groups. CONCLUSIONS: Oral ketamine is an effective premedication for major ambulatory surgery and does not increase the incidence of side effects.

Premedicación con ketamina-midazolam oral en pacientes no colaboradores en cirugía mayor ambulatoria / Oral ketamine-midazolam premedication of uncooperative patients in major outpatient surgery

INTRODUCCIÓN: La ketamina es un fármaco con una baja utilización actualmente como anestésico. Sus características clínicas y mecanismo de acción dependen en gran parte de su efecto antagonista en el receptor del Nmetil- D-aspartato. OBJETIVO: Valorar la idoneidad de la ketamina vía oral como agente preanestésico para la atenuación del estrés quirúrgico en pacientes discapacitados psíquicos. MATERIAL Y MÉTODOS: Estudio retrospectivo y observacional de 112 pacientes discapacitados psíquicos intervenidos de cirugía odontológica en régimen de cirugía mayor ambulatoria. Se incluyeron dos grupos, la premedicación con midazolam e ibuprofeno vía oral (grupo control), y la adicción a los anteriores de ketamina oral a dosis de 6 mg/kg (grupo de estudio). Se recogieron datos demográficos, anestésicos, quirúrgicos, variables fisiológicas, escala de Glasgow, tiempo de inicio de ansiolisis, así como el tiempo de estancia en la sala de recuperación e incidentes. RESULTADOS: En el 66,3% de los pacientes se realizó tratamiento odontológico conservador. Setenta y un pacientes (64,4%) correspondieron al grupo control y 41 pacientes (36,6%) al grupo de estudio. Los cambios hemodinámicos, respiratorios y neurológicos fueron mínimos, sin diferencias estadísticamente significativas entre los grupos. Entre ambos grupos e intragrupo en el grado de sedación a los 15 y 30 minutos en el grupo de estudio (p=0,0001) hubo diferencias estadísticamente significativas. El tiempo medio de la cirugía fue de 72,6±29,7 minutos. La permanencia de los pacientes en las salas de Reanimación postquirúrgica y de readaptación al medio fue de 140,9±52,1 minutos (135,8±54,89 minutos en el grupo de estudio y de 144,2±50,5 minutos en el grupo control). No existieron diferencias estadísticamente significativas en la aparición de efectos adversos. CONCLUSIONES: La ketamina vía oral es eficaz en la premedicación en cirugía mayor ambulatoria sin conllevar un aumento de efectos adversos(AU)

BACKGROUND: Currently, ketamine is not often used as an anesthetic. Its clinical characteristics and mechanism of action largely depend on antagonism of the N-methyl-D-aspartate receptor. Objective: To evaluate the utility of oral ketamine as a preanesthetic agent to lower surgical stress for patients with mental disability. MATERIAL AND METHODS: Observational, retrospective study of 112 mentally disabled patients undergoing major dental surgery on an outpatient basis. The study group received oral midazolam, ibuprofen, and 6 mg/kg of ketamine; the control group received only midazolam and ibuprofen. We recorded data concerning demographics, anesthesia, surgery, physiologic variables, Glasgow score, time of onset of anxiolysis, duration of stay in the recovery ward, and adverse events. RESULTS: Conservative odontologic treatment was provided in 66.3% of the cases. Seventy-one patients (64.4%) were in the control group and 41 patients (36.6%) in the study group. Hemodynamic, respiratory, and neurologic changes were minimal and there were no significant between-group differences. Level of sedation differed significantly between groups (P=.001) at 15 and 30 minutes; differences were also observed within the study group. Mean (SD) duration of surgery was 72.6 (29.7) minutes. Mean duration of stay in the postoperative recovery ward was 140.9 (52.1) minutes (135.8 [54.89] minutes in the study group and 144.2 [50.5] minutes in the control group). The incidence of adverse events did not differ significantly between groups. CONCLUSIONS: Oral ketamine is an effective premedication for major ambulatory surgery and does not increase the incidence of side effects(AU)

[Detecting adverse drug events during the hospital stay]. / Detección de acontecimientos adversos producidos por medicamentos durante la estancia hospitalaria.

