Centro Fisioterapia Serrano

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Code Context
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			'short_description' => 'Centro médico con gabinete de fisioterapia situado en el corazón de Madrid. Nuestra especialidad es el tratamiento de patologías musculo-esqueléticas, trastornos linfáticos y tratamientos especializados para la mujer. ¿ A qué esperas para reservar tu tratamiento?',
			'description' => '<p>Nuestra clínica tiene como objetivo proporcionar a los pacientes técnicas de tratamiento basadas en la evidencia científica con el fin de realizar una fisioterapia de calidad. Ayudamos a los pacientes con lesiones músculo-esqueléticas a disminuir el dolor y a trabajar en la etiología del problema, con el fin de que la lesión interfiera lo menos posible en su calidad de vida. Para ello utilizamos técnicas basadas en el ejercicio terapéutico y terapia manual, todo ello desde un paradigma biopsicosocial.&nbsp;</p>
<p>Por otra parte, nuestro centro está especializado en la mujer. El departamento médico es experto en nutrición, sexología y anti-envejecimiento, por tanto muchos de los tratamientos de fisioterapia están enfocados en la mujer. Realizamos tratamientos de drenaje linfático + ejercicio terapéutico con el fin de complementar dietas pautadas, así como preparación del suelo pélvico durante y después de los embarazos. Los ejercicios del suelo pélvico protegen la cavidad pélvica de futuras complicaciones como puede ser la incontinencia urinaria.&nbsp;</p>',
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			'title' => 'Neuromodulación en vejiga hiperactiva ',
			'description' => '<p>&nbsp;</p>
<div class="page" title="Page 2">
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<div class="column"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">La vejiga hiperactiva (VH) es un s&iacute;ndrome cl&iacute;nico que se define por la </span><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPS'; font-style: italic;">International Continence Society, </span><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">como la presencia de urgencia miccional, con o sin incontinencia de urgencia, asoci&aacute;ndose a un aumento de la frecuencia miccional y nocturia, en ausencia de condiciones patol&oacute;gicas o infecciosas. (1) </span> <span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Por tanto los s&iacute;ntomas m&aacute;s caracter&iacute;sticos de la VH son la urgencia miccional, la incontinencia de urgencia y la frecuencia miccional. Estos s&iacute;ntomas tambi&eacute;n se pueden presentar en otras patolog&iacute;as de pr&oacute;stata o en infecciones de orina, por lo que es conveniente hacer un diagn&oacute;stico diferencial.(1,2)</span>
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<div class="column"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Existen dos subtipos de VH:<br /> - </span><span style="font-size: 12pt; font-family: TimesNewRomanPS;">Vejiga hiperactiva- seca</span><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">, se caracteriza por un aumento de la frecuencia y de la urgencia miccional sin ir acompa&ntilde;ada de la incontinencia de urgencia.<br /></span></div>
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<span style="font-size: 12pt; font-family: TimesNewRomanPSMT;">- </span><span style="font-size: 12pt; font-family: TimesNewRomanPS;">Vejiga hiperactiva- h&uacute;meda</span><span style="font-size: 12pt; font-family: TimesNewRomanPSMT;">, se caracteriza por un aumento de la frecuencia y de la urgencia miccional, acompa&ntilde;ado de la incontinencia de urgencia.</span> <span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">La etiolog&iacute;a de la VH se debe a la hiperactividad del m&uacute;sculo detrusor de forma involuntaria durante la fase de llenado, por causas idiop&aacute;ticas o neurog&eacute;nicas. (1) La hiperactividad del detrusor se ha definido como un proceso urodin&aacute;mico que se caracteriza por presentar contracciones involuntarias de manera espont&aacute;nea o provocada. (2)</span>
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<div class="column"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Existen varios enfoques terap&eacute;uticos para tratar la VH, pudiendo dividirlos en tratamiento conservador y tratamiento no conservador. Dentro de las opciones no conservadoras se encuentra la </span><span style="font-size: 12pt; font-family: TimesNewRomanPS;">neuromodulaci&oacute;n. </span> <span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">La neuromodulaci&oacute;n se define como la modificaci&oacute;n de la actividad de los circuitos neuronales, sin causar lesi&oacute;n de los tejidos nerviosos. Con esta t&eacute;cnica se pretende activar o desactivar una red neuronal mediante la aplicaci&oacute;n de una corriente el&eacute;ctrica, modificando y controlando propiedades como la frecuencia, amplitud y ancho de pulso. </span></div>
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<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">El objetivo principal es estimular, inhibir o modificar determinador circuitos neuronales que funcionan de forma anormal. (3)</span>
