Artropatía neuropática de hombro / Neuropathic arthropathy of the shoulder

Las artropatías neuropáticas conducen a un proceso de destrucción y deformación articular de rápida evolución que se ha relacionado con un trastorno de la inervación propioceptiva y nociceptiva; factores de crecimiento, neuromediadores y vasculares parecen también implicados. En nuestro medio la diabetes, la neuropatía alcohólica o siringomielia suelen ser las causas más frecuentes. Presentamos el caso de una artropatía neuropática de hombro en una mujer de 61 años con antecedente de siringomielia. El diagnóstico diferencial se plantea con entidades neurológicas, artritis sépticas, osteomielitis crónicas, tumores y otras artropatías destructivas como las osteonecrosis asépticas, condromatosis sinovial, metabólicas (gota y condrocalcinosis) o hemartros de repetición en hemofílicos

Neuropathic arthropathies is a destructive and deforming joint process related to a disruption of propioceptive and nocioceptive innervation. Growth factors, neurological and vascular factors might be involved. Diabetes, alcoholic neuropathy or syringomyelia appear as the most common causes. We report the case of a 61-year-old woman affected by syringomyelia, with a neuropathic arthropathy of the shoulder. Differential diagnosis includes neurological diseases, septic arthritis, tumours and other destructive arthropathies such as aseptic nechrosis, chronic osteomyelitis, synovial chondromatosis, metabolic diseases (gout, chondrocalcinosis) or repetitive haemarthrosis in haemophilia

[Neuropathic arthropathy of the shoulder]. / Artropatía neuropática de hombro.

Neuropathic arthropathies is a destructive and deforming joint process related to a disruption of propioceptive and nocioceptive innervation. Growth factors, neurological and vascular factors might be involved. Diabetes, alcoholic neuropathy or syringomyelia appear as the most common causes. We report the case of a 61-year-old woman affected by syringomyelia, with a neuropathic arthropathy of the shoulder. Differential diagnosis includes neurological diseases, septic arthritis, tumours and other destructive arthropathies such as aseptic nechrosis, chronic osteomyelitis, synovial chondromatosis, metabolic diseases (gout, chondrocalcinosis) or repetitive haemarthrosis in haemophilia.

[Perioperative blood management in primary total knee arthroplasty]. / Manejo perioperatorio de sangre en cirugía protésica primaria de rodilla.

Preoperative autologous blood collection and the reinfusion of postoperative blood salvaged from wound drainage can help to decrease the use of homologous blood transfusion in total knee arthroplasty. We have evaluated 100 primary total knee arthroplasties carried out at the García Orcoyen Hospital between 2001-2003. Eighty-eight point seven percent (88.7%) of available autotransfusion blood packs were employed and the average blood reinfusion from wound drainage was 374 ml. (range: 200-950 ml) when this method was possible. In 69% of cases homologous blood transfusion was not necessary. While other techniques are being developed, we think that autologous blood collection and blood reinfusion from wound drainage are effective in reducing the need for homologous blood transfusion; this is important because of the potential risk of reactions, disease transmission and limited blood bank resources.

Manejo perioperatorio de sangre en cirugía protésica primaria de rodilla / Perioperative blood management in primary total knee arthroplasty

En cirugía protésica de rodilla la donación autóloga junto con la recuperación postoperatoria de sangre procedente del sistema de drenaje es una alternativa que puede ayudar a disminuir las necesidades de transfusión homóloga. Se han revisado 100 intervenciones de prótesis total primaria de rodilla realizadas en el Hospital García Orcoyen entre los años 2001-2003. Se emplearon el 88,7% de las bolsas de autotransfusión disponibles y, en los casos que se utilizó el recuperador sanguíneo, la media de reinfusión fue de 374 ml. (rango: 200-950 ml). En un 69% de los casos no fue necesaria la transfusión homóloga de sangre. Mientras se desarrollan otras técnicas hemoterápicas, creemos que la donación autóloga y la recuperación postoperatoria de sangre es eficaz en reducir las necesidades de transfusión homóloga lo cual adquiere importancia por el riesgo potencial de reacciones postransfusionales, transmisión de enfermedades y su reserva limitada en los bancos de sangre

