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Abstract: Introduction: the complex regional pain syndrome type II, also called causalgia, is a rare clinical condition that appears after a traumatic or surgical event with evidence of nervous system involvement. Its clinical presentation is the consequence of a multifactorial pathogenic process that involves peripheral and central mechanisms and has variable clinical manifestations. We present the photographic record of a patient with complex regional syndrome type II. Clinical case: 43-year-old patient who consulted for neuropathic pain during the last four years, of severe intensity, associated with sensory, vasomotor and trophic changes in the right upper limb, as a consequence of neurectomy of the palmar digital nerves of the third finger. Conclusion: achieving the photographic record of the clinical phases of complex regional pain syndrome type II in its entirety is difficult, because not all patients present all clinical phases, a fact that gives relevance to this case.

Resumen: Introducción: el síndrome doloroso regional complejo (SDRC) tipo II, también llamado causalgia, es una condición clínica poco frecuente que aparece después de un evento traumático o quirúrgico con evidencia de afectación del sistema nervioso. Su presentación clínica es consecuencia de un proceso patogénico multifactorial que involucra mecanismos periféricos y centrales y tiene manifestaciones clínicas variables. Presentamos el registro fotográfico de un paciente con síndrome regional complejo tipo II. Caso clínico: paciente de 43 años que consultó por dolor neuropático durante los últimos cuatro años, de intensidad severa, asociado a cambios sensoriales, vasomotores y tróficos en miembro superior derecho, como consecuencia de neurectomía de los nervios digitales palmares propios del tercer dedo. Conclusión: lograr el registro fotográfico de las fases clínicas del SDRC tipo II en su totalidad resulta difícil, debido a que no todos los pacientes presentan todas las fases clínicas; hecho que otorga la relevancia a este caso.

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Objetivo: El dolor óseo por cáncer óseo o metástasis es un dolor de difícil manejo asociado a dolor incidental. Hay distintas estrategias quirúrgicas para su tratamiento, sin embargo, no todos los pacientes con metástasis óseas pueden beneficiarse de un tratamiento quirúrgico. La presente revisión bibliográfica tiene como objetivo identificar terapias intervencionales mínimamente invasivas para el control del dolor por metástasis óseas. Métodos: Revisión bibliográfica acerca de terapias intervencionales para el control del dolor por metástasis óseas utilizando la base de datos PubMed (www.pubmed.gov) y el motor de búsqueda Google (www.google.cl). Tipos de participantes: Pacientes con metástasis óseas dolorosas de cualquier tumor primario. Tipos de intervenciones: Bloqueos anestésicos, bloqueos neurolíticos, terapias ablativas, cementoplastías. Resultados: Se obtuvieron 384 resultados que incluyeron revisiones sistemáticas, revisiones bibliográficas, ensayos clínicos controlados, series de casos y reporte de casos. Todos los artículos relevantes en inglés y español se incluyeron para su análisis. Conclusión: Las metástasis óseas son un evento común en los pacientes con cáncer, y el dolor óseo es un dolor de difícil manejo asociado a dolor incidental. Se han desarrollado terapias intervencionales no invasivas o mínimamente invasivas para tratar el dolor, mejorar la calidad de vida y la funcionalidad, disminuir el consumo de fármacos, y reducir el tamaño del tumor. La gran mayoría ha demostrado ser terapias seguras y eficaces, con pocos eventos adversos y de rápida resolución, y que si son combinadas mejoran los resultados.

Objective: Bone pain from bone cancer or metastasis is a pain that is difficult to manage associated with incidental pain. There are different surgical strategies for its treatment, however, not all patients with bone metastases can benefit from a surgical treatment. This literature review aims to identify minimally invasive interventional therapies for the control of pain due to bone metastasis. Methods: Literature review of interventional therapies for the control of pain due to bone metastases was done using the PubMed database (www.pubmed.gov) and the Google search engine (www.google.cl). Types of participants: Patients with painful bone metastases from any primary tumor. Types of interventions: Anesthetic blocks, neurolytic blocks, ablative therapies, cementoplasties. Results: We obtained 384 results that included systematic reviews, literature reviews, controlled clinical trials, case series and case reports. All relevant articles in English and Spanish were included for analysis. Conclusion: Bone metastases are a common event in cancer patients, and bone pain is a difficult-to-manage pain associated with incidental pain. Non-invasive or minimally invasive interventional therapies have been developed to treat pain, improve quality of life and functionality, decrease drug use, and reduce tumor size. The vast majority therapies have been shown to be safe and effective ones, with few adverse events and rapid resolution, and that if combined they improve the outcomes.

