Modification of Burton and Pellegrini trapeziectomy technique: Medium-term comparative analysis / Modificación de la técnica de trapeciectomía de Burton-Pellegrini: análisis comparativo a medio término

Introduction: Ligament reconstruction and tendon interposition (LRTI) arthroplasty is the procedure of choice of most hand surgeons in the treatment of basal joint arthritis of the thumb. Progressive and natural collapse after trapeziectomy is a common problem. Description of technique: We performed LRTI with flexor carpi radialis (FCR) hemitendon technique, then proceeded to block the hemitendon plasty with a bone fragment at the base of the metacarpal. This technique allows us to maintain tension and to obtain immediate stability. Patients and methods: We conducted a single-center retrospective longitudinal observational study including 51 patients with diagnosis of symptomatic osteoarthritis of the trapeziometacarpal joint. Group A consisted of 24 thumbs treated with trapeziectomy with LRTI with FCR hemitendon using the Burton-Pellegrini technique. Group B included 27 thumbs treated using the modified technique. The postoperative height of the Scaphometacarpal (SM) space was analyzed. Clinical outcome, opposition, retroversion, patient satisfaction and surgical timing were studied. Results: The difference of the SM space, after applying correction factor, at one and six months postoperative is significantly less in the modified technique group (p=0.033 and p=0.001 respectively). The average height loss of the SM space from one to six months postoperative measurement was smaller in the study group, showing greater stability of the plasty. Conclusions: The use of a bone fragment to block the FCR plasty improves the results at one and six months postoperatively, showing a diminished height loss of the SM space, improved thumb opposition and without prolonging surgical timing in our series.(AU)

Introducción: La artroplastia con reconstrucción ligamentosa e interposición tendinosa (LRTI, en inglés) es el procedimiento de elección para tratar la rizartrosis. El colapso progresivo tras la trapeciectomía es un problema habitual. Descripción de la técnica: Realizamos una LRTI con el hemitendón del flexor carpis radialis (FCR) y, posteriormente, colocamos un fragmento óseo en la base del metacarpo para bloquear la plastia. Esta técnica nos permite obtener estabilidad inmediata y mantener la tensión. Método: Presentamos un estudio observacional longitudinal retrospectivo unicéntrico, que incluye a 51 pacientes con diagnóstico de rizartrosis sintomática. Los pacientes se dividieron en 2 grupos: grupo A, pacientes intervenidos mediante trapeciectomía con LRTI del FCR según la técnica de Burton-Pellegrini y grupo B, pacientes intervenidos mediante la técnica modificada. Se analizó la altura del espacio escafometacarpiano (EM) restante en radiografías postoperatorias. Se valoraron los resultados clínicos, como la oposición o retroversión del pulgar, satisfacción del paciente y tiempo quirúrgico. Resultados: Las diferencias en altura del espacio EM a uno y 6 meses tras la cirugía son significativamente menores con la técnica modificada (p=0,033 y p=0,001, respectivamente). La pérdida de altura media del espacio EM del primer al sexto mes tras la cirugía fue menor en el grupo B, con mayor estabilidad de la plastia. Conclusión: El uso de un fragmento óseo para bloquear la plastia del FCR mejora los resultados clínicos y radiológicos a uno y 6 meses tras la cirugía, con menor pérdida de altura del espacio EM y mejoría de la oposición del pulgar, sin aumentar el tiempo quirúrgico.(AU)

[Artículo traducido] Modificación de la técnica de trapeciectomía de Burton-Pellegrini: análisis comparativo a medio término / Modification of Burton and Pellegrini trapeziectomy technique: Medium-term comparative analysis

