[Trabecular metal box for acute acetabular fracture in an elderly patient]. / Caja de metal trabecular para fractura acetabular aguda en paciente anciano.

BACKGROUND: We are currently observing an increase in the incidence of acetabular fractures in elderly patients due to the increase in this population age group. These fractures represent a challenge to the traumatologist because in some cases there is the surgical alternative of combining fixation with total acute hip arthroplasty. In this paper we explore the use of trabecular metal combining the stability provided by a cage with potential bone incorporation, applying the principles of revision surgery to speed-up the healing process without the limitations resulting from the restrictions in the load of the operated limb. MATERIAL AND METHODS: We assessed the clinical and radiological results, with a 2-year follow-up, after total hip arthroplasty for the acute treatment of an acetabular fracture of the anterior column, with involvement of the quadrilateral lamina in an elderly 85 year-old patient. RESULTS: Important pain relief occurred, with functional improvement and an appropriate range of motion using the Merle d'Aubigné system. Radiologically, the graft areas in the particles surrounding the acetabular component were uniformly integrated. No loosening, screw rupture or implant migration occurred. CONCLUSIONS: This indication using a revision technique based on a trabecular metal reconstruction cage should be considered as an alternative to bear in mind in these patients.

Direct percutaneous venous puncture and embolization of giant perimedullary arteriovenous fistulas.

PMAVFs are rare entities that are formed by a direct communication between an artery that feeds the spinal cord and a vein. The goal of treatment is to occlude the shunt; this is done endovascularly either from an arterial or a venous approach. When these approaches are not possible, direct percutaneous puncture of the draining veins may be attempted to embolize the arteriovenous shunt directly.

Polectomía Percutánea Guiada por Eco. Parte II: técnica intravaginal / Percutaneous ultrasound guided A1 pulley release. Part II: Intravaginal technique

Objetivo: Desarrollar la liberación percutánea intravaginal de la polea A1 guiada con ecografía para el tratamiento del dedo en resorte. Material y métodos: Liberamos la polea A1 en 46 dedos de 5 cadáveres, dirigiendo el instrumento de corte hacia la «zona segura» volar desde un posicionamiento intravaginal. Mediante disección, evaluamos la precisión, seguridad y eficacia del método. Sigue un estudio clínico prospectivo en 62 pacientes (62 dedos) comparando la polectomía abierta (n=17) con nuestra técnica (n=45) y evaluando los tiempos quirúrgicos de uso de analgésicos postoperatorios, recuperación motora y reincorporación a tareas habituales. Resultados: La precisión quirúrgica fue adecuada en los cadáveres, sin daños a las estructuras adyacentes. Se efectúa una liberación completa en 44 dedos (95,7%) e incompleta, menor de 1,6 mm en dos. El tiempo quirúrgico mostró correlación con la fecha de intervención (r2 = 0,44). La duración media en la toma de analgésicos, recuperación motora y reincorporación a tareas habituales fueron significativamente menores con nuestra técnica. Conclusiones: Se describe un método de posicionamiento intravaginal de instrumentos quirúrgicos para dirigir su filo hacia la «zona segura» volar en la liberación percutánea de A1 guiada por ultrasonidos. Sugerimos prudencia en el pulgar y conversión a una cirugía abierta si la visualización ecográfica no fuera óptima. La curva de aprendizaje influye en el tiempo de intervención. Los resultados clínicos de esta técnica son mejores a los de las técnicas convencionales (AU)

