El peroné flotante: resultado de una luxación tibioastragalina pura con lesión de la articulación tibioperonea proximal: reporte de caso / The floating fibula: outcome of pure tibiotalar dislocation with lesion to the proximal tibiofibular joint: case report

ANTECEDENTES El peroné flotante tras un traumatismo de alta energía es una entidad muy poco frecuente. Este es el primer reporte de caso asociado a luxación del tendón bicipital. OBJETIVO Presentar un caso de peroné flotante tras luxación divergente de tobillo asociado a luxación peronea proximal. MATERIALES Y MÉTODOS Mujer de 17 añ que, tras accidente de tráfico, sufrió caída y presentó dolor y deformidad del tobillo izquierdo, junto con dolor e impotencia funcional de la rodilla ipsilateral. En las radiografías, se apreció una luxación pura divergente del tobillo izquierdo de tipo IV. Se realizó reducción cerrada en urgencias. El estudio se complementó con una resonancia magnética que mostró una rotura completa de la sindesmosis y del ligamento deltoideo, así como una fractura no desplazada de la meseta tibial externa, junto con un desgarro de la cápsula tibioperonea proximal y desprendimiento completo del ligamento lateral externo y del tendón bicipital desde su inserción en la cabeza del peroné. Se realizó reanclaje de la sindesmosis y del ligamento deltoideo, así como del ligamento lateral externo y del tendón bicipital mediante anclajes óseos metálicos y reducción de peroné tanto proximal como distalmente, mediante sistema de sutura tipo botón. Se inmovilizó con férula cruropédica por cuatro semanas. RESULTADOS La paciente presentó recuperación completa de la fuerza a los cinco meses de seguimiento, con movilidad completa del tobillo y de la rodilla. CONCLUSIÓN El peroné flotante es muy poco frecuente; sólo se ha descrito un caso en la literatura. Implica la disrupción de la articulación tibioperonea proximal y distal, lo que puede provocar inestabilidad en la rodilla y en el tobillo. Por tanto, ante un traumatismo de alta energía en el tobillo, es necesaria la exploración minuciosa de la rodilla ipsilateral.

BACKGROUND Floating fibula after high-energy trauma is a very uncommon entity. The present is the first report of a case associated with avulsion of the bicipital tendon. PURPOSE To present a case of floating fibula after divergent ankle dislocation associated with proximal peroneal dislocation. MATERIALS AND METHODOS A 17-year-old woman who fell after a traffic accident and presented pain and deformity of the left ankle with pain and functional impotence in the ipsilateral knee. The radiographs showed a pure divergent type-IV left-ankle dislocation. Closed reduction was performed in the emergency room. The study was complemented with a magnetic resonance imaging scan which showed complete rupture of the syndesmosis and the deltoid ligament, as well as a non-displaced fracture of the external tibial plateau together with a tear of the proximal tibiofibular capsule and complete detachment of the external lateral ligament and bicipital tendon from its insertion in the peroneal head. The syndesmosis and deltoid ligament were reanchored, as well as the external lateral ligament and the bicipital tendon, using metallic bone anchors and fibula reduction both proximally and distally, using a suture-button system. The patient was immobilized with a long-leg splint for four weeks. RESULTS The patient presented complete recovery of strength at five months of follow-up. CONCLUSSION Floating fibula is a rare entity, with only one case described in the literature. It involves a disruption of the proximal and distal tibiofibular joint, which can lead to knee and ankle instability. Therefore, in cases of high-energy trauma to the ankle, a careful examination of the ipsilateral knee is necessary.