Introduction: Ligament reconstruction and tendon interposition (LRTI) arthroplasty is the procedure of choice of most hand surgeons in the treatment of basal joint arthritis of the thumb. Progressive and natural collapse after trapeziectomy is a common problem. Description of technique: We performed LRTI with flexor carpi radialis (FCR) hemitendon technique, then proceeded to block the hemitendon plasty with a bone fragment at the base of the metacarpal. This technique allows us to maintain tension and to obtain immediate stability. Patients and methods: We conducted a single-center retrospective longitudinal observational study including 51 patients with diagnosis of symptomatic osteoarthritis of the trapeziometacarpal joint. Group A consisted of 24 thumbs treated with trapeziectomy with LRTI with FCR hemitendon using the Burton-Pellegrini technique. Group B included 27 thumbs treated using the modified technique. The postoperative height of the Scaphometacarpal (SM) space was analyzed. Clinical outcome, opposition, retroversion, patient satisfaction and surgical timing were studied. Results: The difference of the SM space, after applying correction factor, at one and six months postoperative is significantly less in the modified technique group (p=0.033 and p=0.001 respectively). The average height loss of the SM space from one to six months postoperative measurement was smaller in the study group, showing greater stability of the plasty. Conclusions: The use of a bone fragment to block the FCR plasty improves the results at one and six months postoperatively, showing a diminished height loss of the SM space, improved thumb opposition and without prolonging surgical timing in our series.(AU)

Introducción: La artroplastia con reconstrucción ligamentosa e interposición tendinosa (LRTI, en inglés) es el procedimiento de elección para tratar la rizartrosis. El colapso progresivo tras la trapeciectomía es un problema habitual. Descripción de la técnica: Realizamos una LRTI con el hemitendón del flexor carpis radialis (FCR) y, posteriormente, colocamos un fragmento óseo en la base del metacarpo para bloquear la plastia. Esta técnica nos permite obtener estabilidad inmediata y mantener la tensión. Método: Presentamos un estudio observacional longitudinal retrospectivo unicéntrico, que incluye a 51 pacientes con diagnóstico de rizartrosis sintomática. Los pacientes se dividieron en 2 grupos: grupo A, pacientes intervenidos mediante trapeciectomía con LRTI del FCR según la técnica de Burton-Pellegrini y grupo B, pacientes intervenidos mediante la técnica modificada. Se analizó la altura del espacio escafometacarpiano (EM) restante en radiografías postoperatorias. Se valoraron los resultados clínicos, como la oposición o retroversión del pulgar, satisfacción del paciente y tiempo quirúrgico. Resultados: Las diferencias en altura del espacio EM a uno y 6 meses tras la cirugía son significativamente menores con la técnica modificada (p=0,033 y p=0,001, respectivamente). La pérdida de altura media del espacio EM del primer al sexto mes tras la cirugía fue menor en el grupo B, con mayor estabilidad de la plastia. Conclusión: El uso de un fragmento óseo para bloquear la plastia del FCR mejora los resultados clínicos y radiológicos a uno y 6 meses tras la cirugía, con menor pérdida de altura del espacio EM y mejoría de la oposición del pulgar, sin aumentar el tiempo quirúrgico.(AU)

Modification of Burton and Pellegrini trapeziectomy technique: Medium-term comparative analysis. / [Artículo traducido] Modificación de la técnica de trapeciectomía de Burton-Pellegrini: análisis comparativo a medio término.

INTRODUCTION: Ligament reconstruction and tendon interposition (LRTI) arthroplasty is the procedure of choice of most hand surgeons in the treatment of basal joint arthritis of the thumb. Progressive and natural collapse after trapeziectomy is a common problem. DESCRIPTION OF TECHNIQUE: We performed LRTI with flexor carpi radialis (FCR) hemitendon technique, then proceeded to block the hemitendon plasty with a bone fragment at the base of the metacarpal. This technique allows us to maintain tension and to obtain immediate stability. PATIENTS AND METHODS: We conducted a single-center retrospective longitudinal observational study including 51 patients with diagnosis of symptomatic osteoarthritis of the trapeziometacarpal joint. Group A consisted of 24 thumbs treated with trapeziectomy with LRTI with FCR hemitendon using the Burton-Pellegrini technique. Group B included 27 thumbs treated using the modified technique. The postoperative height of the Scaphometacarpal (SM) space was analyzed. Clinical outcome, opposition, retroversion, patient satisfaction and surgical timing were studied. RESULTS: The difference of the SM space, after applying correction factor, at one and six months postoperative is significantly less in the modified technique group (P = .033 and P = .001, respectively). The average height loss of the SM space from one to six months postoperative measurement was smaller in the study group, showing greater stability of the plasty. CONCLUSIONS: The use of a bone fragment to block the FCR plasty improves the results at one and six months postoperatively, showing a diminished height loss of the SM space, improved thumb opposition and without prolonging surgical timing in our series.