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Abstract Introduction Allergic rhinitis is a form of IgE mediated inflammation of the nasal mucosa in response to specific allergens, resulting in typical symptoms. Objectives This study was designed with the primary goal of comparing the clinical efficacy of posterior nasal neurectomy with or without pharyngeal neurectomy for the treatment of moderate-to-severe perennial allergic rhinitis. Secondary study aims included a comparison of the severity of comorbidities, including chronic cough and asthma, between patients in these two surgical treatment groups. Methods A total of 52 patients were enrolled in this randomized controlled trial and were assigned to either the control group (posterior nasal neurectomy) or the experimental group (posterior nasal neurectomy + pharyngeal neurectomy). The visual analog scale and rhinoconjunctivitis quality of life questionnaire were used to compare the differences in patient symptoms between baseline and 6-, 12-, and 24-months post-treatment. In addition, patient cough and asthma symptoms were monitored during follow-up via visual analog scale and asthma control test respectively. Results No significant differences in preoperative scores were evident between groups (p> 0.05). At 6-months post-treatment, there were significant differences in visual analog scale, rhinoconjunctivitis quality of life questionnaire, and asthma control test scores relative to baseline values in experimental group and control group patients (p< 0.05), and this remained true upon 12- and 24-month follow-up. No significant differences in visual analog scale, rhinoconjunctivitis quality of life questionnaire, or asthma control test scores were observed between the two treatment groups at any postoperative follow-up time point (p> 0.05), while coughing severity was found to be significantly reduced in the experimental group relative to the control group (p< 0.05). Conclusion posterior nasal neurectomy can be safely implemented with or without pharyngeal neurectomy in order to effectively treat allergic rhinitis. Combined posterior nasal neurectomy and pharyngeal neurectomy treatment may offer greater value than posterior nasal neurectomy alone for the treatment of allergic rhinitis patients with chronic cough.

Resumo Introdução A rinite alérgica é uma forma de inflamação da mucosa nasal mediada por IgE em resposta a alérgenos específicos, resulta em sintomas típicos. Objetivos Comparar a eficácia clínica da neurectomia nasal posterior com ou sem neurectomia faríngea para o tratamento da rinite alérgica perene de moderada a grave. Além disso, comparar a gravidade das comorbidades, inclusive tosse crônica e asma, entre os pacientes nesses dois grupos de tratamento cirúrgico. Método Foram incluidos neste ensaio clínico randomizado e designados para o grupo controle (neurectomia nasal posterior) ou para o grupo experimental (neurectomia nasal posterior + neurectomia faríngea) 52 pacientes. A escala visual analógica e o questionário de qualidade de vida na rinoconjuntivite (rhinoconjunctivitis quality of life questionnaire) foram usados para comparar as diferenças nos sintomas dos pacientes entre o período inicial e 6, 12 e 24 meses após o tratamento. Além disso, a tosse e os sintomas de asma dos pacientes foram monitorados durante o acompanhamento por meio da escala visual analógica e do teste de controle da asma (asthma control test ), respectivamente. Resultados Nenhuma diferença significante nos escores pré‐operatórios foi evidenciada entre os grupos (p > 0,05). Aos seis meses pós‐tratamento, houve diferenças significantes nos escores da escala visual analógica, no questionário de qualidade de vida na rinoconjuntivite e no teste de controle de asma em relação aos valores basais dos pacientes no grupo experimental e no grupo controle (p < 0,05), o que permaneceu verdadeiro após 12 e 24 meses de acompanhamento. Não foram observadas diferenças significantes nos escores da escala visual analógica e nem no questionário de qualidade de vida para conjuntivite ou no teste de controle da asma entre os dois grupos de tratamento em qualquer momento do acompanhamento pós‐operatório (p > 0,05), enquanto a gravidade da tosse foi significantemente reduzida no grupo experimental em relação ao grupo controle (p < 0,05). Conclusão A neurectomia nasal posterior pôde ser feita com segurança com ou sem neurectomia faríngea para o tratamento eficaz da rinite alérgica. O tratamento combinado com neurectomia nasal posterior e neurectomia faríngea pode oferecer mais benefício do que a neurectomia nasal posterior isolada para o tratamento de pacientes com rinite alérgica e tosse crônica.

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Abstract Introduction: The type of endoscopic approach chosen for vidian neurectomy can be specified by evaluating the vidian canal and the surrounding sphenoid sinus structures. Objective: The variations and morphometry of the vidian canal were investigated, focusing on the functional correlations between them which are crucial anatomical landmarks for preoperative planning. Methods: This study was performed using paranasal multidetector computed tomography images that were obtained with a section thickening of 0.625 mm of 250 adults. Results: The distributions of 500 vidian canal variants were categorized as follows; Type 1, within the sphenoid corpus (55.6%); Type 2, partially protruding into the sphenoid sinus (34.8%); Type 3, within the sphenoid sinus (9.6%). The pneumatization of the pterygoid process is mostly seen in vidian canal Type 2 (72.4%) and Type 3 (95.8%) (p < 0.001). The mean distances from the vidian canal to the foramen rotundum and the palatovaginal canal were greater in the vidian canal Type 2 and 3 with the pterygoid process pneumatization (p < 0.001). The prevalence of the intrasphenoid septum between the vidian canal and the vomerine crest and lateral attachment which ending on carotid prominence were much higher in vidian canal Type 3 than other types (p < 0.001). The mean angle between the posterior end of the middle turbinate and the lateral margin of the anterior opening of the vidian canal was measured as 33.05 ± 7.71°. Conclusions: Preoperative radiologic analysis of the vidian canal and the surrounding structures will allow surgeons to choose an appropriate endoscopic approach to ensure predictable postoperative outcomes.

