Suspensión alta al ligamento uterosacro con suturas permanentes en el prolapso apical: seguimiento a 24 meses / High suspension to the uterosacral ligament with permanent sutures in the apical prolapse: 24-month follow-up

Introducción: El prolapso de órganos pélvico (POP) es una patología frecuente que afecta hasta el 60% de las mujeres. La fijación alta al ligamento uterosacro (FAUS) transvaginal es una alternativa para el tratamiento del prolapso apical con buenos resultados, tiempos operatorios y de recuperación acotados, además de bajas tasas de complicaciones. Objetivo: Evaluar la tasa de éxito anatómico y subjetivo en pacientes portadoras de un prolapso apical sometidas a FAUS en el Hospital de Quilpué a 24 meses de seguimiento. Materiales y método: Se realizó un estudio retrospectivo observacional descriptivo, seleccionando a todas las pacientes sintomáticas con un prolapso apical ≥ 2 de la clasificación de POP-Q, sometidas a una FAUS entre septiembre de 2014 y octubre de 2019. Los datos fueron obtenidos desde la base de datos de la unidad de uroginecología del Hospital de Quilpué, previa aprobación del comité de ética. El éxito objetivo se definió como un punto C a 1 centímetro sobre el himen y el éxito subjetivo con una escala de impresión de mejora global del paciente (PGI-I) mejor o mucho mejor y/o una escala visual analógica (EVA) mayor al 80%, a 24 meses de seguimiento. Resultados: Se incluyeron 46 pacientes. La tasa de éxito objetivo fue del 84% y de éxito subjetivo del 70%. Conclusiones: La FAUS transvaginal con suturas permanentes es una excelente alternativa para el tratamiento del prolapso apical con una tasa de éxito similar al gold standard a 24 meses de seguimiento.

Introduction: Pelvic organ prolapse (POP) is a frequent pathology that affects up to 60% of women. Transvaginal uterosacral ligament high fixation (USLs: utero-sacral ligaments) is an alternative for the treatment of apical prolapse with good results, limited operative and recovery times, as well as low rates of complications. Objective: To evaluate the anatomical and subjective success rate in patients with an apical prolapse undergoing STALUS at the Quilpué Hospital at 24 months of follow-up. Materials and method: A descriptive observational retrospective study was carried out, selecting all symptomatic patients with an apical prolapse ≥ 2 of the POP Q classification, submitted to a FAUS between September 2014 and October 2019. The data were obtained from the database of the Urogynecology Unit of the Quilpué Hospital, prior approval of the ethics committee. Objective success was defined as a C-point 1 centimeter above the hymen and subjective success with better or much better Patient Global Impression-Improvement (PGI-I) scale and/or a greater than 80% Visual Analogue Scale (VAS), at 24 months of follow-up. Results: 46 patients were included. The objective success rate was 84% and the subjective success rate was 70%. Conclusions: The transvaginal FAUS with permanent sutures is an excellent alternative for the treatment of apical prolapse with a success rate similar to the gold standard at 24 months of follow-up.

Latest Progresses in Surgical Treatment of Median Arcuate Ligament Syndrome / 中国医学科学院学报

Median arcuate ligament syndrome(MALS)is compression of the celiac trunk by the median arcuate ligament.Median arcuate ligament release is the corner stone for the surgical treatment of MALS.Open surgery,laparoscopic surgery,and robot-assisted surgery have been developed,among which laparoscopic surgery has been proposed as the preferred approach in view of its minimal trauma and short hospital stay.Auxiliary celiac plexus neurolysis could further alleviate the patient's discomfort.Moreover,vascular reconstitution is of vital importance in the case of persistent stenosis in the celiac artery despite of median arcuate ligament decompression.Vascular reconstruction has satisfactory long-term patency rate,while endovascular treatment is less invasive.This article aims to summarize the consensuses and advances and shed light on the surgical treatment of MALS.

Laparoscopic pectopexy: initial experience of single center with a new technique for apical prolapse surgery

ABSTRACT Objective: To share our first experience with laparoscopic pectopexy, a new technique for apical prolapse surgery, and to evaluate the feasibility of this technique. Materials and Methods: Seven patients with apical prolapse underwent surgery with laparoscopic pectopexy. The lateral parts of the iliopectineal ligament were used for a bilateral mesh fixation of the descended structures. The medical records of the patients were reviewed, and the short-term clinical outcomes were analyzed. Results: The laparoscopic pectopexy procedures were successfully performed, without intraoperative and postoperative complications. De novo apical prolapse, de novo urgency, de novo constipation, stress urinary incontinence, anterior and lateral defect cystoceles, and rectoceles did not occur in any of the patients during a 6-month follow-up period. Conclusion: Although laparoscopic sacrocolpopexy has shown excellent anatomical and functional long-term results, laparoscopic pectopexy offers a feasible, safe, and comfortable alternative for apical prolapse surgery. Pectopexy may increase a surgeon's technical perspective for apical prolapse surgery.