Modification of Burton and Pellegrini trapeziectomy technique: Medium-term comparative analysis.

INTRODUCTION: Ligament reconstruction and tendon interposition (LRTI) arthroplasty is the procedure of choice of most hand surgeons in the treatment of basal joint arthritis of the thumb. Progressive and natural collapse after trapeziectomy is a common problem. DESCRIPTION OF TECHNIQUE: We performed LRTI with flexor carpi radialis (FCR) hemitendon technique, then proceeded to block the hemitendon plasty with a bone fragment at the base of the metacarpal. This technique allows us to maintain tension and to obtain immediate stability. PATIENTS AND METHODS: We conducted a single-center retrospective longitudinal observational study including 51 patients with diagnosis of symptomatic osteoarthritis of the trapeziometacarpal joint. Group A consisted of 24 thumbs treated with trapeziectomy with LRTI with FCR hemitendon using the Burton-Pellegrini technique. Group B included 27 thumbs treated using the modified technique. The postoperative height of the Scaphometacarpal (SM) space was analyzed. Clinical outcome, opposition, retroversion, patient satisfaction and surgical timing were studied. RESULTS: The difference of the SM space, after applying correction factor, at one and six months postoperative is significantly less in the modified technique group (p=0.033 and p=0.001 respectively). The average height loss of the SM space from one to six months postoperative measurement was smaller in the study group, showing greater stability of the plasty. CONCLUSIONS: The use of a bone fragment to block the FCR plasty improves the results at one and six months postoperatively, showing a diminished height loss of the SM space, improved thumb opposition and without prolonging surgical timing in our series.

Influencia del desequilibrio sagital en el resultado clínico de la vertebroplastia en pacientes con fractura por compresión vertebral osteoporótica / Sagittal imbalance influences outcome of vertebroplasty in patients with osteoporotic vertebral compression fracture

Antecedentes y objetivos: La correlación entre el equilibrio sagital de la columna y el resultado clínico tras una vertebroplastia (VP) en pacientes con fractura vertebral osteoporótica por compresión (FVOC) ha sido poco estudiada. Analizamos el resultado clínico de la VP en pacientes con FVOC teniendo en cuenta el equilibrio sagital. Material y método: El objetivo primario es valorar el cambio en el dolor axial, la discapacidad y la calidad de vida relacionada con la salud mediante la escala analógica visual (VAS), índice de discapacidad de Oswestry (ODI) y el test SF-36, respectivamente. Todo ello, correlacionado con el eje sagital vertical (SVA) que define el equilibrio sagital. El estudio radiográfico consistió en una radiografía de perfil de columna completa en bipedestación. Los controles clínico-radiológicos se realizaron pre- y post-VP (1, 3 y 12 meses). Resultados: Se incluyeron 51 pacientes con un total de 113 FVOC; 30 pacientes (60,7%) presentaron múltiples FVOC. Comparando la evolución del resultado del VAS y del ODI durante el seguimiento no se observaron diferencias significativas entre los grupos de pacientes con SVA<50mm y >50mm (p>0,05). Por el contrario, en pre-VP los resultados del SF-36 presentaban peores puntuaciones en el grupo de SVA>50mm en la sección de función física (FP) (p<0,05) y de componente de salud física (CSF) (p<0,05). Estas diferencias se mantenían hasta los 3 meses de seguimientos en CSF y hasta el final del seguimiento en la sección de FP (p<0,05). Conclusiones: Los pacientes con SVA>50mm presentan una recuperación más lenta de su calidad de vida relacionada con la salud tras VP por FVOC, pero sin diferencias significativas con respecto al dolor o discapacidad cuando se comparan con pacientes con SVA<50mm.(AU)