Resumo Introdução: O tipo de abordagem endoscópica para a neurectomia do vidiano pode ser definido pela avaliação do canal do vidiano e das estruturas adjacentes aos seios esfenoidais. Objetivo: Investigar as variações e a morfometria do canal vidiano com enfoque nas suas correlações funcionais, pois são parâmetros anatômicos cruciais para o planejamento pré-operatório. Método: Esse estudo foi realizado utilizando-se imagens de tomografia computadorizada multidetectores dos seios paranasais com espessura de corte de 0,625 mm obtidas de 250 indivíduos adultos. Resultados: A distribuição das 500 variantes do canal vidiano foi categorizada da seguinte forma: Tipo 1, dentro do corpo ósseo esfenoidal (55,6%); Tipo 2, protrusão parcial no interior do seio esfenoidal (34,8%); Tipo 3, no interior do seio esfenoidal (9,6%). A pneumatização do processo pterigoide foi observada principalmente no canal vidiano Tipo 2 (72,4%) e Tipo 3 (95,8%) (p < 0,001). As distâncias médias do canal vidiano até o forame redondo e o canal palatovaginal foram maiores no canal vidiano do Tipo 2 e 3, com a pneumatização do processo pterigoide (p < 0,001). A presença do septo intraesfenoidal entre o canal vidiano e a crista vomeriana e a extensão lateral, que termina na proeminência da carótida, foi muito maior no canal vidiano Tipo 3 do que nos outros tipos (p < 0,001). A angulação média entre a cauda da concha média e a margem lateral da abertura anterior do canal vidiano foi de 33,05° ± 7,71°. Conclusões: A análise radiológica pré-operatória do canal do vidiano e das estruturas circunjacentes permitem ao cirurgião escolher uma abordagem endoscópica apropriada e prever resultados pós-operatórios.

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INTRODUCTION: The type of endoscopic approach chosen for vidian neurectomy can be specified by evaluating the vidian canal and the surrounding sphenoid sinus structures. OBJECTIVE: The variations and morphometry of the vidian canal were investigated, focusing on the functional correlations between them which are crucial anatomical landmarks for preoperative planning. METHODS: This study was performed using paranasal multidetector computed tomography images that were obtained with a section thickening of 0.625mm of 250 adults. RESULTS: The distributions of 500 vidian canal variants were categorized as follows; Type 1, within the sphenoid corpus (55.6%); Type 2, partially protruding into the sphenoid sinus (34.8%); Type 3, within the sphenoid sinus (9.6%). The pneumatization of the pterygoid process is mostly seen in vidian canal Type 2 (72.4%) and Type 3 (95.8%) (p<0.001). The mean distances from the vidian canal to the foramen rotundum and the palatovaginal canal were greater in the vidian canal Type 2 and 3 with the pterygoid process pneumatization (p<0.001). The prevalence of the intrasphenoid septum between the vidian canal and the vomerine crest and lateral attachment which ending on carotid prominence were much higher in vidian canal Type 3 than other types (p<0.001). The mean angle between the posterior end of the middle turbinate and the lateral margin of the anterior opening of the vidian canal was measured as 33.05±7.71°. CONCLUSIONS: Preoperative radiologic analysis of the vidian canal and the surrounding structures will allow surgeons to choose an appropriate endoscopic approach to ensure predictable postoperative outcomes.

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Introducción: la incidencia del dolor crónico en pacientes sometidos a hernioplastia con prótesis es de aproximadamente del 10%. Considerando como inguinodínea crónica aquella que dura tres meses o más. La causa mejor conocida es la neuropática y se proponen múltiples estrategias para su tratamiento. Objetivo: comparar dos técnicas de neurectomía para prevenir dolor postoperatorio en hernioplastia con prótesis. Método: se incluyeron 175 pacientes a los que se realizó hernioplastia electiva con prótesis en el período abril 2011 a mayo 2013; para comparar dos técnicas. Se realizó resección de 5-10 cm del nervio a 100 pacientes y a 75 casos sección simple o resección mínima (1 cm). Resultados: en el grupo 1, a las dos semanas el 61% de los pacientes refería dolor moderado, solo uno con dolor intenso. Un mes después el 14% reflejó dolor moderado, y uno con dolor intenso. Un año después solo un paciente refirió dolor moderado. En el grupo 2, a las dos semanas el 62,7% describió dolor moderado y nueve (12%) refirió dolor intenso. Un mes el 44% narró dolor moderado y ocho (10,7%) mantenían dolor intenso. Un año después, ocho (10,7%) reflejó con dolor moderado constante y de estos un paciente se reingresó para tratamiento quirúrgico. La baja incidencia del dolor crónico después de neurectomía fue significativa (1 % vs. 10,7%; p=0,012); la incidencia del dolor intenso a corto y mediano plazo, así como, el dolor moderado al mes fue también menor. Conclusión: La resección profiláctica del nervio fue más efectiva que la simple sección para evitar el dolor postoperatorio.

