Cribado por ultrasonidos de la displasia de desarrollo de la cadera: experiencia aplicando un programa semi-universal / Screening by ultrasound of dysplasia of hip development: experience applying a semi-universal program

Objetivos: Exponer los resultados de la implantación de un cribado ecográfico "semiuniversal" para el diagnóstico precoz de la displasia de desarrollo de la cadera (DDC) que incluye a todas las niñas y a los varones con factor de riesgo. Material y método: De los 16.943 recién nacidos en nuestro hospital en 4 años, se estudiaron por ecografía 8.596 (7.892 niñas y 744 varones). El cribado se realizó a las 5 semanas de vida e incluyó seguimiento de las caderas con inmadurez fisiológica. Resultados: Se detectaron 76 niños con DDC resultando una incidencia del 4,4 por mil. La edad media de detección fue de 1,4 meses y la duración media de los tratamientos 3 meses. Se consiguieron bajos índices de displasias tardías (0,2 por mil) y de cirugía (0,3 por mil). Todos los niños curaron sin secuelas. Conclusión: Consideramos al cribado semiuniversal una opción válida al cribado universal, con resultados similares y menor coste

Objective: The purpose of this article is to describe the findings of our semiuniversal ultrasound screening for the early diagnosis of developmental dysplasia of the hip (DDH) including all newborn females and males with risk factors. Materials and methods: 8596 newborn (7852 females and 744 males) underwent sonography from a total of 16943 newborn in our hospital over a four year period. The screening ultrasound was performed when the infant was five weeks old and included follow-up of the hips with physiological immaturity. Results: 76 infants with hip dysplasia were detected with a resulting incidence of 4.4 per thousand. Mean age at diagnosis was of 1.4months and the mean length of treatment was of 3 months. With this strategy low rates of late dysplasias (0.2 per thousand) and surgical treatment (0.3 per thousand) were achieved All infants recovered without secuelae. Conclusion: We consider the semiuniversal screening to represent a valid alternative to the universal screening, with similar results and reduced costs

[Ultrasonography for surgical pathology discrimination in acute abdominal pain. Prospective study]. / La ecografía en la selección del dolor abdominal quirúrgico urgente. Estudio prospectivo.

Abdominal ultrasonographic study is a part of the acute abdominal pain diagnosis protocol in our hospital. As an internal quality assessment, we performed a six-month prospective study, including those patients who meet one of these requirements: 1st the reason for attendance being non-traumatic abdominal pain 2nd an abdominal ultrasonography achieved at the hospital. Collected data included: demographic characteristics, presenting sign and symptoms, test results, ultrasonography, final diagnosis and treatment. Children attended to the hospital were evaluated through clinical findings to verify concordance between clinical and ultrasound diagnosis, and patients who did not stay at the hospital had telephone follow-up in 2 weeks. A total of 136 patients underwent ultrasonography (7 children did not cooperate and were discarded): 74 females and 55 males with a mean age of 9.52 years. Admission was required in 63 subjects and 66 were sent home after clinical evaluation. Abdominal ultrasonography was performed by the radiologist on duty (occasionally paediatric radiologist). Ultrasound examination, for acute appendicitis, had a sensitivity of 94.8%, specificity of 98.8%, positive predictive value of 97.3% and negative predictive value of 97.8%. Abdominal ultrasonography has showed usefulness for surgical pathology discrimination in acute abdominal pain. When ultrasonography is inconclusive, clinical follow-up and periodical ultrasonography results in a positive change in management and treatment.

Evaluation by explicit criteria of the use of total hip joint replacement.

