Jaume Pomés | Uba - Academia.edu (original) (raw)

Papers by Jaume Pomés

Anesthesiology, Jun 1, 2005

To the Editor:—We read with interest the case report by Sala-Blanch et al. The authors describe a... more To the Editor:—We read with interest the case report by Sala-Blanch et al. The authors describe an unorthodox but interesting treatment for patients undergoing continuous sciatic nerve block that raises several concerns. In short, using computed tomographic imaging without clear clinical indication, the authors documented that nerve stimulator–guided needle placement during sciatic nerve block through the anterior approach resulted in an intraneural needle placement. The authors then inserted the catheter and administered local anesthetics. Conventional wisdom suggests that intraneural needle placement and catheter insertion should be avoided because intraneural application of local anesthetics has been shown to result in neurologic injury in animal models. However, despite the documented intraneural needle and catheter placement—although it is not clear whether the stimulating needle lies between fascia and epineurium or between epineurium and perineurium—the patients did not have neurologic injury. Therefore, this case report suggests that not all intraneural injections lead to neurologic injury. It also suggests that nerve stimulators may not be reliable in avoiding intraneural needle or catheter placement. Finally, a better definition of what constitutes an intraneural versus an intraepineural sheath injection during blockade of peripheral nerves and plexuses is needed for more meaningful discussion of this matter. Some experts may view the patient treatment in report by Sala-Blanch et al. unusual or even potentially hazardous. However, their findings should be welcomed because they clearly pose some important questions. At the least, they suggest that future research should continue to focus on developing more reliable and objective tools of nerve localization and injection monitoring techniques to help avoid intraneural injection and reduce the risk of consequent neurologic injury. In any case, it is recommended to withdraw the needle or the catheter if one has any doubt that its position is too close to the nerve, for the safety of regional anesthesia.

Muscle & Nerve, Feb 14, 2019

ABSTRACTIntroduction: Short tau inversion recovery (STIR) sequences in whole‐body MRI are usually... more ABSTRACTIntroduction: Short tau inversion recovery (STIR) sequences in whole‐body MRI are usually used for detecting muscle edema (ME) in inflammatory myopathies. We evaluated b‐value 800 diffusion‐weighted imaging (b800 DWI).Methods: Two radiologists independently and a consensus reader retrospectively reexamined 60 patients with inflammatory myopathies and 15 controls. For each participant, 78 muscles were analyzed with 3 sets of imaging acquisitions: T1‐weighted (T1) turbo spin echo and STIR; T1 and DWI; and T1, STIR and DWI. Mean edema per patient was compared between sequences. Agreement was evaluated. Results: Diffusion‐weighted imaging detected more ME compared with STIR (P < 0.001). Agreement between readers was better with both sequences (k = 0.94) than with b800 DWI (k = 0.89) or STIR (k = 0.84) alone. Discussion: Diffusion‐weighted imaging is a valuable add‐on for the study of inflammatory myopathies. Muscle Nerve 59:555–555, 2019

Journal of Clinical Oncology, Jul 15, 2004

8263 Background: Metastatic involvement of vertebral columnae affects performance status (PS) of ... more 8263 Background: Metastatic involvement of vertebral columnae affects performance status (PS) of cancer patients (pts) and compromise the efficacy of treatment. Radiotherapy and surgical management are therapeutical options to relieve tumour pain. (VP) can also be an effective modality to treat injured vertebrae. Our objectives were to analyse the clinical benefit of VP: in avoiding the interruption or delay of the chemotherapy treatment and to obtain pain relief without complications. METHODS From April 02 to November 03, a total of 26 VP were performed to 15 pts (7 males and 8 females) with vertebral body lesions. Median age: 58±17 years (22-76). Patients had: breast cancer (6), different solid tumors (7) and, hematologic malignancies (2). Pain was evaluated by means of a visual analogical pain scale (EVA), before the VP, as well at 24 hours, a week and a month after. The incidence of new fractures was also registered. RESULTS An average of 0.7 ± 1.7 (1-3) vertebrae/pt was performed. A new VP was done in two pts for a new lesion in another level. The basal EVA was of 8,1±1,3 (3-10) and, it decreased in the controls made at 24 hours, 1 week and one month. The EVA values averaged 1,1±1,3 (0-3), 0,2±0,4 (0-4), 1,7± 3,0 (0-9) (p<0.01) respectively. Seven pts (46%) were able to start or follow chemotherapy treatment in the next 24 hours after procedure. The cement leaks (CL) were characterized as anterior (3), posterior or back venous leak (6) and, cord channel leak (2). There was a complication in the form of one case of pulmonary embolism. A prospective study is planned in our Institution to include a larger number of patients and, to evaluate risks, benefits and quality of life. CONCLUSIONS VP is an effective procedure for treating pain in patients with vertebral body tumour injury and, it appears to have an excellent safety profile. No significant financial relationships to disclose.