Introduction: The incidence of chronic pain in patients undergoing prosthetic hernioplasty is approximately 10%. Considering as chronic inguinodinea the one that lasts three months or more. The best known cause is neuropathic and multiple strategies are proposed for its treatment. Objetive: Compare two techniques of neurectomy to prevent postoperative pain in prosthetic hernioplasty. Method: one hundred seventy five patients, who had underwent inguinal prosthetic hernioplasty between April 2011 and May 2013 were included; to compare two techniques. Resection of 5-10 cm of the nerve was done to 100 patients and to 75 cases simple section or minimal resection (1 cm). Results: in group 1, at two weeks, 61% of the patients reported moderate pain, only one with severe pain. One month later, 14% showed moderate pain, and one with severe pain. One year later only one patient reported moderate pain. In group 2, at two weeks, 62.7% reported moderate pain and nine (12%) reported severe pain. One month, 44% reported moderate pain and 8 (10.7%) continued with severe pain. One year later, eight (10.7%) reflected with constant moderate pain and of these one patient was re-entered for surgical treatment. The low incidence of chronic pain after neurectomy was significant (1% vs. 10.7%, p = 0.012); the incidence of intense pain in the short and medium term, as well as, moderate pain per month was also lower. Conclusion: prophylactic resection of the nerve was more effective than the simple section to avoid postoperative pain.

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Introducción: la neurectomía es la intervención quirúrgica que consiste en la extirpación de una parte de un nervio Reporte de caso: se presenta un caso que se trata de una mujer que tenía hernia inguinal, la cual fue intervenida para una reparación vía laparoscópica, la cual se realiza aparentemente sin problemas. 3 días después inicia con dolor inguinal, por el que fue evaluada por diferentes especialistas, una de las posibilidades que se pensaron era que podía ser un problema psiquiátrico. Conclusión: Al cabo de más de 3 meses, se pudo resolver el problema con la cirugía llamada Neurectomia triple, donde se realiza la exéresis de las fibras nerviosas que inervan esa zona. Con resultado exitoso.

Introduction: the neurectomy is the surgical intervention that consists of the removal of a part of a nerve. Case report: a case is presented that is a woman who had inguinal hernia, which was operated for a laparoscopic repair, which Is apparently done without problems. 3 days later it starts with inguinal pain, for which it was evaluated by different specialists, one of the possibilities that was thought was that it could be a psychiatric problem. Conclusion: After more than 3 months, the problem could be solved with the surgery called triple Neurectomy, where the excision of the nerve fibers that innervate that area is performed. With successful result.

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The navicular syndrome is a high relevance pathology. It is one of the chronic disease that most attacks equines 4 to 15 years. Several factors as faulty genetic predisposition in the blood circulation for the region of the navicular, biomechanical factors, imperfect resignation and instability of the hoof are proposed like as etiological actors. The aim of this study was report a case of navicular bone syndrome in equine and bring forward the discussed therapeutic conducts. In the physical exam, the animal presented accented claudication on step and the illness was diagnosed through the x-ray and from there, neurectomia was carried out. After the surgical treatment, the animal was treated and discharged for not demonstrating painful signs. There is no remedial treatment for the illness, therefore when the first clinical signs appear, it must be taken the proper steps so does not compromising the life of the animal.

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In Northeastern of Brazil is practiced surgical procedure called "disconnect" with the aim of eliminate chronic lameness in horses. The act is carried out for several decades as a regional cultural element incorporated into the population customs and traditionally practiced by laypeople and veterinarians. This paper aims characterize the surgical procedure known as "disconnect", citing their different access and technical efficiency through information obtained through direct survey of performers (veterinarians or lay) and owners of animals that have undergone the procedure. According to the descriptions, the procedure has four surgical approaches, and can be defined as vascular section followed by profuse bleeding, with or without hemostasis ligature, at medial access of the proximal or distal region of the fore and hindlimbs. The information obtained and the anatomical structural analysis indicate that the practice of "disconnect" is characterized by phlebotomy, associated or not with neurectomy, being a questionable, empirical and inefficient procedure in the treatment of lameness. From the cases report developed, the initial character on the subject concludes the absence of therapy evidence in animals undergoing the procedure, counter indicating it in the clinical and surgical routine horses.

Na região nordeste do Brasil pratica-se o procedimento cirúrgico denominado desgovernar com objetivo de eliminar claudicações crônicas em equinos. O ato é realizado há várias décadas como um elemento cultural regional, incorporado aos costumes da população e habitualmente praticado por leigos e médicos veterinários. Este artigo objetiva identificar o ato cirúrgico conhecido como desgovernar, citando seus diferentes acessos e eficiência da técnica, a partir de informações obtidas através de inquérito direto aos executores (médicos veterinários ou leigos) e proprietários de animais que foram submetidos ao procedimento. De acordo com as descrições, o procedimento possui quatro acessos cirúrgicos, na face medial da região proximal ou distal dos membros torácicos e pélvicos, podendo ser definido como secção vascular seguida de hemorragia profusa, com ou sem hemostasia por ligadura. As informações obtidas e a análise estrutural anatômica indicam que a prática de desgovernar é caracterizada por flebotomia seguida ou não de neurectomia, sendo um procedimento questionável, empírico e ineficiente no tratamento das claudicações. A partir do estudo de casos desenvolvido, de caráter inicial sobre a temática, conclui-se a ausência da comprovação terapêutica nos animais submetidos ao procedimento, o contra indicando na rotina clínico-cirúrgica de equinos.

