The enhancement of osteogenesis through the use of dental pulp pluripotent stem cells in 3D.

The potential for osteogenic differentiation of dental pulp mesenchymal stem cells (DPMSCs) in vitro and in vivo has been well documented in a variety of studies. Previously, we obtained a population of cells from human dental pulp called dental pulp pluripotent stem cells (DPPSCs) that could differentiate into mesodermal, ectodermal and endodermal progenies. We compared the osteogenic capacity of DPPSCs and DPMSCs that had been isolated from the same donors (N=5) and cultivated in the same osteogenic medium in 3D (three dimensions) Cell Carrier glass scaffolds. We also compared the architecture of bone-like tissue obtained from DPPSCs and human maxillary bone tissue. Differentiation was evaluated by scanning electron microscopy, whereas the expression of bone markers such as ALP, Osteocalcin, COLL1 and Osteonectin was investigated by quantitative real time polymerase chain reaction (qRT-PCR). We also used calcium quantification, Alizarin red staining and alkaline phosphatase (ALP) activity to compare the two cell types. New bone tissue formed by DPPSCs was in perfect continuity with the trabecular host bone structure, and the restored bone network demonstrated high interconnectivity. Significant differences between DPPSCs and DPMSCs were observed for the expression of bone markers, calcium deposition and ALP activity during osteogenic differentiation; these criteria were higher for DPPSCs than DPMSCs. Both DPPSCs and differentiated tissue showed normal chromosomal dosage after being cultured in vitro and analysed using short-chromosome genomic hybridisation (short-CGH). This study demonstrates the stability and potential for the use of DPPSCs in bone tissue engineering applications.

Viability of maxillary bone harvesting by using different osteotomy techniques. A pilot study.

The use of autogenous grafts is still considered in bone regeneration surgeries. However, the bone cell viability of such grafts after being harvested from donor sites remains a matter of debate. The aim of the present study is to evaluate particulated and block bone cell viability, in terms of presence or absence of apoptosis and necrosis, obtained from different maxillary intra-oral harvesting methods: bone scraper, rotary carbide burs and piezoelectric device. Five healthy patients were enrolled in the study. The patients required sinus augmentation by lateral window approach. The bone was harvested by the bone scraper, piezoelectric device and rotary surgical instrument. The samples were processed with the Annexin V/FITC (fluorescein isothiocyanate stain) kit and were analyzed by means of Fluoresence-Activated Cell Sorted (FACS) technique. Within the limitations of this pilot study, the results indicated that autogenous bone chips collected from the three harvesting methods presented a large percentage of apoptotic cells, although large scale production of necrotic cells was not detected. In summary, although rotary surgical instrument and piezoelectric devices are frequently used instruments for oral osteotomy, fresh autogenous bone chips collected from them did not present a viable bone cell source.

Comparative study of the Weil osteotomy with and without fixation.

BACKGROUND: Weil osteotomy is a technique widely used in patients with metatarsalgia which shortens the metatarsal and reduces the load under the metatarsal head. METHODS: The aim of this paper is to compare the results of the Weil osteotomy with and without any fixation system. We present a retrospective study of 92 patients (97 feet) who underwent treatment for metatarsalgia between 1999 and 2005. One hundred and six osteotomies were vixed using a screw amd no fixation was used in 92. The mean follow-up was 51.2 and 46.6 months respectively. RESULTS: All the patients were evaluated following the AOFAS LMIS scale, obtaining a mean score of 69.8 points (ranged 15-100) and 75.3 points (from 47 to 100) in each group (P=0.11). CONCLUSIONS: The results of fixed and unfixed Weil osteotomies were not significantly different. Our study could not find a significant relationship between metatarsal shortening and main complications (recurrent metatarsalgia, transfer metatarsalgia and stiffness of the metatarsophalangeal joint).

Stevens-Johnson syndrome and toxic epidermal necrolysis in children: a review of the experience with paediatric patients in a university hospital.

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening drug reactions considered to be part of the spectrum of a single pathological process. OBJECTIVE: To describe the clinical and epidemiological characteristics of SJS/TEN in children attended at our hospital. MATERIALS AND METHODS: Retrospective study of children diagnosed with SJS/TEN between 1999 and 2009 in a University Hospital provided with regional-level burn and paediatric intensive care units. RESULTS: We found 14 paediatric patients (eight SJS and six TEN). They presented an average of 60% of the body surface area affected and 31% of epidermal sloughing. The average of suspected drugs was 1.7 per patient, anticonvulsants (carbamazepine, phenytoin and lamotrigine) and antibiotics (penicillin and macrolides) being the most frequent ones. Silver sulfadiazine was the topical treatment most frequently used, 86% of patients received systemic steroids and 28.5% intravenous immunoglobulins. One patient died. CONCLUSIONS: The SJS/TEN complex is a true dermatological critical condition that also affects children. Any drug can be the causative agent, more frequently anticonvulsants and antibiotics. Depending on the extension of the affected body surface, patients should be rapidly admitted to a critical care area with experience in the care of burn patients. Discontinuation of the suspected offending drugs is mandatory. Optimal supportive care and management of denuded skin areas are still the mainstay of treatment. The use of specific therapies remains controversial. Compared with adults, the disease in children seems to be milder with lower mortality.