OBJECTIVE: To evaluate the appropriateness of the use of total hip replacement (THR) using explicit criteria developed by an expert panel. METHODS: Patients with a diagnosis of osteoarthritis who were undergoing THR in five public hospitals in Spain were included consecutively in the study during a 1-yr period. The appropriateness of the indication was judged by explicit criteria developed using a mutidisciplinary approach. Complications were measured 3 months after surgery. One year after discharge, pain, functional limitation and general health were measured. RESULTS: After evaluation of 583 patients, 82 (13.6%) were considered to have undergone inappropriate procedures, and for 279 (46.2%) patients indication for the procedure was considered uncertain. Differences were found in the rate of appropriateness among some centres. One year after discharge, the perception of general health was slightly better in those patients who had been judged to have undergone an appropriate procedure. CONCLUSIONS: The study identified a moderate percentage of inappropriately performed THR. When considered together with those cases that were judged to have uncertain indications, the results indicate that further studies should be done to identify patients who may have an inadequate benefit:risk ratio from this procedure.

[The treatment of vasospastic disease by chronic spinal cord stimulation. A case report]. / Tratamiento de la enfermedad vasoespática con la estimulación medular crónica. Presentación de un caso.

In 1976, by first time, Cook used the chronic medullar stimulation (CMS) for the treatment of chronic arteriopathies at the limbs in patients with distal ischemic ulcerations. Up to now, some studies about this procedure have been published. Results, poor at first, have presented an important improvement with the time and the better choosing of patients. In 1981, Neglio used by first time CMS as a treatment of vasospastic disease, with excellent results. With this procedure, pain and vasospastic crisis disappeared and re-epithelialization of ischemic ulcerations is found. In this article, we presented a case interesting because it show the different possibilities of this method as a symptomatic treatment of such kind of disease. Patient, with a Raynaud syndrome secondary to an sclerodermia treated previously by medical and surgical procedures, was treated, in different times, with CMS because of digital ischemic ulcerations in both hands. Results were positives and ulcerations healed.

[Embolism of the humeral artery originating in a thrombosed axillo-femoral bypass]. / Embolia de arteria humeral originada por un by-pass axilo-femoral trombosado.

A case of a patient, with acute arterial ischemia at the upper limb is reported. On this case, ischemia was caused by humeral arterial embolism. The embolic origin was focused on the proximal end of a thrombosed axillofemoral bypass. After a rude manipulation during surgical procedure, part of the thrombus, following the sanguineous current, occluded the humeral artery. Patient underwent an emergent surgery. Posterior course was good. Histology showed a re-epithelialized, ancient thrombus. Cardiologic studies and angiography showed no others embolic focuses.

[Ulcerated plaque in the terminal aorta as a source of recurrent embolism in the young patient]. / Placa ulcerada de aorta terminal como fuente de embolias de repetición en paciente joven.

In the last years, some case reports about peripheral arterial embolism originated from ulcerative disorders in the wall of aorta and main vascular structures, have been published. Patients affected by this disease are usually aged and arteriosclerotic injuries at divers levels are common. The current case report presents a patient, 37 years old, with a history of 3 surgical procedures because of recurrent arterial embolism in the left femoro-popliteal area with unknown embolic origin. Further, a complete angiographic exploration was realized because a new occlusion in the left ileo-femoral area occurred and suspicious images of an ulcerative atheroma plaque in final aorta were found. This conjecture was confirmed during surgical procedure. It should be noted that some histories of peripheral embolism, with unknown origin, in young patients could be caused by this type of disorders.

[Chronic osteomyelitis: open excision and grafting after saucerization (author's transl)]. / Ostéomyélite chronique: excision et greffe de spongieux à l'air libre après mises à plat extensives.

From January 1960 to January 1974, 180 cases of chronic osteomyelitis were treated by the same surgeon in the infection unit of Notre-Dame Hospital in Montreal. Of these cases, 71.4% were treated by saucerization, followed by secondary closure or by skin grafting. In ten cases (5.4%) the limb was amputated. However, in 39 cases two similar techniques of open excision and grafting were used. The infection was mostly traumatic in origin and a staphylococcus was cultured in 75% of cases. The organism was sensitive to cloxacillin and dicloxacillin in the majority of cases. Since 50% of these 39 cases were referred for amputation, the results were much betts. Two late recurrences were recently seen and treated, one 17 years and one 4 years after the initial treatment.