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In Northeastern of Brazil is practiced surgical procedure called "disconnect" with the aim of eliminate chronic lameness in horses. The act is carried out for several decades as a regional cultural element incorporated into the population customs and traditionally practiced by laypeople and veterinarians. This paper aims characterize the surgical procedure known as "disconnect", citing their different access and technical efficiency through information obtained through direct survey of performers (veterinarians or lay) and owners of animals that have undergone the procedure. According to the descriptions, the procedure has four surgical approaches, and can be defined as vascular section followed by profuse bleeding, with or without hemostasis ligature, at medial access of the proximal or distal region of the fore and hindlimbs. The information obtained and the anatomical structural analysis indicate that the practice of "disconnect" is characterized by phlebotomy, associated or not with neurectomy, being a questionable, empirical and inefficient procedure in the treatment of lameness. From the cases report developed, the initial character on the subject concludes the absence of therapy evidence in animals undergoing the procedure, counter indicating it in the clinical and surgical routine horses.(AU)

Na região nordeste do Brasil pratica-se o procedimento cirúrgico denominado desgovernar com objetivo de eliminar claudicações crônicas em equinos. O ato é realizado há várias décadas como um elemento cultural regional, incorporado aos costumes da população e habitualmente praticado por leigos e médicos veterinários. Este artigo objetiva identificar o ato cirúrgico conhecido como desgovernar, citando seus diferentes acessos e eficiência da técnica, a partir de informações obtidas através de inquérito direto aos executores (médicos veterinários ou leigos) e proprietários de animais que foram submetidos ao procedimento. De acordo com as descrições, o procedimento possui quatro acessos cirúrgicos, na face medial da região proximal ou distal dos membros torácicos e pélvicos, podendo ser definido como secção vascular seguida de hemorragia profusa, com ou sem hemostasia por ligadura. As informações obtidas e a análise estrutural anatômica indicam que a prática de desgovernar é caracterizada por flebotomia seguida ou não de neurectomia, sendo um procedimento questionável, empírico e ineficiente no tratamento das claudicações. A partir do estudo de casos desenvolvido, de caráter inicial sobre a temática, conclui-se a ausência da comprovação terapêutica nos animais submetidos ao procedimento, o contra indicando na rotina clínico-cirúrgica de equinos.(AU)

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The navicular syndrome is a high relevance pathology. It is one of the chronic disease that most attacks equines 4 to 15 years. Several factors as faulty genetic predisposition in the blood circulation for the region of the navicular, biomechanical factors, imperfect resignation and instability of the hoof are proposed like as etiological actors. The aim of this study was report a case of navicular bone syndrome in equine and bring forward the discussed therapeutic conducts. In the physical exam, the animal presented accented claudication on step and the illness was diagnosed through the x-ray and from there, neurectomia was carried out. After the surgical treatment, the animal was treated and discharged for not demonstrating painful signs. There is no remedial treatment for the illness, therefore when the first clinical signs appear, it must be taken the proper steps so does not compromising the life of the animal.(AU)

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A neurectomia digital palmar é utilizada em animais que apresentam dor devido às doenças degenerativas podais que não respondem ao tratamento conservativo. Diversas técnicas de neurectomia foram desenvolvidas com objetivo de obter menor trauma cirúrgico, evitando o desenvolvimento de neuroma doloroso,considerado uma das principais complicações da secção nervosa. Para os animais atletas registrado sem associações de criadores, a neurectomia é considerada doping por não tratar a doença de base da claudicação,impedindo-o de participar de eventos esportivos. A presente revisão bibliográfica abrange estudos das diferentes técnicas de neurectomia, avaliando suas indicações, vantagens e desvantagens. As técnicas relatadas apresentam diferentes resultados quando comparadas em relação ao tempo e taxa de formação do neuroma, podendo este ser doloroso ou não.(AU)

Palmar digital neurectomy is utilized in horses suffering from degenerative and painful conditionslocalized in the foot, unresponsive to medical and conservative forms of therapy. Different techniques of palmar digital neurectomy were developed in order to minimize surgical trauma and avoid the most commoncomplication associated with nerve transection, that is painful neuroma. Neurectomy is considered doping inanimais registered in breeders' associations, once it does not represent a treatment for the underlying condition,and horses that have had surgery are not allowed to compete. This literature review describes different neurectomy techniques, evaluating their indications, advantages and complications. Presented techniques vary in results when rate and time to neuroma formation are considered, be it painful or not.(AU)