Artroplastia de cabeza radial mediante prótesis metálicas en fracturas no reconstruibles. Nuestra experiencia / Radial Head Arthroplasty using metallic prosthesis in unreconstructible fractures. Our experience

Objetivo: Analizar los resultados obtenidos con la atroplastia de cabeza radial mediante prótesis metálicas en fracturas no reconstruibles. Material y métodos: Estudio observacional en 9 pacientes con fractura conminuta de la cabeza radial tratadas con prótesis metálicas. Se evaluaron retrospectivamente mediante el Mayo Elbow Performance Index (MEPI) y el cuestionario DASH. También evaluamos la presencia de dolor, los arcos de movilidad, los hallazgos radiográficos y la aparición de complicaciones. El seguimiento medio fue de dieciocho (5-42) meses. Resultados: Tras un seguimiento medio de dieciocho meses (5-42) se obtuvieron cuatro resultados excelentes, tres buenos, uno regular y uno malo según la escala MEPI. El arco de movilidad fue de 110º de flexo-extensión (60º- 145º), 64º de pronación (50º-70º) y 72º de supinación (35º-80º). Aparecen complicaciones en cinco pacientes. Conclusiones: El uso de prótesis metálicas de cabeza radial es una opción terapéutica para casos seleccionados de fracturas conminutas de cabeza radial con una elevada tasa de complicaciones (AU)

Objective: To analyze the outcomes using metallic prosthesis in unreconstructible radial head fractures. Materials and methods: Nine patients with conminuted radial head fractures in which metallic prosthetic arthroplasty was performed were retrospectively evaluated using the Mayo Elbow Performance Index (MEPI) and the DASH questionnaire. The mean follow-up were eighteen (5-42) months. Pain, mobility, X-Rays outcomes and complications were also evaluated. Results: there were four excellent results, three good, one fair and one bad using the MEP score . The average range of motion was 110º of flexo-extension, (60º-145º), 64º of pronation (50º-70º) and 72º of supination (35º-80º). Five complications were observed. Conclusion: The use of radial head metallic prosthesis is an option for the treatment of conminuted radial head fractures in selected cases with a high rate of complications (AU)

Rotura del aparato extensor tras artroplastia total de codo para el tratamiento de una pseudoartrosis de húmero distal / Extensor mechanism rupture after total elbow arthroplasty for the treatment of a distal humerus non-union

Introducción. La artroplastia total de codo es una opción disponible para el tratamiento de diversas patologías del codo. Además de la indicación clásica en la artritis reumatoide, han surgido nuevas indicaciones en fracturas y pseudoartrosis de húmero distal. Sin embargo, no es una técnica exenta de complicaciones. La rotura del aparato extensor es una de ellas. Caso clínico. Mujer de 61 años con fractura conminuta no consolidada supraintercondílea de húmero distal, en un codo con afectación severa por artritis reumatoide, es tratada mediante artroplastia total semiconstreñida de codo tipo Coonrad Morrey. Al mes postoperatorio desarrolló una osificación en el tríceps distal que se extirpó. Varios meses después presenta una lesión del aparato extensor que fue tratada mediante sutura directa. Conclusión. Para casos seleccionados, el empleo de prótesis totales de codo ofrece resultados alentadores. Una correcta indicación y una buena técnica quirúrgica son indispensables para obtener resultados satisfactorios y minimizar la aparición de complicaciones (AU)

Introduction. Total elbow arthroplasty is an available option for the treatment of many pathologies of the elbow. Apart from the classic indication in rheumatoid arthritis, new indications have arisen in fractures and non-unions of the distal part of the humerus. Many complications have been described with the use of this technique. Extensor mechanism rupture is one of them. Case report. We present the case of a 61-year-old woman with a nonunited comminuted distal humerus fracture in a severely affected rheumatoid elbow who was treated with a Coonrad-Morrey semiconstrained total elbow arthroplasty. One month after the operation she developed a palpable ossification in distal triceps which was extirpated. Some months later she presented an extensor mechanism rupture which was surgically treated using a direct suture. Conclusion. In selected cases, the use of total elbow prosthesis is related to good results. A correct indication and a meticulous surgical technique are essential in order to obtain satisfactory results and to minimise the risk of complications (AU)

Estudio comparativo de la osteotomía de Weil abierta: ¿es necesaria siempre la fijación? / Comparative study of two types of Weil osteotomy: is fixation always necessary?

