Prótesis tumoral de cadera en displasia fibrosa de fémur proximal. Informe de un caso / Tumor hip prosthesis in fibrous dysplasia of proximal femur. Case report

Resumen: Antecedentes: La displasia fibrosa se caracteriza por la formación de tejido fibroso inmaduro que genera trabéculas mal formadas. Su afectación puede ser monostótica o poliostótica. Caso clínico: Femenino de 30 años con displasia fibrosa de cadera izquierda. A los 15 años sufre fractura de la misma cadera sin trauma aparente, manejada conservadoramente y con acortamiento importante de la misma extremidad. A los 30 años de edad se embaraza, presenta dolor en cadera izquierda y se exacerba la deformidad y el acortamiento. La radiografía simple muestra deformidad en «cayado de pastor¼, se manejó con bifosfonatos y la tomografía corrobora los hallazgos anteriores. Posteriormente sufrió caída con fractura subtrocantérica de cadera izquierda en sitio de displasia, imagen de vidrio despulido de apariencia quística que involucra el cuello femoral, zona trocantérica y subtrocantérica. Se colocó prótesis tumoral de cadera izquierda, a los cuatro meses mostró evolución favorable. Conclusión: La prótesis tumoral femoral reduce la deformidad, mejora la longitud y disminuye el dolor en pacientes con resección de displasia fibrosa de cadera.

Abstract: Background: Fibrous dysplasia is characterized by the formation of fibrous tissue that generates immature malformed trabeculae. Their involvement may be monostotic or poliostotic. Case report: Thirty years old female with fibrous dysplasia of the left hip. At age 15 suffered hip fracture without apparent trauma, she was managed conservatively and significant shortening of the same limb was observed. At 30 years old, is pregnant, it had left hip pain, deformity and shortening is exacerbated. Simple radiography showed «shepherd's crook deformity¼, she was treated with bisphosphonates. Computed axial tomography corroborates previous findings. She subsequently underwent subtrochanteric fracture fall with left hip dysplasia site, ground glass image of cystic appearance involving the femoral neck, trochanteric and subtrochanteric area. Tumor prosthesis of the left hip was implanted, four months evolution was favorable. Conclusion: Modular hip prosthesis system, reduces deformity, improves length and reduces pain in patients with resection of fibrous dysplasia of the hip.

Pioderma gangrenoso post-quirúrgico: reporte de un caso en paciente con fibrosis retroperitoneal / Postoperative pyoderma gangrenosum: a case report of a patient with retroperitoneal fibrosis

El pioderma gangrenoso (PG), es una patología ulcerativa infrecuente de etiología desconocida, asociado ocasionalmente a enfermedades autoinmunes. Es una condición crónica, de curso clínico impredecible y puede ser invalidante. Al ser complejo su diagnóstico, el retraso del mismo puede ocasionar al paciente morbilidades añadidas, como: tratamientos incorrectos y períodos de hospitalizaciones prolongados. Se presenta el caso de un paciente de 52 años, sin antecedentes mórbidos, que ingresa a Urgencias en el Hospital el Pino, por dolor abdominal recurrente. Durante el estudio de imágenes se evidencia una masa retroperitoneal, asociada a hidro-uretero-nefrosis izquierda. Ingresa al Servicio de Cirugía para estudio, realizándose una laparotomía media exploratoria y toma de muestras para biopsia. Procedimiento realizado sin incidentes. El paciente pese a múltiples tratamientos otorgados en esa unidad, evoluciona con dehiscencia de suturas recurrentes por tres meses. Evaluado por Dermatología se inicia estudio y se diagnostica PG, teniendo una excelente respuesta al tratamiento indicado.