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<div class="column"><span style="font-size: 12pt; font-family: TimesNewRomanPS;">- Neuromodulaci&oacute;n perif&eacute;rica: </span> <span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Se define como cualquier t&eacute;cnica de neuromodulaci&oacute;n que se encargue de estimular de forma indirecta las ra&iacute;ces nerviosas motoras y/o sensitivas de alg&uacute;n &oacute;rgano, v&iacute;scera u otras estructuras. </span></div>
</div>
</div>
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<div class="column"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">En el s&iacute;ndrome de VH, encontramos tres tipos de neuromodulaci&oacute;n perif&eacute;rica que resultan beneficiosas. Estos beneficios se obtienen debido a los procesos que desencadenan, que ser&aacute;n explicados posteriormente. </span></div>
<div class="column"><span style="font-size: 12pt; font-family: TimesNewRomanPS;">a) Neuromodulaci&oacute;n percut&aacute;nea del nervio tibial posterior: </span> <span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Esta t&eacute;cnica de neuromodulaci&oacute;n presenta varias ventajas frente a la estimulaci&oacute;n de fibras nerviosas, ya que es menos invasiva que la primera, adem&aacute;s de ser m&aacute;s asequible econ&oacute;micamente. La aplicaci&oacute;n de la neuromodulaci&oacute;n percut&aacute;nea del nervio tibial posterior se realiza a trav&eacute;s de un electrodo de aguja de calibre 35, situado 5 cent&iacute;metros por encima del maleolo medial y se coloca un electrodo de superficie en arco del pie. (4) </span></div>
<div class="column"><span style="font-size: 12pt; font-family: TimesNewRomanPS;">b) Neuromodulaci&oacute;n del nervio pudendo: </span> <span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Esta opci&oacute;n de neuromodulaci&oacute;n surgio? con el fin de buscar una alternativa a aquellos pacientes que no obten&iacute;an resultados con la estimulaci&oacute;n central o sacra. Consiste en estimular las aferencias pudendas. Surge como alternativa ya que las aferencias pudendas corresponden, seg&uacute;n estudios neurofisiol&oacute;gicos, en un 4% a S1, en un 60% a S2 y en un 35% a S3. (5)&nbsp;</span></div>
<div class="column"><span style="font-size: 12pt; font-family: TimesNewRomanPS;">c) Neuromodulaci&oacute;n transcut&aacute;nea del nervio tibial posterior: </span></div>
</div>
</div>
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">La electroestimulaci&oacute;n nerviosa mediante el Transcutaneous electrical nerve (TENS), consiste en la aplicaci&oacute;n de corrientes alternas de baja frecuencia, con impulsos de duraci&oacute;n desde los 0,005 a 0,4 milisegundos. La frecuencia debe ser entre 1 y 150 Hz. Estas corrientes se transmiten a trav&eacute;s de dos electrodos que se deben colocar en el trayecto del nervio perif&eacute;rico. Por otra parte el TENS es un tratamiento que se est&aacute; llevando a la actualidad de manera muy frecuente debido a su f&aacute;cil aplicaci&oacute;n y a que puede llevarse a cabo por parte del paciente en el domicilio. Adem&aacute;s se observa una buena tolerancia por parte del paciente y no ocasiona efectos adversos. (6)</span></div>
<div class="column">&nbsp;</div>
<div class="column"><span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">Bibliografia</span></div>
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<div class="column"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">1. Salazar AH, Acun?a AB, Salazar IS. La Vejiga Hiperactiva. Rev.Obstet.Ginecol. 2013; Vol 8 (2): 101-110</span></div>
<div class="column">&nbsp;</div>
<div class="column">2.Patra PB, Patra S. Research Findings on Overactive Bladder. Curr Urol. 2015 May;8(1):1&ndash;21.&nbsp;</div>
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<div class="column">3.&nbsp;Textbook of Neuromodulation: Principles, Methods and Clinical Applications. Springer; 2014. 283 p.</div>
<div class="column">&nbsp;</div>
<div class="column">4. Staskin DR, Peters KM, MacDiarmid S, Shore N, de Groat WC. Percutaneous tibial nerve stimulation: a clinically and cost effective addition to the overactive bladder algorithm of care. Curr Urol Rep. 2012;13(5):327&ndash;34.</div>
<div class="column">&nbsp;</div>
<div class="column">5. Manri?quez G V, Sandoval S C, Lecannelier A J, Naser N M, Guzma?n R R, Valdevenito S R, et al. NEUROMODULACIO?N EN PATOLOGI?AS DE PISO
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<div class="column" style="text-align: justify;"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">PE?LVICO. Rev Chil Obstet Ginecol. Sociedad Chilena de Obstetricia y </span> <span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Ginecologi?a; 2010;75(1):58&ndash;63</span></div>
<div class="column" style="text-align: justify;">&nbsp;</div>
<div class="column" style="text-align: justify;">6. Tellenbach M, Schneider M, Mordasini L, Thalmann GN, Kessler TM.Transcutaneous electrical nerve stimulation: an effective treatment for refractory non-neurogenic overactive bladder syndrome? World J Urol. 2013 Oct;31(5):1205&ndash;10.&nbsp;</div>
</div>
</div>
<p>&nbsp;</p>
