Incidencia del síndrome neurológico transitorio con lidocaína intradural en cirugía mayor ambulatoria / Incidence of Transient Neurologic Syndrome with intradural lidocainein ambulatory surgical procedures

El síndrome neurológico transitorio (SNT) es una entidad que se caracteriza por dolor autolimitado en nalgas y muslos sin déficit neurológico, que aparece tras un bloqueo neuroaxial. La incidencia de SNT en la bibliografía es muy heterogénea. Se han comunicado casos con la mayoría de los anestésicos locales, sin embargo, la lidocaína es el que más se ha asociado a este síndrome. En este trabajo se realiza una revisión bibliográfica hasta noviembre de 2018 y se presentan los datos de nuestro centro durante 4 años, desde 2014 hasta 2017, en lo referente al SNT (0,83 % [IC95 % 0,57-1,09 %]), cefalea pospunción dural (1,90 % [IC95 % 1,1-2,7 %]) y náuseas y vómitos posalta hospitalaria (2,39 % [IC95 % 1,53-3,25 %]). Tras el análisis de nuestros datos en el contexto de la bibliografía disponible, se concluye que la incidencia observada en nuestro estudio es muy baja y clínicamente poco relevante

Manifestations of transient neurologic syndrome include self-limited pain in the buttocks and legs without neurologic deficit that appeared after spinal anesthesia. There is controversy regarding the incidence of TNS between studies. The risk of developing TNS after spinal anaesthesia with lidocaine is significantly higher compared to other local anaeshtetics.The objective of this study is to review the references until November 2018, and to show the prevalence of TNS (0.83 % [IC95 % 0.57-1.09 %]), postoperative nausea and vomiting (POVN) (2.39% [IC95 % 1.,53-3,25]) and postdural puncture headache (PDPH) (1.90% [IC95% 1,1-2,7%]) in a ambulatory surgery center from 2014 to 2017.After analyzing our data in the context of the available literature, we conclude that the incidence observed in our study is very low and clinically not very relevant

La ciencia de la revisión en la investigación médica / The sciencie of review in medical research

En los últimos años el metaanálisis ha suscitado mucho interés en la investigación médica; sin embargo, numerosas áreas metodológicas, en concreto las referentes a los sesgos, y al objetivo del metaanálisis continúan siendo controvertidas. El presente trabajo revisa los diferentes métodos usados en la revisión. Finalmente, resumimos los pasos para realizar una revisión narrativa o sistemática

Much attention has been given in recent years to meta-analysis in medical research; however, numerous methodologic issues particularly with respect to biases and the use of meta-analysis are still controversial. The current study summarizes the different methods used in narrative and systematic reviews. Finally, we explain the main steps for conducting a meta-analysis

[Rett's syndrome in the Spanish population]. / Estudio del síndrome de Rett en la población española.

INTRODUCTION AND OBJECTIVE: Rett syndrome was described in 1966 and became known through the English medical literature in 1983. There are typical and atypical forms. The objective of this study was to record the cases diagnosed in Spain and discover their clinical characteristics in order to describe its phenotype and geographical distribution. PATIENTS AND METHODS: We know of 207 cases and have obtained the records of 168 of these patients. A protocol and data collection programme has been developed giving the criteria for inclusion, and data which support or exclude this. Data collection was by post and the data for identification were the date of birth and the initials of the name and two surnames. With these variables, double-registering of patients was almost impossible. A statistical study with descriptive analysis and a study of continuous and alternating variables was immediately done. RESULTS AND CONCLUSION: The results gave the main characteristics, the differences between typical and atypical cases and a comparative study of variables. It has given clinical data which may be useful for prognosis of the condition in the future.

[Alternative to bromocriptine (BEC) management in patients with prolactinoma and intolerance to oral BEC]. / Alternativa de manejo con bromocriptina (BEC) en pacientes con prolactinoma e intolerancia a BEC oral.

Currently, the treatment of choice in cases of prolactinoma, is oral administration of bromocriptine mesilate, (BEC*), which, in a majority of cases, obtains satisfactory results. However, there do exist patients who show a clear intolerance to the oral administration of the medication in spite of low doses and other strategies. This leaves trans-sphenoidal surgery as the sole alternative since access to other dopamine-agonists medications is usually limited and the injection preparation of BEC is still in the experimental stages. This study follows the case histories of eleven patients who showed a clear intolerance to the oral administration of BEC and who would not accept or were otherwise disqualified from having hypophyseal surgery. Instead, their cases were handled through another alternative, the vaginal administration of BEC. The patients involved had an average age of 32 ranging from 26 to 44 years of age. All showed an important reduction in prolactinemia levels after the seventh day of vaginal administration of BEC. From an initial average high of 121.3 +/- 21.2 ng/ml levels were reduced after one week to 21.2 +/- 4.7 ng/ml, after ten days to 14.7 and after one month to 15.7 ng/ml. Patients were kept under observation for a twelve month period, during which time a significant reduction was noted in six patients, four became pregnant and one, finally rejected vaginal treatment. In every case, the bothersome side effects of the medication, which led to use of the alternative method of administration, specially the gastro-intestinal problems, subsided. This may be an interesting alternative for those patients with prolactinoma and evident intolerance to oral BEC.