Colpopexia al ligamento sacroespinoso con CapioTM; cirugía, resultados y evolución de pacientes / Sacroespinous ligament colpopexy with CapioTM; surgery patient outcomes and evolution

Introducción: El prolapso genital femenino altera significativamente la calidad de vida de la mujer. El prolapso apical es el segundo más frecuente después del defecto de pared anterior y la colposuspensión al ligamento sacroespinoso es una de las técnicas quirúrgicas descritas para su tratamiento. Objetivos: Determinar la factibilidad de la corrección del prolapso apical en pacientes sometidas a la colposuspensión al ligamento sacroespinoso, utilizando el dispositivo de captura de sutura CapioTM. Materiales y métodos: Análisis retrospectivo de pacientes intervenidas desde junio de 2015 a junio de 2016, en la unidad de piso pélvico del Hospital Luis Tisné Brousse, basándose principalmente en la evaluación del punto C del Prolpase Organ Pelvic Quatinfication (POP-Q). Resultados: Se intervinieron 15 pacientes, con edad promedio de 60,7 ± 6,8 años. Todas presentaron prolapso genital estadio III o IV. El seguimiento se realizó entre 3 y 13 meses después de la cirugía. Ninguna presentó complicaciones graves durante ni después de la cirugía y sólo una paciente recidivó. Conclusiones: La colposuspensión al ligamento sacroespinoso con CapioTM, es una técnica factible, segura y eficaz para el tratamiento del prolapso apical, sin embargo, es necesario mayor tiempo de seguimiento y estudios comparativos con otras técnicas de colposuspensión.

Introduction: Female genital prolapse significantly alter the quality of life of women. The apical prolapse is the second common defect after anterior wall and the colposuspension to sacrospinous ligament is one of the described surgical techniques for its treatment. Objective: To determine the feasibility of apical prolapse correction in patients undergoing sacrospinous colposuspension using the suture capture device CapioTM. Methods: Retrospective analysis of patients undergoing this surgery from June 2015 to June 2016, including an objective assessment focused mainly in the C point of Prolapse Organ Pelvic Quatinfication (POP-Q) and a subjective evaluation of the patient. Results: 15 patients, of which only 11 were able to complete follow-up, were included. The mean age of the patients at the time of surgery was 60.7 ± 6.8 years, and all were classified as prolapse stages III or IV. The evaluation was performed in average 6.75 ± 3.39 months after surgery, with a minimum of 3 and a maximum of 13 months. No patient had several complications during or after surgery and only one recurred. Conclusions: The colposuspension to sacrospinous ligament with CapioTM is a safe and effective alternative for the treatment of apical genital prolapse. However, a longer follow-up study is needed, in addition to comparative studies with other colposuspension techniques.

Sacrospinous ligament suspension with transobturator mesh versus sacral colpopexy for genital prolapse

OBJECTIVE: To compare the safety and efficacy of abdominal sacral colpopexy and sacrospinous ligament suspension with the use of vaginal mesh for apical prolapse. METHOD: This retrospective study was conducted from 2005 to 2012 and included 89 women with apical prolapse who underwent surgery. Assessments included pre- and postoperative Pelvic Organ Prolapse Quantification (POP-Q) stage. Rates of objective cure and immediate/late complications were compared. RESULTS: In total, 41 of the 89 women underwent sacrospinous ligament suspension, and 48 of the women underwent abdominal sacral colpopexy. A total of 40.4% of the women had vault prolapse (p=0.9361). Most of them had no complications (93.2%) (p=0.9418). Approximately 30% of the women had late complications; local pain was the main symptom and was found only in women who underwent the abdominal procedure (25.6%) (p=0.001). Only the women who were submitted to the vaginal procedure had mesh exposure (18.4%). The objective success rate and the rate of anterior vaginal prolapse (p=0.2970) were similar for both techniques. CONCLUSION: Sacrospinous ligament suspension was as effective and had a similar objective success rate as abdominal sacral colpopexy for the treatment of apical prolapse. Sacrospinous ligament suspension performed with the use of vaginal mesh in the anterior compartment was effective in preventing anterior vaginal prolapse after surgery.

Síndrome ligamento arcuato medio / Median arcuate ligament syndrome

Background: Median arcuate ligament syndrome (SLAM) is caused by extrinsic compression of the celiac artery by fibrous bands of this ligament and periaortic lymph node tissue. Case report: We report a 59 years old man with a history of weight loss, epigastric pain and a postprandial murmur. The syndrome was diagnosed by CT angiography. The patient was operated, performing a midline laparotomy and releasing the extrinsic compression. An early and sustained remission of symptoms was achieved.