Background and objectives: The correlation between sagittal balance of the spine and clinical outcome after vertebroplasty (VP) in patients with osteoporotic vertebral compression fractures (OVCF) is poorly investigated. We analysed the clinical outcome of patients with OVCF undergoing VP taking into account sagittal balance. Material and method: The primary endpoint was the change in axial back pain, disability and health-related quality-of-life using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and SF-36, respectively, in correlation to the parameters that define sagittal balance (SVA). Radiographic assessment included full spine standing lateral films. Imaging and clinical data were collected pre- and post-procedure at 1, 3 and 12 months. Results: 51 patients were included presenting a total of 113 OVCF. 30 patients (60.7%) had multiple OVCF. Comparing the evolution of VAS and ODI throughout the follow-up it does not seem that there are significant differences in their behaviour between the SVA>50mm and the SVA<50mm groups (p>0.05). On the contrary, pre-VP SF-36 scores showed worst results in the SVA>50mm group in the physical functioning (PF) section (p<0.05) and in the physical component score (PCS) (p<0.05). These differences were maintained until 3 months of follow-up in the case of the PCS and until the end of follow-up in the case of the PF (p<0.05). Conclusions: Patients with a SVA>50mm showed a slower recovery of their quality-of-life after VP for OVCF, but without significant differences with respect to pain or disability, when compared patients with SVA<50mm.(AU)

[Translated article] Sagittal imbalance influences outcome of vertebroplasty in patients with osteoporotic vertebral compression fracture / Influencia del desequilibrio sagital en el resultado clínico de la vertebroplastia en pacientes con fractura por compresión vertebral osteoporótica

Antecedentes y objetivos: La correlación entre el equilibrio sagital de la columna y el resultado clínico tras una vertebroplastia (VP) en pacientes con fractura vertebral osteoporótica por compresión (FVOC) ha sido poco estudiada. Analizamos el resultado clínico de la VP en pacientes con FVOC teniendo en cuenta el equilibrio sagital. Material y método: El objetivo primario es valorar el cambio en el dolor axial, la discapacidad y la calidad de vida relacionada con la salud mediante la escala analógica visual (VAS), índice de discapacidad de Oswestry (ODI) y el test SF-36, respectivamente. Todo ello, correlacionado con el eje sagital vertical (SVA) que define el equilibrio sagital. El estudio radiográfico consistió en una radiografía de perfil de columna completa en bipedestación. Los controles clínico-radiológicos se realizaron pre- y post-VP (1, 3 y 12 meses). Resultados: Se incluyeron 51 pacientes con un total de 113 FVOC; 30 pacientes (60,7%) presentaron múltiples FVOC. Comparando la evolución del resultado del VAS y del ODI durante el seguimiento no se observaron diferencias significativas entre los grupos de pacientes con SVA<50mm y >50mm (p>0,05). Por el contrario, en pre-VP los resultados del SF-36 presentaban peores puntuaciones en el grupo de SVA>50mm en la sección de función física (FP) (p<0,05) y de componente de salud física (CSF) (p<0,05). Estas diferencias se mantenían hasta los 3 meses de seguimientos en CSF y hasta el final del seguimiento en la sección de FP (p<0,05). Conclusiones: Los pacientes con SVA>50mm presentan una recuperación más lenta de su calidad de vida relacionada con la salud tras VP por FVOC, pero sin diferencias significativas con respecto al dolor o discapacidad cuando se comparan con pacientes con SVA<50mm.(AU)