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<p style="text-align: justify;"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">&nbsp;</span></p>
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			'description' => '<p>&nbsp;</p>
<div class="page" title="Page 2">
<div class="layoutArea">
<div class="column"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">La vejiga hiperactiva (VH) es un s&iacute;ndrome cl&iacute;nico que se define por la </span><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPS'; font-style: italic;">International Continence Society, </span><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">como la presencia de urgencia miccional, con o sin incontinencia de urgencia, asoci&aacute;ndose a un aumento de la frecuencia miccional y nocturia, en ausencia de condiciones patol&oacute;gicas o infecciosas. (1) </span> <span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Por tanto los s&iacute;ntomas m&aacute;s caracter&iacute;sticos de la VH son la urgencia miccional, la incontinencia de urgencia y la frecuencia miccional. Estos s&iacute;ntomas tambi&eacute;n se pueden presentar en otras patolog&iacute;as de pr&oacute;stata o en infecciones de orina, por lo que es conveniente hacer un diagn&oacute;stico diferencial.(1,2)</span>
<div class="page" style="text-align: justify;" title="Page 2">
<div class="layoutArea">
<div class="column"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Existen dos subtipos de VH:<br /> - </span><span style="font-size: 12pt; font-family: TimesNewRomanPS;">Vejiga hiperactiva- seca</span><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">, se caracteriza por un aumento de la frecuencia y de la urgencia miccional sin ir acompa&ntilde;ada de la incontinencia de urgencia.<br /></span></div>
</div>
</div>
<span style="font-size: 12pt; font-family: TimesNewRomanPSMT;">- </span><span style="font-size: 12pt; font-family: TimesNewRomanPS;">Vejiga hiperactiva- h&uacute;meda</span><span style="font-size: 12pt; font-family: TimesNewRomanPSMT;">, se caracteriza por un aumento de la frecuencia y de la urgencia miccional, acompa&ntilde;ado de la incontinencia de urgencia.</span> <span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">La etiolog&iacute;a de la VH se debe a la hiperactividad del m&uacute;sculo detrusor de forma involuntaria durante la fase de llenado, por causas idiop&aacute;ticas o neurog&eacute;nicas. (1) La hiperactividad del detrusor se ha definido como un proceso urodin&aacute;mico que se caracteriza por presentar contracciones involuntarias de manera espont&aacute;nea o provocada. (2)</span>
<div class="page" style="text-align: justify;" title="Page 3">
<div class="layoutArea">
<div class="column"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Existen varios enfoques terap&eacute;uticos para tratar la VH, pudiendo dividirlos en tratamiento conservador y tratamiento no conservador. Dentro de las opciones no conservadoras se encuentra la </span><span style="font-size: 12pt; font-family: TimesNewRomanPS;">neuromodulaci&oacute;n. </span> <span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">La neuromodulaci&oacute;n se define como la modificaci&oacute;n de la actividad de los circuitos neuronales, sin causar lesi&oacute;n de los tejidos nerviosos. Con esta t&eacute;cnica se pretende activar o desactivar una red neuronal mediante la aplicaci&oacute;n de una corriente el&eacute;ctrica, modificando y controlando propiedades como la frecuencia, amplitud y ancho de pulso. </span></div>
</div>
</div>
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">El objetivo principal es estimular, inhibir o modificar determinador circuitos neuronales que funcionan de forma anormal. (3)</span>
<div class="page" style="text-align: justify;" title="Page 4">
<div class="layoutArea">
<div class="column"><span style="font-size: 12pt; font-family: TimesNewRomanPS;">- Neuromodulaci&oacute;n perif&eacute;rica: </span> <span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Se define como cualquier t&eacute;cnica de neuromodulaci&oacute;n que se encargue de estimular de forma indirecta las ra&iacute;ces nerviosas motoras y/o sensitivas de alg&uacute;n &oacute;rgano, v&iacute;scera u otras estructuras. </span></div>
</div>
</div>
<div class="page" style="text-align: justify;" title="Page 5">
<div class="layoutArea">
<div class="column"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">En el s&iacute;ndrome de VH, encontramos tres tipos de neuromodulaci&oacute;n perif&eacute;rica que resultan beneficiosas. Estos beneficios se obtienen debido a los procesos que desencadenan, que ser&aacute;n explicados posteriormente. </span></div>
<div class="column"><span style="font-size: 12pt; font-family: TimesNewRomanPS;">a) Neuromodulaci&oacute;n percut&aacute;nea del nervio tibial posterior: </span> <span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Esta t&eacute;cnica de neuromodulaci&oacute;n presenta varias ventajas frente a la estimulaci&oacute;n de fibras nerviosas, ya que es menos invasiva que la primera, adem&aacute;s de ser m&aacute;s asequible econ&oacute;micamente. La aplicaci&oacute;n de la neuromodulaci&oacute;n percut&aacute;nea del nervio tibial posterior se realiza a trav&eacute;s de un electrodo de aguja de calibre 35, situado 5 cent&iacute;metros por encima del maleolo medial y se coloca un electrodo de superficie en arco del pie. (4) </span></div>
