Massive Desmoplastic Fibroma of the Proximal Tibia: Case Report.

Desmoplastic fibroma of bone is a very uncommon, benign but locally aggressive fibrogenic tumor. This report describes the case of a 45-year-old patient with a massive desmoplastic fibroma of the proximal tibia. A two-staged surgical procedure was successfully performed: wide resection and endoprosthetic reconstruction. Surgeons should be aware of the complexity of its treatment in the locally advanced and aggressive cases. A comprehensive review of the literature is also provided.

Preliminary Outcomes of a Staged Percutaneous Retrograde Prefabricated Gentamicin-coated Intramedullary Nail to Manage Complications after Ankle Fusion through Tibial Bone Transport.

Aim: Distal tibial injuries combining bone loss, articular destruction and infection can be treated through distraction osteogenesis combined with ankle fusion. Bone transport is not without complications. This study investigates our preliminary results using a retrograde prefabricated gentamicin-coated nail (ETN PROtect®) to treat complications after infected bone defects of the distal tibial were managed by ankle arthrodesis and distraction osteogenesis. Materials and methods: This is a retrospective case series study. All consecutive patients with bone transport complications after ankle arthrodesis and distraction osteogenesis who were subsequently operated on using a retrograde ETN PROtect® nail were analysed. The cases occurred between 2017 and 2020. The primary objective was to report on the resolution of the clinical problem and the risk of deep infection after nail implantation. Results: Five patients have included: two docking site non-unions, two regenerated bone fractures and one hypotrophic regenerated bone. These complications were resolved in all patients (5/5, 100%). A painless, stable and plantigrade ankle arthrodesis was achieved in all cases. No patient developed a local infection or required nail removal (mean follow-up: 35.2 months). The mean LEFS score was 46.8 ± 13.8 and the mean knee ROM was 112 ± 12.7°. All patients tolerated full weight-bearing. All patients were very satisfied with the procedure (mean SAPS score was 93.8 points). Conclusion: The staged retrograde nailing technique using the ETN PROtect® nail may represent an effective and safe treatment for bone transport complications in high-infection-risk patients. Furthermore, the technique allows simultaneous achievement of ankle arthrodesis. The patients had good functional outcomes and were satisfied with the procedure. Clinical significance: This strategy of using retrograde gentamicin-coated tibial nails offers a solution to resolve bone transport complications while simultaneously achieving functional ankle arthrodesis. How to cite this article: Pujol O, Vicente M, Castellanos S, et al. Preliminary Outcomes of a Staged Percutaneous Retrograde Prefabricated Gentamicin-coated Intramedullary Nail to Manage Complications after Ankle Fusion through Tibial Bone Transport. Strategies Trauma Limb Reconstr 2023;18(3):155-162.

Método madre canguro con oxigenoterapia domiciliaria: cuidados culturales maternos, una mirada desde la enfermería / Kangaroo mother care method with home oxygen therapy: cultural maternity care, a nursing perspective / Método mãe-canguru com oxigenoterapia domiciliar: cuidados culturais maternos, o olhar de enfermagem

Introducción: Un 40% de los niños prematuros son egresados de las unidades neonatales y las familias se ven enfrentados a una situación inesperada. Criar un niño prematuro y bajo peso al nacer en posición canguro en el hogar no es tarea fácil para las madres es un cuidado extremo, significa un reto que será compensado con el crecimiento infantil. Objetivo: describir el significado del cuidado materno cultural del lactante prematuro y/o de bajo peso al nacer con oxígeno domiciliario. Metodología: estudio de tipo cualitativo con abordaje etnográfico, realizado en un Programa Canguro ambulatorio de un hospital de Bogotá Colombia. En la investigación previo consentimiento informado y aprobación institucional, participaron 8 madres, la descripción densa o la saturación de la muestra se dio con 21 entrevistas grabadas en los hogares y transcritas textualmente. Para la recolección y análisis de la información se usó la teoría de la diversidad y de la universalidad de los cuidados culturales de Madeleine Leininger y la entrevista a profundidad de James Spradley. Resultados: El significado que asignan las madres al cuidado del niño/a con oxígeno domiciliario es descrito en 9 dominios: El oxígeno como una necesidad vital, conocimientos culturales, conocimientos y educación sobre la administración de oxígeno domiciliario, trámites y sus dificultades, el desplazamiento de la madre con el niño/a prematuro con oxígeno domiciliario, higiene y vestido, los costos se aumentan, participación del padre y familiar y alteración de las emociones maternas. Conclusiones: En el saber de las madres el cuidar a su hijo con oxígeno domiciliario significa "estar pendiente" e interpretan el oxígeno como una necesidad vital. Se requiere incluir el tema en los programas de pregrado y posgrado de enfermería y generar investigaciones al respecto.