INTRODUCTION: The principal objective was to determine the incidence rate of adverse drug events (ADEs) in hospitalised patients and evaluate the event prevention percentage. METHODS: Multi-centre, prospective observational study lasting four months, performed in five hospitals providing different levels of care. We included all adult patients who were admitted to one of the selected centres for longer than 48 hours and who required pharmacological treatment. ADEs were identified by direct observation and the use of previously defined alarm signals. The Karch-Lasagna scale was used to determine the causality relationship, and the Schumock and Thornton questionnaire adapted by Otero was used to evaluate ADE preventability. Preventable drug-induced adverse events were classified according to the taxonomy that the Ruiz-Jarabo 2000 group defined, and coordinated by ISMP-Spain. RESULTS: We included 1,550 patients, 159 of whom experienced at least one ADE (10.3 %). The preventability percentage was 51.6 %, which represented 5.3 % of the total sample. The endocrine system (34.8 %) and the cardiovascular system (20.7 %) were the most affected by preventable ADEs. Antibiotics were responsible for 16.5 % of all ADEs. 9.3 % of all preventable ADEs were triggered by use of opiates. The vast majority of preventable ADEs (36.3 %) resulted from omitting a necessary medication. Only 4.4 % of preventable ADEs are considered to be serious. CONCLUSIONS: There is a high incidence rate of ADEs during patients' hospital stay (10.3 %), and half of them (51.6 %) could have been prevented. Implementation of an automatic alarm system and certain best practices for problem spots along the care circuit will help detect and avoid preventable ADEs.

Development and characterization of polymorphic markers for the sap-stain fungus Ophiostoma quercus.

Eight polymorphic markers were developed from South African isolates of Ophiostoma quercus. The genome was screened for repeat regions using the fast isolation by amplified fragment length polymorphism of sequences containing repeats protocol and 20 de novo primer pairs flanking putative microsatellite regions were designed. Eight loci were optimized and their polymorphisms evaluated by sequencing. The repeat and flanking regions were highly polymorphic containing both indels and base-pair substitutions revealing a total of 46 alleles in 14 isolates and an average heterozygosity of 0.68. Substantial sequence variability makes these markers useful for genotyping populations in order to calculate diversity and monitor global movement of O. quercus.

Topiramato y síndrome constitucional en pacientes oncológicos / Topiramate and constitutional syndrome in the oncological patients

IntroductionNeuropatic pain in cancer patients is a difficult problemwhich represents a difficult challenge, with good answer tothe antiepileptic drugs. Diverse studies exist that confirm thegood results associated to the use of topiramate in cancer patientswith neuropatic pain. The data demonstrate that antiepilepticdrugs can differ from substantially in their effects onweight. Approximately a fifth of patients treated with topiramateexperience anorexia and/or weight loss.Clinical casesThree oncologic patients in the reduction weight associatedto the topiramate use was lived like a physical and psychicnegative effect.ConclusionsTopiramate is an effective drug in the treatment of thepain neuropatic. The reduction in weight that is from its usecan be beneficial in patients with important overweight. Thiseffect could be a contraindication relative to its use in patientswith anorexic clinic, severe desnutrition and cancer patients.In these last ones, the appearance of this constitutionalsyndrome can entail an important increase of episodes of anxietyin the family and the own patient, as well as an excessof medical tests to discard a tumorlike progression(AU)

IntroducciónLos pacientes oncológicos pueden presentar dolor de tiponeuropático, el cual representa un reto difícil, con buenarespuesta a la medicación antiepiléptica. Existen diversos estudiosque confirman los buenos resultados asociados al usode topiramato en pacientes con cáncer y sintomatología neuropáticaacompañante. Las diferentes drogas antiepilépticasdifieren de forma sustancial en sus efectos sobre el peso corporal.El topiramato conlleva cuadros de anorexia y/o pérdidadel peso hasta en un 15% de los casos.Casos clínicosTres pacientes oncológicos en los que la pérdida de pesoasociada al empleo de topiramato fue vivida como un efectonegativo físico y psíquico, por temor a una posible recidivatumoral.ConclusionesTopiramato es un fármaco eficaz en el tratamiento del dolorde tipo neuropático. La pérdida de peso que resulta de suutilización puede ser beneficiosa en pacientes con sobrepesoimportante. Este efecto podría ser una contraindicación relativaa su uso en pacientes con clínica de anorexia, desnutriciónsevera y en pacientes oncológicos. En estos últimos, laaparición de este síndrome constitucional puede conllevar un importante aumento de episodios de ansiedad en la familia yel propio enfermo, así como un exceso de pruebas médicaspara descartar una progresión tumoral(AU)

Microsatellite markers for the Eucalyptus stem canker fungal pathogen Kirramyces gauchensis.