Preoperative autologous blood collection and the reinfusion of postoperative blood salvaged from wound drainage can help to decrease the use of homologous blood transfusion in total knee arthroplasty. We have evaluated 100 primary total knee arthroplasties carried out at the García Orcoyen Hospital between 2001-2003. Eighty-eight point seven percent (88.7%) of available autotransfusion blood packs were employed and the average blood reinfusion from wound drainage was 374 ml. (range: 200-950 ml) when this method was possible. In 69% of cases homologous blood transfusion was not necessary. While other techniques are being developed, we think that autologous blood collection and blood reinfusion from wound drainage are effective in reducing the need for homologous blood transfusion; this is important because of the potential risk of reactions, disease transmission and limited blood bank resources

[Acute local reaction to intra-articular infiltration with synvisc (Hylan GF20). About two cases]. / Reacción aguda local tras infiltración intraarticular con Synvisc (Hylan GF 20). A propósito de dos casos.

A second stage in the treatment of arthrosis following the non-steroid anti-inflammatories is formed by the so-called chondroprotectors and intraarticular viscosupplementation with hyaluronic acid, generally in the knee. Although infrequent, cases have been described of transitory inflammatory arthritis following intra-articulary administration. The main problem is differential diagnosis with a septic secondary arthritis and its consequences. This is a generally benign process with a still unknown transitory aetiology with different hypotheses, but which involves suspension of the treatment. We present two cases that resolved the sequels with different moments of appearance, the first in the three hours following infiltration, and the second four days later.

Reacción aguda local tras infiltración intraarticular con Synvisc (Hylan GF 20). A propósito de dos casos / Acute local reaction to intra-articular infiltration with Synvisc (Hylan GF20). About two cases

Un segundo escalón en el tratamiento de la artrosis después de los antiinflamatorios no esteroideos son los denominados condroprotectores y la viscosuplementación intraarticular con ácido hialurónico empleado generalmente en la rodilla. Aunque poco frecuente hay descritos casos de artritis inflamatoria transitoria tras su administración intraarticular. El principal problema es el diagnóstico diferencial con una artritis séptica secundaria y sus consecuencias. Se trata de un proceso generalmente benigno y transitorio de etiología aún desconocida con diversas hipótesis pero que conlleva la suspensión del tratamiento. Presentamos dos casos que resolvieron sin secuelas con diferentes momentos de aparición, el primero en las tres horas siguientes a la infiltración y el segundo cuatro días después (AU)

Bone metastases from osteosarcoma.

Bony metastases in patients with osteosarcoma are unusual and normally appear late in the course of the disease. We report our experience with eight such patients, four with solitary and four with multiple metastases. Those with solitary metastases were treated as new tumours with neoadjuvant chemotherapy and surgery. Three remain alive with no evidence of disease at 5, 7 and 8 years follow-up respectively. Histology and response to neoadjuvant chemotherapy was similar in both the primary and metastatic lesions and is a predictive factor of outcome. Those with multiple metastases were treated by palliative measures, and none survived. We conclude that resection of solitary metastases from osteosarcoma after neoadjuvant chemotherapy can be curative.

[Surgical treatment of vertebral metastasis]. / Tratamiento quirúrgico de las metástasis vertebrales.

Spinal metastases may cause pain and neurologic dysfunction secondary to bone destruction and spinal cord compression. The new oncology therapy have prolonged life expectancy of many patients with different primary tumors. The treatment of metastases is frequently necessary to enhance quality of life. We reviewed 121 patients with spinal metastases of different primary tumors operated between 1982 and 1995. We employed different approach and instrumentation depending on particular case, metastases location and life expectancy. We analysed primary tumor location, spinal pain, neurologic function, pre and post surgical treatment, complications and development. Spinal stabilization and cord decompression gives excellent results for pain relief, neurological improvement and quality of life, always helping to medical treatment of a patient with metastatic disease.