Introduction: Forty percent of premature infants are discharged from neonatal intensive care units, and their families face an unexpected situation. Raising a premature or low-birthweight baby using the kangaroo method at home is not an easy task, and, for mothers, it involves extreme care and is a challenge that will be compensated with the infant's growth. Objective: To describe the cultural meaning assigned by mothers to the care they give to their preterm or low-birthweight infants with home oxygen therapy. Methods: Qualitative study with an ethnographic approach conducted with mothers enrolled in an outpatient kangaroo program in a hospital in Bogotá, Colombia. Eight mothers participated in the research after informed consent and institutional approval were obtained. Thick description or data saturation was achieved with 21 interviews recorded at the participants' homes and transcribed verbatim. For data collection and analysis, Madeleine Leininger's theory of culture care diversity and universality and James Spradley's in-depth interview were used. Results: T h e m e a n i n g assigned by the mothers to the care given to their children with home oxygen therapy is described in nine domains: oxygen as a vital necessity, cultural knowledge, knowledge and education about oxygen therapy administration at home, paperwork and paperwork difficulties, mother's trips with a preterm infant on home oxygen therapy, hygiene and dressing, increased costs, father and other family member involvement, and maternal emotion alterations. Cultural beliefs and practices immersed in the three types of cultural care (preservation, accommodation, and repatterning) are also identified from the analysis of Madeleine Leininger's theory. The technological, religious and physiological, social, cultural, political, economic, and educational factors that influence the culture of the mothers interviewed are evident. Conclusions: In the mothers' minds, caring for their children receiving home oxygen therapy means "being vigilant," and they interpret oxygen as a vital necessity. It is necessary to include the topic in undergraduate and graduate nursing programs and to conduct research on the subject.

Introdução: 40% das crianças prematuras recebem alta das unidades neonatais e as famílias se deparam com uma situação inesperada. Criar um bebê prematuro e/ou de baixo peso ao nascer na posição canguru em casa não é uma tarefa fácil, e para as mães é um cuidado extremo e representa um desafio que será compensado com o crescimento da criança. Objetivo: descrever o significado cultural que as mães atribuem aos cuidados que prestam aos filhos prematuros e/ou de baixo peso com oxigênio domiciliar. Método: estudo qualitativo com abordagem etnográfica, realizado em um programa ambulatorial canguru de um hospital de Bogotá, Colômbia. Oito mães participaram da pesquisa, com Consentimento Livre e Esclarecido e aprovação institucional. A saturação da amostra ocorreu com 21 entrevistas gravadas nos domicílios e transcritas na íntegra. Para a coleta e análise das informações, utilizou-se a teoria da diversidade e universalidade dos cuidados culturais de Madeleine Leininger e a entrevista em profundidade de James Spradley. Resultados: o significado que as mães atribuem ao cuidado da criança com oxigênio domiciliar é descrito em nove domínios: oxigênio como necessidade vital, conhecimentos culturais, conhecimentos e educação sobre administração de oxigênio domiciliar, procedimentos e suas dificuldades, deslocamento do mãe com o prematuro com oxigênio domiciliar, higiene e vestuário, aumento de custos, participação do pai e da família e alteração das emoções maternas; Também são identificadas crenças e práticas culturais imersas nos três tipos de cuidado: preservação, adaptação e reorientação do cuidado cultural a partir da análise com a teoria de Madeleine Leininger e os fatores tecnológicos, religiosos e fisiológicos, sociais, culturais, políticos, econômicos e educacionais que influenciam a cultura das mães entrevistadas. Conclusões: no conhecimento das mães, cuidar do filho com oxigênio domiciliar significa "estar atentas" e elas interpretam o oxigênio como uma necessidade vital. É necessário incluir o tema nos programas de graduação e pós-graduação em enfermagem e gerar pesquisas sobre o assunto.