Introducción: El síndrome del ligamento arcuato medio (SLAM), es causado por la compresión extrínseca del tronco celíaco por bandas fibrosas de este ligamento y tejido ganglionar periaórtico. Caso clínico: Reportamos el caso de un hombre de 59 años con historia de baja de peso, dolor postprandial y soplo epigástrico, al cual se le diagnostica SLAM por medio de angioTC. Se realiza abordaje quirúrgico, con laparotomía media y liberación de la compresión extrínseca, logrando remisión de los síntomas de forma inmediata y sostenida. El SLAM es una causa infrecuente de dolor abdominal, requiere estudio por imágenes para su diagnóstico, la resolución quirúrgica constituye su tratamiento.

Avaliação tomográfica dinâmica pré e pós-reconstrução do ligamento patelofemoral medial de pacientes com instabilidade patelar recidivante / Dynamic computerized tomography for analyzing patients with patellar instability before and after medial patellofemoral ligament reconstruction

A instabilidade patelar é uma patologia comum dentro da especialidade da cirurgia do joelho. O principal fator estabilizador dessa articulação é o ligamento patelofemoral medial, sendo esta a principal estrutura a ser reconstruída no tratamento cirúrgico da instabilidade patelar. Apesar de sua reconstrução apresentar excelentes resultados clínicos, não se sabe ao certo o real efeito in vivo desse procedimento no movimento da patela ao redor do fêmur. A avaliação da articulação patelofemoral tradicionalmente é feita através de exames de imagem estáticos. Com a evolução dos aparelhos de tomografia computadorizada, se tornou possível realizar esse exame durante movimento ativo, técnica ainda pouco utilizada para estudo de articulações como o joelho. O objetivo deste estudo foi padronizar o uso da tomografia de 320 fileiras de detectores para estudo dinâmico da articulação patelofemoral em pacientes com instabilidade patelar recidivante pré e pós-reconstrução do ligamento patelofemoral medial, analisando o efeito da cirurgia no trajeto da patela ao longo do arco de movimento. Foram selecionados 10 pacientes com instabilidade patelar e indicação de reconstrução do ligamento patelofemoral medial isolada, que foram submetidos à tomografia antes e após um mínimo de 6 meses da cirurgia. Os parâmetros anatômicos avaliados foram os ângulos de inclinação da patela e distância da patela ao eixo da tróclea através de um programa de computador desenvolvido especificamente para esse fim. Foram aplicados os escores clínicos de Kujala e Tegner e calculada a radiação dos exames. O protocolo escolhido para aquisição de imagens na tomografia foi: potencial do tubo de 80 kV, carga transportável de 50 mA, espessura de corte de 0,5 mm e tempo de aquisição de 10 segundos, o que gerou um DLP (dose length product) de 254 mGycm e uma dose efetiva estimada de radiação de 0,2032 mSv. O paciente realizava uma extensão ativa do joelho contra a gravidade. Os resultados não mostraram mudança...

Patellar instability is a common pathology in the practice of knee surgeons. The most important stabilizing structure in the patellofemoral joint is the medial patellofemoral ligament. This ligament is the main structure to be reconstructed during surgery for patellofemoral instability. Although clinical results for this procedure are excellent, the real in vivo effect of medial patellofemoral ligament reconstruction on patellar tracking is unknown. The study of this joint is usually made with static imaging. With the recent evolution of tomographers, it is now possible to analyze anatomical structures moving during active range of motion. This technique (dynamic computerized tomography) has not been routinely used to study joints as the knee. This study had the purpose of standardizing the use of 320-detector row computerized tomography for the patellofemoral joint, analyzing patients before and after surgical reconstruction of medial patellofemoral ligament. We selected 10 patients with patellofemoral instability referred to isolated medial patellofemoral ligament reconstruction surgery, and submitted them to a dynamic computerized tomography before and at a minimum of 6 months after surgery. Patellar tilt angles and shift distance were analyzed using a computer software specifically designed for this purpose. Kujala and Tegner scores were applied and the radiation of the exams was recorded. The protocol for imaging acquisition was: tube potential of 80 kV, 50 mA, slice thickness of 0.5 mm and 10 seconds of acquisition duration. This produced a DLP (dose length product) of 254 mGycm and a radiation effective estimated dose of 0.2032 mSv. There were no changes in patellar tracking after medial patellofemoral ligament reconstruction. There was no instability relapse. Clinical scores showed an average improvement of 22.33 points for Kujala (p=0.011) and of 2 levels for Tegner (p=0.017).