<div class="column"><span style="font-size: 12pt; font-family: TimesNewRomanPS;">b) Neuromodulaci&oacute;n del nervio pudendo: </span> <span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Esta opci&oacute;n de neuromodulaci&oacute;n surgio? con el fin de buscar una alternativa a aquellos pacientes que no obten&iacute;an resultados con la estimulaci&oacute;n central o sacra. Consiste en estimular las aferencias pudendas. Surge como alternativa ya que las aferencias pudendas corresponden, seg&uacute;n estudios neurofisiol&oacute;gicos, en un 4% a S1, en un 60% a S2 y en un 35% a S3. (5)&nbsp;</span></div>
<div class="column"><span style="font-size: 12pt; font-family: TimesNewRomanPS;">c) Neuromodulaci&oacute;n transcut&aacute;nea del nervio tibial posterior: </span></div>
</div>
</div>
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">La electroestimulaci&oacute;n nerviosa mediante el Transcutaneous electrical nerve (TENS), consiste en la aplicaci&oacute;n de corrientes alternas de baja frecuencia, con impulsos de duraci&oacute;n desde los 0,005 a 0,4 milisegundos. La frecuencia debe ser entre 1 y 150 Hz. Estas corrientes se transmiten a trav&eacute;s de dos electrodos que se deben colocar en el trayecto del nervio perif&eacute;rico. Por otra parte el TENS es un tratamiento que se est&aacute; llevando a la actualidad de manera muy frecuente debido a su f&aacute;cil aplicaci&oacute;n y a que puede llevarse a cabo por parte del paciente en el domicilio. Adem&aacute;s se observa una buena tolerancia por parte del paciente y no ocasiona efectos adversos. (6)</span></div>
<div class="column">&nbsp;</div>
<div class="column"><span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">Bibliografia</span></div>
<div class="column">
<div class="page" title="Page 9">
<div class="layoutArea">
<div class="column"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">1. Salazar AH, Acun?a AB, Salazar IS. La Vejiga Hiperactiva. Rev.Obstet.Ginecol. 2013; Vol 8 (2): 101-110</span></div>
<div class="column">&nbsp;</div>
<div class="column">2.Patra PB, Patra S. Research Findings on Overactive Bladder. Curr Urol. 2015 May;8(1):1&ndash;21.&nbsp;</div>
<div class="column">&nbsp;</div>
<div class="column">3.&nbsp;Textbook of Neuromodulation: Principles, Methods and Clinical Applications. Springer; 2014. 283 p.</div>
<div class="column">&nbsp;</div>
<div class="column">4. Staskin DR, Peters KM, MacDiarmid S, Shore N, de Groat WC. Percutaneous tibial nerve stimulation: a clinically and cost effective addition to the overactive bladder algorithm of care. Curr Urol Rep. 2012;13(5):327&ndash;34.</div>
<div class="column">&nbsp;</div>
<div class="column">5. Manri?quez G V, Sandoval S C, Lecannelier A J, Naser N M, Guzma?n R R, Valdevenito S R, et al. NEUROMODULACIO?N EN PATOLOGI?AS DE PISO
<div class="page" title="Page 11">
<div class="layoutArea">
<div class="column" style="text-align: justify;"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">PE?LVICO. Rev Chil Obstet Ginecol. Sociedad Chilena de Obstetricia y </span> <span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Ginecologi?a; 2010;75(1):58&ndash;63</span></div>
<div class="column" style="text-align: justify;">&nbsp;</div>
<div class="column" style="text-align: justify;">6. Tellenbach M, Schneider M, Mordasini L, Thalmann GN, Kessler TM.Transcutaneous electrical nerve stimulation: an effective treatment for refractory non-neurogenic overactive bladder syndrome? World J Urol. 2013 Oct;31(5):1205&ndash;10.&nbsp;</div>
</div>
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<p>&nbsp;</p>
</div>
</div>
</div>
<p style="text-align: justify;"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">&nbsp;</span></p>
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			'short_description' => 'En el centro tratamos todas las patologías de las vías respiratorias y del oído utilizando el agua de mar como herramienta terapéutica a través de vapores, nebulizaciones y duchas nasales, así como técnicas de fisioterapia para el drenaje de la mucosidad bronquial.',
			'description' => '<p style="box-sizing: border-box; margin: 0.85em 0px; padding: 0px; border: 0px #e1e1e1; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-stretch: inherit; font-size: 13px; line-height: inherit; font-family: Arial, Helvetica, Verdana, sans-serif; vertical-align: baseline; color: #666666; background-color: #f8f8f8;">En el año 2002 nació el Balneari Respiratori bajo la dirección del Dr. Miquel Pros, prestigioso médico naturista pionero en la introducción en España de las terapias procedentes de la escuela alemana de medicina naturista.</p>
<p style="box-sizing: border-box; margin: 0.85em 0px; padding: 0px; border: 0px #e1e1e1; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-stretch: inherit; font-size: 13px; line-height: inherit; font-family: Arial, Helvetica, Verdana, sans-serif; vertical-align: baseline; color: #666666; background-color: #f8f8f8;">El Dr. Pros afirma que la acumulación crónica de las mucosidades en el interior de las cavidades nasales las convierte en una zona altamente conflictiva, un foco infeccioso que puede llegar a generar más de 20 patologías respiratorias y del oído, además de afectar a otras partes de nuestro organismo, como el sistema digestivo y el sistema inmunológico. Es su&nbsp;Teoría de la Sinusitis Silenciosa.&nbsp;</p>