A comparative of a single novice surgeon's direct anterior approach and posterior approach learning curves in total hip arthroplasty: a retrospective cohort study.

INTRODUCTION: The purpose of the present study was to compare a novice surgeon's learning curves with the direct anterior approach and posterior approach in total hip arthroplasty. METHODS: A consecutive series of 376 total hip arthroplasties performed from November 2014 to September 2019 in a level-one healthcare center by a single surgeon (V.B) were retrospectively studied. Demographic data, functional outcomes, and complications were collected and compared. RESULTS: Within the ranks of the patients studied, we found differences between groups with respect to dislocation rate and length of stay; these were lower in the direct anterior approach (DAA) group. The approach was not associated with an increase in complications, but rather with a decrease in the rate of dislocations and better functional outcomes at 1-year follow-up. Operative time was initially higher with this approach, but equalized during the learning curve. CONCLUSION: The DAA can be safe even in the early stages of a novice surgeon's learning curve. It does not present a higher complication rate than the posterior approach, either in infection rate or in periprosthetic fractures. However, the DAA may provide greater functionality, lower dislocation rate and a shorter hospital stay. It can also be concluded that after having performed a certain number of interventions, operative time for the DAA can be comparable to that of other approaches.

Restoring hip biomechanics during the learning curve of a novice surgeon: Direct anterior approach vs posterior approach.

INTRODUCTION: It remains controversial whether the direct anterior approach (DAA) or the posterior approach (PA) allows better restoration of hip biomechanics after total hip arthroplasty (THA). Besides, it is not certain which approach is best for a novice surgeon to avoid implant malposition, neither during the learning curve nor once the curve plateau has been reached. METHODS: We performed a retrospective cohort study of THAs operated on between 2014 and 2019 by a single novice surgeon (DAA, n = 187; PA, n = 184). The surgeon used both approaches, and thus went through parallel learning curves. RESULTS: While the DAA presented a greater number of acetabular cup implantations within Lewinnek's "safe zone" for inclination (84.5% vs. 79.3%; p = 0.003), the PA returned superior results for anteversion (77.7% vs. 68.4%; p = 0.000). The PA showed a tendency to verticalize acetabular cups, while the DAA tended to antevert them. The DAA resulted in fewer patients with leg length discrepancy (3.2% vs. 8.2%, p = 0.041). No differences were found in stem coronal alignment or femoral offset. CONCLUSION: Both approaches are safe and reliable for restoring hip biomechanics through THA surgery during the learning curve of a novice hip surgeon. Similar radiological outcomes are also seen once the surgeon has reached the learning curve plateau.

Significado del cuidado materno cultural del niño(a) con oxígeno domiciliario / Meaning of cultural maternal care of the child with home oxygen

La presente investigación se realizó con el objetivo de describir el significado del cuidado materno cultural del niño(a) prematuro y/o de bajo peso al nacer con oxígeno domiciliario en el Programa Madre Canguro de un hospital de Bogotá. Estudio de tipo cualitativo con abordaje etnográfico, apoyado en el referente teórico de Madeleine Leininger a través de la teoría de la diversidad y de la universalidad de los cuidados culturales, el método de análisis se realizó con la entrevista etnográfica de James Spradley. Se realizaron 21 entrevistas a profundidad a 8 madres, que acudieron con sus hijos/as prematuros con oxígeno domiciliario al plan canguro de un hospital de Bogotá y se tomaron notas de campo a través de la observación participante. Como resultado se encontraron 9 dominios: 1. El oxígeno como una necesidad vital, 2. Conocimientos culturales, 3. Conocimientos y educación sobre la administración de oxígeno domiciliario al prematuro, 4. Trámites y sus dificultades, 5. El desplazamiento de la madre con el niño/a prematuro con oxígeno domiciliario, 6. Higiene y vestido del niño/a con oxígeno domiciliario, 7. Los costos se aumentan, 8. Participación del padre y familiar, y 9. Alteración de las emociones maternas. Conclusión: para las madres de los niños/as con oxígeno domiciliario, el cuidado materno cultural significa "estar pendiente" y "tener cuidado" e interpretan el oxígeno como una necesidad vital.