Ten microsatellite markers were developed for the fungus Kirramyces gauchensis, which causes an important stem canker disease of Eucalyptus trees in plantations. Primers for 21 microsatellite regions were designed from cloned fragments. Fourteen of the primer pairs provided single amplicons and 10 of these were polymorphic for K. gauchensis. Allelic diversity ranged from 0.21 to 0.76 with a total of 30 alleles. None of the markers was able to amplify in the phylogenetically distinct but morphologically similar species Kirramyces zuluensis. The 10 characterized polymorphic microsatellite regions will be studied to determine the population structure of K. gauchensis in plantations of different countries.

Microsatellite markers for the red band needle blight pathogen, Dothistroma septosporum.

Twelve microsatellite markers were developed for population analyses of the fungal pathogen, Dothistroma septosporum. Intersimple sequence repeat polymerase chain reaction (ISSR-PCR) and an enrichment protocol (fast isolation by amplified fragment length polymorphism of sequences containing repeats [FIASCO]) were both used to identify 28 unique microsatellite regions in the genome. From 22 primer pairs designed, 12 were polymorphic. These markers, screened on two populations representing 42 isolates, produced 40 alleles across all loci with an allelic diversity of 0.09-0.76 per locus. Cross-species amplification showed variable success with Dothistroma rhabdoclinis and Mycosphaerella dearnessi and some sequence variation within isolates of Dothistroma pini. These markers will be used to further study the population structure and diversity of D. septosporum.

Avulsión del plexo braquial traumático no controlado con remifentalino. Papel de la analgesia epidural cervical / Avulsión del plexo braquial traumático no controlado con remifentalino. Papel de la analgesia epidural cervical

Presentamos el caso de una paciente que sufrió accidente de tráfico con avulsión del plexo braquial izquierdo, y que presentaba dolor muy intenso (escala visual analógica 8) de características neuropáticas en la fase aguda postraumática. Dosis altas de remifentanilo fueron inefectivas para control del cuadro álgico, el cual se trato con exito con una infusión de ropivacaína a través de catéter epidural cervical (C5-6). El dolor es controlado en fase crónica (escala visual analógica 2) con agentes específicos contra dolor neuropático (gabapentina, amitriptilina, clonacepam y tramadol)

We presented you a patient who suffered a left brachial plexus avulsion with hard neuropatic pain in the posttraumatic acute phase (visual analogue scale 8). High-dose remifentanil infusion was uneffective in controlling pain, which was further ameliorated by ropivacaine infused through a cervical (C5-6) epidural catheter. At discharge pain remained controlled (visual analogue scale 2) with specific treatment against neuropathic pain (gabapentin, amytriptiline, clonacepam, and tramadol)

Manejo del nódulo en cicatriz de Pfannenstiel en régimen de CMA: diagnóstico diferencial y actitud terapéutica / No disponible

Introducción: Un nódulo descubierto en torno a una cicatriz de tipo Pfannenstiel es un reto diagnóstico por su múltiple y variada etiología. Se debe considerar la posibilidad de que se trate de una endometriosis cicatricial. Pacientes y método: Se estudiaron de forma retrospectiva 17 pacientes que consultaron por nódulo doloroso pericicatricial. Se analizaron las variables: edad, antecedentes médicos, sintomatología, estudios de imagen, diagnóstico preoperatorio y postoperatorio, tratamiento realizado y estudios posteriores. El procedimiento quirúrgico se realizó en régimen ambulatorio. Resultados: La edad media de las pacientes fue de 33,7 años (rango 25-44), con una mediana de 33. En 14 casos la cirugía previa fue cesárea y en 3 fueron histerectomías. El motivo de consulta en todos los casos fue la existencia de un nódulo o masa sobre la antigua cicatriz, con un dolor cíclico en 6 de ellos. El diagnóstico preoperatorio fue de hernia (5 casos); granuloma a cuerpo extraño (7 casos); y endometrioma (5 casos). El diagnóstico anatomopatológico de endometrioma se dio en 9 casos. El tratamiento fue la exéresis de los endometriomas y granulomas, y la hernioplastia con prótesis en los casos de hernia laparotómica. No hubo morbilidad asociada. El seguimiento de los casos de endometriosis incluyó los controles ginecológicos, descubriéndose afectación ovárica con posterioridad en 7 de los 9 casos estudiados. Discusión: Una buena anamnesis junto con las pruebas de imagen pertinentes facilita el diagnóstico diferencial del nódulo pericicatricial. Es posible realizar con éxito el procedimiento quirúrgico en régimen ambulatorio. En los casos de endometriosis es indispensable el seguimiento ginecológico posterior (AU)

