Protrusio acetabular en artroplastía total de cadera: diez tácticas para un buen resultado quirúrgico / Total hip arthroplasty in protrusio acetabuli: ten tips to improve surgical outcomes

Los pacientes candidatos a artroplastía total de cadera con protrusio acetabular asociada generan distintos desafíos en los equipos quirúrgicos. Múltiples estrategias han sido utilizadas a lo largo de los años para optimizar los resultados. Mediante una revisión de la evidencia actualizada disponible, proponemos diez tácticas a realizar en el manejo de estos pacientes que pueden mejorar y hacer predecible el tratamiento de un paciente con protrusio acetabular al que se le realiza una artroplastía total de cadera. Nivel de Evidencia V.

Patients with acetabular protrusio and osteoarthritis are a challenge for the surgical team. Many strategies have been developed to anticipate, plan and optimize the surgical results of these patients. Based on the current available clinical evidence, we propose ten tips to improve the surgical management of hip arthroplasty patients with protrusio acetabuli. Level of Evidence V.

Transferencia artroscópica del trapecio inferior en pacientes con rotura irreparable del manguito rotador posterosuperior. Resultados preliminares de ocho pacientes / Arthroscopically assisted lower trapezius transfer in patients with irreparable posterosuperior rotator cuff tears. Preliminary outcomes in eight patients

Introducción: El objetivo de este trabajo es evaluar resultados clínicos y funcionales de pacientes con una rotura irreparable del manguito rotador posterosuperior, sometidos a una transferencia artroscópica del trapecio inferior. Materiales y métodos: estudio de una cohorte retrospectiva de pacientes con roturas irreparables del manguito rotador, en quienes se realizó una transferencia del trapecio inferior asistida por artroscopía. Se evaluó la evolución clínica mediante la ganancia del rango de movilidad del hombro y la disminución del dolor. Del mismo modo, se evaluó la evolución funcional usando el índice de Constant-Murley y la valoración subjetiva del hombro (SSV, por sus siglas en inglés). Resultados: se incluyeron ocho pacientes, con un seguimiento promedio de veintidós meses. Obtuvimos una ganancia estadísticamente significativa de rotación externa de 32°, disminución de 5 puntos en la escala del dolor, aumento de 31 puntos en el score de Constant y un aumento de 38% del SSV. Se registró un aumento de 12° de elevación, sin embargo, este no fue estadísticamente significativo. Dos pacientes presentaron un seroma en el sitio de la cosecha del trapecio, que se resolvió con manejo conservador. Conclusión: la transferencia del trapecio inferior con asistencia artroscópica, en pacientes con rotura irreparable del manguito rotador posterosuperior, es una técnica segura que mejora significativamente la rotación externa y los índices funcionales en este grupo de pacientes. Tipo de estudio: Serie de casos IV

Introduction: The purpose of this study is to compare clinical and functional outcomes of patients with irreparable posterosuperior rotator cuff tears treated by arthroscopic assisted lower trapezius transfer. Materials and methods: retrospective cohort design of patients with irreparable rotator cuff tear, treated by arthroscopy-assisted lower trapezius transfer. The clinical evolution was evaluated according to the gain in the range of shoulder movement and the decrease of pain. Functional outcomes were evaluated using the Constant-Murley score and the subjective shoulder value (SSV). Results: eight patients were included, with average follow-up of twenty-two months. We obtained a statistically significant gain in active external rotation of 32°, 5-point decrease in the pain scale (VAS), a 31-point increase in the Constant score, and a 38% increase in SSV. There was a 12° increase in active forward elevation, however this was not statistically significant. Two patients had a seroma at the trapezius harvest site, which resolved with conservative treatment. Conclusion: arthroscopically assisted lower trapezius transfer in patients with irreparable posterosuperior rotator cuff tears were a safe technique that significantly improves external rotation and functional scores in patients. Type of study: Case series IV

Tabaquismo entre las internas de un centro penitenciario para mujeres / Smoking among prisoners of a penitentiary center for women

Introducción: El tabaquismo es una de las principales causas de enfermedad y muerte en el mundo, y su consumo puede aumentar ante situaciones de estrés. Objetivos: Caracterizar el tabaquismo dentro de la cárcel de mujeres Casa del Buen Pastor. Materiales y métodos: Estudio observacional, descriptivo, de corte transversal con una encuesta anónima utilizando el método de múltiple opción de respuestas. Resultados: Declararon ser fumadoras 73 de las 101 internas encuestadas, y la gran mayoría de ellas quiere dejar de fumar. Conclusión: Hay una alta prevalencia de tabaquismo entre las mujeres en prisión, y su mayoritario deseo de cesación es una oportunidad que debe aprovecharse para apoyarlas con medidas adecuadas para lograrlo.