The goal of this research was to describe the meaning of cultural maternal care for prematury children and/or low birthweight infants with home oxygen in the KMC program at a hospital in Bogotá city. Qualitative research with an ethnographic approach, supported by Madeleine Leininger's theoretical benchmark on the theory of diversity and universality of cultural care. The analysis methodology was undertaken using the James Spradley´s ethnographic interview outline. 21 deep interviews were performed to 8 mothers being part of the KMC program, who came with their home oxygen premature children to a hospital in Bogota; field notes were also taken through participant´s observation. As a result 9 domains: 1. Oxygen as a vital necessity, 2. Cultural Knowledge, 3. Knowledge management and education on home oxygen to premature 4. Procedures and difficulties, 5. The displacement of the mother with child premature home oxygen, 6. Hygiene and child Dress with home oxygen, 7. The costs are increased, 8. Participation of father and family, and 9. Alteration of maternal emotions. Conclusion: for mothers of children with home oxygen, maternal cultural care means "be aware" and "be careful" and interpret oxygen as a vital necessity.

[Associated metabolic and nutritional side effects to biological cancer therapy]. / Efectos adversos metabólicos y nutricionales asociados a la terapia biológica del cáncer.

INTRODUCTION: The different types of cancer represent one of the main causes of morbimortality worldwide. Classical anti-tumor therapy (surgery, chemotherapy, radiotherapy) has notably increased the survival rate. Biological therapies, with selective and frequently specific mechanisms of action, are a relatively recent acquisition in oncologic therapy; among the most commonly used ones are: cytokines, monoclonal antibodies, tyrosine kinase inhibitors, and mTOR inhibitors. The nutritional and metabolic adverse effects of classical therapy are well documented in the literature and the clinical guidelines, which is not the case for biological therapy. OBJECTIVE: To review the literature in this field and to detail in an organized manner the results obtained. METHODS: Indexed literature and the technical data sheets of the drugs included in the different families were revised through the Spanish Agency of Medicines and Health Care Products until July of 2013. The symptoms and clinical signs of a theoretical action on the nutritional and metabolic status were recorded. RESULTS: The specific action of each family is described. The possible adverse effects of each one of them on the nutritional and metabolic status are grouped, detailing and differentiating them in tables for easier and more friendly-user consultation. The most prevalent possible side effects observed are those related with the appetite, the gastrointestinal tract, and electrolytic impairments. CONCLUSIONS: the possible side effects associated to biological therapies are plenty and occur with different frequency and severity. It is important to know the nutritional and metabolic impact when using these therapies for preventing and managing them.

Introducción: Los diferentes tipos de cáncer constituyen una de las principales causas de morbi-mortalidad en el mundo. La terapia clásica antitumoral (cirugía, quimioterapia, radioterapia) ha incrementado notoriamente la supervivencia. Las terapias biológicas, con mecanismos de acción selectivos y frecuentemente específicos, constituyen una incorporación relativamente reciente al tratamiento oncológico; entre las más utilizadas se incluyen: citoquinas, anticuerpos monoclonales e inhibidores de tirosin kinasa y de mTOR. Si bien están adecuadamente documentados los efectos adversos nutricionales y metabólicos asociados a la terapia clásica, tanto en literatura como en guías clínicas, no ocurre igual con la terapia biológica. Objetivo: Revisar la literatura al respecto y detallar de modo organizado los resultados obtenidos. Métodos: Se revisó la literatura indizada así como todas las fichas técnicas de los fármacos incluidos en las distintas familias mediante la Agencia Española del Medicamento y Productos Sanitarios a Julio de 2013. Se registran los síntomas y signos clínicos con teórica acción sobre el estado nutricional o metabólico. Resultados: Se describe la acción específica de cada familia. Se agrupan los posibles efectos adversos de cada una sobre el estado nutricional y metabolismo, detallando y diferenciándolos en tablas para una más fácil y cómoda revisión y consulta. Se observan como posibles efectos secundarios más prevalentes los relacionados con el apetito, aparato digestivo y alteraciones electrolíticas. Conclusiones: Los posibles efectos secundarios asociados a terapias biológicas son múltiples y aparecen con diferente frecuencia y gravedad. Es importante al utilizarlas conocer el impacto nutricional y metabólico que pueden presentar, para su prevención y tratamiento.