Background and objectives: The correlation between sagittal balance of the spine and clinical outcome after vertebroplasty (VP) in patients with osteoporotic vertebral compression fractures (OVCF) is poorly investigated. We analysed the clinical outcome of patients with OVCF undergoing VP taking into account sagittal balance. Material and method: The primary endpoint was the change in axial back pain, disability and health-related quality-of-life using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and SF-36, respectively, in correlation to the parameters that define sagittal balance (SVA). Radiographic assessment included full spine standing lateral films. Imaging and clinical data were collected pre- and post-procedure at 1, 3 and 12 months. Results: 51 patients were included presenting a total of 113 OVCF. 30 patients (60.7%) had multiple OVCF. Comparing the evolution of VAS and ODI throughout the follow-up it does not seem that there are significant differences in their behaviour between the SVA>50mm and the SVA<50mm groups (p>0.05). On the contrary, pre-VP SF-36 scores showed worst results in the SVA>50mm group in the physical functioning (PF) section (p<0.05) and in the physical component score (PCS) (p<0.05). These differences were maintained until 3 months of follow-up in the case of the PCS and until the end of follow-up in the case of the PF (p<0.05). Conclusions: Patients with a SVA>50mm showed a slower recovery of their quality-of-life after VP for OVCF, but without significant differences with respect to pain or disability, when compared patients with SVA<50mm.(AU)

[Translated article] Sagittal imbalance influences outcome of vertebroplasty in patients with osteoporotic vertebral compression fracture.

BACKGROUND AND OBJECTIVES: The correlation between sagittal balance of the spine and clinical outcome after vertebroplasty (VP) in patients with osteoporotic vertebral compression fractures (OVCF) is poorly investigated. We analysed the clinical outcome of patients with OVCF undergoing VP taking into account sagittal balance. METHODS: The primary endpoint was the change in axial back pain; disability and health-related quality of life using VAS, ODI and SF-36 respectively in correlation to the parameters that define sagittal balance (SVA). Radiographic assessment included full spine standing lateral films. Imaging and clinical data were collected pre and post procedure at 1, 3 and 12 months. RESULTS: Fifty-one patients were included presenting a total of 113 OVCF. Thirty patients (60.7%) had multiple OVCF. Comparing the evolution of VAS and ODI throughout the follow-up it does not seem that there are significant differences in their behaviour between the SVA>50mm and the SVA<50mm groups (p>0.05). On the contrary, preVP SF-36 scores showed worst results in the SVA>50mm group in the physical functioning section (PF) (p<0.05) and in the physical component score (PCS) (p<0.05). These differences were maintained until 3 months of follow-up in the case of the PCS and until the end of follow-up in the case of the PF (p<0.05). CONCLUSIONS: Patients with a SVA>50mm showed a slower recovery of their quality of life after VP for OVCF, but without significant differences with respect to pain or disability, when compared with patients with SVA<50mm.

Sagittal imbalance influences outcome of vertebroplasty in patients with osteoporotic vertebral compression fracture. / Influencia del desequilibrio sagital en el resultado clínico de la vertebroplastia en pacientes con fractura por compresión vertebral osteoporótica.

BACKGROUND AND OBJECTIVES: The correlation between sagittal balance of the spine and clinical outcome after vertebroplasty (VP) in patients with osteoporotic vertebral compression fractures (OVCF) is poorly investigated. We analysed the clinical outcome of patients with OVCF undergoing VP taking into account sagittal balance. MATERIAL AND METHOD: The primary endpoint was the change in axial back pain, disability and health-related quality-of-life using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and SF-36, respectively, in correlation to the parameters that define sagittal balance (SVA). Radiographic assessment included full spine standing lateral films. Imaging and clinical data were collected pre- and post-procedure at 1, 3 and 12 months. RESULTS: 51 patients were included presenting a total of 113 OVCF. 30 patients (60.7%) had multiple OVCF. Comparing the evolution of VAS and ODI throughout the follow-up it does not seem that there are significant differences in their behaviour between the SVA>50mm and the SVA<50mm groups (p>0.05). On the contrary, pre-VP SF-36 scores showed worst results in the SVA>50mm group in the physical functioning (PF) section (p<0.05) and in the physical component score (PCS) (p<0.05). These differences were maintained until 3 months of follow-up in the case of the PCS and until the end of follow-up in the case of the PF (p<0.05). CONCLUSIONS: Patients with a SVA>50mm showed a slower recovery of their quality-of-life after VP for OVCF, but without significant differences with respect to pain or disability, when compared patients with SVA<50mm.