Principais osteotomias para o tratamento da ruptura do ligamento cruzado cranial em cães - revisão de literatura / Main osteotomies for treating rupture of the cranial cruciate ligament in dogs - a literature review / Principales osteotomías para el tratamiento de ruptura del ligamento cruzado craneal en perros - revisíon de literatura

A ruptura do ligamento cruzado cranial é a principal causa de claudicação do membro pélvico em cães. A causa da ruptura é multifatorial como processo degenerativo, inflamatório e traumático. Acomete principalmente cães de grande porte, não havendo predisposição sexual. O principal sinal clínico é a claudicação. Os testes de compressão tibial e de gaveta são realizados para o diagnóstico, associados à anamnese. As radiografias são importantes para avaliação do platô tibial e o diagnóstico de doença articular degenerativa. Muitas técnicas cirúrgicas podem ser utilizadas para o tratamento. Atualmente as osteotomias são as mais aceitas, devido a conformação anatômica do joelho canino. O objetivo desse trabalho é descrever as principais osteotomias para o tratamento da ruptura do ligamento cruzado cranial em cães, relacionando as indicações e complicações de cada técnica. Conclui-se que existem várias técnicas de osteotomias para o tratamento da ruptura do ligamento cruzado cranial, cada uma com suas indicações e complicações. Sendo de grande importância a medida do ângulo do platô tibial para a escolha da técnica a ser utilizada...

The cranial cruciate ligament is the main cause of lameness in the pelvic limb in dogs. Rupture causes are multifactorial, such as degenerative, inflammatory and traumatic processes. It mainly affects large dogs with no gender predisposition. The main clinical sign is lameness. Tibial compression and tray tests are performed for diagnosis, together with anamnesis. Radiographs are also important for assessing the tibial plateau and the diagnosis of degenerative joint disease. Many surgical techniques can be used for treatment. Osteotomies are currently the most accepted ones, due to the anatomical conformation of the canine knee. The aim of this paper is to describe the main osteotomy for treating cranial cruciate ligament rupture in dogs, stating the indications and complications of each technique. It can be concluded that there are several osteotomy techniques for the treatment of cranial cruciate ligament, each of them with their own indications and complications. It is, therefore, very important to measure the tibial plateau angle for the correct choice of techniques...

La ruptura del ligamento cruzado craneal es la principal causa de claudicación del miembro pélvico en perros. La causa de la ruptura es multifactorial como proceso degenerativo, inflamatorio y traumático. Afecta principalmente perros grandes, no ocurriendo predisposición sexual. La principal señal clínica es la claudicación. Las pruebas de compresión tibial y la bandeja tibial se llevan a cabo para el diagnóstico, asociados a la anamnesis. Las radiografías son importantes para evaluación de la meseta tibial y el diagnóstico de la enfermedad degenerativa de las articulaciones. Muchas técnicas quirúrgicas pueden ser utilizadas para el tratamiento. Actualmente las osteotomías son las más aceptadas, debido la conformación anatómica de la rodilla canina. El objetivo de esta investigación ha sido describir las principales osteotomías para el tratamiento de la rotura del ligamento cruzado craneal en perros, relacionando las indicaciones y complicaciones de cada técnica. Se concluye que hay varias técnicas de osteotomías para el tratamiento de la ruptura del ligamento cruzado craneal, cada uno con sus indicaciones y complicaciones. Es de gran importancia la medida del ángulo de la meseta tibial para la elección de la técnica a ser utilizada...

Anchor proximal migration in the medial patellofemoral ligament reconstruction in skeletally immature patients / Migracao proximal de ancora na reconstrucao do ligamento patelofemoral medial em pacientes esqueleticamente imaturos

The medial patellofemoral ligament (MPFL) injury has been considered instrumental in lateral patellar instability after patellar dislocation. Consequently, the focus on the study of this ligament reconstruction has increased in recent years. The MPFL femoral anatomical origin point has great importance at the moment of reconstruction surgery, because a graft fixation in a non anatomical position may result in medial overload, medial subluxation of the patella or excessive tensioning of the graft with subsequent failure. In the pediatric population, the location of this point is highlighted by the presence of femoral physis. The literature is still controversial regarding the best placement of the graft. We describe two cases of skeletally immature patients in whom LPFM reconstruction was performed. The femoral fixation was through anchors that were placed above the physis. With the growth and development of the patients, the femoral origin point of the graft moved proximally, resulting in failure in these two cases.

