Research progress of the diagnosis and treatment of anterior shoulder instability / 中国修复重建外科杂志

The shoulder joint is the most prone to dislocation in the whole body, and more than 95% of them are anterior dislocation. Improper treatment after the initial dislocation is easy to lead to recurrent anterior dislocation or anterior shoulder instability, and the outcomes following conservative treatment is poor. Anterior shoulder instability can damage the soft tissue structure and bone structure that maintain the stability of shoulder joint, among which bone structure is the most important factor affecting the stability of shoulder joint. Diagnosis should be combined with medical history, physical examination, and auxiliary examination. Currently, three-dimensional CT is the most commonly used auxiliary examination means. However, various bone defect measurement and preoperative evaluation methods based on three-dimensional CT and the glenoid track theory have their own advantages and disadvantages, and there is still a lack of gold standard. Currently, the mainstream treatment methods mainly include Bankart procedure, coracoid process transposition, glenoid reconstruction with free bone graft, Bankart combined with Remplissage procedure, and subscapular tendon binding tamponade, etc. Each of these procedures has its own advantages and disadvantages. For the diagnosis and treatment of anterior shoulder instability, there are still too many unknown, further research and exploration need to be studied.

Hipertensión arterial e insuficiencia cardíaca: Innovaciones terapéuticas

Alrededor de un tercio de los adultos en la mayoría de las comunidades presentan hipertensión arterial (HTA). En Argentina, los registros denotan una prevalencia del 33,5%; donde el 44,6% son hombres y el 25,9% son mujeres. Se estima que un tercio de la población con HTA desconoce que la padece y la mitad se encuentra bajo tratamiento antihipertensivo; pero sólo la cuarta parte está bien controlada. Por otro lado la epidemia de insuficiencia cardíaca (IC) alcanza aproximadamente los 61 millones de individuos a nivel mundial, y se encuentra estrechamente relacionada con la HTA, siendo ésta la principal etiología sobre todo en Europa y Estados Unidos. De aquí surge el vínculo entre ambas entidades, ya muy conocidas y con fármacos avalados para su tratamiento hace ya mucho tiempo. Tanto la HTA como la IC (sea con fracción de eyección preservada o reducida) son patologías muy vinculadas y prevalentes en todas las comunidades. Los últimos avances en investigación nos llevan a plantearnos que a mayor reducción de los valores de presión arterial, se generan una cascada de mecanismos beneficiosos para el sistema cardiovascular que conllevan beneficios clínicos francos. Ahora bien, ¿existen nuevas terapéuticas que puedan encausar el rumbo de estos pacientes o sólo existen nuevos y más estrictos objetivos con los fármacos que previamente conocíamos?

About a third of adults in most communities have high blood pressure (HBP). In Argentina the records show a prevalence of 33.5%; where 44.6% are men and 25.9% are women. It is estimated that a third of the population with HBP is unaware that they suffer from it and half are under antihypertensive treatment; but only a quarter is well controlled. On the other hand, the epidemic of heart failure (HF) reaches approximately 61 million individuals worldwide, and is closely related to hypertension, this being the main etiology, especially in Europe and the United States. From here arises the link between both entities, already well known and with drugs endorsed for their treatment for a long time. Both HBP and HF (whether with preserved or reduced ejection fraction) are highly linked and prevalent pathologies in all communities. The latest advances in research lead us to consider that the greater the reduction in blood pressure values, a cascade of beneficial mechanisms for the cardiovascular system are generated that lead to frank clinical benefits. Now, are there new therapies that can guide the course of these patients or are there only new and stricter objectives with the drugs that we previously knew?

Cerca de um terço dos adultos na maioria das comunidades tem hipertensão arterial (HTA). Na Argentina, os registros mostram uma prevalência de 33,5%; onde 44,6% são homens e 25,9% são mulheres. Estima-se que um terço da população com HTA desconhece que a sofre e metade está em tratamento anti-hipertensivo; mas apenas um quarto está bem controlado. Por outro lado, a epidemia de insuficiência cardíaca (IC) atinge cerca de 61 milhões de pessoas em todo o mundo, e está intimamente relacionada à hipertensão, sendo esta a principal etiologia, principalmente na Europa e nos Estados Unidos. Daqui surge o vínculo entre as duas entidades, já bastante conhecidas e com medicamentos há muito endossados para o seu tratamento. Tanto a HTA quanto a HF (seja com fração de ejeção preservada ou reduzida) são patologias altamente vinculadas e prevalentes em todas as comunidades. Os últimos avanços nas pesquisas nos levam a considerar que quanto maior a redução dos valores da pressão arterial, gera-se uma cascata de mecanismos benéficos para o sistema cardiovascular que levam a francos benefícios clínicos. Agora, ¿existem novas terapias que podem orientar o curso desses pacientes ou existem apenas alvos novos e mais rígidos com medicamentos que conhecíamos anteriormente?

Porción hepática izquierda (A05. 8. 01. 037) / Left part of the liver

RESUMEN: El conocimiento anatómico es necesario para la cirugía hepática. Los conocimientos acerca de la porción izquierda del hígado que aparecen en los textos de anatomía, cirugía y en la Internet deben ser mejorados y enriquecidos, proponemos hacerlo con este trabajo. Se estudiaron 286 hígados humanos que nos permitieron determinar entre otros conocimientos los siguientes: La porción izquierda del hígado fue más grande que la derecha en 21 % de casos. 2) La porción izquierda del hígado estuvo formada por los cuatro primeros segmentos portales (79 %) o por los cinco primeros (21 %). 3) La fisura umbilical se inclinó 50 grados hacia la izquierda en relación al plano sagital del hígado y no contuvo a la vena hepática izquierda en 100 % de casos. 4) La vena hepática izquierda tuvo un trayecto intrasegmentario y presentó tres modalidades de drenaje. 5) La irrigación arterial de los segmentos izquierdos I y IV nació de la rama derecha en 16 % y de ambas ramas en 24 %. 6) El drenaje biliar de los segmentos derechos VI-VII llegó al conducto hepático izquierdo en 21 % de casos. Estos resultados fueron diferentes de los conocimientos que figuran en los textos de anatomía humana usados en las Escuelas de Medicina a nivel general.

SUMMARY: Accurate anatomical knowledge is necessary for liver surgery. Much of the knowledge about the left portion of the liver in the anatomy, surgery and internet texts must be improved and enriched; we propose to do this with this work. We studied 286 human livers that allowed us to determine further knowledge, along with the following information: 1) The left liver portion was larger than the right liver in 21 % of cases. 2) The left portion of the liver was formed by the first four portal segments (79 %) or by the first five (21 %). 3) The umbilical fissure tilted 50 degrees to the left relative to the sagittal plane of the liver and did not contain the left hepatic vein in 100 % of cases. 4) The left hepatic vein had an intrasegmental path and presented three drainage modalities. 5) Arterial irrigation of the left segments I and IV were born from the right branch in 16 % and from both branches in 24 %. 6) Bile drainage of right segments VI-VII reached the left hepatic canal in 21 % of cases. These results were different from the knowledge contained in the human anatomy texts used in medical schools at the general level.