El polietileno de alto entrecruzamiento no reduce el desgaste en la artroplastia total de rodilla / Cross-linked polyethylene does not reduce wear in total knee arthroplasty

Objetivo: Comparar dos pares de fricción (metal/polietileno de ultra alto peso molecular [UHMWPE], metal/polietileno de alto entrecruzamiento) mediante análisis cuantitativo y cualitativo de partículas de polietileno en líquido sinovial a los 3 años postintervención en pacientes portadores de prótesis total de rodilla (PTR). Material y métodos: Se llevó a cabo un estudio de cohortes prospectivo, aleatorizado, con evaluación ciega incluyendo 25 pacientes a quienes se intervino de PTR de manera bilateral, con 6 meses de diferencia. A los 3 años postintervención, se realizaron artrocentesis de rodilla a 12 pacientes y se analizaron las partículas de polietileno. Resultados: No se hallaron diferencias significativas en el número de partículas generadas por los diferentes insertos de polietileno a los 3 años tras la implantación de una artroplastia total de rodilla (3.000×: x¯ entrecruzado=849,7; x¯ UHMWPE=796,9; p=0,63; 20.000×: x¯ entrecruzado=66,3; x¯ UHMWPE=73,1; p=0,76). Tampoco existen diferencias significativas entre los 2 tipos de inserto, entre la posibilidad de encontrar partículas de forma elongada (χ2=0,19; p=0,66) ni redonda (χ2=1,44; p=0,23). Sin embargo, la probabilidad de encontrar partículas de forma fibrilar es 3,08 veces mayor en el UHMWPE. Conclusiones: El polietileno altamente entrecruzado no reduce significativamente la generación de partículas de polietileno en aquellos pacientes intervenidos mediante una artroplastia total de rodilla, con muestras a 3 años postintervención

Aim: To compare two different types of inserts: Ultra-high molecular weight polyethylene (UHMWPE) and cross-linked polyethylene with a quantitative and qualitative study of polyethylene wear particles in synovial fluid 3 years after total knee arthroplasty. Material and methods: A prospective, randomized, controlled cohort study with blinded evaluation was carried out on 25 patients undergoing staged bilateral total knee replacement, 6 months apart. Knee arthrocentesis was performed on 12 patients 3 years after surgery, and the polyethylene particles were analyzed. Results: No significant differences were found in the number of particles generated by the two different types of inserts at 3 years from total knee arthroplasty (3,000×: x¯ cross-linked=849.7; x¯ UHMWPE=796.9; P=.63; 20,000×: x¯ cross-linked=66.3; x¯ UHMWPE=73.1; P=.76). Likewise, no differences in the probability of finding elongated (χ2=0.19; P=.66) or rounded (χ2=1.44; P=.23) particles in both types of inserts were observed. However, the probability of finding fibrillar particles is 3.08 times greater in UHMWPE. Conclusions: Cross-linked polyethylene does not significantly reduce the generation of polyethylene particles in patients with total knee arthroplasty, 3 years after the surgical procedure

Cross-linked polyethylene does not reduce wear in total knee arthroplasty. / El polietileno de alto entrecruzamiento no reduce el desgaste en la artroplastia total de rodilla.