Synthesis, characterization and utilization of a new series of 1,2,3-triazole derivatives to neutralize some toxic activities of Bothrops jararaca snake venom

Abstract Snake envenomation is a public health problem, and while serum therapy prevents death, the local effects of venoms can lead to amputations or morbidities. Thus, alternative treatments deserve attention. In this study, we tested eight derivatives of 1,2,3-triazole against some toxic activities of Bothrops jararaca venom. The derivatives were synthesized, and their structures analyzed by infrared and nuclear magnetic resonance. After that, the ability of compounds to inhibit hemolysis, coagulation, proteolysis, hemorrhaging, edema, and lethal activities of B. jararaca venom was investigated. The derivatives were incubated with B. jararaca venom (incubation protocol), administered before (prevention protocol) or after (treatment protocol) injecting venom into the mice. Then, hemorrhaging assay occurred. As a result, most of the derivatives inhibited the activities, even if they were incubated, injected before or after B. jararaca venom. However, the derivatives TRI 07 and TRI 18 seemed to be the most efficient in impairing hemorrhaging. The derivatives showed a low drug score of toxicity based on an in silico technique. Therefore, the derivatives fulfilled physicochemical and biological requirements to become drugs, and they may be a brand new initiative for designing antivenom molecules to complement antivenom therapy to efficiently block tissue necrosis or any other local effects.

Caracterización de la enzima similar a trombina del veneno de Bothrops pictus "jergón de costa" / Characterization of thrombin like enzyme from Bothrops pictus venom

Realizar una caracterización bioquímica y molecular del principio coagulante del veneno de Bothrops pictus. Materiales y métodos. Se realizó la amplificación del gen a partir de cDNA, se analizó la homología de la secuencia nucleotídica y de la proteína deducida. Se procedió a purificar la enzima para los análisis de secuenciación directa N terminal de los primeros 20 aminoácidos y los ensayos de coagulación sobre plasma humano y fibrinógeno humano, por otro lado, se evaluó el patrón de corte del fibrinógeno por medio de PAGE SDS y la actividad defibrinogenante en roedores albinos (18-22 g). Se determinó el contenido de carbohidratos asociados, el efecto de inhibidores clásicos de proteasas y el efecto de iones bajo la forma de cloruros. Resultados. La enzima mostró homología en la estructura primaria con otras TLEs reportadas para la familia Viperidae, la dosis coagulante mínima (DCM) sobre plasma y fibrinógeno humano fue de 18 y 6 ug respectivamente y su potencia coagulante fue de 131,1 NHI unidades de trombina. La enzima se mostró estable a condiciones fisiológicas y prescinde de iones para su actividad. Los carbohidratos asociados detectados fueron hexosas (25,76%), hexosaminas (13,1%) y ácido siálico (0,76%). Los agentes fluoruro de fenil metil sulfonil floruro (PMSF) ditiotreitol (DTT) fueron los principales inhibidores de la actividad enzimática en tanto que la heparina no tuvo efecto inhibidor. Conclusiones. El principio coagulante del veneno de Bothrops pictus es una enzima similar a trombina...

To perform a biochemical and molecular characterization of the coagulant principle from Bothrops pictus venom. Materials and methods. We amplified the genetic sequence of this enzyme from cDNA and analyzed the homology of its nucleotide sequence and its deduced protein. This enzyme was also purified for N-terminal sequencing of first 20 amino acids and for coagulation assays using human plasma and human fibrinogen. Furthermore, cleavage pattern on fibrinogen was evaluated using SDS-PAGE and defibrinogenant activity on white mice (18-22 g). Finally, associated carbohydrate content, effect of protease inhibitors and chloride ions on its enzymatic activity were analyzed. Results. The Thrombin-like Enzyme from Bothrops pictus showed homology at primary level of structure with other previously reported TLEs from Viperidae family. Minimum Coagulant Dosis (MCD) on plasma and human fibrinogen were 18 and 6 ug, respectively, and its coagulant potency was 131.1 NHI Thrombin units. This TLE was stable under physiological conditions and chloride ions are not necessary for its activity. Detected associated carbohydrates were hexoses (25.76%), hexosamines (13.12%) and sialic acid (0.76%). Phenyl methyl sulphonyl fluoride (PMSF) and dithiothreitol (DTT) were the main inhibitors of its enzymatic activity, but heparin had no inhibitor effect. Conclusions. The coagulant principle of Bothrops pictus venom is a Thrombin-like enzyme...