Introduction: Smoking is one of the main causes of disease and death in the world, and its consumption may increase in situations of stress. Objectives: To characterize smoking within the Casa del Buen Pastor women's prison. Materials and methods: Observational, descriptive, cross-sectional study with an anonymous survey using the method of multiple choice of answers. Results: 73 of the 101 inmates surveyed declared themselves to be smokers, and the vast majority of them want to quit smoking. Conclusion: There is a high prevalence of smoking among women in prison, and their majority desire for cessation is an opportunity that should be used to support them with appropriate measures to achieve it.

Intento de validación al español del instrumento FertiSTAT en población universitaria joven de Chile, 2018 / Spanish validation try of the FertiSTAT instrument in young university chilean population, 2018

INTRODUCCIÓN: Infertilidad es una enfermedad del sistema reproductivo. Su prevalencia ha aumentado, por diversos factores de riesgo. Actualmente no existe un sistema estandarizado en Chile para pesquisar dichos factores tempranamente, por lo que un instrumento con dicho fin sería útil. La encuesta inglesa FertiSTAT, cumple dicho rol desde 2010. El objetivo fue validarla al idioma español. MATERIAL Y MÉTODO: Estudio cuantitativo, transversal, que utilizó a la población estudiantil femenina, de 18 a 44 años, de la Universidad de Concepción 2018, mediante un muestreo presencial, no probabilístico, secuencial en dependencias de la Universidad. El instrumento FertiSTAT, fue revisada por experto y traducida al español de forma independiente. Al ser 19 preguntas en total, fueron necesarios 38 sujetos para prueba piloto y 190 sujetos para validación mediante pruebas psicométricas, realizadas mediante programa IBM-SPSS Statistic 22. Aprobado por comité de ética de la facultad de medicina de la Universidad de Concepción. RESULTADOS: Promedio de edad fue de 20.9 años. Respecto a las pruebas psicométricas: Alfa de Cronbach 0.213. Se obtuvieron correlaciones positivas significativas de baja intensidad. El análisis factorial concluyó en 8 dominios para explicar el 66.39% del grupo. DISCUSIÓN: El instrumento es poco confiable, con mayor número de dominios que el original. Dicho resultado se podría deber a un método no adecuado con preguntas mal estructuradas, errores en los sujetos de investigación e investigadores y una selección de muestra no adecuada. Sería útil revalidar en consultas preconcepcionales o policlínicos de fertilidad. Aun así, se logró traducir un instrumento al español que pesquisa factores de riesgo de infertilidad

INTRODUCTION: Infertility is a disease of the reproductive system. Its prevalence has increased, due to several risk factors. Currently, there is no standardized method in Chile to early identify these factors, so an instrument for this purpose would be useful. The English FertiSTAT survey fulfills this role since 2010. The objective was to validate it to Spanish language. MATERIAL AND METHOD: Quantitative, cross-sectional study that used the female student population, from 18 to 44 years old, from University of Concepción 2018, through a face-to-face, non-probabilistic, sequential sampling at the University's facilities. The FertiSTAT tool was reviewed by an expert and translated into Spanish by an interpreter; both independently. There were 19 questions in total, 38 subjects were needed for pilot test and 190 subjects for validation through psychometric tests, done through the IBM-SPSS Statistic 22 program. Ethics committee approval by the ethic committee of medicine faculty of the Universidad de Concepción. RESULTS: Average age was 20.9 years. About the psychometric tests: Cronbach Alpha; 0.213. Positive correlations were obtained of low intensity. The factorial analysis obtained 8 domains that explain 66.39% of the group. DISCUSSION: The tool is unreliable, with more domains than the original. This result could be due to a poor method with bad structured questions, mistakes in the research subjects and researchers, and an inadequate sample selection. It would be useful to re-validate in pre-conception or fertility polyclinics. At the end, it achieved a Spanish translated tool, which looks for infertility risk factors.