AIM: To compare two different types of inserts: Ultra-high molecular weight polyethylene (UHMWPE) and cross-linked polyethylene with a quantitative and qualitative study of polyethylene wear particles in synovial fluid 3 years after total knee arthroplasty. MATERIAL AND METHODS: A prospective, randomized, controlled cohort study with blinded evaluation was carried out on 25 patients undergoing staged bilateral total knee replacement, 6 months apart. Knee arthrocentesis was performed on 12 patients 3 years after surgery, and the polyethylene particles were analyzed. RESULTS: No significant differences were found in the number of particles generated by the two different types of inserts at 3 years from total knee arthroplasty (3,000×: x¯ cross-linked=849.7; x¯ UHMWPE=796.9; P=.63; 20,000×: x¯ cross-linked=66.3; x¯ UHMWPE=73.1; P=.76). Likewise, no differences in the probability of finding elongated (χ2=0.19; P=.66) or rounded (χ2=1.44; P=.23) particles in both types of inserts were observed. However, the probability of finding fibrillar particles is 3.08 times greater in UHMWPE. CONCLUSIONS: Cross-linked polyethylene does not significantly reduce the generation of polyethylene particles in patients with total knee arthroplasty, 3 years after the surgical procedure.

Infecciones necrosantes de partes blandas atendidas en un servicio de urgencias de tercer nivel: evolución y correlación con la escala laboratory risk indicator for necrotizing fasciitis (LRINEC) / Necrotizing fasciitis attended in the Emergency Department in a tertiary Hospital: evaluation of the LRINEC scale

Objetivo. Describir la mortalidad y las complicaciones de pacientes atendidos en urgencias, con diagnóstico de infección necrosante de partes blandas (INPB) y su correlación con la escala Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC). Método. Estudio observacional retrospectivo con inclusión de pacientes con diagnóstico de INPB en urgencias de un hospital terciario durante 7 años. Los resultados se muestran como mediana, rango intercuartílico y rango absoluto para las variables cuantitativas. En el caso de las variables cualitativas, como frecuencias absoluta y relativa. La comparación se ha llevado a cabo mediante comparación post-hoc a partir de un análisis ANOVA con aproximación no paramétrica. Las comparaciones entre grupos de LRINEC en las variables cualitativas se han realizado con la prueba exacta de Fisher. Resultados. Se identificaron 24 pacientes con edad media de 51,9 años. La escala LRINEC se determinó en 21 pacientes: en 10 indicó bajo riesgo (<6), en 4 riesgo intermedio (6 o 7) y en 7 alto riesgo (≥8). La tasa de amputación en riesgos bajo, intermedio y alto fue del 10, 25 y 66%, respectivamente, con una mortalidad del 4,2%. Se observa un aumento en la estancia hospitalaria entre los niveles bajo y alto de la escala (p=0,007). Conclusiones. En general no se ha podido constatar un cambio en el pronóstico entre los niveles medio y alto de la escala LRINEC. Pero sí entre la estancia hospitalaria entre el nivel bajo y el alto, triplicando prácticamente la mediana de días de estancia hospitalaria (AU)

Aim. To describe mortality and complications of patients seen in the emergency room, diagnosed with necrotizing soft tissue infection (NSTI) and the correlation of such complications with the Laboratory Risk Indicator for Necrotizing fasciitis scale (LRINEC). Methods. Retrospective observational study including patients with a diagnosis of NSTI in the emergency room of a tertiary hospital over 7 years. The results are shown as median, interquartile range and absolute range for quantitative variables. In the case of qualitative variables, the results are shown as absolute and relative frequency. The comparison between the categories of the LRINEC scale was performed through a post-hoc comparison from a non-parametric ANOVA analysis. Comparisons between LRINEC groups in the qualitative variables were performed using Fisher's Exact test. Results. 24 patients with a mean age of 51.9 years were identified. The LRINEC scale was used on 21 patients: in 10, the value indicated low risk (<6), in 4 it indicated intermediate risk (6 or 7) and in 7 it indicated high risk (≥8). The amputation rate in patients with low, intermediate and high risk was 10%, 25% and 66% respectively with a mortality of 4.2%. There was an increase in hospital stay between the low and high level of the scale (p=0,007). Conclusions. In general, a change in the prognosis between the medium and high levels of the LRINEC scale could not be recorded, but was recorded in hospital stay between the low and the high level, practically tripling the median of days of hospital stay (AU)

Necrotizing fasciitis attended in the Emergency Department in a tertiary Hospital: Evaluation of the LRINEC scale. / Infecciones necrosantes de partes blandas atendidas en un servicio de urgencias de tercer nivel: evolución y correlación con la escala laboratory risk indicator for necrotizing fasciitis (LRINEC).