La neurectomía digital palmar se utiliza en animales que presentam dolor decorri ente de enfermidades degenerativas de los pies que no responden ai tratamiento conservador. Varias técnicas de neurectomía han sido desarrolladas con el fin de obtener un menor trauma quirúrgico, evitando el desarrollo de neuromadoloroso, considerado una complicación importante de Ia sección dei nervio. Para los animales atletas inscritos en asociaciones de creadores, Ia neurectomía se considera dopaje por no tratar Ia enfermedad subyacente de Ia claudicación, que le impide de participar de los eventos deportivos. Esta revisión de Ialiteratura incluye estudios de diferentes técnicas de neurectomía, Ia evaluación de sus indicaciones, ventajasy desventajas. Las técnicas han reportado diferentes resultados cuando se compara con el tiempo y Ia velocidadde formación dei neuroma, que puede ser doloroso o no.(AU)

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A neurectomia digital palmar é utilizada em animais que apresentam dor devido às doenças degenerativas podais que não respondem ao tratamento conservativo. Diversas técnicas de neurectomia foram desenvolvidas com objetivo de obter menor trauma cirúrgico, evitando o desenvolvimento de neuroma doloroso,considerado uma das principais complicações da secção nervosa. Para os animais atletas registrado sem associações de criadores, a neurectomia é considerada doping por não tratar a doença de base da claudicação,impedindo-o de participar de eventos esportivos. A presente revisão bibliográfica abrange estudos das diferentes técnicas de neurectomia, avaliando suas indicações, vantagens e desvantagens. As técnicas relatadas apresentam diferentes resultados quando comparadas em relação ao tempo e taxa de formação do neuroma, podendo este ser doloroso ou não.

Palmar digital neurectomy is utilized in horses suffering from degenerative and painful conditionslocalized in the foot, unresponsive to medical and conservative forms of therapy. Different techniques of palmar digital neurectomy were developed in order to minimize surgical trauma and avoid the most commoncomplication associated with nerve transection, that is painful neuroma. Neurectomy is considered doping inanimais registered in breeders' associations, once it does not represent a treatment for the underlying condition,and horses that have had surgery are not allowed to compete. This literature review describes different neurectomy techniques, evaluating their indications, advantages and complications. Presented techniques vary in results when rate and time to neuroma formation are considered, be it painful or not.

La neurectomía digital palmar se utiliza en animales que presentam dolor decorri ente de enfermidades degenerativas de los pies que no responden ai tratamiento conservador. Varias técnicas de neurectomía han sido desarrolladas con el fin de obtener un menor trauma quirúrgico, evitando el desarrollo de neuromadoloroso, considerado una complicación importante de Ia sección dei nervio. Para los animales atletas inscritos en asociaciones de creadores, Ia neurectomía se considera dopaje por no tratar Ia enfermedad subyacente de Ia claudicación, que le impide de participar de los eventos deportivos. Esta revisión de Ialiteratura incluye estudios de diferentes técnicas de neurectomía, Ia evaluación de sus indicaciones, ventajasy desventajas. Las técnicas han reportado diferentes resultados cuando se compara con el tiempo y Ia velocidadde formación dei neuroma, que puede ser doloroso o no.

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RESUMO

El dolor pélvico crónico (DPC) requiere diagnóstico y tratamiento adecuados. Hay alternativas terapéuticas tanto quirúrgicas (ablación, fulguración de úterosacros y neurectomía presacra) como médicas. Objetivo: comparar el nivel de DPC de etiología desconocida entre la fulguración laparoscópica de úterosacros y sólo observación, en el Hospital de San José de Bogotá DC. Materiales y métodos: estudio de cohortes prospectivas mediante escala análoga visual prequirúrgica y seguimiento al primero, tercero y sexto meses después de laparoscopia entre marzo de 2008 y abril de 2010. Resultados: se incluyeron 69 pacientes, 28 del grupo de fulguración y 41 de observación. No se presentaron complicaciones intraoperatorias. La prueba de Friedman prequirúrgica en el grupo de fulguración presentó una mediana de 8 (RIC:6-8) y la mediana del dolor pélvico a los seis meses fue de 3 (RIC:2-6) con un p-valor de 0.001, mostrando cambios estadísticos significativos en la mejoría del dolor a través del tiempo. Para evaluar las diferencias entre los grupos a los seis meses se utilizó la prueba de Mann-Whitney Wilcoxon obteniendo un p-valor de 0.66, es decir, no existe diferencia en el dolor mediano entre ambos grupos. Conclusiones: la mejoría del dolor no muestra diferencia significativa a los seis meses entre los dos grupos. Es posible que con mayor seguimiento y otras técnicas quirúrgicas se puedan ofrecen mejores resultados...

Chronic pelvic pain (CPP) requires an adequate diagnosis and treatment. Surgical therapeutic options (ablation, fulguration of uterosacral ligaments and presacral neurectomy) as well as pharmacological treatments exist. Objective: we sought to compare the level of CPP of unknown etiology treated with laparoscopic fulguration of uterosacral ligaments with observation only, at Hospital de San José, Bogotá DC. Materials and Methods: a prospective cohort study by means of a pre-surgical visual analogous scale and follow-up at one, two and six month intervals after the laparoscopy was conducted between March 2008 and April 2010. Results: 69 patients were included, 28 in the fulguration group and 41 in the observation group. There were no intraoperative complications. The media of the pre-surgical Friedman test in the fulguration group was 8 (RIC:6-8) and the media of pelvic pain at six months was 3 (RIC:2-6) with a p-value of 0.001, showing statistic significance in pain improvement over time. The Mann-Whitney Wilcoxon test was used to assess differences between groups at six months obtaining a p-value of 0.66, thus no difference between the media of pain in the two groups was observed. Conclusions: there is no significant difference on the improvement of pain between the two groups. Better results may be offered through longer follow-up periods and other surgical techniques...