Purpose: To develop a percutaneous intravaginal A1 pulley release under ultrasonography guidance for the treatment of Trigger Fingers. Materials and Methods: We released the A1 pulley on 46 fingers in 5 cadavers aiming our cutting device towards the volar «safe area» (described in our previous study) from an intravaginal positioning. The precision, safety and efficacy of the release were evaluated by surgical exposure. We performed a prospective clinical study in 62 patients (62 fingers) comparing the open approach (n=17) with our technique (n=45). Timings assessed for: surgery, use of postsurgical analgesics, motor recovery and return to normal daily tasks. Results: Surgical precision was good in cadavers with no injuries to adjacent structures, a complete release in 44 digits (95,7%) and a less than 1,6 mm incomplete release in two digits. Clinically, surgical times showed a lineal correlation with the date of surgery (R2 = 0,44). The average times for using analgesics, motor recuperation and returning to daily tasks were significantly shorter with our technique. Conclusions: This study shows a method for positioning surgical instruments intravaginally for aiming their edge towards the volar «safe area» in a percutaneous ultrasound guided release of A1. We suggest being cautious in the thumb and converting the surgery to an open procedure if the ultrasound visualization is suboptimal. Clinical results of this technique are better that the classical approach (AU)

[Spontaneous intestinal hematoma as anticoagulant treatment complication]. / Ematoma intestinale spontaneo come complicanza del trattamento anticoagulante.

The haemoperitoneum and bowel haematoma are complications of the oral anticoagulant treatment. The abdominal pain in patient under oral anticoagulant drugs represents a diagnostic problem; apart of the acute abdomen, we also have to consider unusual haemorrhagic lesion, rare in patients without coagulation problems. The early diagnosis of the complication in the patients permits a conservative treatment with excellent prognosis, instead of performing surgical operations in subjects with frequent comorbidities. We report a case of haemoperitoneum and intramural bowel haematoma in a patient with altered laboratory parameters and haemodynamic instability that required an urgent surgical procedure.

[Causes of reoperations in patients with lumbar spinal stenosis treated with instrumentations]. / Causas de reintervención quirúrgica en pacientes con fijación lumbar intervenidospor estenosis de canal.

OBJECTIVE: In present study we analyze the causes leading to reoperation patients treated for lumbar spinal stenosis with laminectomy and lumbar instrumentation. MATERIAL AND METHODS: 74 patients operated between January of 1996 and December of 2000 with a minimum 4 year follow-up were seleted for the study. RESULTS: 16 patients (21.1%) underwent a new surgical intervention. The main cause for reoperation was stenosis of the adjacent level superiorly to the instrumentation (in 50%). Other causes were radicular fibrosis, persistence of stenosis after the surgery, neuropatic pain, failure of the instrumentation system, transpedicular screws misplacement and break of screws. CONCLUSIONS: Complications related with the initial surgical procedure are low, as half of the reoperations were due to stenosis of the segment superior to the fixation.

Causas de reintervención quirúrgica en pacientes con fijación lumbar intervenidos por estenosis de canal / Causes of reoperations in patients with lumbar spinal stenosis treated with instrumentations

Objetivo. En el presente trabajo analizamos las causas por las que se ha debido reintervenir a pacientes diagnosticados de estenosis de canal que habían sido tratados mediante descompresión quirúrgica y fijación lumbar. Material y métodos. Seleccionamos 74 pacientes entre enero de 1996 y diciembre de 2000 con un seguimiento mínimo de 4 años. Resultados. 16 (21,1%) fueron sometidos a una nueva intervención quirúrgica. La principal causa fue la estenosis de niveles adyacentes superiores a la instrumentación (en el 50%). Otras causas fueron la fibrosis perirradicular, la persistencia de estenosis tras la cirugía, el dolor neuropático, la desconexión del sistema de fijación, la compresión radicular por tornillos transpediculares y la rotura de tornillos. Conclusiones. Las complicaciones relacionadas con la técnica quirúrgica son bajas ya que la mitad de las reintervenciones en pacientes con estenosis del canal lumbar está producida por la estenosis del segmento superior a la fijación

Objective. In present study we analyzes the causes leading to reoperation patients treated for lumbar spinal stenosis with laminectomy and lumbar instrumentation. Material and methods. 74 patients operated between January of 1996 and December of 2000 with a minimum4 year follow-up were seleted for the study. Results. 16 patients (21 1%) underwent a new surgicall intervention. The main cause for reoperation was stenosis of the adjacent level superiorly to the instrumentation (in 50%). Other causes were radicular fibrosis, persistence of stenosis after the surgery, neuropatic pain, failure of the instrumentation system, transpedicular screws misplacement and break of screws. Conclusions. Complications related with the initial surgical procedure are low, as half of the reoperations were due to stenosis of the segment superior to the fixation

