To provide recommendations for the implementation of syndromic diagnosis, management of adult carriers of low back pain, and correct reference. Implementation of clinical practice guidelines for low back pain syndrome consists of an assessment of the patient by way of "verification", which evaluates certain signs of symptoms, with a total of 37 items for rating, including the sections of clinical symptomatology, AP X-ray, lateral X-ray, sagittal (optional) and axial magnetic resonance imaging (optional), and pain type. Oriented data quickly and easily, from first contact to a syndromic diagnosis in patients with low back pain.
Objective: To describe the indications and contraindications of negative pressure assisted wound therapy as well as a modification to the negative pressure technique that has been shown to shorten the number of changes of dressings and hospital stay with the early closure of the wound. Methods: A review of the existing literature in the databases OVID, PubMed, Cochrane and Medigraphic was carried out in relation to the pressure-assisted closure of wounds. This is a non-invasive and active healing system that uses localized and controlled negative pressure, which consists of a specialized dressing that includes reticulated foam that removes the exudates through a tube to an airtight container. This set forms microdeformations in the wound bed, which are known to cause an important increase in fibroblastic migration and consequently of higher quality tissue, granulation tissue formation and angiogenesis. Results: It was found that this method shortens the number of days of hospital stay. The technique describes the primary closure of the wound after intense cleansing and debridement of the non-viable tissue and signs of infection. Conclusions: Negative pressure wound therapy is effective for the treatment of deep infections in postsurgical spinal wound, with average time of use of 1 to 4 weeks in the most severe cases. Level of evidence IV; Case Series. RESUMOObjetivo: Descrever as indicações e contraindicações da terapia de cicatrização assistida pela pressão negativa, assim como uma modificação nessa técnica, que demonstrou diminuir o número de recargas de curativos e de internação hospitalar, por meio da manipulação do fechamento precoce de feridas. Métodos: Foi realizada uma revisão da literatura, em bases de dados da OVID, PubMed, Cochrane e Medigraphic, sobre a terapia de cicatrização assistida pela pressão negativa. Este é um sistema ativo de cura não invasivo utilizando pressão negativa controlada e localizada, que consiste em um curativo especializado, com a inclusão de uma espuma reticulada que conduz, através de um tubo de exsudado, a um recipiente hermético, formando micro deformações no leito da ferida. A técnica tem provado ser uma importante causa do aumento da migração fibroblástica e, consequentemente, de tecido de qualidade mais elevada, junto com a formação de tecido de granulação e angiogénese. Resultados: Em relação à técnica, descreve-se as etapas como forma de fechamento primário da ferida após limpeza intensa, desbridamento da área não viável e das características infecciosas. Além disso, o uso da técnica demonstrou diminuir o número de dias de internação hospitalar. Conclusão: Este método de pressão negativa é eficaz para o tratamento de infecções pós-cirúrgicas profundas da coluna vertebral, sendo usado, em média, de um a quatro semanas nos casos mais graves. Nível de evidência IV; Série de Casos. Descritores: Tratamento de Ferimentos com Pressão Negativa; Infecção; Coluna Vertebral. RESUMENObjetivo: Describir las indicaciones y contraindicaciones de la terapia de cicatrización de heridas ...
Introduction: Low back pain is defined as pain in the upper portion of T12 and below the crease of the buttocks and functional limitation. The prevalence of low back pain gradually increases 11.4% per year. In Mexico, the clinical practice guidelines are not followed in handling low back pain, so it is important to systematize medical care more efficient, since resources are scarce. The first level doctor must meet the benchmarks according to patient need, an incomplete anamnesis is performed, inadequate physical examination, misinterpretation of clinical studies, misdiagnosis, ineffective management, and reference to second or third level not justified. Objective: To provide recommendations for the implementation of syndromic diagnosis, management of adult carriers of low back pain, and correct reference. Implementation of clinical practice guidelines for low back pain syndrome consists of an assessment of the patient by way of "verification", which evaluates certain signs of symptoms, with a total of 37 items for rating, including the sections of clinical symptomatology, AP X-ray, lateral X-ray, sagittal (optional) and axial magnetic resonance imaging (optional), and pain type. Oriented data quickly and easily, from first contact to a syndromic diagnosis in patients with low back pain.
Introducción: El cirujano de columna cuenta con conocimientos y habilidades que le permiten tomar decisiones al momento de realizar un procedimiento quirúrgico, basado en la evidencia, en valores éticos y en las expectativas del paciente. Cualquier procedimiento quirúrgico será precedido por el diagnóstico basado en cuatro pilares fundamentales: traumático, degenerativo, síndrome de destrucción vertebral y deformidades. Una vez categorizada la lesión, el cirujano utilizará sus conocimientos para identificar la inestabilidad o el compromiso neurológico. Al realizar un procedimiento quirúrgico, en el transoperatorio deberán tenerse en mente los cuatro objetivos fundamentales con los que contará para lograr un manejo satisfactorio: descomprimir, instrumentar, fusionar y corregir el balance sagital. Objetivo: Analizar los criterios fundamentales en la toma de decisión para el manejo conservador o quirúrgico en la columna vertebral. Resultados: Se analizaron las escalas de medición y de evaluación más frecuentes y mayormente efectivas en relación a la cirugía de columna, mismos que obligadamente tienen que ser aplicadas y evaluadas en cada caso particular, lo cual permite fortalecer la impresión diagnóstica y el valor pronóstico. Conclusión: Implementar la cultura del uso de mediciones de resultados de pacientes como instrumento de evaluación ayuda al cirujano de columna a decidir un plan de tratamiento que pueda adecuarse a las preferencias y las necesidades del paciente. Debemos fundamentar nuestro objetivo clínico en la estabilidad y el compromiso neurológico del paciente, existiendo cuatro posibilidades diagnósticas, que se corregirán para cuatro objetivos fundamentales.
Introduction:The radiations used during surgery are electromagnetic radiations, similar to visible light, but of shorter wavelength, which penetrates materials that absorb light. The relevant concepts, there are several factors that can affect the absorption, such as thickness, density, atomic number, contrast media, kilovoltage, filtration, the composition of the target and the distance from where the beam emanates. The federal regulation code in the United States establishes a permissible level in the hands of 18,750 mlrem to three months or 70 rems per year, but it should be noted that in the bibliography consulted, it is not necessary to specify what the minimum amount of harmful radiation is. Within these risks, malignancy has been reported at the level of the eye lens, liver, spleen, gonads and skin, and complications at low doses in relation to the risk of thyroid cancer in adults. Conclusion: Monitoring of real radiation with evaluations every three months should be considered, since it is cumulative, so it must be taken into account what is not known and not seen, of the likely long-term risks.
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