O ligamento patelo-femoral medial (LPFM) é a estrutura mais lesada com a luxação aguda da patela e tem sido considerada a lesão essencial na instabilidade lateral-patelar. Consequentemente, o enfoque no estudo da reconstrução desse ligamento tem aumentado nos últimos anos. O ponto anatômico da origem femoral do LPFM recebe grande importância no momento da reconstrução, pois a fixação do enxerto em uma posição não anatômica pode acarretar sobrecarga medial, luxação medial da patela ou tensionamento excessivo do enxerto, com sua posterior falha. Na população pediátrica, a localização dessa origem femoral ganha destaque pela presença da fise do fêmur distal. A literatura ainda é controversa com relação ao melhor posicionamento do enxerto. Descrevemos dois casos em que foi feita a reconstrução do LPFM em pacientes esqueleticamente imaturos. A fixação femoral se deu por meio de âncoras que foram posicionadas acima da fise. Com o crescimento e o desenvolvimento dos pacientes, o ponto de origem femoral do neoligamento migrou proximalmente e acarretou a falha do enxerto nesses dois casos.

Laparoscopic ovarian ligament plication in pregnancy / Plicatura laparoscópica del ligamento ovárico en el embarazo

This 32-year old patient presented at seven weeks gestation with severe left-sided lower abdominal pain. This was against the background of a previous history of left salpingectomy from a ruptured ectopic gestation seven years previously. Transvaginal sonographic evaluation revealed a viable seven week intrauterine embryo, a 2 cm left corpus luteum cyst and Doppler studies revealed reduced internal flow. This led the way for a conservative approach via laparoscopy of untwisting the pedicle to restore blood flow. In this case, the ovarian ligament was shorted using 1/0 vicryl and the pregnancy went to term.

Esta paciente de 32 años se presentó en la séptima semana de gestación con un severo dolor abdominal en el lado inferior izquierdo. Esto ocuría teniendo la paciente por antecedente una historia previa de salpingectomía izquierda a partir de la ruptura de un embarazo ectópico siete años antes. La evaluación sonográfica transvaginal reveló un embrión intrauterino viable de siete semanas, un quiste del 2 cm en el cuerpo lúteo izquierdo, y los estudios de Doppler revelaron un flujo interno reducido. Esto abrió el camino para un abordaje conservador vía laparoscopia encaminada a deshacer la torsión del pedículo y restablecer así el flujo sanguíneo. En este caso, el ligamento ovárico fue acortado usando vicryl 1/0, y el embarazo continuó a término.

Acute single-stage reconstruction of multiligament knee injuries using the ligament advanced reinforcement system

The purpose of the study was to report our early outcome in the management of multiligament knee injuries with the ligament advanced reinforcement system [LARS]. Between 2007 and 2010, 9 of 11 patients operated on for multiligament knee injuries were included in this study; 2 patients were excluded due to complicated neurovascular injuries, open knee dislocations and severe comorbidities. All patients were managed acutely [<3 weeks] by reconstructions of the cruciate and collateral ligaments with LARS ligament and were followed up for an average of 30 months [18-46 months]. The mean Lysholm score of the 9 patients at final follow-up was around 90 [range 88-94] with an average Tegner activity score of 5.5. The postoperative function of 1 case of KD-11 and 2 cases of KD-111 was rated as 'A,' while the remaining cases were rated 'B'. At final follow-up, minor osteoarthritic degeneration was detected in 1 case of KD-III and 2 cases of KD-IV. Superficial infection developed in 1 case, and no cases of knee synovitis and premature osteoarthritis were recorded. A creditable outcome at mean of 30 months' follow-up was obtained in acute single-stage reconstruction of uncomplicated multiligament knee injuries with LARS ligament

Classification and Surgical Treatment of Symphalangism in Interphalangeal Joints of the Hand

BACKGROUND: Symphalangism is a rare congenital difference characterized by ankylosis of interphalangeal (IP) joints of the fingers and toes. In adults, there were several attempts to restore the stiff joints into mobile ones, but these treatment options resulted in poor outcomes and could not be applied to growing children. Here, we report our experiences on surgical treatment for children who had symphalangism of the hand. METHODS: We treated 36 joints in 17 children with symphalangism of the hand using dorsal capsulotomy and collateral ligament release. The diagnoses were based on history, physical examination, and simple radiographs. Affected fingers were classified according to our grading system. Simple compressive dressing was applied using Coban after surgery. Passive range of motion (ROM) exercise was started on day one or 2 postoperative, with the help of a hand therapist and patients' parents. The patients were prescribed passive ROM exercises for at least 2 hours a day over a period of 6 months. RESULTS: A single surgeon operated on 30 proximal IP joints, 3 distal IP joints, and 3 IP joints of the thumb. Twenty six joints were classified as grade I, and 10 as grade II. The ROM of affected joints, which was 7.8 +/- 8.1 (mean +/- SD) degrees preoperatively, increased to 46.8 +/- 18.6 degrees at final follow-up. The final ROM was significantly better in grade I joints, especially when the children had operations at ages 24 months or younger. CONCLUSIONS: Symphalangism of the hand in children, can be restored into a mobile joint by release of the collateral ligament, a dorsal capsulotomy, and postoperative physical therapy.