Introduction: A nodule discovered around a scar of Pfannenstiel type raises diagnostics doubts to the facultative. We must consider the possibility in question of a cicatricial endometriosis. Patients and method: 17 patients were studied in a retrospective form who consulted by pericicatricial painful nodule. The age of the patients, medical antecedents, sintomatology, studies of image, preoperating diagnosis, postoperating diagnosis, later treatment and studies were analyzed. The surgical procedure was made in ambulatory regime. Results: The average age of the patients was 33,7 years (rank 25-44), median of 33. In 14 cases the previous surgery was caesarean and 3 were hysterectomies. The reason for consultation in all the cases was nodule or mass on the old scar, related to cyclical pain in 6 them. The preoperating diagnosis was hernia (5 cases); granuloma to strange body (7 cases); and endometrioma (5 cases). The pathologic diagnosis of endometrioma occurred in 9 cases. The treatment was the exeresis of endometriomas and granulomas, and hernioplastia with prothesis in the cases laparotomic of hernia. There was no morbidity. The pursuit of the cases of endometriosis included the gynaecological controls, being discovered ovarian affectation later in 7 of the 9 studied cases. Discussion: A good anamnesis along with the pertinent tests of image facilitates the differential diagnosis of the pericicatricial nodule. The later gynaecological pursuit is possible successfully to make intervention surgical in ambulatory regime. In the cases of endometriosis is indispensable (AU)

Secreción por ambas axilas sin presencia de pezón supernumerario / Lactation from bilateral axillary breast tissue in the absence of a supernumerary nipple

Paciente que presenta secreción por ambas axilas en su octavo día de puerperio. En la exploración no presenta pezón supernumerario y la secreción se produce por los poros de la piel. El estudio ecográfico demuestra tejido mamario ectópico.Las malformaciones congénitas de la mama aparecen hasta en un 10% de la población. La existencia de tejido mamario en algún punto de las líneas mamarias se clasifica, según Kajava, en 8 clases, que se diferencian por la presencia o no de aréola, pezón y tejido glandular. Nuestro caso es una clase IV de Kajava.Ante una malformación mamaria, la actitud conservadora parece ser la más correcta, aunque por razones estéticas es común la realización de cirugía. Será necesario tener en cuenta la mama supernumeraria para el cribado del cáncer de mama

We report the case of a patient who developed bilateral axillary secretion on the eighth day of lactation. On examination, there were no supernumerary nipples and secretion was through the skin pores. Ultrasound study revealed ectopic breast tissue.Congenital breast malformations occur in up to 10% of the general population. The presence of supernumerary breast tissue in any point of the milk lines has been classified by Kajava into eight types, distinguished by the presence or absence of areola, nipple, and glandular tissue. Our patient had a class IV malformation in Kajava’s classification. A conservative attitude to breast malformations may be the optimal approach, although surgery is frequently performed for cosmetic reasons. It is important to be alert to the possibility of breast carcinoma in ectopic tissue

Resultados de un programa de cirugía mayor ambulatoria en oftalmología / Results an outpatient major surgery program in ophthalmology

