[Surgical decision pattern in the prescription of MESS-scale amputations in tibia fractures exposed grade III-B Gustilo-Anderson]. / Patrón de decisión quirúrgica en la prescripción de amputaciones con escala MESS en fracturas de tibia expuesta grado III-B Gustilo-Anderson.

INTRODUCTION: The management of severely traumatized extremity continues to be a matter of debate. Gustilo-Anderson tibial fractures III-B have a wide spectrum of variants, there are no guidelines using this classification for management. MESS has demonstrated functional and prognostic association. OBJECTIVE: To identify the pattern of decision made by surgeons for the prescription of amputations in tibial fractures exposed grade III-B Gustilo-Anderson with MESS scale. Material and methods. RESULTS: There was no association between the variables, with the application of MESS. (2 = 1.28, p = 0.2575). Surgeons of more than 10 years, increased once the possibility of matching the result of experts (OR = 2.088, 95% CI) (p = 0.0066). CONCLUSION: Academic degrees, surgical experience, and frequent clinical practice do not influence the correct application of the MESS scale. Surgeons with more than 10 years of experience have doubled the possibility of a precise decision.

INTRODUCCIÓN: El manejo de la extremidad severamente traumatizada continúa siendo materia de debate. Las fracturas de tibia III-B de Gustilo-Anderson tienen un amplio espectro de variantes, no hay guías mediante esta clasificación para un manejo. MESS ha demostrado asociación funcional y pronóstica. OBJETIVO: Identificar el patrón de decisión por parte de los cirujanos para la prescripción de amputaciones en fracturas de tibia expuesta grado IIIB Gustilo-Anderson con escala MESS. MATERIAL Y MÉTODOS: Es un estudio descriptivo, observacional, prospectivo, transversal y analítico. Se evaluaron 131 ortopedistas de un centro de referencia de patología traumática, quienes con uso de la escala MESS evaluaron 10 casos clínicos representativos de fracturas de tibia expuesta grado III-B de Gustilo-Anderson presentados en dispositivo electrónico. Se evaluó la concordancia de las decisiones entre cirujanos que laboran y expertos. Se realizó análisis inferencial mediante 2 (p 0.05) de las variables del estudio: experiencia del cirujano, postgrados académicos, práctica clínica frecuente de amputaciones, concordancia de las decisiones con escala MESS con respecto al patrón de prescripción obtenido por expertos. RESULTADOS: No se encontró asociación entre las variables con la aplicación de MESS (2 = 1.28, p = 0.2575). Los cirujanos de más de 10 años incrementaron una vez la posibilidad de coincidir con el resultado de expertos (OR = 2.088, IC 95%) (p = 0.0066). CONCLUSIÓN: Las variables como postgrados académicos, experiencia quirúrgica y práctica clínica frecuente no influyen en la correcta aplicación de la escala MESS. Los cirujanos de más de 10 años de experiencia incrementaron al doble la posibilidad de una decisión precisa.

[Diagnostic value of a predictive model for complete ruptures of the rotator cuff associated to subacromial impingement]. / Valor diagnóstico de un modelo de predicción clínico-radiográfico para rupturas completas del manguito de los rotadores por pinzamiento subacromial.

Pathology related to the rotator cuff remains among the most prevalent musculoskeletal diseases. There is an increasing need for imaging studies (MRI, US, arthroscopy) to test the diagnostic performance of the medical history and physical examination. OBJECTIVE: To prove the diagnostic value of a clinical-radiographic predictive model to find complete ruptures of the rotator cuff. MATERIAL AND METHODS: Descriptive, observational, prospective, transversal and analytical study. Fifty-five patients with preoperative shoulder pain were evaluated with 13 predictive variables: age > 50 years, nocturnal pain, muscle weakness, clinical signs of Neer, Hawkins, Jobe, external rotation lag (ERLS), belly-press, bear hug, and lift-off, radiographic measurement of subacromial space, acromial index and critical shoulder angle. Sensitivity, specificity, and positive and negative predictive values were measured in each variable, comparing the results of each one against the postoperative findings. RESULTS: Of the 55 patients evaluated, 42 had a complete rupture of the rotator cuff in the postoperative period. The eight variables with a higher diagnostic value were selected and a ROC curve was performed, providing an area under the curve of 0.88. CONCLUSIONS: This predictive model uses eight variables (age > 50 years, nocturnal pain, muscle weakness, Jobe, Hawkins, ERLS, subacromial space ≤ 6 mm, and critical shoulder angle > 35°), which together add the predictive value of 0.88 (AUC) to diagnose complete ruptures of the supraspinatus tendon.