Classification and Surgical Treatment of Symphalangism in Interphalangeal Joints of the Hand

BACKGROUND: Symphalangism is a rare congenital difference characterized by ankylosis of interphalangeal (IP) joints of the fingers and toes. In adults, there were several attempts to restore the stiff joints into mobile ones, but these treatment options resulted in poor outcomes and could not be applied to growing children. Here, we report our experiences on surgical treatment for children who had symphalangism of the hand. METHODS: We treated 36 joints in 17 children with symphalangism of the hand using dorsal capsulotomy and collateral ligament release. The diagnoses were based on history, physical examination, and simple radiographs. Affected fingers were classified according to our grading system. Simple compressive dressing was applied using Coban after surgery. Passive range of motion (ROM) exercise was started on day one or 2 postoperative, with the help of a hand therapist and patients' parents. The patients were prescribed passive ROM exercises for at least 2 hours a day over a period of 6 months. RESULTS: A single surgeon operated on 30 proximal IP joints, 3 distal IP joints, and 3 IP joints of the thumb. Twenty six joints were classified as grade I, and 10 as grade II. The ROM of affected joints, which was 7.8 +/- 8.1 (mean +/- SD) degrees preoperatively, increased to 46.8 +/- 18.6 degrees at final follow-up. The final ROM was significantly better in grade I joints, especially when the children had operations at ages 24 months or younger. CONCLUSIONS: Symphalangism of the hand in children, can be restored into a mobile joint by release of the collateral ligament, a dorsal capsulotomy, and postoperative physical therapy.

Análisis de la longitud del ligamento estilohiodeo mediante sistema cone beam / Analysis of the stylohyoid ligament's in cone beam images

Introducción y Objetivo: La elongación y/o osificación del ligamento estilohioideo es una patologíapoco conocida, con un diagnóstico difícil de establecer. El propósito del presente estudio fuerealizar un análisis retrospectivo de exámenes para evaluar la presencia de variaciones en la longitud del ligamento estilohiodeo, según edad y género, mediante un Sistema de tomografía de alta resolución Cone Beam debido a su gran confiabilidad dimensional. Materiales y Métodos: La muestra consistió en 82 exámenes imagenológicos, los cuales fueron obtenidos con fines de estudios Ortodóncicos, de Implantología o de Diagnóstico general, durante el año 2008-2009. Se realizó el análisis retrospectivo de la muestra, y se clasificó según edad, género, y se individualizó el análisis cuantitativo tridimensional de los procesos estilohioideos. Resultados: El análisis realizado no mostró diferencias significativas en las variables relacionadas con el género, sin embargo en los pacientes mayores de 50 años, hubo un incremento importante en la longitud del ligamento estilohioideo. Conclusión: Los resultados obtenidos difieren con los resultados de trabajos anteriores analizados mediante ortopantomografía. Esto se explicaría por la gran sensibilidad diagnóstica del método utilizado.

Introduction and Objetive: This paper analyzes the existence of variations in the length of the stylohyoid ligament, according to age a genre, by using the high resolution Cone Beam System. Materials and Methods: The research was based in a sample of 82 imagenology examinations taken during the period 2008-2009 for routine studies in orthodontics, implantology and general diagnosis. The sample was examined with 3D measurements of the styloid process considering aprevious classification by age a genre, to establish if there is difference through these variables. Results: We found no significant difference in the length of the stylohyoid ligament by genre. However, there is evidence of an increase of the lengths of the ligament in patients over 50 years old. Conclusion: Our findings differ from previous documentation by using less accurate systems like orthopantomography.

Lipolifting de coxa: cicatriz crural com ancoragem duplo-ligamentar / Thigh lift: crural scar using dual-ligament anchor

Objetivo: Apresentar uma alternativa para as técnicas já conhecidas de cirurgia corretiva da face interna de coxa, a partir de um estudo anatômico mais detalhado da região, onde conseguimos obter resultados superiores, cicatrizes menores, e um pós-operatório reduzido, por meio de lipolifting crural com ancoragem duplo ligamentar. Método: Técnica preconiza a associação da diminuição de tecido gorduroso por lipoaspiração, quando necessário associado ao tratamento da fáscia superficial com dupla ancoragem ligamentar, sendo uma no ligamento inguinal e outra no tendão do músculo adutor longo, promovendo a prevenção absoluta das queixas de migração de cicatrizes tão discutidas no passado, favorecendo inclusive a possibilidade de maior retirada de substância de uma forma mais segura. Resultados: A ancoragem duplo-ligamentar propicia uma cicatriz menor e mais bem posicionada, bem como permite uma ressecção maior de tecidos. O pós-operatório também é beneficiado, uma vez que a paciente fica liberada mais precocemente a retornar seus movimentos diários, e no seguimento a longo prazo (2 anos) não foi observada migração da cicatriz ou deformidade genital.