Assuntos

RESUMO

Avaliou-se macro e microscopicamente o tecido cicatricial pós-operatório de eqüinos submetidos a duas técnicas de neurectomia digital: guilhotina (TG) e stripping (TS). Decorridos 14 meses das cirurgias, foram colhidas 32 amostras de tecido cicatricial em quatro éguas, que tiveram os membros submetidos a ambas as técnicas. À macroscopia, verificaram-se as dimensões da cicatriz do coto proximal e a distância entre os cotos proximal e distal. À microscopia, foi quantificada a proporção de tecido nervoso regenerado por meio de histomorfometria. Não houve diferença nas dimensões do tecido cicatricial, contudo a distância entre cotos foi 5,6 vezes maior na TS (P<0,001). Histologicamente, observou-se a presença de tecido conjuntivo frouxo e denso, macrófagos e fibras nervosas delgadas em ambas as técnicas cirúrgicas. Estruturas nodulares, compostas por fascículos nervosos, foram visualizadas em 56,2 por cento (9/16) das amostras colhidas em nervos submetidos à TS. As porcentagens médias de tecido nervoso no tecido cicatricial foram de 0,31 por cento na TG e 2,6 por cento na TS (P<0,001). Concluiu-se que o retorno à sensibilidade nervosa deve demorar mais a ocorrer após a TS, devido à maior distância entre cotos. A maior proporção de tecido nervoso sugere que essa técnica favorece a regeneração nervosa.(AU)

The post-operative healed tissues in horses submitted to two digital neurectomy techniques, the guilhotine (GT) and the stripping (ST), were evaluated by macroscopy and microscopy. Fourteen months after surgery, 32 samples of scar tissue were collected from four mares that had the members experimentally submitted to both surgical techniques. By macroscopy, the dimensions of the scar tissue of the proximal stump and the distance between nerve stumps were taken. By microscopy, the proportion of nervous tissues in the scar tissue was quantified by histomorphometry. There were no differences between the scar tissue dimensions, but the distance between stumps was 5.6-fold greater in ST subjects. Histologically, connective tissue, macrophages, and thin nervous fibers were observed in scar tissue present in animals of both groups. Nodular structures composed by nervous fascicules were visualized in 56.2 percent (9/16) of the samples collected from the ST group. The mean percentage of the nervous tissue in scar tissue was 0.31 percent in GT samples and 2.6 percent in ST samples (P<0.001). After ST, a longer time to the return of the sensibility may occur due to the greater distance between stumps. However, greater proportion of nervous tissue in the scar tissue suggests that the use of this technique favors nervous regeneration.(AU)

Assuntos

RESUMO

Avaliou-se macro e microscopicamente o tecido cicatricial pós-operatório de eqüinos submetidos a duas técnicas de neurectomia digital: guilhotina (TG) e stripping (TS). Decorridos 14 meses das cirurgias, foram colhidas 32 amostras de tecido cicatricial em quatro éguas, que tiveram os membros submetidos a ambas as técnicas. À macroscopia, verificaram-se as dimensões da cicatriz do coto proximal e a distância entre os cotos proximal e distal. À microscopia, foi quantificada a proporção de tecido nervoso regenerado por meio de histomorfometria. Não houve diferença nas dimensões do tecido cicatricial, contudo a distância entre cotos foi 5,6 vezes maior na TS (P<0,001). Histologicamente, observou-se a presença de tecido conjuntivo frouxo e denso, macrófagos e fibras nervosas delgadas em ambas as técnicas cirúrgicas. Estruturas nodulares, compostas por fascículos nervosos, foram visualizadas em 56,2 por cento (9/16) das amostras colhidas em nervos submetidos à TS. As porcentagens médias de tecido nervoso no tecido cicatricial foram de 0,31 por cento na TG e 2,6 por cento na TS (P<0,001). Concluiu-se que o retorno à sensibilidade nervosa deve demorar mais a ocorrer após a TS, devido à maior distância entre cotos. A maior proporção de tecido nervoso sugere que essa técnica favorece a regeneração nervosa.

