Neuropatía de fibras pequeñas: una revisión / Small fibre neuropathy: a review

La neuropatía de fibras pequeñas es una afectación del sistema nervioso periférico cuya principal manifestación es un cuadro de dolor neuropático crónico, acompañado generalmente de alteraciones del sistema nervioso autónomo. Esta enfermedad afecta a fibras nerviosas mielinizadas (Adelta) y no mielinizadas (C), de pequeño calibre. Sus causas pueden ser primarias o secundarias a trastornos del metabolismo, infecciones, enfermedades autoinmunes, neurológicas o tóxicos. Los estudios neurofisiológicos habituales suelen ser negativos. El diagnóstico puede realizarse con exploraciones complementarias de difícil acceso desde la atención primaria, como la microneurografía, test con estímulos sensitivos y otras, aunque la prueba más utilizada es la biopsia cutánea. El tratamiento debe dirigirse a las causas y/o a los síntomas neurológicos. Dada la variabilidad de síntomas con los que puede iniciarse, creemos que es importante conocer esta entidad para aumentar la sospecha clínica, orientar el diagnóstico y poder ofrecer la posibilidad de tratamiento

Small fibre neuropathy is a disorder of the peripheral nervous system for which main clinical manifestation is chronic neuropathic pain, often accompanied by alterations of the autonomic nervous system. This disease affects the small diameter myelinated (ADelta) and non-myelinated nerve fibres (C). Its causes are primary or secondary, such as metabolism defects, infection, and autoimmune, neurological or toxic diseases, among others. Routine neurophysiological tests are usually negative. Diagnosis can be made with complementary tests which are difficult to access from Primary Health Care. These include microneurography, and the sensory stimulation test; but the most used technique is the skin biopsy. Treatment is directed at the causes and the neurological symptoms. Due to the variability of symptoms that can be presented, the importance of being aware of this condition is emphasised in order to reach a diagnosis and offer the appropriate treatment

[Small fibre neuropathy: A review]. / Neuropatía de fibras pequeñas: una revisión.

Small fibre neuropathy is a disorder of the peripheral nervous system for which main clinical manifestation is chronic neuropathic pain, often accompanied by alterations of the autonomic nervous system. This disease affects the small diameter myelinated (Aδ) and non-myelinated nerve fibres (C). Its causes are primary or secondary, such as metabolism defects, infection, and autoimmune, neurological or toxic diseases, among others. Routine neurophysiological tests are usually negative. Diagnosis can be made with complementary tests which are difficult to access from Primary Health Care. These include microneurography, and the sensory stimulation test; but the most used technique is the skin biopsy. Treatment is directed at the causes and the neurological symptoms. Due to the variability of symptoms that can be presented, the importance of being aware of this condition is emphasised in order to reach a diagnosis and offer the appropriate treatment.

La seguridad del paciente en urgencias y emergencias: balance de cuatro años del Programa SEMES-Seguridad Paciente / Patient safety in emergency medicine: report on 4 years’ implementation of a program designed for the Spanish Society of Emergency Medicine (SEMES)

Los servicios de urgencias y emergencias (SUE) son áreas asistenciales donde existe un alto riesgo de incidentes y eventos adversos, que afectan, por tanto, a la seguridad del paciente (SP). El Programa SEMES-Seguridad Paciente inició una estrategia hace cuatro años (2008) en los SUE enfocada a la difusión de la cultura de seguridad, la formación en SP de los profesionales, el análisis de los incidentes con o sin daño en los SUE y el desarrollo de herramientas proactivas para la detección de riesgos durante la atención urgente. Como fruto de ello se ha generado una red de instructores de SP para SUE, compuesta actualmente por 176 profesionales; se ha desarrollado el estudio EVADUR y CULTURA, que han permitido conocer tanto la incidencia de sucesos adversos en dichos servicios, sus causas y evitabilidad, como el grado de seguridad y cultura de las organizaciones; y finalmente se ha elaborado un mapa de riesgos de la atención urgente. Todo ello ha permitido, no sólo conocer la situación en SP de los SUE, sino recomendar y desarrollar estrategias específicas enfocadas a la reducción de riesgos para el paciente derivados de la asistencia en los SUE (AU)

Emergency departments (ED) and Emergency Medical Systems (EMS) are areas where there is high risk of adverse events and incidents that affect patient safety. In 2008 the Spanish Society of Emergency Medicine (SEMES) initiated a program to promote a patient safety culture in ED and EMS. The program included training in patient safety, the analysis of incidents with and without patient harm, and the development of proactive tools to detect risk during emergency interventions. Outcomes of this program include the establishment of a network of 176 instructors in emergency patient safety and the EVADUR and CULTURA studies to determine the types of incidents and adverse events in our ED and EMS, their causes and preventability, and the level of safety and safety culture within organizations. The results make it possible to draw an emergency service risk map. After 4 years the program has provided information on patient safety in Spanish ED and EMS and allows us to develop guidelines for devising risk reduction strategies for this setting (AU)

[Peroperative myocardial infarction and myocardial ischemia in non cardiac surgery: prevalence and predictive factors]. / Infarto e isquemia miocárdica peroperatoria en cirugía no cardíaca: prevalencia y factores predictivos.

