Geometric Model for the Postural Characterization in the Sagital Plane of Lumbar Raquis.

The individual's posture is the physical expression of his body. It is modified throughout life and it is determined by the particular anatomical characteristics that directly affect the biomechanics of the spine. The typing of the spinal curvature is important for the knowledge of body posture. The possibility of having a method for the systematic postural characterization of the spine is an essential objective resource in order to obtain normal or control patterns of the spinal morphology of the population. A widely accepted methodology of morphological characterization of the spine is a necessary requirement for the establishment of preventive criteria for spinal pathologies based on epidemiological population studies. It also represents a necessary requirement for the classification of individuals, based on the biomechanical, orthopaedic or ergonomic criteria necessary for disciplines such as sports, industrial design or sports performance. The present study proposes the development of a morphological postural model of the spine in the lumbar region. The model is based on a system of measurement of objective and comparable parameters by means of X-ray analysis, in order to characterize its morphology in the sagittal plane. The comparison of the results in a population of 47 individuals allowed the possibility to carry out a statistical study on three morphological parameters: sacral angle (α1); reversal angle (α2) and degree of lordosis (DL). The statistical hypothesis that the results behave according to a normal distribution with p < 0.05 is relevant and allows the systematization and postural modelling of the individual.

Video-Assisted Minithoracotomy Diaphragmatic Plication: Respiratory Effects in Adults.

Objectives The objective of this study was to analyze the clinical respiratory and spirometric effects of video-assisted minithoracotomy diaphragmatic plication (VAM-T DP) in the treatment of diaphragmatic eventration. Methods A retrospective longitudinal study of 18 patients who underwent a VAM-T DP in our service between February 2005 and July 2011 was performed. Data of patient characteristics, preoperative clinical variables, and postoperative results (3, 6, and 12 months) were collected for statistical analysis using the software package SPSS 13.0 for Windows (Wilcoxon test, Friedman test, and Z-test). Results The main clinical respiratory and spirometric variables improved significantly and remained stable over 1 year. Conclusions VAM-T DP is a viable and safe procedure that improves the spirometry values and offers stable results during the first year. To our knowledge, the present series is the second largest published report in English relating to this procedure in adults.

Osteoporosis in patients with subclinical hypothyroidism treated with thyroid hormone.

OBJECTIVE: to estimate the prevalence of osteoporosis in patients being treated with thyroid hormone. METHOD: cross-sectional retrospective study of primary care patients. EXPERIMENTAL GROUP: patients diagnosed with subclinical hypothyroidism receiving thyroid hormone replacement therapy. CONTROL GROUP: patients not receiving replacement therapy. Once the sample was selected its members were summoned to complete a clinical questionnaire and undergo a bone density scan with a validated measuring device. The description of qualitative data was done in absolute frequencies and percentages and that of the quantitative data as mean standard deviation, median. In the comparison of qualitative data between groups we used the Chi-square test and contingency tables by rearranging the percentages of several variables. RESULTS: 182 patients were studied (112 experimental and 70 control), diagnosed with subclinical hypothyroidism. The average age at diagnosis was 42.5 and 41.2 years, respectively. 32.7% and 33.2% were smokers. In the experimental group the coexistence of two or more cardiovascular risk factors was detected in 5.7% of the patients. Mean TSH was 6.67 mU/L, mean free T(4) 1,04 ng/dl. 67% of the patients studied had some level of bone loss: 87% osteopenia and 14% osteoporosis. 56% of those suffering from bone less were women. With regard to the size of the thyroid hormone treatment, only 12% received 150 µg/day or more. 61% had received treatment for between 5 and 10 years and 19.5% for more than 10 years. CONCLUSIONS: there is a high prevalence of bone loss in patients with subclinical hypothyroidism treated with exogenous thyroxin.

Is prophylactic cholecystectomy useful in obese patients undergoing gastric bypass?

BACKGROUND: Obesity constitutes a clear risk factor for cholelithiasis, especially if it is associated with a rapid weight loss, as is the case of patients following bariatric surgery. Prophylactic cholecystectomy is indicated in biliopancreatic diversions due to the high incidence of postoperative cholelithiasis. However, there is no agreement on gastric bypass. This study was conducted to establish the incidence of cholecystopathy demonstrated by histology and to assess the indication for prophylactic cholecystectomy in a systematic way on patients undergoing gastric bypass. METHODS: The evaluation is based on 100 consecutive morbidly obese patients undergoing open gastric bypass surgery with concomitant prophylactic cholecystectomy. Variables studied were: age, gender, body mass index, preoperative ultrasound and the anatomopathologic analysis of the gallbladder that was removed. RESULTS: Of the 100 patients who took part in the trial, 11 had had a previous cholecystectomy. Among the 89 patients remaining, preoperative ultrasound diagnosis of cholelithiasis was 16.8%, and the actual postoperative incidence was 24.7%. Other histologic alterations were: cholesterolosis 46.1%, chronic unspecified cholecystitis 22.5%, and granulomatous cholecystitis 1.1%. The total incidence of cholecystopathy was 93.3%. The morbi-mortality related to cholecystectomy was 0%. CONCLUSIONS: Based on these results and given the absence of morbidity, we believe that prophylactic cholecystectomy is suitable during open gastric bypass.

Autologous stem cell transplantation for treatment of rectovaginal fistula in perianal Crohn's disease: a new cell-based therapy.

BACKGROUND AND AIMS: Rectovaginal fistulas in patients with Crohn's disease are difficult to resolve, and surgical failure is very frequent. Recent studies have shown that adult stem cells extracted from certain tissues, such as adipose tissue, can develop into different tissues, such as muscle. PATIENT AND METHODS: We report here the case of a young patient with Crohn's disease who had a recurrent rectovaginal fistula that was treated by autologous stem-cell transplantation with a lipoaspirate as the source of stem cells. RESULTS: Although Crohn's disease is the worst condition for a surgical approach in cases of rectovaginal fistula, we observed good closure. Since the surgical procedure 3 month ago the patient has not experienced vaginal flatus or fecal incontinence through her vagina. Thus our treatment seems to be effective. CONCLUSION: Cell transplantation to overcome healing problems is a new surgical tool, and careful evaluation of this new modality may provide an opportunity to define a new era in the treatment of surgical challenges associated with healing disorders. Ethical and safety items do not seem to be critical problems using autologous stem cells.