La patología relacionada al manguito de los rotadores permanece entre las enfermedades musculoesqueléticas más prevalentes. Hay una creciente necesidad de estudios de imagen (RMN, US, artroscopía) para probar el rendimiento diagnóstico de la historia clínica y el examen físico. Objetivo: Demostrar el valor diagnóstico de un modelo predictor clínico-radiográfico para rupturas completas del manguito de los rotadores. Material y métodos: Estudio descriptivo, observacional, prospectivo, transversal, analítico. Se evaluaron 55 pacientes con dolor de hombro en forma preoperatoria con 13 variables de predicción: edad > 50 años, dolor nocturno, debilidad muscular, signos clínicos de Neer, Hawkins, Jobe, caída de la rotación externa, Napoleón, abrazo del oso, Gerber; medición radiológica del espacio subacromial, índice acromial y ángulo crítico del hombro. En cada variable se midió sensibilidad-especificidad, valor predictivo positivo y negativo. Se compararon los resultados de cada variable para diagnosticar rupturas del manguito de los rotadores contra los hallazgos postoperatorios. Resultados: De los 55 pacientes evaluados, 42 presentaron ruptura completa del mango rotador en el postoperatorio. Se seleccionaron las ocho variables con mayor valor diagnóstico y se realizó una curva ROC, proporcionando un área bajo la curva de 0.88. Conclusiones: Este modelo de predicción emplea ocho variables (edad > 50 años, dolor nocturno, debilidad muscular, caída de la rotación externa, Jobe, Hawkins, espacio subacromial ≤ 6 mm y ángulo crítico del hombro > 35°) que en conjunto suman el valor predictivo de 0.88 (AUC) para diagnosticar rupturas completas del tendón supraespinoso.

[Treatment protocol in elderly patients with three- or four-fragment proximal humerus facture at a referral center located in an emerging economy]. / Patrón de tratamiento en pacientes adultos mayores con fractura de húmero proximal en tres o cuatro fragmentos en un centro de referencia de una economía emergente.

BACKGROUND: Proximal humerus fractures account for 4-5% of the fractures that occur among elderly people; they represent 45% of humerus fractures, and 13-16% of them are three- or four-fragment fractures. METHODS: Retrospective, observational, cross-sectional study of secondary data sources. The records of patients over 60 years of age with a diagnosis of three- or four-fragment proximal humerus fractures were analyzed. A non-probabilistic sampling technique of consecutive cases was used. The following variables were analyzed: age, sex, fragment number, limb involved and dominant limb, and treatment protocol. RESULTS: 118 patients were included, most of them females (83.9%), age range was 60-93 years, with a mean age of 73 years. Three-fragment fractures represented 63%, and four-fragment fractures 36%. The left limb was more frequently affected, accounting for 57%; 43% of cases were treated conservatively. Open reduction and internal fixation (ORIF) was performed in 39 cases with a tension band, in 22 patients with hemiarthroplasty, ORIF with a 4.5 T-plate in 5 patients, and ORIF with a LCP LISS plate in one patient. CONCLUSIONS: Female patients over 72 years of age underwent this kind of treatment more frequently. Surgical treatment accounted for 57%, unlike what the literature reports (20%).

ANTECEDENTES: Las fracturas proximales de húmero corresponden 4 y 5% de las fracturas en adultos mayores, ocupando 45% de las fracturas humerales, siendo 13 al 16% fracturas en tres y cuatro fragmentos. MÉTODOS: Estudio retrospectivo, observacional y transversal de fuentes secundarias, se estudiaron registros de pacientes con diagnóstico de fractura proximal de húmero en tres o cuatro fragmentos en pacientes adultos mayores de 60 años. Técnica de muestreo no probabilístico de casos consecutivos, considerándose de cada uno: el sexo, edad, número de fragmentos, extremidad afectada y extremidad dominante, el patrón de tratamiento. RESULTADOS: Se incluyeron 118 pacientes, siendo el sexo predominante el femenino (83.9%), con rango de edad de 60 a 93 años y una mediana de 73 años. Las fracturas en tres fragmentos representó 63% y de cuatro fragmentos 36%. La extremidad izquierda fue la mayormente afectada siendo 57%, la extremidad dominante fue la derecha ocupando 82%. El patrón quirúrgico predominó, representado 57% y el tratamiento conservador representó 43%. Se realizó en 39 casos reducción abierta y fijación interna (RAFI) con banda a tensión, en 22 pacientes con hemiartroplastía, en cinco pacientes RAFI con placa en T 4.5 y en uno RAFI con placa LCP LISS. CONCLUSIONES: Los pacientes femeninos mayores de 72 años, mostraron mayor frecuencia de manejo quirúrgico. El patrón de tratamiento quirúrgico fue de 57%, a diferencia de lo reportado en la literatura mundial (20%).