<p style="box-sizing: border-box; margin: 0.85em 0px; padding: 0px; border: 0px #e1e1e1; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-stretch: inherit; font-size: 13px; line-height: inherit; font-family: Arial, Helvetica, Verdana, sans-serif; vertical-align: baseline; color: #666666; background-color: #f8f8f8;">Esta teoría lo llevó a sistematizar el uso del agua de mar para el tratamiento de las afecciones respiratorias y del oído en lo que hoy conocemos como Balneari Respiratori. A lo largo de estos 15 años y acompañado por la fisioterapeuta Núria Oliver, que actualmente dirige el centro, se ha demostrado la gran eficacia del método terapéutico del Dr. Pros, más de 6.000 pacientes han recibido los tratamientos con agua de mar.</p>
<p style="box-sizing: border-box; margin: 0.85em 0px; padding: 0px; border: 0px #e1e1e1; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-stretch: inherit; font-size: 13px; line-height: inherit; font-family: Arial, Helvetica, Verdana, sans-serif; vertical-align: baseline; color: #666666; background-color: #f8f8f8;">En el año 2010 se realizó un estudio piloto con un grupo de niños de guardería de 0 a 6 años para constatar científicamente los beneficios de los tratamientos con agua de mar en niños, obteniendo unos resultados altamente satisfactorios, pues 9 de cada 10 niños y niñas mejoraron sus trastornos respiratorios respecto a su situación inicial.</p>
Alergias? Sinusitis? Oídos tapados? Dolor de garganta o de cabeza? Congestión nasal?

&nbsp;



<p style="box-sizing: border-box; margin: 0.85em 0px; padding: 0px; border: 0px #e1e1e1; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; font-size: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline;">Te podemos ayudar a disminuir y eliminar todos estos síntomas.</p>
<p style="box-sizing: border-box; margin: 0.85em 0px; padding: 0px; border: 0px #e1e1e1; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; font-size: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline;">Ven y haremos una desensibilización de las mucosas respiratorias con agua de mar natural y INDIBA (hipertermia profunda). A través de nuestros tratamientos ayudamos a drenar la mucosidad estancada y disminuir la inflamación de las mucosas respiratorias.</p>

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<div class="page" title="Page 2">
<div class="layoutArea">
<div class="column"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">La vejiga hiperactiva (VH) es un s&iacute;ndrome cl&iacute;nico que se define por la </span><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPS'; font-style: italic;">International Continence Society, </span><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">como la presencia de urgencia miccional, con o sin incontinencia de urgencia, asoci&aacute;ndose a un aumento de la frecuencia miccional y nocturia, en ausencia de condiciones patol&oacute;gicas o infecciosas. (1) </span> <span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Por tanto los s&iacute;ntomas m&aacute;s caracter&iacute;sticos de la VH son la urgencia miccional, la incontinencia de urgencia y la frecuencia miccional. Estos s&iacute;ntomas tambi&eacute;n se pueden presentar en otras patolog&iacute;as de pr&oacute;stata o en infecciones de orina, por lo que es conveniente hacer un diagn&oacute;stico diferencial.(1,2)</span>
<div class="page" style="text-align: justify;" title="Page 2">
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<div class="column"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Existen dos subtipos de VH:<br /> - </span><span style="font-size: 12pt; font-family: TimesNewRomanPS;">Vejiga hiperactiva- seca</span><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">, se caracteriza por un aumento de la frecuencia y de la urgencia miccional sin ir acompa&ntilde;ada de la incontinencia de urgencia.<br /></span></div>
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<span style="font-size: 12pt; font-family: TimesNewRomanPSMT;">- </span><span style="font-size: 12pt; font-family: TimesNewRomanPS;">Vejiga hiperactiva- h&uacute;meda</span><span style="font-size: 12pt; font-family: TimesNewRomanPSMT;">, se caracteriza por un aumento de la frecuencia y de la urgencia miccional, acompa&ntilde;ado de la incontinencia de urgencia.</span> <span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">La etiolog&iacute;a de la VH se debe a la hiperactividad del m&uacute;sculo detrusor de forma involuntaria durante la fase de llenado, por causas idiop&aacute;ticas o neurog&eacute;nicas. (1) La hiperactividad del detrusor se ha definido como un proceso urodin&aacute;mico que se caracteriza por presentar contracciones involuntarias de manera espont&aacute;nea o provocada. (2)</span>
<div class="page" style="text-align: justify;" title="Page 3">