Lumbalgia en varón diagnosticado de luxación congénita de cadera / No disponible

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Estudio prospectivo de los reactantes fase aguda tras una artroplastia total de rodilla / Prospective study of acute phase response factors after total knee artrhoplasty

Introducción: La artroplastia total de rodilla actualmentees el tratamiento de elección para las artrosis evolucionadasde dicha articulación. Al igual que otras lesiones mayores, lasintervenciones quirúrgicas o los traumatismos, originan respuestasmetabólicas, hormonales y hemodinámicas. Nos proponemosvalorar los reactantes de fase aguda tanto en prótesistotales de rodilla normales como en infectadas.Material y método: De forma consecutiva, a partir de marzodel 2003, se reclutaron 36 pacientes a los que se les implantóuna prótesis total de rodilla (grupo I). Además se estudiaron10 pacientes (grupo II) a los que se les habíaimplantado una prótesis de rodilla y presentaban criterios deinfección.Resultado: En el grupo I, los leucocitos y la PCR presentanun pico máximo a las 24 horas de la intervención, observándoseniveles preoperatorios en la extracción obtenida al mes;El fibrinógeno y la VSG muestran un ascenso hasta la extraccióntomada al mes de la cirugía, y continúan con niveles superioresa los basales incluso después de tres meses.Lo pacientes del grupo II mostraron niveles, estadísticamentesignificativos, más altos de fibrinógeno, VSG y PCR.Conclusiones: Los reactantes de fase aguda ofrecen unamoderada eficacia diagnóstica por lo que deben apoyar aldiagnóstico basado en los criterios clínicos de infección

Introduction: Nowadays total knee arthroplasty (TKA) isthe choice treatment in evolved knee artrosis. Operations ortraumas cause metabolism and hormone responses.Patients and Methods: Consecutively, from 2003, we includedprospectively in this research, 36 patients undergoingelective TKA (group I). Also we studied 10 patients (group II)that were diagnosed as infected TKA.Results: Acute phase response evolution in group I showsmaximum leukocytes and C-reactive protein (CRP) levels duringthe first 24 hours after the surgery, returning to presurgicallevels after one month. Erythrocyte sedimentation (ESR)rate and fibrinogen are increased even 3 months after the surgery.The patients of the goup II showed hihger levels, statisticallysignificant, of fibrinogen, CRP and ESR.Discussion: Acute phase response factors offer modest diagnosticefficacy, so we always have to use the clinical criterionto achive a god diagnosis

Lumbalgia inespecífica tras artroplastia lumbar / No disponible

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[Dorsal subdural spinal abscess after epidural anesthesia]. / Absceso subdural espinal dorsal tras anestesia epidural.

Spinal subdural empyema (SE) is a rare condition. We describe a young patient with a torathic SE after lumbar epidural anaesthesia. SE was distant from the region of manipulation. Spinal magnetic resonance was the most useful procedure for diagnosis and follow-up. Treatment with intravenous antibiotics and drainage was not enough, and she needed complete surgical excision of the lesion.

[Gastric ulcers caused by post-burning stress: contribution of free radicals]. / Ulceras gástricas de estres postquemadura: contribución de los radicales libres.