Objective: To present an alternative method to the already known corrective thigh surgery techniques. Due to a closer anatomic study of the region, we suggest the using of anatomical structures known as inguinal ligament and the tendon of the long adutor muscle, to prevent the scar migration. Methods: The method also suggests the diminution of the adipose tissue by liposuction, the superficial fascia treatment, and resection of the skin leaving only a crural scar. Results: The dual-ligament anchor besides promote a minimumscar, do also offer the opportunity to the patient to regress earlier to their activities. The two years follow up shows no scar migration, genital deformities, an a great acceptation of the aesthetics results by the patients.

Botones: una alternativa para fijación del ligamento cruzado anterior / Buttons: an alternative for fixation of anterior cruciate ligament

El presente estudio pretende evaluar la alternativa quirúrgica de usar dos botones uno a nivel femoral y el otro a nivel tibial para fijar el injerto autologo hueso tendón hueso, en pacientes con ruptura del ligamento cruzado anterior, fabricado los 24 primeros botones en nuestro país, y los 16 restantes con algunas modificaciones en USA. Se realizaron los primeros 12 casos en pacientes con déficit de LCA utilizando injertos de tendón rotuliano autologos entre abril y diciembre de 2005 con edad promedio 31,7 años con la salvedad de no comenzar con una rehabilitación agresiva sino con una rehabilitación suave, evaluados pre y post-operatorio con el test de Lisholm, se encontraron luego de 35 meses de seguimiento resultados excelentes y buenos en el 91,6% y regulares en el 8,4% los siguiente 8 casos se realizaron entre febrero y mayo 2006, con edad promedio de 25 años evaluados con el mismo test, se evidenciaron a los 28 meses de evolución resultados excelentes y buenos en el 75%, un caso regular 12,5% y un caso malo 12,5%. Si sumamos ambos estudios de 20 casos los resultados son, excelentes y buenos 17 casos 85% dos casos regulares 10% y un caso malo 5%. Se concluye que los dos botones es una altenativa segura, confiable y barata.

A review on the celiac trunk compression syndrome: some anatomic clinical-surgical aspects / Una revisión del síndrome de compresión del tronco celíaco: algunos aspectos anatómicos clínicos-quirúrgicos

The objective of this study was to review some celiac trunk compression syndrome aspects such as: symptom-posture relationship; absence of symptoms; syndrome-age relationship; angiographic study on anatomy of the celiac trunk stenosis; congenital or acquired origin; invasive diagnostic tests; surgical and postoperative results.

El objetivo de este estudio fue hacer una revisión del síndrome de compresión del tronco celíaco, en cuanto a aspectos tales como: relación síntoma-postura; ausencia de síntomas; relación síndrome-edad; estudio angiográfico sobre la anatomía de la estenosis del tronco celíaco; origen congénito o adquirido; tests diagnósticos no invasivos; resultados quirúrgicos y post-quirúrgicos.

Suspensión transvaginal alta a ligamentos uterosacros para el tratamiento de defectos apicales (stalus): descripción de la técnica y resultados anatómicos a mediano plazo / High uterosacral vaginal vault suspension for the treatment of apical prolapse: anatomical outcomes

Objetivos: Describir una técnica quirúrgica, novedosa en el medio nacional, de abordaje vaginal, para el tratamiento del prolapso apical: la suspensión transvaginal alta a ligamentos úterosacros (STALUS). Método: Estudio descriptivo longitudinal, de 57 pacientes con defectos apicales, a los cuales se les realizó esa técnica entre Diciembre de 2002 y Octubre 2005. Se realizó estadística descriptiva y test t (2 muestras) para análisis de pronóstico anatómico (POP-Q). Para análisis de potenciales factores pronósticos se utilizó ANOVA, regresión lineal y logística. Resultados: El tiempo operatorio promedio fue de 151 minutos. El resultado anatómico (POP-Q), pre y postoperatorio, resultó favorable y estadísticamente significativo, en los nueve puntos evaluados, 49 de las 54 pacientes fueron seguidas en promedio durante 15 meses. En el compartimiento apical (punto C) obtuvimos curación del 89 por ciento y no hubo fracasos. En la pared anterior, 22 por ciento de las pacientes recidivaron. En cuanto a las complicaciones, se produjo una fístula ureterovaginal. Conclusiones: Tomando las precauciones necesarias, es una técnica segura y reproducible, con buenas tasa de curación. Asegurar la indemnidad del uréter, siempre será una obligación. La recidiva en pared anterior, aunque sea asintomática, resulta ser extremadamente alta, lo que nos obliga a pensar en nuevas técnicas de abordaje de este compartimiento.

