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Background Spinal metastatic disease is a silent progressive cancer complication with an increasing prevalence worldwide. The spine is the third most common site where solid tumors metastasize. Complications involved in spinal metastasis include root or spinal cord compression, progressing to a declining quality of life as patient autonomy reduces and pain increases. The main objective of this study is to report the incidence of patients and typology of spinal metastases in three reference centers in Mexico. Methodology Retrospective cohorts of patients diagnosed with spinal metastases from January 2010 to February 2017 at the National Cancer Institute, National Rehabilitation Institute, and the Traumatology and Orthopedics Hospital "Lomas Verdes" in Mexico City were analyzed. Results A total of 326 patients (56% males) with spinal metastases were reported. The mean age was 58.06 ± 14.05 years. The main sources of spinal metastases were tumors of unknown origin in 53 (16.25%) cases, breast cancer in 67 (20.5%) cases, prostate cancer in 59 (18%) cases, myeloma in 24 (7.4%) cases, and lung cancer in 23 (7.1%) cases. Conclusions The data obtained in this analysis delivers an updated standpoint on Mexico, providing the opportunity to distinguish the current data from global references. Collecting more epidemiological information for better recording of cancer and its associated complications, as well as further studies on them, is necessary.
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OBJECTIVE: This was a pre-post study in a network of hospitals in Mexico-City, Mexico. Participants developed and implemented Quality Improvement (QI) interventions addressing perioperative pain management. METHODS: PAIN OUT, an international QI and research network, provided tools for web-based auditing and feedback of pain management and patient-reported outcomes (PROs) in the clinical routine. Ward- and patient-level factors were evaluated with multi-level models. Change in proportion of patients reporting worst pain ≥6/10 between project phases was the primary outcome. RESULTS: Participants created locally adapted resources for teaching and pain management, available to providers in the form of a website and a special issue of a national anesthesia journal. They offered teaching to anesthesiologists, surgeons, including residents, and nurses. Information was offered to patients and families. A total of 2658 patients were audited in 9 hospitals, between July 2016 and December 2018. Participants reported that the project made them aware of the importance of: training in pain management; auditing one's own patients to learn about PROs and that QI requires collaboration between multi-disciplinary teams. Participants reported being unaware that their patients experienced severe pain and lacked information about pain treatment options. Worst pain decreased significantly between the two project phases, as did PROs related to pain interfering with movement, taking a deep breath/coughing or sleep. The opportunity of patients receiving information about their pain treatment options increased from 44% to 77%. CONCLUSIONS: Patients benefited from improved care and pain-related PROs. Clinicians appreciated gaining increased expertise in perioperative pain management and methods of QI.
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Resumen: El manejo del dolor postoperatorio en cirugía de columna lumbar no ha sido protocolizado en México. La cirugía en columna lumbar (discectomía, laminectomía, fusión e instrumentación) se encuentra entre las primeras seis cirugías más dolorosas. El tratamiento adecuado del dolor postoperatorio en esta población, debe guiarse mediante un abordaje perioperatorio ordenado, con la identificación temprana de factores de riesgo para dolor severo y factores asociados con la respuesta funcional a largo plazo (visite https://becertain.shinyapps.io/lumbar_fusion_calculator), la premedicación y establecimiento de protocolos analgésicos de acuerdo con las características clínicas de los pacientes, lo cual derivará en una movilización temprana, disminución del riesgo de neumonía, de íleo, de úlceras de presión, además de acelerar el alta hospitalaria, la disminución de costos y el aumento de la calidad en la atención (visita http://www.painoutmexico.com para obtener la versión completa del artículo y recomendaciones).
Abstract: Management of postoperative pain in lumbar spine surgery has not been protocolized in Mexico. Lumbar spine surgery (discectomy, laminectomy, fusion and instrumentation) is among the first six most painful surgeries. Adequate treatment of postoperative pain in this population should be guided with the identification of early risk factors for severe pain and factors associated with long-term functional response (visit https://becertain.shinyapps.io/lumbar_fusion_calculator), pre-medication and the establishment of an adequate analgesic approach according to the clinical characteristics of the patients will lead to early mobilization, decreasing the risk of pneumonia, ileus, pressure ulcers, in addition to accelerating hospital discharge, lower costs and increase the quality of care (visithttp://www.painoutmexico.com to get the full version of the article and recommendations) .
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Patellar osteochondral lesions are difficult to diagnose, there must be a high index of suspicion in order to treat them timely. We present this case to point the keys of an early diagnosis and to expose Pritsch technique, which consists in suturing the osteochondral fragment to the anterior surface of the patella. It is an easy procedure and available to the orthopedist, we also present the functional result that was satisfactory in this case.