The red seaweed Plocamium brasiliense shows anti-snake venom toxic effects

Background Snakebite is considered a neglected tropical disease by the World Health Organization. In Brazil, about 70% of the envenomation cases are caused by Bothrops snakes. Its venom may provoke hemorrhage, pain, necrosis, hemolysis, renal or cardiac failure and even death in victims. Since commercial antivenom does not efficiently neutralize the local toxic effects of venoms, natural products have been tested in order to provide alternative or complementary treatment to serum therapy. Therefore, the present study aimed to evaluate the ability of the seaweed Plocamium brasiliense and its active derivatives to neutralize hemorrhagic, edematogenic, hemolytic, coagulant and proteolytic activities of B. jararaca venom. Methods Specimens of P. brasiliense were collected in Rio de Janeiro state, Brazil, dried and submitted to oil extraction using four solvents of increasing polarities, n-hexane (HEX), dichloromethane (DCM), ethyl acetate (ETA) and hydroalcoholic solution (HYD). The solvents were evaporated, yielding HEX, DCM, ETA and HYD extracts. Further, all extracts were dissolved in dimethylsulfoxide. In addition, two monoterpenes (8-bromo-3,4,7-trichloro-3,7-dimethyl-1E, 5E-octadiene and 1,8-dibromo-3,4,7-trichloro-3,7-dimethyl-1E, 5E-octadiene) and a cholesterol fraction were isolated from the extract of P. brasiliense prepared in hexane. Algal samples were incubated for 30 minutes with B. jararaca venom, and then tested for lethality; hemorrhagic, edematogenic, hemolytic, coagulant and proteolytic effects. Results Most of the algal extracts inhibited the toxic effects with different potencies. The DCM extract was the most effective, since it inhibited all types of toxic activity. On the other hand, the HYD extract failed to inhibit any effect. Moreover, the isolated products inhibited proteolysis and protected mice from hemorrhage in 30% of the cases, whereas 8-bromo-3,4,7-trichloro-3,7-dimethyl-1E, 5E-octadiene inhibited 100% and ...

El intervencionismo coronario percutáneo previo no aumenta la mortalidad hospitalaria en cirugía coronaria: análisis de una serie de 63.420 casos / Previous Percutaneous Coronary Intervention Does Not Increase In-Hospital Mortality After Surgical Revascularization: Analysis of 63420 Cases

Introducción En diversas publicaciones de los últimos años se señala una mortalidad hospitalaria mayor de la cirugía de revascularización miocárdica en pacientes con antecedente de intervencionismo coronario percutáneo previo exitoso; por su parte, los modelos de riesgo de mortalidad en cirugía cardíaca publicados hasta la actualidad no han incluido este antecedente como factor de riesgo. Objetivo Analizar si el intervencionismo coronario percutáneo previo es un factor de riesgo de mortalidad hospitalaria en la cirugía de revascularización coronaria. Material y métodos Entre enero de 1997 y diciembre de 2007 se analizaron un total de 78.794 pacientes sometidos a cirugía coronaria, recogidos en la base de datos del Ministerio de Sanidad de España. Tras aplicar los criterios de exclusión, el estudio se realizó sobre un total de 63.420 pacientes, de los que 2.942 (4,6%) tenían intervencionismo coronario percutáneo previo. Las variables continuas se compararon con las pruebas de U de Mann-Whitney o de la t de Student y las variables categóricas, mediante chi cuadrado. Se realizó un análisis de regresión logística univariado y multivariado y un análisis multivariado que incluía un índice de propensión. Resultados El intervencionismo coronario percutáneo previo no fue un predictor independiente de mortalidad hospitalaria en el análisis multivariado (odds ratio 0,88; intervalo de confianza del 95% 0,72-1,07; p = 0,20) ni en el modelo que incluía un índice de propensión (odds ratio 0,9; intervalo de confianza 95% 0,75-1,08; p = 0,27). Conclusión El intervencionismo coronario percutáneo previo parece no ser un factor de riesgo independiente de mortalidad hospitalaria en pacientes con intervención quirúrgica coronaria.