Efectos adversos metabólicos y nutricionales asociados a la terapia biológica del cáncer / Associated metabolic and nutritional side effects to biological cancer therapy

Introducción: Los diferentes tipos de cáncer constituyen una de las principales causas de morbi-mortalidad en el mundo. La terapia clásica antitumoral (cirugía, quimioterapia, radioterapia) ha incrementado notoriamente la supervivencia. Las terapias biológicas, con mecanismos de acción selectivos y frecuentemente específicos, constituyen una incorporación relativamente reciente al tratamiento oncológico; entre las más utilizadas se incluyen: citoquinas, anticuerpos monoclonales e inhibidores de tirosin kinasa y de mTOR. Si bien están adecuadamente documentados los efectos adversos nutricionales y metabólicos asociados a la terapia clásica, tanto en literatura como en guías clínicas, no ocurre igual con la terapia biológica. Objetivo: Revisar la literatura al respecto y detallar de modo organizado los resultados obtenidos. Métodos: Se revisó la literatura indizada así como todas las fichas técnicas de los fármacos incluidos en las distintas familias mediante la Agencia Española del Medicamento y Productos Sanitarios a Julio de 2013. Se registran los síntomas y signos clínicos con teórica acción sobre el estado nutricional o metabólico. Resultados: Se describe la acción específica de cada familia. Se agrupan los posibles efectos adversos de cada una sobre el estado nutricional y metabolismo, detallando y diferenciándolos en tablas para una más fácil y cómoda revisión y consulta. Se observan como posibles efectos secundarios más prevalentes los relacionados con el apetito, aparato digestivo y alteraciones electrolíticas. Conclusiones: Los posibles efectos secundarios asociados a terapias biológicas son múltiples y aparecen con diferente frecuencia y gravedad. Es importante al utilizarlas conocer el impacto nutricional y metabólico que pueden presentar, para su prevención y tratamiento (AU)

Introduction: The different types of cancer represent one of the main causes of morbimortality worldwide. Classical anti-tumor therapy (surgery, chemotherapy, radiotherapy) has notably increased the survival rate. Biological therapies, with selective and frequently specific mechanisms of action, are a relatively recent acquisition in oncologic therapy; among the most commonly used ones are: cytokines, monoclonal antibodies, tyrosine kinase inhibitors, and mTOR inhibitors. The nutritional and metabolic adverse effects of classical therapy are well documented in the literature and the clinical guidelines, which is not the case for biological therapy. Objective: To review the literature in this field and to detail in an organized manner the results obtained. Methods: Indexed literature and the technical data sheets of the drugs included in the different families were revised through the Spanish Agency of Medicines and Health Care Products until July of 2013. The symptoms and clinical signs of a theoretical action on the nutritional and metabolic status were recorded. Results: The specific action of each family is described. The possible adverse effects of each one of them on the nutritional and metabolic status are grouped, detailing and differentiating them in tables for easier and more friendly-user consultation. The most prevalent possible side effects observed are those related with the appetite, the gastrointestinal tract, and electrolytic impairments. Conclusions: the possible side effects associated to biological therapies are plenty and occur with different frequency and severity. It is important to know the nutritional and metabolic impact when using these therapies for preventing and managing them (AU)