Anesthesiology, Oct 1, 2004

European Journal of Anaesthesiology, Jun 1, 2014

Background: Even correctly performed peripheral nerve blocks lead to systemic absorption, and loc... more Background: Even correctly performed peripheral nerve blocks lead to systemic absorption, and local anesthetic systemic toxicity remains a concern. Data on the ma ximum admissible dose of local anesthetic using dif ferent techniques is old and does not take into account the technique used to perform the block, whether it be neurostimulation (NS) or ultrasound (US) guidance. Objective: Our aim was to establish a plasma concentration curve of ropivacaine for femoral nerve blocks and to ascertain whether the resulting plasma concentrations dif fer significantly depending on the nerve localization technique used (US vs. NS). Methods: Six teen patients receiving a femoral nerve block as part of their anesthetic for unilateral lower ex tremity surgery were enrolled in this prospective study. They were randomized to undergo either US or NS guidance. All blocks were performed with 20 mL of 5 mg/mL ropivacaine. Blood samples were drawn before the nerve block and 20, 30, 40, 50, 60, 70, and 80 minutes af ter the block. Plasma levels of ropivacaine were analyzed by high performance liquid chromatography (HPLC). Results: All blocks were successful and no patient showed signs or symptoms of local anesthesia toxicity. The plasma concentration of ropivacaine peaked at 30 minutes in both arms. There was no significant dif ference in peak levels between US and NS-guidance (0.325 ± 0.186 vs. 0.356 ± 0.106 mcg/mL; ns). Between 50 and 70 minutes, there was a trend toward higher plasma concentrations of ropivacaine in the US group than in the NS group but it did not reach significance. Conclusion: Plasma concentrations of ropivacaine peak around 30 minutes af ter femoral nerve block regardless of the technique used. No significant dif ference was found between US-and NS-guidance, despite a trend toward higher levels in the US group between 50 and 70 minutes. We will repeat this study with other nerve blocks, such as the interscalene block, to investigate whether plasma levels dif fer depending on the technique.

Nephrology Dialysis Transplantation, May 1, 2015

Journal of Clinical Oncology, 2004

Revista Española de Anestesiología y Reanimación (English Edition), 2017

Introduction: Ultrasound-guided infraclavicular block in the costoclavicular space located betwee... more Introduction: Ultrasound-guided infraclavicular block in the costoclavicular space located between the clavicle and the first rib, reaches the secondary trunks when they are clustered together and lateral to the axillary artery. This block is most often performed through a lateral approach, the difficulty being finding the coracoid process an obstacle and guiding the needle towards the vessels and pleura. A medial approach, meaning from inside to outside, will avoid these structures. Traditionally the assessment of a successful block is through motor or sensitive responses but a sympathetic fibre block can also be evaluated measuring the changes in humeral artery blood flow, skin temperature and/or perfusion index. Objective: To describe the medial approach of the ultrasound-guided costoclavicular block evaluating its development by motor and sensitive response and measurement of sympathetic changes. Materials and methods: Description of the technique and administration of 20 ml of contrast in a fresh cadaver model, evaluating the distribution with CT-scan and sagittal sections of the anatomic piece. Subsequently in a clinical phase, including 11 patients, we evaluated the establishment of motor, sensitive and sympathetic blocks. We evaluated the sympathetic changes reflected by humeral artery blood flow, skin temperature and distal perfusion index. Results: In the anatomical model the block was conducted without difficulties, showing an adequate periclavicular distribution of the contrast in the CT-scan and in sagittal sections, reaching