BACKGROUND: The decrease in the prevalence of infarction in the population has not been accompanied by a reduction in postinfarct mortality, particularly in the population segment which does not present major symptoms of coronary disease. The aim of the present study was to determine the incidence and predictive factors of cardiac complications in patients undergoing non cardiac surgery. METHODS: Eight hundred seventy-five patients undergoing elective surgery from May 1990-1991 had some of the following criteria: history of heart disease, major surgery, and medical risk other than cardiac. A sample of 328 patients was selected to whom an ECG an CK-MB isoenzyme test were performed on admission, every 8 h, and at the second and third days. Infarction or ischemia were diagnosed by electrocardiographic and enzymatic criteria. Minimum follow up was 72 hours. RESULTS: IAM was diagnosed in 10 cases (3%, confidence interval 95%, 2 to 4%) and ischemia in 47 cases (14%, CI 95%, 11 to 18%). Operative mortality of cardiac origin was 4% (CI 95%, 2 to 6%). Arrhythmia not preoperatively present was detected in 11%, hemodynamic instability in 25%, and sinusal tachycardia in 21%. Other complications were: abdominal 12%, respiratory 14%, neurologic 6% and renal 4%. The appearance of cardiac complications was related with: ASA classification (p < 0.05), previous history of heart disease (p < 0.01), cardiovascular drug administration (p < 0.01) and changes in preoperative electrocardiogram (p < 0.001). CONCLUSIONS: The present study suggests that patients with changes of the ST-T segment in the preoperative ECG should undergo examination to determine the degree of cardiac involvement. A strict peroperative hemodynamic control may reduce the prevalence of cardiac complications in those patients at high risk.

[Comparative study between continuous and bolus subarachnoid administration of 2% lidocaine]. / Estudio comparativo entre la administración subaracnoidea continua o en bolos de lidocaína al 2%.

OBJECTIVE: To compare anesthesia with lidocaine 2% by bolus or by continuous perfusion through a subarachnoid catheter. PATIENTS AND METHODS: Thirty-one patients undergoing surgery on a lower limb were studied prospectively. Patients were divided into two groups: 14 received subarachnoid anesthesia in continuous perfusion (group CP) while 17 were given subarachnoid anesthesia in bolus form (group B). An 18G Tuohy needle was used with a 20 G catheter. An initial bolus of 20 mg (1 ml) was administered in group CP and followed by continuous perfusion at a rate of 16 mg/h (0.8 ml/h). In group B an initial 20 mg bolus was followed by additional ones of 10 mg (0.5 ml). The optimum sensory level was T 10. RESULTS: The two groups were homogeneous with respect to age, weight, height and medical history. Fewer boluses were needed with continuous perfusion. Seven patients (50%) in group CP required additional boluses. The ratio of total drug dose administered in mg to time of surgery was significantly higher in group CP. The sensory and motor blockade levels obtained were similar in the two groups. One case of hypotension and one of bradycardia were recorded. Two cases of minor headache were recorded in group B. Sedation was used in 7 patients (50%) in group CP and in 13 (76%) in group B. CONCLUSION: Subarachnoid administration of lidocaine 2% in continuous perfusion affords the same sensory and motor blockade as administration in bolus form and does not reduce the overall amount of lidocaine used.

[Functional classification of chronic alcoholic hepatopathy in primary care]. / Clasificación funcional de la hepatopatía crónica alcohólica en atención primaria.

OBJECTIVE: To evaluate the use of Pugh's Classification in assessing patients with diffuse alcoholic Chronic Hepatopathy in the out-patient context. DESIGN: Descriptive-retrospective study. SITE. The Base Health Area of "La Mina" in Barcelona. PATIENTS OR OTHER PARTICIPANTS: 143 patients over the age of 14 diagnosed as suffering diffuse chronic Hepatopathy were identified. 37 of these were excluded because of lack of data. MAIN MEASUREMENTS AND RESULTS: The following data were gathered: those relating to semeiology, anamnesis, quantifying alcoholic intake, where the original diagnosis was made, how rapidly the condition evolved, laboratory and complementary explorations' parameters. Out of the 106 patients studied 71 (67%) were classified in group A; 22 (21%) in B and 13 (12%) in C. No significant differences were found in relation to age or sex. Significant differences concerning the speed of the condition's evolution and the average intake in grammes of alcohol per day were observable. The number of hospital admissions increased as the patient's functional stage became worse and complications increased. CONCLUSIONS: Pugh's test was shown to be useful in the out-patient context for classifying patients suffering chronic diffuse Hepatopathy in line with the severity of their condition.