Comparative study of the second and third generation of gamma nail for trochanteric fractures: review of 218 cases.

OBJECTIVES: The aim of this study was to compare the complications of the trochanteric gamma nail (TGN) and the Gamma3 Nail (G3), focusing on cutout failure. DESIGN: Retrospective comparative cohort analysis. SETTING: Level II Teaching Trauma Center academic trauma center. PATIENTS/METHODS: Two hundred eighteen trochanteric fractures with a mean follow-up of 15 months were included in the study. They were treated either with the TGN or the G3 between January 2005 and December 2010. Bivariate, stratified, and logistic regression analysis was conducted to determine the association between cutout and the independent variables. INTERVENTION: Proximal anterograde nailing with either the TGN or the G3. MAIN OUTCOME MEASUREMENTS: Patient age, sex, type of intramedullary device, stability fracture pattern, tip-apex distance (TAD), distraction at the fracture site, cervical angle, and cutout. RESULTS: The relative risk (RR) of cutout was 4.71 times higher in the group treated with G3 (P < 0.01). RR of cutout for unstable fractures compared with stable fractures was 3.07 (1.01-9.35). In unstable fractures, the RR of cutout was 8.78 times higher in patients with G3 (P < 0.01). RR of cutout was 1.54 times higher with TAD >25 mm (P = 0.4). DISCUSSION: We have not found any relationship between cutout rate and TAD. Only the fracture pattern and the type of implant have shown to be associated with cutout risk. In our study, Gamma3 Nail has higher cutout rates than TGN in unstable fractures. LEVEL OF EVIDENCE: Therapeutic level III. See Instructions for Authors for a complete description of levels of evidence.

[Relationship between migraine and atopy in childhood: a retrospective case-control study]. / Relación entre la migraña y la atopia en la infancia: estudio retrospectivo de casos y controles.

INTRODUCTION: Migraine is a common complaint in childhood. Atopy is the predisposition to the complaint of one or more of the following conditions: atopic dermatitis, rhinoconjunctivitis and asthma. AIM: To examine whether there is a relationship between atopy, taking into account each of its different variants, and migraine with or without aura. The practical application of knowing about this association includes improvement in the diagnosis of migraine, which is often difficult in children. SUBJECTS AND METHODS: We performed a retrospective case-control study of children (5-15 years old) with and without migraine; recruitment time: six months. Data evaluated included age, sex, questions from a questionnaire about atopy to measure prevalence, and medical diagnosis that appears in the patient's medical record and overall (intersection of the previous ones), among other things. A statistical analysis was performed. The odds ratio (OR) and the 95% confidence interval were both estimated. Confusion factors were studied. RESULTS: Altogether 216 children were analysed. The prevalence of atopic dermatitis (OR = 7.1; p < 0.01), rhinoconjunctivitis (OR = 7.3; p < 0.01) and allergic asthma (OR = 4.69; p < 0.01), as well as their previous and overall medical diagnoses, is significantly higher and more severe in children with migraine. Dermatitis and rhinitis are more commonly diagnosed in the cases with aura. CONCLUSIONS: The prevalence and the percentage of prior and overall diagnoses of the three atopic diseases are significantly higher in children with migraine.

Relación entre la migraña y la atopia en la infancia: estudio retrospectivo de casos y controles / Relationship between migraine and atopy in childhood: a retrospective case-control study

Introducción. La migraña es un padecimiento común en la infancia. La atopia es la predisposición al padecimiento de una o varias de las siguientes patologías: dermatitis atópica, rinoconjuntivitis y asma. Objetivo. Estudiar si existe una relación entre la atopia, valorando cada una de sus variantes y la migraña con o sin aura. El uso práctico de conocer esta asociación incluye la mejora en el diagnóstico de la migraña, con frecuencia difícil en niños. Sujetos y métodos. Estudio retrospectivo de casos y controles de niños (5-15 años) con migraña o sin ella; tiempo de reclutamiento: seis meses. Se evalúan edad, sexo, preguntas de un cuestionario sobre atopia para medir prevalencia, y diagnóstico médico constatable en su historial y global (intersección de los previos), entre otros datos. Se realiza un análisis estadístico. Se estima la odds ratio (OR) junto con el intervalo de confianza del 95%. Se estudian factores de confusión. Resultados. Se analizan 216 niños. La prevalencia de dermatitis atópica (OR = 7,1; p < 0,01), rinoconjuntivitis (OR = 7,3;p < 0,01) y asma alérgica (OR = 4,69; p < 0,01), así como su diagnóstico médico previo y global, es significativamente más alta y grave en los niños con migraña. Se observa más diagnóstico de dermatitis y rinitis en los casos con aura. Conclusiones. La prevalencia y el porcentaje de diagnóstico previo y global de las tres enfermedades atópicas son significativamente mayores en los niños con migraña (AU)