Comparación entre el cálculo del porcentaje de masa grasa por sumatoria de cuatro pliegues e interactancia infrarroja / Comparison among the percentage of calculation or fatty mass by sumatoria of four pleats and infrared interactancia

Estudio cuyo objetivo es establecer posibles diferencias entre los valores de porcentaje de grasa corporal total empleando la ecuación que suma cuatro pliegues cutáneos, y la medición por interactancia infrarroja en pacientes adultos. Se comparan los datos obtenidos por cada método sobre una población de 61 pacientes, y se analizan sus principales características

Comparación entre el cálculo del porcentaje de masa grasa por sumatoria de cuatro pliegues e interactancia infrarroja / Comparison among the percentage of calculation or fatty mass by sumatoria of four pleats and infrared interactancia

Estudio cuyo objetivo es establecer posibles diferencias entre los valores de porcentaje de grasa corporal total empleando la ecuación que suma cuatro pliegues cutáneos, y la medición por interactancia infrarroja en pacientes adultos. Se comparan los datos obtenidos por cada método sobre una población de 61 pacientes, y se analizan sus principales características

Stomatopods (Crustacea: Hoplocarida) from the Gulf of Tehuantepec, Mexico.

A total of 1,173 specimens of Stomatopoda were captured in 27 localities at different depths (20 to 73 m) during three oceanographic cruises in the Mexican Pacific along the continental shelf of the states of Oaxaca and Chiapas. Seven species were identified of the families Eurysquillidae, Lysiosquillidae and Squillidae. Squilla hancocki and Squilla parva were the most abundant species and the most frequently found together. The relationships between total length and carapace length were obtained for these species, which show that males of S. hancocki have a longer carapace length than females having the same total length, whereas for S. parva the opposite occurs. Larger sizes than previously reported were obtained for Lysiosquilla panamica and Squilla mantoidea. Squilla bigelowi was recorded for the first time in the Gulf of Tehuantepec. All the species were found in the intermediate platform (25-60 m); E. veleronis, S. hancocki and S. parva extended their distributions to the external platform (60-120 m), and S. hancocki and S. parva reached the circalittoral zone (10-25 m).

Association of Epstein-Barr virus latent membrane protein and Hodgkin's disease in Mexico.

Epstein-Barr virus (EBV) has been demonstrated in association with Hodgkin's disease (HD) in approximately 40 to 50% of cases in series from North America, Europe, and Japan. However, few data are available concerning this association in developing countries. Recent studies, including mostly a pediatric population from Peru and a pediatric population from Honduras, showed a higher percentage of EBV positivity compared with those in developed countries. To determine the prevalence of EBV in Hodgkin's disease in a Mexican adult population, we analyzed 50 formalin-fixed, paraffin-embedded cases of HD by a three-step technique using a monoclonal antibody to the latent membrane protein of EBV. All the cases were confirmed immunophenotypically as HD (CD15+ and/or CD30+, CD45-). Reed-Sternberg cells and variants were positive for LMP in 35 cases (70%). The staining was found both on the cell surface and/or within the cytoplasm with enhancement of the Golgi area. EBV latent membrane protein was found in 1/1 case (100%) of diffuse lymphocyte-predominant HD, 10/20 cases (50%) of nodular-sclerosis, 18/22 cases of mixed-cellularity (81%), and 6/7 (86%) cases of lymphocyte-depleted HD. Our results show a high prevalence of EBV in HD in this Mexican adult population. All histologic subtypes of HD in the population analyzed appear to be strongly associated with EBV, in contrast to the strong association of mixed cellularity HD in developed countries. Patient age and gender were not predictive of the presence of EBV.

[High prevalence of the Epstein-Barr virus in a Mexican population with Hodgkin's disease]. / Prevalencia alta del virus de Epstein-Barr en una población mexicana con enfermedad de Hodgkin.

The Epstein-Barr virus (EBV) has been demonstrated in association with cases of Hodgkin's disease (HD) indicating that, in at least in some cases, EBV may play a pathogenic role in the development of HD. To determine the prevalence of EBV in HD in a Mexican adult population, we studied 39 formalin-fixed and/or B-5, paraffin embedded samples of patients with HD, by immunoperoxidase; in situ hybridization was done in 32 of the 39 cases. We analyzed the presence of the latent membrane protein (LMP) and EBV-specific DNA sequences. Reed-Sternberg cells and mononuclear variants were positive for LMP in 28 cases (72%). LMP staining was found both on the cell surface and/or within the cytoplasm with enhancement in the Golgi area. The LMP was found in the single case of diffuse lymphocyte predominant HD, in 6/12 cases of nodular sclerosis (50%), in 10/15 cases of mixed cellularity (67%) and in all eleven cases of lymphocyte depleted HD (100%). No EBV-specific DNA sequences were found by in situ hybridization. Our results show: 1) a higher association of EBV in our population compared to the approximately 48% reported in developed countries; 2) all histologic subtypes of HD in Mexico appear to be strongly associated with EBV in contrast to the strong association with only mixed cellularity seen in Western populations; 3) the high prevalence of EBV in HD in Mexico may be a function of histology, ethnic groups, socioeconomic factors and/or geography.