Introduction Recent publications indicate higher in-hospital mortality following myocardial revascularization in patients with previous history of successful percutaneous coronary intervention. Yet, no risk models of surgical mortality have included percutaneous intervention as a risk factor. Objectives The purpose of this study was to analyze whether previous percutaneous coronary intervention is a risk factor of in-hospital mortality in coronary artery bypass grafting. Methods The study included 78794 patients retrieved from the Spanish Ministry of Health database, who underwent coronary artery bypass graft surgery between January 1997 and December 2007. After applying exclusion criteria, 63420 patients were included in the study, 2942 (4.6%) of whom had previously undergone percutaneous coronary intervention. Continuous variables were compared using the Mann-Whitney U test or Student's t test, and categorical variables using the chi-square test. Univariate and multivariate logistic regression analyses and a multivariate analysis including a propensity score were performed. Results Previous percutaneous coronary intervention was not an independent risk factor of in-hospital mortality in the multivariate logistic regression analysis (odds ratio 0.88; 95% confidence interval, 0.72-1.07; p = 0.20) or after adjusting for propensity score (odds ratio 0.9; 95% confidence interval, 0.75-1.08; p = 0.27). Conclusion Previous percutaneous coronary intervention is not an independent risk factor of in-hospital mortality in patients undergoing coronary artery bypass grafting.

Inhibitory effect of a Brazilian marine brown alga Spatoglossum schröederi on biological activities of Lachesis muta snake venom

The ability of crude extracts of the brown seaweed Spatoglossum schröederi to counteract some of the biological activities of Lachesis muta snake venom was evaluated. In vitro assays showed that only the extract of S. schröederi prepared in ethyl acetate was able to inhibit the clotting of fibrinogen induced by L. muta venom. On the other hand, all extracts were able to inhibit partially the hemolysis caused by venom and those prepared in dichloromethane or ethyl acetate fully neutralized the proteolysis and hemorrhage produced by the venom. Moreover, the dichloromethane or ethyl acetate extracts inhibited the hemolysis induced by an isolated phospholipase A2 from L. muta venom, called LM-PLA2-I. In contrast, the hexane extract failed to protect mice from hemorrhage or to inhibit proteolysis and clotting. These results show that the polarity of the solvent used to prepare the extracts of S. schröederi algae influenced the potency of the inhibitory effect of the biological activities induced by L. muta venom. Thus, the seaweed S. schröederi may be a promising source of natural inhibitors of the enzymes involved in biological activities of L. muta venom.

Disección septal tras infarto de miocardio inferior / Septal dissection after inferior acute myocardial infarction

La disección del septum interventricular y su rotura constituyen una posible causa de la comunicación interventricular luego de un infarto de miocardio. En esta presentación se describe el caso de un varón de 68 años con un infarto agudo de miocardio inferior que fue intervenido en forma satisfactoria de un seudoaneurisma septal diagnosticado intraoperatoriamente.

Septal dissection after inferior acute myocardial infarction Septal dissection and rupture are a possible cause of ventricular septal defect after acute myocardial infarction. This presentation reports the case of a 68 year-old man with inferior acute myocardial infarction, who was satisfactorily operated of a septal pseudoaneurysm diagnosed intraoperatively.

Anti-snake venom effect of secodolastane diterpenes isolated from Brazilian marine brown alga Canistrocarpus cervicornis against Lachesis muta venom

The effect of a Brazilian algae extract and also a mixture of two secodolastane diterpenes (linearol/isolinearol) that were isolated from the marine brown alga Canistrocarpus cervicornis were evaluated against biological activities of Lachesis muta snake venom. In vitro assays showed that the crude extract and the diterpenes were able to inhibit the clotting and proteolytic activity induced by L. muta crude venom, but not the hemolytic activity. However, only the diterpenes inhibited the hemolysis caused by a purified phospholipase A2 previously isolated from L. muta venom, denoted LM-PLA2-I. Interestingly, the crude algal extract and the diterpenes were able to protect mice from hemorrhage induced by L. muta venom. Thus, we may conclude that marine algae are rich and powerful sources of molecules that may be used against L. muta accidents in order to improve treatment of envenomation by this snake.