Introduction. Migraine is a common complaint in childhood. Atopy is the predisposition to the complaint of one or more of the following conditions: atopic dermatitis, rhinoconjunctivitis and asthma. Aim. To examine whether there is a relationship between atopy, taking into account each of its different variants, and migraine with or without aura. The practical application of knowing about this association includes improvement in the diagnosis of migraine, which is often difficult in children. Subjects and methods. We performed a retrospective case-control study of children (5-15 years old) with and without migraine; recruitment time: six months. Data evaluated included age, sex, questions from a questionnaire about atopy to measure prevalence, and medical diagnosis that appears in the patient’s medical record and overall (intersection of the previous ones), among other things. A statistical analysis was performed. The odds ratio (OR) and the 95% confidence interval were both estimated. Confusion factors were studied. Results. Altogether 216 children were analysed. The prevalence of atopic dermatitis (OR = 7.1; p < 0.01), rhinoconjunctivitis (OR = 7.3; p < 0.01) and allergic asthma (OR = 4.69; p < 0.01), as well as their previous and overall medical diagnoses, is significantly higher and more severe in children with migraine. Dermatitis and rhinitis are more commonly diagnosed in the cases with aura. Conclusions. The prevalence and the percentage of prior and overall diagnoses of the three atopic diseases are significantly higher in children with migraine (AU)

Ankle fractures with posterior malleolar fragment: management and results.

Trimalleolar ankle fractures can be difficult to manage and convey a high risk of long-term morbidity. The question of whether internal fixation of the posterior malleolar fragment is warranted remains open. We conducted a retrospective cohort study involving 45 patients who underwent surgical repair of a trimalleolar fracture. Our goal was to study the effect of the size of the posterior fragment on outcomes. We defined small posterior malleolar fragments as being ≤ 25% of the distal tibial articular surface as viewed on the lateral radiograph. Outcome measures included the radiographic appearance of the reduction, as well as Olerud and Molander (O&M) scores and AOFAS scores. Overall better outcomes were obtained in patients whose fractures involved ≤ 25% of the articular surface, and the difference in outcomes was statistically significant in regard to the AOFAS scores (P = .05), although not statistically significant in regard to Olerud and Molander scores and the radiographic appearance of the reduction (P = .14 and P = .45, respectively). Anatomic reduction was achieved in 73.3% of patients, but they did not have better clinical results than nonanatomic reduction patients: AOFAS (P = .14), O&M (P = .38), radiographic appearance (P = .74).

Safety and effectiveness of the intragastric balloon for obesity. A meta-analysis.

BACKGROUND: Intragastric balloons have been used since 1985 to treat obesity, but an evidence-based systematic review had not been previously performed. The objective of this study is to determine the safety, efficacy, and effectiveness of the most widely used balloon, BioEnterics Intragastric Balloon (BIB), to treat obesity. METHODS: Systematic literature review of Medline, Embase, and other information sources from inception to March 2006. The quality of selected studies was assessed. Meta-analysis of weighted mean difference was made using the inverse variance method. RESULTS: We pooled 15 articles (3,608 patients) to estimate BIBs effectiveness. The estimates for weight lost at balloon removal for BIB were the following: 14.7 kg, 12.2% of initial weight, 5.7 kg/m(2), and 32.1% of excess weight. However, data were scant after balloon removal. Yet, efficacy at balloon removal was estimated with a meta-analysis of two randomized controlled trials (75 patients) that compared balloon versus placebo, indicating the balloon group lost more weight than the placebo group. These differences in weight lost were 6.7 kg, 1.5% of initial weight, 3.2 kg/m(2), and 17.6% of excess weight. Regarding BIB safety, the majority of complications were mild and the early removal rate was 4.2%. CONCLUSION: The use of the BIB, within a multidisciplinary weight management program, is a short-term effective treatment to lose weight, but it is not yet possible to verify its capacity to maintain the weight lost over a long period of time.