An unusual case of posterior elbow dislocation with proximal radioulnar translocation. / Un caso inusual de luxación posterior del codo con translocación radiocubital proximal.

We present a 9-year-old girl who suffered a posterior dislocation of the right elbow with a proximal translocation between the ulna and the radius. It is a type of exceptional dislocation which in our case was not accompanied by lesions of the joint surfaces of the elbow unlike most cases already published. This article stresses the importance of making an early diagnosis of this variety of dislocation; this is the best way to prevent it from going unnoticed. The use of Computed Tomography (CT) helped this early diagnosis, enabling an immediate closed orthopaedic reduction and achieving a cure without sequelae.

Gender-associated comorbidities in rheumatoid arthritis and their impact on outcome: data from GENIRA.

GENIRA [Gender in Rheumatoid Arthritis (RA)] is a comprehensive project aimed at studying gender differences in RA patients and how these differences impact on these patient outcomes. We are now reporting such data. Seventy RA patients of each gender were cross-sectionally evaluated following a preestablished protocol. Univariate and multivariate analyses focused in the different gender-associated comorbidity profiles and how they impact in the quality of life and disability of RA patients as assessed by the SF-36 and the Modified Health Assessment Questionnaire (M-HAQ), respectively. Both groups were comparable regarding their main demographic and clinical features. Different comorbidity profiles were found in both genders, with higher frequencies of diabetes mellitus, peptic ulcer, ischemic heart disease, smoking and chronic obstructive pulmonary disease among men and of depression and osteoporosis among women. The M-HAQ was lower in women than in men (0.89 ± 2.6 vs 0.22 ± 0.9, p = 0.04) as there were some sub-scales of the SF-36 [mental health (63.7 ± 22.0 vs 71.8 ± 21.1; p = 0.02), general health (41.3 ± 21.7 vs 50.0 ± 24.3; p = 0.02), physical functioning (PF) (57.7 ± 22.1 vs 67.3 ± 22.7; p = 0.01) and the physical summary component (PSC) (39.3 ± 8.9 vs 42.4 ± 9.3, p = 0.04)]. Multivariate analysis indicated the independent association between depression and osteoporosis rather than gender with the M-HAQ, PSC and PF and of only depression with the MH and GH. Women with RA present significantly worse disability and QOL outcomes than men; these differences can be explained by female gender-associated comorbidities such as depression and osteoporosis rather than gender per se.

[Use of embolization in the treatment of pulsatile tinnitus secondary to dural arteriovenous fistula]. / Utilidad de la embolización en el tratamiento de acúfenos pulsátiles secundarios a fístulas arteriovenosas durales.

Three cases of dural arteriovenous fistula (DAVF) in patients who consulted for pulsatile tinnitus are reported. All were treated successfully by embolization. If DAVF is suspected, angiography of the carotid and vertebral arteries should be performed to confirm its presence and to identify sources of blood flow and venous drainage. If treatment is needed, embolization, surgery, or radiotherapy may be indicated either separately or in combination therapy. The numerous branches and site of the fistula make therapeutic embolization the procedure of choice for many cases.

[Cholesterol granuloma of the petrous apex]. / Granuloma de colesterol de punta de peñasco.

Cholesterol granuloma of the petrous apex is an inflammatory granulation tissue response to the presence of cholesterol crystals. It is not generally associated with middle-ear pathology. CT and MRI are fundamental for diagnosis. MRI is more specific and shows a well-circunscribed mass with high signal intensity on both T1 and T2 weighted images. We present a case of cholesterol granuloma of the petrous apex that was previously diagnosed as cholesteatoma. We emphasize the importance of preoperatory differentiation of the lesion from cholesteatoma. Cholesterol granuloma does not require full excision of the lesion. Drainage and permanent aeration is usually sufficient.