Objetivo. Comparar los resultados clinicorradiológicos de la osteotomía de Weil fijada frente a la realizada de modo abierto pero sin osteosíntesis posterior. Material y método. Estudio retrospectivo de 96 pacientes intervenidos por metatarsalgia durante el período 1999-2003, mediante la osteotomía de Weil. En 48 pacientes se fijaron las osteotomías mediante tornillo cefálico y en los 48 restantes no se sintetizaron. Se realizaron 92 osteotomías con fijación y 102 sin ella. La evolución media para el grupo con osteosíntesis ha sido de 29,9 meses y de 28,2 meses para el grupo sin osteosíntesis. La edad media fue de 57,2 años (22-82) para el grupo con osteosíntesis y 59,3 años (36-79) para el grupo no fijado. La gran mayoría de los pacientes son mujeres (96%) con fórmula digital egipcia y fórmula metatarsal index minus. Resultados. Todos los pacientes fueron evaluados clínicamente mediante la escala AOFAS-LMIS, obteniendo una media de 81,1 puntos (54-95) y 80,4 puntos (57-94) para los grupos con y sin osteosíntesis respectivamente. Un 68% de los pacientes atornillados presentaron buenos resultados frente a un 72% en el grupo sin osteosíntesis. El 72% del primer grupo se mostraron satisfechos con los resultados, así como un 67% del segundo. El acortamiento metatarsal medio de ambos grupos fue de 5,1 y 4,8 mm. La complicación principal de la serie ha sido la hipoestesia (31%). La recidiva de la metatarsalgia es más frecuente en el grupo sin osteosíntesis (18% frente al 12% con osteosíntesis) y la metatarsalgia de transferencia es predominante en el grupo con osteosíntesis. Conclusiones. El resultado clínico de la osteotomía de Weil parece independiente del hecho de emplear o no osteosíntesis para su fijación. No sintetizar da lugar a un menor acortamiento que favorece la aparición de metatarsalgia recidivante, de menor intensidad que la inicial y disminuye el índice de reintervenciones (retirada del material de osteosíntesis y metatarsalgia por transferencia secundaria a un excesivo acortamiento de la longitud metatarsal)

Purpose. To compare the clinical-radiological results of Weil osteotomy with fixation with those in which the osteotomy was not posteriorly stabilized. Materials and methods. Retrospective study of 96 patients operated on for metatarsalgia between 1999 and 2003 by means of a Weil osteotomy. In 48 patients, osteotomies were stabilized with a lag screw and in the remaining 48 the osteotomies were not fixated. Ninety-two osteotomies were performed with fixation and 102 without. The average evolution for the osteosynthesis group was 29.9 months and 28.2 months for the group without osteosynthesis. Mean patient age was 57.2 (range: 22-82) for the former group and 59.3 (range: 36-79) for the latter. The large majority of patients were female (96%) with an Egyptian foot and an index minus metatarsal formula. Results. Patient clinical assessment with the AOFAS-LMIS scale gave a mean of 81.1 points (range: 54-95) and 80.4 points (range: 57-94) for the groups with and without osteosynthesis respectively. Sixty-eight percent of the ORIF patients had good results as compared with 72% in the group with no fixation. Seventy-two percent of patients in the first group and 67% in the second were satisfied with the results obtained. Mean metatarsal shortening was 5.1 and 4.8 mm respectively. The main complication was hyposthesia (31%). Recurrence of metatarsalgia was more frequent in the group not treated with osteosynthesis (18% vs. 12% for the treated group) and transfer metatarsalgia predominated in the group with fixation. Conclusions. The clinical result of Weil osteotomy seems to be the same regardless of whether osteosynthesis is employed or not. Failure to stabilize the osteotomy produces less shortening, which favors the appearance of transfer metatarsalgia ­ less intense than the initial variety ­ and leads to fewer reinterventions (withdrawal of the ORIF material and transfer metatarsalgia secondary to an excessive shortening of metatarsal length)

[Vulvar lymphedema: unusual manifestation of metastatic Crohn's disease]. / Linfedema vulvar: una manifestación infrecuente de la enfermedad de Crohn metastásica.

Cutaneous-mucosal lesions constitute one of the most frequent extraintestinal manifestations of Crohn's disease and in some cases may be the first symptom of intestinal disease. We describe the case of a 45-year-old female patient who sought medical help for genital tumefaction of 20 years' evolution. For the previous 15 years, she had been experiencing digestive symptomatology attributed to irritable bowel syndrome. Two months before the consultation, and coinciding with aggravation of the condition, the patient had been diagnosed with colonic Crohn's disease. Skin biopsy of the labia minora revealed sarcoid granulomas. The results of microbiological studies (staining for microorganisms and cultures) were negative. A diagnosis of metastatic vulvar Crohn's disease was made and, treatment with metronidazole was started, which improved the genital edema after 2 months. Genital lymphedema is an exceptionally rare manifestation of metastatic Crohn's disease that may appear several years before intestinal symptomatology develops. Treatment with metronidazole seems to be a good therapeutic option.

Síndrome de Stevens-Johnson por nevirapina

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