Objetivo: Evaluar los resultados de un programa de cirugía mayor ambulatoria en pacientes intervenidos quirúrgicamente de diversas patologías oculares en nuestro hospital. Métodos: Este estudio retrospectivo incluye 13.878 pacientes intervenidos de forma programada por el Servicio de Oftalmología desde septiembre de 1998 a diciembre de 2004. En 11.187 pacientes se realizaron diferentes procedimientos quirúrgicos de forma ambulatoria, siendo la cirugía de catarata (facoemulsificación) la operación mayoritaria (8.155 casos). Se han analizado diversos índices (sustitución, suspensión, ingresos, reingresos), así como el rendimiento quirúrgico y las complicaciones sistémicas y oculares que surgieron dentro de las primeras 72 horas tras la cirugía. La medición de las variables se realizó mediante frecuencias relativas. El análisis utilizado para la evolución de las complicaciones en el período de estudio fue la Chi cuadrado de tendencias. Resultados: 13.878 pacientes fueron intervenidos en el período indicado, de los que 11.187 se operaron de forma ambulatoria (índice de sustitución global del 80,6%). El rendimiento quirúrgico medio fue 74,36%. El índice de ingresos tras la cirugía fue 4,46% (499 pacientes), siendo ingresos inmediatos en el 92,18% de los casos (460). 21 pacientes sufrieron complicaciones graves (cardiovasculares, neurológicas, metabólicas, infecciosas), representando un riesgo proporcional de 1:532. En 45 pacientes aparecieron complicaciones de menor gravedad (hipertensión arterial, nauseas, vómitos, síncope vasovagal) que requirieron su ingreso hospitalario. Las complicaciones oftalmológicas ocurrieron en 79 casos (0,56%). Conclusiones: La cirugía mayor ambulatoria (CMA) es un excelente modelo organizativo de asistencia quirúrgica multidisciplinar que permite tratar pacientes bien seleccionados de una manera efectiva, segura y eficiente. A pesar del cumplimiento de los requisitos óptimos, existe un porcentaje pequeño de complicaciones postoperatorias de gravedad variable, aunque afortunadamente la mortalidad es prácticamente nula

Purpose: To evaluate the outcomes in our hospital of an ambulatory major surgery program in patients with a variety of different ocular pathologies. Method: This retrospective study includes 13,878 patients who underwent programmed surgery by the Department of Ophthalmology between September 1998 and December 2004. Different ophthalmological surgical procedures were performed as outpatient surgery in 11,187 patients, with cataract surgery (phacoemulsification) being the most frequent operation performed (8,155 cases). We have analysed several indicators (substitution, suspension, admission and readmission rates), as well as surgical yield and systemic and ocular complications which appeared within 72 hours after surgery. The variables were measured as relative frequencies. The evolution of complications during the study period was analysed by the Chi-square trend test. Results: 13,878 patients had ophthalmic surgery during the study period; 11,187 had outpatient surgery with a global substitution ratio of 80.6%. The median surgical yield was 74.36%. The admission rate after surgery was 4.46% (499 patients), with 92.18% (460) of these requiring immediate admission. Twenty-one patients suffered from severe complications (cardiovascular, neurological, metabolic, infectious), representing a proportional risk of 1:532. Forty-five patients had less severe complications (arterial hypertension, nausea, vomiting, vasovagal syncope) that required admission to hospital. Ophthalmologic complications occurred in 79 cases (0.56%). Conclusions: Ambulatory major surgery (AMS) is an excellent organization model of multidisciplinary surgical assistance that makes it possible to treat well selected patients in an effective, safe and efficient manner. There is a low incidence of postoperative complications of variable severity despite following the optimum requisites, although fortunately mortality is practically absent

County-level surveillance of white-tailed deer infestation by Ixodes scapularis and Dermacentor albipictus (Acari: Ixodidae) along the Illinois River.

From 1998 to 2003, 4,935 hunter-killed deer in northern and central Illinois were examined for ticks; 4,066 blacklegged ticks, Ixodes scapularis Say, and 6,530 winter ticks, Dermacentor albipictus (Packard) (Acari: Ixodidae), were collected. I. scapularis was the predominant tick species in the northern portion of the study area, with a decreasing north-to-south prevalence gradient. In contrast, D. albipictus was more common in the south with a decreasing south-to-north prevalence gradient. Compared with previous studies, the geographic range for both species expanded into the central portion of the Illinois River. Prevalence and intensity of both tick species were greater on bucks, and infested bucks were geographically more widespread than infested does and fawns. These findings indicate that blacklegged tick and winter tick distributions remain dynamic in the north central United States