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<div class="column"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Existen varios enfoques terap&eacute;uticos para tratar la VH, pudiendo dividirlos en tratamiento conservador y tratamiento no conservador. Dentro de las opciones no conservadoras se encuentra la </span><span style="font-size: 12pt; font-family: TimesNewRomanPS;">neuromodulaci&oacute;n. </span> <span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">La neuromodulaci&oacute;n se define como la modificaci&oacute;n de la actividad de los circuitos neuronales, sin causar lesi&oacute;n de los tejidos nerviosos. Con esta t&eacute;cnica se pretende activar o desactivar una red neuronal mediante la aplicaci&oacute;n de una corriente el&eacute;ctrica, modificando y controlando propiedades como la frecuencia, amplitud y ancho de pulso. </span></div>
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<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">El objetivo principal es estimular, inhibir o modificar determinador circuitos neuronales que funcionan de forma anormal. (3)</span>
<div class="page" style="text-align: justify;" title="Page 4">
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<div class="column"><span style="font-size: 12pt; font-family: TimesNewRomanPS;">- Neuromodulaci&oacute;n perif&eacute;rica: </span> <span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Se define como cualquier t&eacute;cnica de neuromodulaci&oacute;n que se encargue de estimular de forma indirecta las ra&iacute;ces nerviosas motoras y/o sensitivas de alg&uacute;n &oacute;rgano, v&iacute;scera u otras estructuras. </span></div>
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<div class="column"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">En el s&iacute;ndrome de VH, encontramos tres tipos de neuromodulaci&oacute;n perif&eacute;rica que resultan beneficiosas. Estos beneficios se obtienen debido a los procesos que desencadenan, que ser&aacute;n explicados posteriormente. </span></div>
<div class="column"><span style="font-size: 12pt; font-family: TimesNewRomanPS;">a) Neuromodulaci&oacute;n percut&aacute;nea del nervio tibial posterior: </span> <span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Esta t&eacute;cnica de neuromodulaci&oacute;n presenta varias ventajas frente a la estimulaci&oacute;n de fibras nerviosas, ya que es menos invasiva que la primera, adem&aacute;s de ser m&aacute;s asequible econ&oacute;micamente. La aplicaci&oacute;n de la neuromodulaci&oacute;n percut&aacute;nea del nervio tibial posterior se realiza a trav&eacute;s de un electrodo de aguja de calibre 35, situado 5 cent&iacute;metros por encima del maleolo medial y se coloca un electrodo de superficie en arco del pie. (4) </span></div>
<div class="column"><span style="font-size: 12pt; font-family: TimesNewRomanPS;">b) Neuromodulaci&oacute;n del nervio pudendo: </span> <span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Esta opci&oacute;n de neuromodulaci&oacute;n surgio? con el fin de buscar una alternativa a aquellos pacientes que no obten&iacute;an resultados con la estimulaci&oacute;n central o sacra. Consiste en estimular las aferencias pudendas. Surge como alternativa ya que las aferencias pudendas corresponden, seg&uacute;n estudios neurofisiol&oacute;gicos, en un 4% a S1, en un 60% a S2 y en un 35% a S3. (5)&nbsp;</span></div>
<div class="column"><span style="font-size: 12pt; font-family: TimesNewRomanPS;">c) Neuromodulaci&oacute;n transcut&aacute;nea del nervio tibial posterior: </span></div>
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<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">La electroestimulaci&oacute;n nerviosa mediante el Transcutaneous electrical nerve (TENS), consiste en la aplicaci&oacute;n de corrientes alternas de baja frecuencia, con impulsos de duraci&oacute;n desde los 0,005 a 0,4 milisegundos. La frecuencia debe ser entre 1 y 150 Hz. Estas corrientes se transmiten a trav&eacute;s de dos electrodos que se deben colocar en el trayecto del nervio perif&eacute;rico. Por otra parte el TENS es un tratamiento que se est&aacute; llevando a la actualidad de manera muy frecuente debido a su f&aacute;cil aplicaci&oacute;n y a que puede llevarse a cabo por parte del paciente en el domicilio. Adem&aacute;s se observa una buena tolerancia por parte del paciente y no ocasiona efectos adversos. (6)</span></div>
<div class="column">&nbsp;</div>
<div class="column"><span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">Bibliografia</span></div>
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<div class="page" title="Page 9">
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<div class="column"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">1. Salazar AH, Acun?a AB, Salazar IS. La Vejiga Hiperactiva. Rev.Obstet.Ginecol. 2013; Vol 8 (2): 101-110</span></div>
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<div class="column">2.Patra PB, Patra S. Research Findings on Overactive Bladder. Curr Urol. 2015 May;8(1):1&ndash;21.&nbsp;</div>
<div class="column">&nbsp;</div>
<div class="column">3.&nbsp;Textbook of Neuromodulation: Principles, Methods and Clinical Applications. Springer; 2014. 283 p.</div>
<div class="column">&nbsp;</div>
