ABSTRACT
Objetivo. El diagnóstico clínico de la insuficiencia del LCA está sometido a criterios subjetivos y su sensibilidad es baja. La RM se ha convertido en el estándar en la evaluación no invasiva de las lesiones de rodilla. Es importante determinar el valor diagnóstico de la exploración clínica (EC) y resonancia magnética (RM) frente al patrón artroscopia en lesiones del LCA y conocer y precisar sus parámetros exploratorios objetivos. Material y método. Se han revisado 101 H. Clínicas con las condiciones: EC-radiológica sospechosa de patología LCA, exploración protocolizada con test subjetivos/objetivos, RMN, EC objetiva bajo anestesia y artroscopia diagnóstica/terapéutica. Se seleccionaron datos epidemiológicos, tiempos desde la lesión del LCA hasta la cirugía, intervenciones previas sobre rodilla afecta, datos subjetivos, datos objetivos incluyendo artrometría, número de centros que realizaron la RM, número de RM por centro y observadores, y artroscopia. Material y método. Se ha realizado estudio estadístico comparando variables cuantitativas y cualitativas, precisión, fiabilidad y consistencia entre medidas. Resultados. Respectivamente el 94%, el 100% y el 83% fueron diagnosticados mediante EC-sin-anestesia, con-anestesia y RM, con una sensibilidad del 94,06%, 100%, y 83,17%. Discusión. La EC, con/sin-anestesia, diagnóstica más veces la insuficiencia del LCA que la RM. La RM diagnostica un número total mayor de lesiones concomitantes y detecta más lesiones del menisco externo. El test de Lachman y la artrometría son los métodos diagnósticos más significativos en la insuficiencia del LCA (AU)
Objective. The clinical diagnosis of anterior cruciate ligament (ACL) failure uses subjective criteria and its sensitivity is low. Magnetic resonance imaging (MRI) has become the standard in the non-invasive evaluation of knee injuries. It is important to determine the diagnosis by clinical examination (CE) and MR versus the arthroscopy pattern in the ACL injuries, and to know and specify their objective exploratory parameters. Materials and Methods. A total of 101 medical records were reviewed: CE-radiological suspicion of ACL failure, examination using a subjective/objective test protocol, MR, objective CE under anaesthesia and diagnostic/therapeutic arthroscopy. We selected epidemiological data, times from the ACL to surgery, previous operation on the affected knee, subjective data, objective data including arthrometry, number of centres that performed MR, the number of MR per centre, observations and arthroscopy. Results. A statistical study was performed comparing quantitative and qualitative variables, precision, reliability and consistency between actions. A total of 94%, 100% and 83% were diagnosed using EC without anaesthesia, with anaesthesia and MR, with a sensitivity of 94.06%, 100% and 83.17%, respectively. Discussion. The CE with/without-anaesthesia, diagnosed ACL failure more often than MR. MR diagnoses the total number of concomitant injuries and detects more external meniscus injuries. The Lachman test and arthrometry are the most significant diagnostic methods in ACL failure (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Magnetic Resonance Imaging/methods , Arthroscopy/methods , Arthrometry, Articular/methods , Anterior Cruciate Ligament/surgery , Knee/surgery , Knee , Knee Injuries/surgery , Knee Joint/surgery , Diagnostic Techniques and Procedures/instrumentation , Diagnostic Techniques and Procedures/statistics & numerical data , Anterior Cruciate Ligament/physiopathology , Sensitivity and Specificity , Arthrometry, Articular/trendsABSTRACT
The formation of ferryl heme (Fe(IV) = O) species, i.e., compound I and compound II, has been identified as the main intermediates in heme protein peroxidative reactions. We report stopped-flow kinetic measurements which illustrate that the reaction of hemoglobin I (HbI) from Lucina pectinata with hydrogen peroxide produce ferryl intermediates compound I and compound II. Compound I appears relatively stable displaying an absorption at 648 nm. The rate constant value (k'(2)) for the conversion of compound I to compound II is 3.0 x 10(-2) s(-1), more than 100 times smaller than that reported for myoglobin. The rate constant value for the oxidation of the ferric heme (k'(12) + k'(13)) is 2.0 x 10(2) M(-1) s(-1). These values suggest an alternate route for the formation of compound II (by k'(13)) avoiding the step from compound I to compound II (k'(2)). In HbI from L. pectinata the stabilization of compound I is attribute to the unusual collection of amino acids residues (Q64, F29, F43, F68) in the heme pocket active site of the protein.
