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

Breast cancer brain metastases: a review of the literature and a current multidisciplinary management guideline

Breast cancer represents the second most frequent etiology of brain metastasis (BM). It is estimated that 10-30 % of patients with breast cancer are diagnosed with BM. Breast cancer BM are increasing due to the aging population, detection of subclinical disease, and better control of systemic disease. BM is a major cause of morbidity and mortality affecting neurocognition, speech, coordination, behavior, and quality of life. The therapy of BM remains controversial regarding use and timing of surgical resection, application of whole-brain radiotherapy, stereotactic radiosurgery and systemic drugs in patients with particular tumor subtypes. Despite numerous trials, the range of interpretation of these has resulted in differing treatment perspectives. This paper is a review of the state of the art and a multidisciplinary guideline on strategies to improve the therapeutic index in this situation (AU)

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Breast cancer brain metastases: a review of the literature and a current multidisciplinary management guideline.

Breast cancer represents the second most frequent etiology of brain metastasis (BM). It is estimated that 10-30 % of patients with breast cancer are diagnosed with BM. Breast cancer BM are increasing due to the aging population, detection of subclinical disease, and better control of systemic disease. BM is a major cause of morbidity and mortality affecting neurocognition, speech, coordination, behavior, and quality of life. The therapy of BM remains controversial regarding use and timing of surgical resection, application of whole-brain radiotherapy, stereotactic radiosurgery and systemic drugs in patients with particular tumor subtypes. Despite numerous trials, the range of interpretation of these has resulted in differing treatment perspectives. This paper is a review of the state of the art and a multidisciplinary guideline on strategies to improve the therapeutic index in this situation.

Individualization of treatment strategies.

This section focuses on different aspects of the individualization of hormone treatment in breast cancer. This includes tumor-related biological factors such as expression of hormone receptors, HER-2, and Ki-67; host-related factors such as CYP2D6 or body mass index, and risk and/or development of specific toxicities and treatment adherence. The best predictor of response to hormonal interventions is the expression of hormone receptors, in particular, estrogen receptors. Treatment adherence and compliance are key factors and strategies aiming to identify and intervene when patients are at risk of abandoning treatment. Currently, routine assessment of CYP2D6 is not recommended to guide tamoxifen treatment. Likewise, there are no criteria regarding bone mass density, lipid profile, or arthralgias to recommend one class of agent versus another. Aromatase inhibitors should not be administered to patients who are pre- or perimenopausal.