The post-operative healed tissues in horses submitted to two digital neurectomy techniques, the guilhotine (GT) and the stripping (ST), were evaluated by macroscopy and microscopy. Fourteen months after surgery, 32 samples of scar tissue were collected from four mares that had the members experimentally submitted to both surgical techniques. By macroscopy, the dimensions of the scar tissue of the proximal stump and the distance between nerve stumps were taken. By microscopy, the proportion of nervous tissues in the scar tissue was quantified by histomorphometry. There were no differences between the scar tissue dimensions, but the distance between stumps was 5.6-fold greater in ST subjects. Histologically, connective tissue, macrophages, and thin nervous fibers were observed in scar tissue present in animals of both groups. Nodular structures composed by nervous fascicules were visualized in 56.2 percent (9/16) of the samples collected from the ST group. The mean percentage of the nervous tissue in scar tissue was 0.31 percent in GT samples and 2.6 percent in ST samples (P<0.001). After ST, a longer time to the return of the sensibility may occur due to the greater distance between stumps. However, greater proportion of nervous tissue in the scar tissue suggests that the use of this technique favors nervous regeneration.

Assuntos

RESUMO

Compararam-se as dificuldades transcirúrgicas e as complicações pós-operatórias das técnicas guilhotina (TG) e stripping (TS) para a neurectomia digital em eqüinos. Sob anestesia com halotano, quatro éguas tiveram os nervos digitais de um dos membros torácicos e um dos pélvicos submetidos à TG, enquanto os nervos digitais dos membros colaterais foram submetidos à TS. Os tempos cirúrgicos médios de TG e TS foram semelhantes. O comprimento médio do fragmento do nervo removido foi três vezes maior em TS (P<0,001). Independente da técnica utilizada, houve perda total da sensibilidade nos talões de todos os membros dentro dos quatro primeiros meses da cirurgia. Após 14 meses, houve retorno da sensibilidade em 37 por cento dos membros em TG e 18,8 por cento em TS (P=0,06). Ao exame de palpação para identificação de neuromas dolorosos, houve episódios de sensibilidade discreta em um maior número de cotos nervosos proximais operados com TS, 53,6 por cento contra 6,4 por cento dos operados com TG (P=0,003). Ambas as técnicas foram satisfatórias por não apresentarem maiores complicações durante ou após a cirurgia. Considerou-se que TG apresentou menor potencial para produzir reinervação e neuromas dolorosos.(AU)

The surgical difficulties and the postoperative complications of two techniques for equine digital neurectomy, the guillotine (TG) and the stripping (TS), were evaluated. Four mares under halothane anesthesia were submitted to the TS in the digital nerves of a thoracic and a pelvic limbs, and TG in the contralateral limbs. The mean surgical times for TG and TS were similar. The mean transected nerve length was three times greater in TS (P<0.001). In both techniques, total lost of sensibility was observed in all heel bulbs during the first four months. After 14 months, sensibility returned to 37 percent limbs in treated by TG, and 18.8 percent in those treated by TS (P=0.06). Discreet painful sensation was identified by the response of digital palpation of the neuroma in a greater number of nerve stumps where TS was performed, 53.6 percent versus 6.4 percent of those operated by TG (P=0.003). No major complications were observed during or after surgery and both techniques were considered satisfactory. TG was considered with less potential to produce painful neuromas and reinnervation.(AU)

Assuntos

RESUMO

Compararam-se as dificuldades transcirúrgicas e as complicações pós-operatórias das técnicas guilhotina (TG) e stripping (TS) para a neurectomia digital em eqüinos. Sob anestesia com halotano, quatro éguas tiveram os nervos digitais de um dos membros torácicos e um dos pélvicos submetidos à TG, enquanto os nervos digitais dos membros colaterais foram submetidos à TS. Os tempos cirúrgicos médios de TG e TS foram semelhantes. O comprimento médio do fragmento do nervo removido foi três vezes maior em TS (P<0,001). Independente da técnica utilizada, houve perda total da sensibilidade nos talões de todos os membros dentro dos quatro primeiros meses da cirurgia. Após 14 meses, houve retorno da sensibilidade em 37 por cento dos membros em TG e 18,8 por cento em TS (P=0,06). Ao exame de palpação para identificação de neuromas dolorosos, houve episódios de sensibilidade discreta em um maior número de cotos nervosos proximais operados com TS, 53,6 por cento contra 6,4 por cento dos operados com TG (P=0,003). Ambas as técnicas foram satisfatórias por não apresentarem maiores complicações durante ou após a cirurgia. Considerou-se que TG apresentou menor potencial para produzir reinervação e neuromas dolorosos.

The surgical difficulties and the postoperative complications of two techniques for equine digital neurectomy, the guillotine (TG) and the stripping (TS), were evaluated. Four mares under halothane anesthesia were submitted to the TS in the digital nerves of a thoracic and a pelvic limbs, and TG in the contralateral limbs. The mean surgical times for TG and TS were similar. The mean transected nerve length was three times greater in TS (P<0.001). In both techniques, total lost of sensibility was observed in all heel bulbs during the first four months. After 14 months, sensibility returned to 37 percent limbs in treated by TG, and 18.8 percent in those treated by TS (P=0.06). Discreet painful sensation was identified by the response of digital palpation of the neuroma in a greater number of nerve stumps where TS was performed, 53.6 percent versus 6.4 percent of those operated by TG (P=0.003). No major complications were observed during or after surgery and both techniques were considered satisfactory. TG was considered with less potential to produce painful neuromas and reinnervation.

Assuntos