Subject(s)
Ferric Compounds/chemical synthesis , Ferrous Compounds/chemical synthesis , Hemoglobins, Abnormal/chemistry , Hemoglobins , Hydrogen Peroxide/chemistry , Mollusca/chemistry , Amino Acids/chemistry , Animals , Catalase/metabolism , Ferric Compounds/chemistry , Ferrous Compounds/chemistry , Spectrophotometry, UltravioletABSTRACT
La revisión de una artroplastia de rodilla pasa por ser una de las intervenciones más complejas de la cirugía ortopédica actual debido a la gran cantidad de dificultades técnicas que plantea. El adecuado planteamiento de cada caso en particular, que comienza con la definición del mecanismo o mecanismos del fracaso de la artroplastia primaria y continúa con la descripción de los déficits óseos y de partes blandas, permitirá al cirujano afrontar cada intervención con las máximas garantías. El plan de reconstrucción debe perseguir siempre los objetivos de restaurar la interlínea articular a la posición anatómica más adecuada y de recuperar la normalidad cinemática de la rodilla. Para ello será imprescindible una reparación adecuada de los déficits óseos con cemento, suplementos o injertos óseos y el restablecimiento de un eje mecánico correcto con cualquiera de los diferentes modelos de implantes disponibles en la actualidad. Como norma general se escogerá la prótesis lo menos constreñida posible para conseguir una estabilidad satisfactoria de forma que se reduzca al máximo el estrés en la interfaz hueso-implante, pero será la intensidad de la deficiencia ósea la que influirá de forma definitiva en la longitud del vástago a utilizar. Ante un caso complejo será aconsejable disponer de varias soluciones incluidos los implantes tipo bisagra, para solucionar si fuera necesario, una deficiencia grave de partes blandas tan común en este tipo de intervenciones. Se exponen los resultados publicados en la resolución de los diversos problemas planteados en los recambios protésicos de rodilla (AU)
Subject(s)
Humans , Arthroplasty, Replacement, Knee/methods , Reoperation/methods , Prosthesis Failure , Prosthesis-Related Infections/surgery , Postoperative Complications/surgery , Preoperative Care/methods , Bone Cements/therapeutic useABSTRACT
OBJECTIVE: To identify the mechanisms which influence the development of cardiac insufficiency in Paget's disease of bone (PD). METHODS: In this hospital-based case-control study 23 consecutive, recently diagnosed and untreated PD patients were compared against 23 controls frequency-matched by sex, age and body index. All subjects underwent non-invasive assessment of cardiac function by two-dimensional Doppler echocardiography. Calcium, phosphate, and creatinine were determined in the serum and urine, along with alkaline phosphatase and hydroxyproline excretion, two biochemical parameters of PD activity. RESULTS: Peripheral vascular resistance proved lower (1604.9 +/- 390.1 vs 1801.2 +/- 421.0) and the stroke volume higher in PD patients (67.2 +/- 14.4 vs 56.0 +/- 8.6; p = 0.07) compared with controls. These differences were greater (1504.7 +/- 289.9 and 71.0 +/- 6.2) and attained statistical significance (p = 0.008) when the subgroup with more extensive skeletal disease only was considered. A moderate correlation was observed between hydroxyproline excretion and the E/A ratio (r = 0.45; p = 0.03), peripheral vascular resistance (r = -0.42; p = 0.04), and diastolic arterial pressure (r = -0.42; p = 0.04). The final model obtained via multivariate analysis identified both urinary hydroxyproline and age as predictive variables linked to peripheral vascular resistance. CONCLUSION: In the early phases of PD there is a trend towards a reduction in peripheral vascular resistance. If this persists, it may lead progressively to increased cardiac output, which is mainly influenced by the degree of turnover impairment and the age of the individual.