Revisión bibliográfica: obesidad infanto juvenil y cirugía bariátrica / Literature review: juvenile obesity and bariatric surgery

La prevalencia de sobrepeso y obesidad en pacientes pediátricos ha aumentado significativamente en las últimas décadas, lo que se asocia a complicaciones a corto y largo plazo lo que conlleva un deterioro en la calidad de vida y aumento de la morbimortalidad asociada principalmente a enfermedades cardiovasculares. El manejo inicial de un paciente con exceso de peso se basa fundamentalmente en dieta y la realización periódica de actividad física. Sin embargo, en los casos de obesidad severa las modificaciones de estilo de vida son insuficientes para la disminución de peso, existiendo en la mayoría de los casos una reganancia de peso. En estos casos la cirugía bariátrica es una opción terapéutica y complementaria al tratamiento médico. Existen diversas técnicas quirúrgicas que alteran anatómicamente y/o funcionalmente el tracto gastrointestinal usado para el tratamiento de la obesidad. Estos procedimientos actúan mediante la restricción de la capacidad del estómago, interferencia con la progresión de la comida, o la desviación de los contenidos ingeridos de una región del tracto gastrointestinal a otra. En la actualidad, los procedimientos más utilizados para los adolescentes incluyen el bypass gástrico en Y de Roux, la banda gástrica ajustable, y por último la gastrectomía en manga, no existiendo estudios que evalúen las complicaciones a largo plazo. Las indicaciones de cirugía bariátrica en adolescentes se basan en el grado de obesidad, la presencia de comorbilidades y el fracaso de tratamiento médico multidisciplinario, entre otras.

The prevalence of overweight and obesity in pediatric patients has sharply increased in recent decades, that is associated with short and long term complications that imply a worsening in the quality of life and increased morbidity and mortality mainly associated with cardiovascular disease. The initial management of a patient with overweight is primarily based on diet and regular physical activity. However, in cases of severe obesity, changes in lifestyle are insufficient for weight reduction, existing in most cases weight gain. In these cases, bariatric surgery is a complementary therapeutic option to medical treatment. There are several surgical techniques that modify the anatomy and/or function of the gastrointestinal tract used in the treatment of obesity. These methods act by restricting stomach capacity, interfering with the progression of food, or deviation of ingested in a region of the gastrointestinal tract to other content. Currently, the most widely used procedures in obese teenagers include gastric bypass Roux, adjustable gastric banding, and finally sleeve gastrectomy. There are not studies evaluating long-term complications. Indications for bariatric surgery in adolescents are based on the degree of obesity, the presence of comorbidities and the failure of multidisciplinary medical treatment, among others.

Trasplante alogénico de precursores hematopoyéticos de sangre de cordón umbilical de donante no emparentado: primera experiencia, en tres casos, con donantes del banco público chileno de células de cordón / Allogenic hematopoietic stem cell transplantation with unrelated cord blood: Report of three cases from the Chilean cord blood bank

Public cord blood banks are a source of hematopoietic stem cells for patients with hematological diseases who lack a family donor and need allogeneic transplantation. In June 2007 we started a cord blood bank with units donated in three maternity wards in Santiago, Chile. We report the first three transplants done with cord blood units form this bank. Cord blood units were obtained by intrauterine collection at delivery. They were depleted of plasma and red cells and frozen in liquid nitrogen. Tests for total nucleated cells, CD34 cell content, viral serology, bacterial cultures and HLA A, B and DRB1 were done. Six hundred cord blood units were stored by March 2012. Three patients received allogeneic transplant with cord blood from our bank, two with high risk lymphoblastic leukemia and one with severe congenital anemia. They received conditioning regimens according to their disease and usual supportive care for unrelated donor transplantation until full hematopoietic and immune reconstitution was achieved. The three patients had early engraftment of neutrophils and platelets. The child corrected his anemia and the leukemia patients remain in complete remission. The post-transplant course was complicated with Epstein Barr virus, cytomegalovirus and BK virus infection. Two patients are fully functional 24 and 33 months after transplant, the third is still receiving immunosuppression.

Hematopoietic stem cell transplantation: clinical use and perspectives

Hematopoietic stem cell transplantation is the accepted therapy of choice for a variety of malignant and non-malignant diseases in children and adults. Initially developed as rescue therapy for a patient with cancer after high doses of chemotherapy and radiation as well as the correction of severe deficiencies in the hematopoietic system, it has evolved into an adoptive immune therapy for malignancies and autoimmune disorders. The procedure has helped to obtain key information about the bone marrow environment, the biology of hematopoietic stem cells and histocompatibility. The development of this new discipline has allowed numerous groups working around the world to cure patients of diseases previously considered lethal. Together with the ever growing list of volunteer donors and umbilical cord blood banks, this has resulted in life saving therapy for thousands of patients yearly. We present an overview of the procedure from its cradle to the most novel applications, as well as the results of the HSC transplant program developed at our institution since 1989.