<div class="column">4. Staskin DR, Peters KM, MacDiarmid S, Shore N, de Groat WC. Percutaneous tibial nerve stimulation: a clinically and cost effective addition to the overactive bladder algorithm of care. Curr Urol Rep. 2012;13(5):327&ndash;34.</div>
<div class="column">&nbsp;</div>
<div class="column">5. Manri?quez G V, Sandoval S C, Lecannelier A J, Naser N M, Guzma?n R R, Valdevenito S R, et al. NEUROMODULACIO?N EN PATOLOGI?AS DE PISO
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<div class="column" style="text-align: justify;"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">PE?LVICO. Rev Chil Obstet Ginecol. Sociedad Chilena de Obstetricia y </span> <span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Ginecologi?a; 2010;75(1):58&ndash;63</span></div>
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<div class="column" style="text-align: justify;">6. Tellenbach M, Schneider M, Mordasini L, Thalmann GN, Kessler TM.Transcutaneous electrical nerve stimulation: an effective treatment for refractory non-neurogenic overactive bladder syndrome? World J Urol. 2013 Oct;31(5):1205&ndash;10.&nbsp;</div>
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<p style="text-align: justify;"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">&nbsp;</span></p>
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	'title' => 'Neuromodulación en vejiga hiperactiva ',
	'description' => '<p>&nbsp;</p>
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<div class="column"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">La vejiga hiperactiva (VH) es un s&iacute;ndrome cl&iacute;nico que se define por la </span><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPS'; font-style: italic;">International Continence Society, </span><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">como la presencia de urgencia miccional, con o sin incontinencia de urgencia, asoci&aacute;ndose a un aumento de la frecuencia miccional y nocturia, en ausencia de condiciones patol&oacute;gicas o infecciosas. (1) </span> <span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Por tanto los s&iacute;ntomas m&aacute;s caracter&iacute;sticos de la VH son la urgencia miccional, la incontinencia de urgencia y la frecuencia miccional. Estos s&iacute;ntomas tambi&eacute;n se pueden presentar en otras patolog&iacute;as de pr&oacute;stata o en infecciones de orina, por lo que es conveniente hacer un diagn&oacute;stico diferencial.(1,2)</span>
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<div class="column"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Existen dos subtipos de VH:<br /> - </span><span style="font-size: 12pt; font-family: TimesNewRomanPS;">Vejiga hiperactiva- seca</span><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">, se caracteriza por un aumento de la frecuencia y de la urgencia miccional sin ir acompa&ntilde;ada de la incontinencia de urgencia.<br /></span></div>
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<span style="font-size: 12pt; font-family: TimesNewRomanPSMT;">- </span><span style="font-size: 12pt; font-family: TimesNewRomanPS;">Vejiga hiperactiva- h&uacute;meda</span><span style="font-size: 12pt; font-family: TimesNewRomanPSMT;">, se caracteriza por un aumento de la frecuencia y de la urgencia miccional, acompa&ntilde;ado de la incontinencia de urgencia.</span> <span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">La etiolog&iacute;a de la VH se debe a la hiperactividad del m&uacute;sculo detrusor de forma involuntaria durante la fase de llenado, por causas idiop&aacute;ticas o neurog&eacute;nicas. (1) La hiperactividad del detrusor se ha definido como un proceso urodin&aacute;mico que se caracteriza por presentar contracciones involuntarias de manera espont&aacute;nea o provocada. (2)</span>
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<div class="column"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Existen varios enfoques terap&eacute;uticos para tratar la VH, pudiendo dividirlos en tratamiento conservador y tratamiento no conservador. Dentro de las opciones no conservadoras se encuentra la </span><span style="font-size: 12pt; font-family: TimesNewRomanPS;">neuromodulaci&oacute;n. </span> <span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">La neuromodulaci&oacute;n se define como la modificaci&oacute;n de la actividad de los circuitos neuronales, sin causar lesi&oacute;n de los tejidos nerviosos. Con esta t&eacute;cnica se pretende activar o desactivar una red neuronal mediante la aplicaci&oacute;n de una corriente el&eacute;ctrica, modificando y controlando propiedades como la frecuencia, amplitud y ancho de pulso. </span></div>
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<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">El objetivo principal es estimular, inhibir o modificar determinador circuitos neuronales que funcionan de forma anormal. (3)</span>
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<div class="column"><span style="font-size: 12pt; font-family: TimesNewRomanPS;">- Neuromodulaci&oacute;n perif&eacute;rica: </span> <span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Se define como cualquier t&eacute;cnica de neuromodulaci&oacute;n que se encargue de estimular de forma indirecta las ra&iacute;ces nerviosas motoras y/o sensitivas de alg&uacute;n &oacute;rgano, v&iacute;scera u otras estructuras. </span></div>