The purpose of this study was to analyse the blocking effect of superoxide dismutase (S.O.D.) at doses of 15.000 U.I. per kilogram (body weight), on the release of oxygen-derived free radicals, experimentally caused in the rat by burning 20% of the surface of its body, and its impact over macroscopic and microscopic lesions of the gastric mucosa. We used 48 rats divided into 5 groups. In groups 3 and 5 we provided S.O.D. i.v. immediately after the burn. All the animals had a catheter in their femoral vein for the administration of drugs. Morphologic data showed that 2 hours after the burn S.O.D. did not have any influence on the gastric injury; 5 hours after the burn, the morphologic damage of the gastric mucosa was less severe. The scavenging of the superoxide ion (free radical) by the superoxide dismutase may be responsible of the lower tissular damage of the gastric mucosa. These results confirm that a period of initial ischaemia may be an important etiopathogenic factor in severe lesions of the gastric mucosa after burns.

[Syndrome of rostral occlusion of the basilar artery]. / Síndrome de oclusión rostral de la arteria basilar.

Upper occlusion of the basilar artery ("top of the basilar" syndrome) causes ischemics lesions in brainstem, thalamus and occipital and temporal lobes, producing visual, oculomotor and behavioral disorders, with slight motor affectation concomitant. We expose a case with a typical clinical setting and infarctions in thalamus and both occipital lobes with an unusual symmetric distribution.

Principios generales del tratamiento del enfermo quemado / General principles of burn patient treatment

Aunque actualmente el tratamiento del paciente quemado supone una sere de medidas y actuaciones terapeuticas muy especilizadas, es habitual que sea el medico general o de asistencia primaria quien tiene el primer contacto con el paciente. En ese primer momento, el medico debe tomar decisiones que influiran de manera basica en la posterior evolucion del herido. Mas aun, de la actitud del primer medico que atienda al enfermo depende la propia supervivencia del mismo y, en el mejor de los casos, el estado general con que llegue a un centro especializado. Por todo lo anterior, es facil comprender lo fundamental que es el que todo medico sea capaz de: 1.- Adoptar las medidas de atencion inmediata, de las que dependera la supervivencia del paciente. 2.- Realizar una correcta valoracion de la extension y profundidad de las lesiones. 3.- Estabilizar al paciente quemado.4.- Conocer aquellas quemaduras especiales (electricas y quimicas) que presentan caracteristicas diferenciadas. 5.- Tener claros los criterios para el traslado de aquellos paciente cuyas condiciones exijan su tratamiento en un centro especializado

Tetanus intoxication causes an increment of serotonin in the central nervous system.

Mice injected with tetanus toxin (TTx) showed an increase of 5-hydroxytryptamine (serotonin, 5-HT) levels in the central nervous system. The increment was not uniform throughout the central nervous system. Particularly significant were the 25% and 80% increases observed, respectively, in whole brain and spinal cord. The levels of dopamine and norepinephrine remained unchanged. The subsequent studies of 5-HT turnover revealed a synthesis rate in the tetanic animals that was almost double that of controls. The degradation rate of the amine as well as the levels of 5-hydroxyindolacetic acid were unaffected.

Tetanus toxin does not affect the release of noradrenaline and taurine from rat cerebral cortex slices evoked by high K+ and Na+-free media.

Noradrenaline and taurine release from superfused rat cerebral cortex slices was stimulated by potassium ions, veratrine, ouabain and omission of sodium ions. Tetanus toxin enhanced only the ouabain-evoked calcium-dependent noradrenaline release and the ouabain-evoked calcium-independent taurine release. The uptake of both was marginally affected.

Ruthenium red interferes with the tetanus toxin inhibition of potassium-stimulated GABA release from rat cerebral cortex slices.

The influence of Ruthenium Red on the release of exogenous GABA from rat cerebral cortex slices was studied in a superfusion system. Ruthenium Red inhibited the 50 mM K(+)-induced GABA release in a dose-dependent manner. It also attenuated the GABA release elicited by Na(+)-free and ouabain-containing media both with and without calcium ions. The veratrine-induced release was inhibited only in the absence of calcium. Ruthenium Red also impaired the inhibition of GABA release by tetanus toxin and decreased the mortality in mice injected with tetanus toxin. It is suggested that Ruthenium Red interferes with the fixation of tetanus toxin to the membrane binding sites involved in the incorporation of the toxin to its intracellular targets.