Gangrenous pioderma (PG) is an uncommon ulcerative pathology of unknown etiology associated with autoimmune diseases. It is a non-predictable chronic condition, that can be incapacitating and patients that suffer this disease can also present systemic compromise. As it is a diagnosed by exclusion it may lead to long periods of failed treatments. The present work deals with a case of a 52-year-old male patient with no prior record of disease, who was admitted to the ER of El Pino Hospital suffering from recurrent abdominal pain. During the imaging study a retroperitoneal mass was found, associated with a left hydro-uretero-nephrosis. He was admitted and a exploratory mid-laparotomy was performed and samples were taken for biopsy. The procedure was successful and the established protocol was followed. However, during the recovery period the patient developed repeated surgical wound dehiscences of the surgical wounds. An internal consultation with the Dermatology Service took place, and the diagnosis of PG was made; proper pharmaceutical treatment was provided attaining excellent results.

Adelantamiento rotuliano tipo Bandi versus limpieza articular artroscópica para el manejo de la artrosis patelofemoral: Seguimiento a un año / Bandi tibial tubercule osteotomy vs artrhroscopy lavage in patelo femoral arthritis: 1 year follow-up

Introducción: La osteoartritis (OA) es una artropatía degenerativa que modifica las propiedades mecánicas y biológicas, del cartílago articular y del hueso subcondral, su tratamiento va encaminado hacia el alivio del dolor, mantener la función articular y reducir la progresión de la enfermedad. El objetivo de este trabajo es comparar los resultados quirúrgicos de la limpieza articular artroscópica y adelantamiento rotuliano utilizando la escala WOMAC. Metodología: Estudio transversal en el que se compara el resultado funcional del tratamiento de la OA patelofemoral en pacientes operados por limpieza articular artroscópica y pacientes operados por adelantamiento rotuliano con técnica de Bandi. Las variables fueron, género, edad, lado afectado, técnica quirúrgica e índice de WOMAC prequirúrgico y a los 12 meses de seguimiento. Utilizamos estadística descriptiva así como t de Student para la diferencia de promedios de WOMAC entre ambos grupos de pacientes. Resultados: n = 37 pacientes, la edad promedio fue 53.48 años (28-82), ± 12.55, el género 11 (29.7%) hombres y 26 (70.3%) mujeres, el lado afectado: 19 (51.35%) derecho y 18 (48.65%) izquierdo. Técnica quirúrgica: 45.9% artroscópico y 54.1% con técnica de Bandi. Los pacientes operados mediante Bandi y adelantamiento rotuliano tuvieron mejoría del dolor, rigidez articular y de la función física (p = 0.00); la comparación del puntaje global de WOMAC para ambas técnicas al año no mostró diferencias estadísticamente significativas (p = 0.78). Conclusión: Ambas técnicas (Bandi y limpieza artroscópica) ofrecen buenos resultados a los 365 días de operados, sin embargo, los pacientes manejados por limpieza artroscópica presentan menor dolor comparados con los de adelantamiento rotuliano tipo Bandi.

Introduction: Osteoarthritis is a degenerative joint disease that modifies the mechanical and biological properties of articular cartilage and subchondral bone, treatment is aimed at relieving pain, maintain joint and reduce disease progression function. The aim of this paper is to compare the surgical outcomes of the arthroscopic articular cleaning and Bandi procedure by using the WOMAC scale. Methods: Cross-sectional study, functional outcome of treatment of patellofemoral ostheoarthritis by arthroscopic articular cleaning and Bandi procedure are compared. Variables were gender, age, affected side, surgical technique and preoperative and 12 months follow up WOMAC evaluation. We used descriptive statistics and t-test for mean difference in WOMAC between both groups of patients. Results: n = 37 patients, the mean age was 53.48 (28-82), ± 12.55 years; 11 (29.7%) males and 26 (70.3%) women, the affected side: 19 (51.35%) right and 18 (48.65%) left. Surgical technique: 45.9% arthroscopic articular cleaning and 54.1% Bandi procedure. Patients operated by both technics: Bandi and arthroscopic articular cleaning had improvement in pain, stiffness and physical function (p = 0.00); comparison of global WOMAC score for both techniques a year after showed no statistically significant differences (p = 0.78). Conclusion: Both techniques (Bandi and arthroscopic articular cleaning) offer good results at 365 days of surgery, however patients managed by arthroscopic articular cleaning have less pain compared with Bandi procedure.

