Caracterización de pacientes con fractura de cadera, intervenidos con artroplastia / Characterizing Patients with Hip Fracture, Operated with Arthroplasty

Introducción: Las lesiones traumáticas de la cadera ocupan uno de los propósitos más importantes de la cirugía traumatológica. El uso de la artroplastia como regla de oro en el tratamiento quirúrgico de las mismas, es el fundamento del trabajo. Objetivo: Caracterizar los pacientes con diagnóstico de fractura de cadera, intervenidos con artroplastia total y parcial y estudiar la mortalidad, según el tipo de prótesis utilizada. Métodos: Se realizó un estudio descriptivo de corte transversal retrospectivo en 1506 pacientes del Hospital Ortopédico Docente Fructuoso Rodríguez entre 2015 y 2019, portadores de fractura de cadera, y tratados con artroplastia. Se analizaron variables tales como edad, sexo y comorbilidades presentes. Resultados: Se colocaron prótesis totales a 427 pacientes y en 1079 se utilizó la modalidad de prótesis parcial. Predominaron las personas entre 61 y 80 años de edad. El sexo femenino prevaleció en el estudio, con una relación 3:1. Predominó el grupo de pacientes con 1 o 2 enfermedades asociadas. La mortalidad < 30 días resultó el 1,1 por ciento y ≥ 30 días el 9,2 por ciento. Conclusiones: La utilización de prótesis totales dista mucho de la media interpuesta actualmente en el mundo, donde la prótesis total se maneja como herramienta de elección. Las prótesis parciales quedan reservadas para pacientes que tienen una corta expectativa de vida y muy poco validismo(AU)

Introduction: Traumatic hip injuries occupy one of the most important purposes of trauma surgery. The use of arthroplasty as a golden rule in their surgical treatment is the foundation of the work. Objectives: To characterize patients with a diagnosis of hip fracture, who underwent total and partial arthroplasty and to study mortality, according to the type of prosthesis used. Methods: A descriptive retrospective cross-sectional study was carried out in 1506 patients from Fructuoso Rodríguez Orthopedic Teaching Hospital from 2015 to 2019, with hip fracture, and treated with arthroplasty. Variables such as age, sex, and present comorbidities were analyzed. Results: Total prostheses were placed in 427 patients and in 1079 the partial prosthesis modality was used. Persons between 61 and 80 years of age predominated. The female sex prevailed in this study, with a 3: 1 ratio. The group of patients with 1 or 2 associated diseases predominated. Mortality <30 days was 1.1 percent and ≥30 days was 9.2 percent. Conclusions: The use of total prostheses is far from the current average in the world, where the total prosthesis is used as the tool of choice. Partial prostheses are reserved for patients who have short life expectancy and very little validity(AU)

Hipofisitis linfocitaria primaria. Caso clínico / Primary lymphocytic hypophysitis. Report of one case

Primary lymphocytic hypophysitis is an autoimmune disease characterized by lymphocytic infiltration of the pituitary gland, with a higher incidence during late pregnancy and the postpartum period. It causes glandular destruction, mass effect and symptoms such headache, visual field defects, ophthalmoplegia and symptoms of hypopituitarism. We report a 38-year-old postpartum woman who, after giving birth presented decreased left visual acuity associated with a non ictal headache. Magnetic resonance imaging demonstrated a sellar mass associated with decreased free thyroxine and cortisol levels. Suspecting a primary lymphocytic hypophysitis, she was treated with prednisone 60 mg/day and hormonal replacement therapy. One month later, size of the pituitary gland decreased, and the visual field defect improved. Steroidal treatment was maintained for 36 months and progressively tapered. After two years of follow-up, the imaging studies show a normal sized pituitary gland.

Experiencia en el tratamiento endovascular del accidente cerebrovascular isquémico agudo en un centro chileno / Emergency endovascular management of ischemic stroke: experience in 104 patients

Background: Recently, five randomized controlled trials confirmed the efficacy and safety of endovascular treatment with or without intravenous thrombolysis in acute ischemic stroke with large-vessel occlusion. Aim: To report patients with ischemic stroke treated with endovascular methods. Material and Methods: Retrospective analysis of 104 patients aged 61 ± 15 years (54% males) with ischemic stroke who received endovascular treatment at a single medical center between 2009 and 2017. Results: Sixty one percent were treated with intravenous thrombolysis plus endovascular procedures and 39% with endovascular procedures alone. The median door-to needle time was 61 minutes and door-to femoral puncture was 135 minutes. The median National Institute of Health Stroke Scale (NIHSS) scores on admission, 24 hours later and at discharge were 12,4 and 1 points, respectively. Middle cerebral artery was occluded in 60% of cases. Other frequent localizations where distal carotid artery in 17% and vertebro-basilar artery in 14%. Thrombolysis in cerebral infarction (TICI) scale flow score after the procedure was 3 or 2b in 58% of cases and significantly correlated with NIHSS scores at 24 hours and discharge. Fifty percent of patients had a mRankin score < = 1 and ten patients died (9.6%). Eight percent had a symptomatic intracerebral hemorrhage. Conclusions: The clinical improvement of these patients 24 hours after the procedure and at discharge demonstrate the effectiveness of endovascular treatment in ischemic stroke. The presence neurologists able to interpret multimodal images at the emergency room, the use of local guidelines, the availability of an experienced neuro-interventional team engaged with the workflow and the use of stent retrievers are strongly associated with good outcomes.