Objective: To describe a novel surgery technique in the national ground, of vaginal approach for the treatment of apical prolapse: the transvaginal high suspension to the uterosacral ligaments (STALUS). Method: It is a longitudinal descriptive study that included 57 patients with apical support defects, in which this technique was performed between December 2002 and October 2005. Descriptive statistics and t test were per-formed for the anatomical outcome (POP-Q). For the potential prognosis factors, ANOVA, lineal regression and logistic, were used. Results: The average surgery time was 151 minutes. The anatomical result (POP-Q), before and after surgery, was favourable and significant in the nine points evaluated. 49 of 54 patients were followed for 15 months in average. In the apical compartment (C point) we got an 89 percent of cure and there were no failure. In the anterior wall, instead, 22 percent of our patients recurred. About complications, there was an ureterovaginal fistula. Conclusions: If all precautions are taking, there is a secure and reproducible technique, with good cure rate. To secure the ureter it is always an obligation. The recurrence in the anterior wall, even been asymptomatic, is too high, that make us think in new techniques in order to manage this compartment.

Analgesia controlada pelo paciente com morfina ou fentanil no pós-operatório de reconstruçäo de ligamentos do joelho: estudo comparativo / Patient controlled analgesia with morphine or fentanyl in knee ligament reconstruction postoperative period: a comparative study

Justificativa e objetivos - a morfina ou o fentanil têm sido utilizados para analgesia pós-operatória, por via peridural, de forma contínua com bomba de infusäo, permitindo também que a analgesia seja controlada pelo paciente (ACP). O objetivo deste estudo foi avaliar a qualidade da analgesia, o consumo de opióides e os efeitos colaterais do emprego de infusäo contínua e de ACP com morfina ou fentanil, no pós-operatório de pacientes submetidos a reconstruçäo de ligamento do joelho, sob anestesia peridural com bupivacaína associada ao fentanil. Método - participaram do estudo 42 pacientes com idade entre 16 e 50 anos, estado físico ASA I e II, divididos aleatoriamente em dois grupos de 21: Grupo M (Morfina) e Grupo F (Fentanil). Todos os pacientes foram submetidos a anestesia peridural com bupivacaína a 0,5 por cento (100 mg) associada a fentanil (100 µg). Ao final da cirurgia os pacientes receberam morfina (Grupo M) ou fentanil (Grupo F) em regime de ACP, por via peridural, através de bomba de infusäo. No Grupo M foi utilizada soluçäo fisiológica (93 ml) contendo morfina 2 mg (2ml) e bupivacaína 0,5 por cento (5 ml). No Grupo F foi utilizada soluçäo fisiológica (85 ml) contendo fentanil 500 µg (10 ml), bupivacaína (5 ml a 5 por cento) sem adrenalina. Para os dois grupos foi programado inicialmente infusäo contínua de 4 ml.h elevado a menos um, com doses de 2 ml em bolus liberado pelo paciente num intervalo de 30 minutos. Foram comparados os seguintes parâmetros: dor; número de bolus acionados; consumo de opióides; bloqueio motor; sedaçäo e efeitos colaterais (prurido, náuseas, vômitos e retençäo urinária). Resultados - Näo houve necessidade de suplementaçäo anestésica no per-operatório. A maioria dos pacientes (85,7 por cento) obteve excelente grau de analgesia pós-operatória (EAV 0a 2), sem diferença significativa entre os grupos. A média de bolus acionados näo diferiu nos dois grupos. O consumo médio de morfina foi de 1,663 ñ 0,384 mg sendo o de fentanil de 0,435 ñ 0,083 mg. Näo houve bloqueio motor após a instituiçäo da ACP. A incidência de sedaçäo e de outros efeitos colaterais foi também significativamente maior no grupo da morfina

Ligamentoplastía interespinosa lumbar con corion para el tratamiento de inestabilidad vertebral. Reporte de 4 años de seguimiento / Lumbar interspinous ligamentoplasty performed with chorion for treatment of vertebral instability. Report after a 4-year follow-up period

En este estudio consideramos que el reforzamiento del ligamento supra e interespinoso con corion (dermis) estabiliza la columna lumbar y evita la lumbalgia posquirúrgica en el caso de la cirugía de hernias de disco. Se evaluó a los pacientes después de su cirugía mediante estudios de rayos X; valorando el grado de inestabilidad con y sin movimiento, se describió la técnica utilizada y se observaron los cambios degenerativos intervertebrales con un seguimiento a 4 años de la cirugía. Los resultados mostraron que existe notable disminución de los rangos de movimiento del segmento afectado, se evitó la lumbalgia postoperatoria, no existe movimiento intersomático anormal de los cuerpos vertebrales, y para concluir nuestro objetivo con significancia estadística continuaremos el seguimiento sumando un mayor número de pacientes