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<div class="column"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">En el s&iacute;ndrome de VH, encontramos tres tipos de neuromodulaci&oacute;n perif&eacute;rica que resultan beneficiosas. Estos beneficios se obtienen debido a los procesos que desencadenan, que ser&aacute;n explicados posteriormente. </span></div>
<div class="column"><span style="font-size: 12pt; font-family: TimesNewRomanPS;">a) Neuromodulaci&oacute;n percut&aacute;nea del nervio tibial posterior: </span> <span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Esta t&eacute;cnica de neuromodulaci&oacute;n presenta varias ventajas frente a la estimulaci&oacute;n de fibras nerviosas, ya que es menos invasiva que la primera, adem&aacute;s de ser m&aacute;s asequible econ&oacute;micamente. La aplicaci&oacute;n de la neuromodulaci&oacute;n percut&aacute;nea del nervio tibial posterior se realiza a trav&eacute;s de un electrodo de aguja de calibre 35, situado 5 cent&iacute;metros por encima del maleolo medial y se coloca un electrodo de superficie en arco del pie. (4) </span></div>
<div class="column"><span style="font-size: 12pt; font-family: TimesNewRomanPS;">b) Neuromodulaci&oacute;n del nervio pudendo: </span> <span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Esta opci&oacute;n de neuromodulaci&oacute;n surgio? con el fin de buscar una alternativa a aquellos pacientes que no obten&iacute;an resultados con la estimulaci&oacute;n central o sacra. Consiste en estimular las aferencias pudendas. Surge como alternativa ya que las aferencias pudendas corresponden, seg&uacute;n estudios neurofisiol&oacute;gicos, en un 4% a S1, en un 60% a S2 y en un 35% a S3. (5)&nbsp;</span></div>
<div class="column"><span style="font-size: 12pt; font-family: TimesNewRomanPS;">c) Neuromodulaci&oacute;n transcut&aacute;nea del nervio tibial posterior: </span></div>
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<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">La electroestimulaci&oacute;n nerviosa mediante el Transcutaneous electrical nerve (TENS), consiste en la aplicaci&oacute;n de corrientes alternas de baja frecuencia, con impulsos de duraci&oacute;n desde los 0,005 a 0,4 milisegundos. La frecuencia debe ser entre 1 y 150 Hz. Estas corrientes se transmiten a trav&eacute;s de dos electrodos que se deben colocar en el trayecto del nervio perif&eacute;rico. Por otra parte el TENS es un tratamiento que se est&aacute; llevando a la actualidad de manera muy frecuente debido a su f&aacute;cil aplicaci&oacute;n y a que puede llevarse a cabo por parte del paciente en el domicilio. Adem&aacute;s se observa una buena tolerancia por parte del paciente y no ocasiona efectos adversos. (6)</span></div>
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<div class="column"><span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">Bibliografia</span></div>
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<div class="column"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">1. Salazar AH, Acun?a AB, Salazar IS. La Vejiga Hiperactiva. Rev.Obstet.Ginecol. 2013; Vol 8 (2): 101-110</span></div>
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<div class="column">2.Patra PB, Patra S. Research Findings on Overactive Bladder. Curr Urol. 2015 May;8(1):1&ndash;21.&nbsp;</div>
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<div class="column">3.&nbsp;Textbook of Neuromodulation: Principles, Methods and Clinical Applications. Springer; 2014. 283 p.</div>
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<div class="column">4. Staskin DR, Peters KM, MacDiarmid S, Shore N, de Groat WC. Percutaneous tibial nerve stimulation: a clinically and cost effective addition to the overactive bladder algorithm of care. Curr Urol Rep. 2012;13(5):327&ndash;34.</div>
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<div class="column">5. Manri?quez G V, Sandoval S C, Lecannelier A J, Naser N M, Guzma?n R R, Valdevenito S R, et al. NEUROMODULACIO?N EN PATOLOGI?AS DE PISO
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<div class="column" style="text-align: justify;"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">PE?LVICO. Rev Chil Obstet Ginecol. Sociedad Chilena de Obstetricia y </span> <span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">Ginecologi?a; 2010;75(1):58&ndash;63</span></div>
<div class="column" style="text-align: justify;">&nbsp;</div>
<div class="column" style="text-align: justify;">6. Tellenbach M, Schneider M, Mordasini L, Thalmann GN, Kessler TM.Transcutaneous electrical nerve stimulation: an effective treatment for refractory non-neurogenic overactive bladder syndrome? World J Urol. 2013 Oct;31(5):1205&ndash;10.&nbsp;</div>
</div>
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<p>&nbsp;</p>
</div>
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<p style="text-align: justify;"><span style="font-size: 12.000000pt; font-family: 'TimesNewRomanPSMT';">&nbsp;</span></p>
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