AJNR. American journal of neuroradiology

Colloid cysts represent between 0.25-1 % of intracranial tumors [1-3]. Although most frequently l... more Colloid cysts represent between 0.25-1 % of intracranial tumors [1-3]. Although most frequently located in the third ventricle, they are also found throughout the ventricular system [4]. Extraventricular location is rare [5]. We describe a case of a neuroepithelial cyst located in the craniocervical region, which was examined by CT and vertebral angiography, with subsequent biochemical study of the cyst contents and histologic confirmation. Case Report The patient was a 14-year-old girl with hypoacusia of the right ear and right-sided headaches , which had intensified over the 2 preceding months, accompanied by nausea and vomiting. Physical examination revealed right facial paralysis, horizontal bilateral nystagmus, absent nausea reflex , hypotonia, right hyporeflexia, and bilateral papilledema. Plain skull and cervical spine radiographs were normal. CT scan showed a round, well-defined high-density area (97 HU) extending from C1 through the foramen magnum and into the posterior fossa. The right cerebellopontine angle was occupied by the mass that passed in front of the cerebral trunk, displacing the fourth ventricle to the left. Active hydrocephalus was present. There was no contrast enhancement (Fig. 1). Vertebral angiography revealed an expansive avascular lesion. Resection of the posterior arc of the atlas was performed together with hemicraniectomy of the posterior fossa , during which a cystic lesion covered by a fine membrane and containing rapidly coagulating brownish material was removed. Microscopic study of the cyst wall revealed that this was formed by columnar epithelium on the interior wall and an external layer of lax connective tissue (Fig. 2). The epithelium was flattened and tense in places, and the acellular content appeared densely proteinaceous. Biochemical analysis of the contents revealed highly viscous material: one gram of material contained 910 mg of protein. Electrophoresis showed that 64% corresponded to albumin while the remaining 36% was globulin (26% CY , + CY2 + (3 and 10% gammaglobulin). Discussion Colloid cysts are most frequently found in the anterior half of the third ventricle [6 , 7] , although they may also be found in the fourth and lateral ventricles [8]. Location outside the ventricular system, in the leptomeninges of the quadrigeminal

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Medicina clínica, Jan 12, 1991

Radiología, 2012

We describe the magnetic resonance imaging (MRI) findings for the spine in patients with seronega... more We describe the magnetic resonance imaging (MRI) findings for the spine in patients with seronegative spondyloarthropathy (SNS) and discuss the indications for MRI in the diagnosis and follow-up of this type of patients. We describe the pathological aspects of four patients diagnosed with SNS (Crohn's disease, ankylosing spondylitis, and psoriasis) with spinal involvement. The MRI findings in SNS vary in function of the type and stage of disease. Osteitis of the anterior vertebral bodies is a very early sign of spinal involvement in this group of diseases. Inflammatory involvement of the discovertebral complex that involves the adjacent vertebral bodies to a greater or lesser extent occurs later. MRI of the spine makes it possible to evaluate incipient signs of disease that are characteristic of these patients, so it is a useful tool for the diagnosis of SNS.

Revista española de …, 2002

Algunos pacientes con enfermedad ósea de Paget pueden desarrollar un osteosarcoma en la lesión pa... more Algunos pacientes con enfermedad ósea de Paget pueden desarrollar un osteosarcoma en la lesión pagética. Aunque se trata de una complicación infrecuente, el diagnóstico precoz de esta entidad es fundamental debido a su elevada mortalidad. Con el fin de analizar las ...

Journal of Biomechanics, 2008

Journal of Biomechanics, Volume 41, Issue null, Pages S256, July 2008, Authors:RamiroGonzalez; Ma... more Journal of Biomechanics, Volume 41, Issue null, Pages S256, July 2008, Authors:RamiroGonzalez; Manel Llusa; Jaume Pomes; Josep Planell; Damien Lacroix. ...