Stereotactic retransplantation in Parkinson's disease: clinical, imaging and electrophysiological evidence of adrenal brain graft viability

In March 1993, a patient with idiopathic Parkinson disease who had received an adrenal brain autograft 6 years before underwent bilateral stereotactic transplantation of a mesencephalic cell suspension into the striatum, in order to prevent further deterioration in his neurological condition. During the CT-guided surgical planning and the transplantation procedures, electrophysiological evidence of the adrenal graft viability was assessed. Based on these findings, we drew the preliminary conclusion that the chromaffin tissue implanted in April 1987 is still functional, which explains the clinical evolution of this patient during the postoperative long-term follow-up

CT-oriented microrecording guide selective thalamotomy

A further trial of CT-oriented microrecording guided stereotactic selective thalamotomy was conducted at the centro Internacional de Restauraciøn Neuroløgica, Havana City as treatment of resting tremor in 11 patients with idiopathic Parkinson's disease (PD) and in 3 other patients with intentional tremor associated with multisystemic atrophy and cerebral palsy. Three of the parkinsonian patients had undergone fetal mesencephalic tissue transplantation with significant improvement of the most debilitating symptoms of PD and stabilization the motor state, but predominantly unilateral tremor had impaired them progressively despite increased levodopa doses. A Leksell frame was used with a novel surgical planning system and electrophysiological recording to identify the optimal target point inside the ventralis intermedius. In all but case, the tremor was totally arrested. No persistent complications were observed

Computer assisted CT-guided stereotactic transplantation of foetal ventral mesencephalon to the caudate nucleus and putamen in Parkinson's disease

We report our preliminary results related to CT-guided stereotactic transplantation of foetal ventral mesencephalic cell suspension into the stiatum of five patients with idiopathic Parkinson's disease. The mean age was 51 years, the evolution time of the disease ranged from 7 to 14 years, and all of them had motor complications associated with chronic l-dopa therapy. The patients were evaluated according to the Core Assessment Program from Intracerebral Transplantation (CAPIT) for one year before and three months after surgery. The postoperative clinical assessment demostrated significant improvement of neurological symtoms and reduction of daily l-dopa dosage

Effect of brodimoprim on Mycobacterium leprae in vitro and in mouse foot-pads.

The new in vitro screening system reported earlier was adopted to determine anti-M. leprae activity of a dihydrofolate reductase inhibitor, brodimoprim, and the results were compared with those obtained using mouse foot-pad technique. Even though the MIC of brodimoprim against M. leprae was very high compared to other commonly used anti-leprosy drugs, in combination with dapsone it showed a remarkable synergistic activity in inhibiting the growth of M. leprae at concentrations much lower than the MICs of each of the drugs used singly. Similar effects were also demonstrated in mouse foot-pad experiments.

An in vitro culture method for screening new drugs against Mycobacterium leprae.

An in vitro culture system has been devised for the maintenance and growth of M. leprae in a cell-free medium. Cells from four-week old cultures could be transferred to fresh medium and normal growth was observed in subcultures. Using this system, the M.I.Cs of dapsone and rifampicin were determined. Dapsone at 25 ng/ml and rifampicin at 300 ng/ml completely inhibited the growth of host-grown as well as in vitro-adapted M. leprae. It was further shown that the effects of both the drugs were bactericidal; this observation was subsequently confirmed using mouse foot-pad technique.

Epidermolisis ampollar distrofica recesiva con compromiso esofagico. / Recessive distrophic epidermolysis bullosa with severe esophagic involvement

Los autores presentan un paciente del sexo masculino, de 44 anos de edad, portador de una epidermolisis ampollar distrofica recesiva. Se analiza la clasificacion actual y se hacen las consideraciones clinicas e histologicas de cada uno de los cuadros, con especial referencia al enfermo que lo motiva. Se describe el cuadro dermatologico y se ponen en evidencia las graves manifestaciones esofagicas. Se hace una sintesis de los trabajos sobre el tema publilinfomas de tipo histiocitario. En 1977 te