AIM: To describe mortality and complications of patients seen in the emergency room, diagnosed with necrotizing soft tissue infection (NSTI) and the correlation of such complications with the Laboratory Risk Indicator for Necrotizing fasciitis scale (LRINEC). METHODS: Retrospective observational study including patients with a diagnosis of NSTI in the emergency room of a tertiary hospital over 7 years. The results are shown as median, interquartile range and absolute range for quantitative variables. In the case of qualitative variables, the results are shown as absolute and relative frequency. The comparison between the categories of the LRINEC scale was performed through a post-hoc comparison from a non-parametric ANOVA analysis. Comparisons between LRINEC groups in the qualitative variables were performed using Fisher's Exact test. RESULTS: 24 patients with a mean age of 51.9 years were identified. The LRINEC scale was used on 21 patients: in 10, the value indicated low risk (<6), in 4 it indicated intermediate risk (6 or 7) and in 7 it indicated high risk (≥8). The amputation rate in patients with low, intermediate and high risk was 10%, 25% and 66% respectively with a mortality of 4.2%. There was an increase in hospital stay between the low and high level of the scale (p=0,007). CONCLUSIONS: In general, a change in the prognosis between the medium and high levels of the LRINEC scale could not be recorded, but was recorded in hospital stay between the low and the high level, practically tripling the median of days of hospital stay.

Demanda al servicio de urgencias de profilaxis para infecciones de transmisión sexual tras prácticas sexuales de riesgo / Sexual risk behavior and demand for prophylaxis for sexually transmitted diseases

Objetivos: Analizar las características de las consultas a urgencias en demanda de profilaxis para las infecciones de transmisión sexual (ITS) tras una práctica sexual de riesgo. Método: Durante 6 meses se han revisado las demandas de profilaxis atendidas en el servicio de urgencias tras una práctica sexual de riesgo. Se utilizaron como variables datos epidemiológicos, tipo de práctica, motivo de consulta, tratamiento profiláctico y coste económico. Resultados: Se han incluido 189 pacientes con una edad media de 32,5 (8,3) años. De ellos, 162 eran hombres (85,7%). El 67,2% eran españoles. Ciento trece casos (59,8%)eran hombres que tuvieron sexo con otros hombres (HSH), con pareja VIH positiva(30,7%) o de estatus serológico desconocido (61,9%). Usaron preservativo el 49,7%de pacientes, pero consultaron por su rotura o pérdida el 45,5%. La penetración anal, activa o pasiva, fue la práctica sexual más frecuente (53,4%). El 85,2% recibió tratamiento profiláctico para el VIH con antirretrovirales durante 28 días, el 77,2% recibió también profilaxis antibiótica para otras ITS y un 22,8% inició inmunización para virus hepatotropos. El coste medio de la visita y de la profilaxis administrada o prescrita en urgencias fue de 858 (275) euros por paciente. Conclusiones: La práctica sexual de riesgo como motivo de consulta a urgencias es frecuente, principalmente entre un hombre que practica sexo con otro hombre. La mayoría de pacientes acude por una rotura del preservativo, pero casi la mitad no lo usan a pesar de desconocer el estado serológico de la pareja o ser ésta portadora del VIH. La consulta a urgencias y el tratamiento farmacológico generan un coste económico elevado (AU)

Objective: To analyze the characteristics of patients coming to the emergency room seeking postexposure prophylaxis for sexually transmitted diseases (STDs) after high-risk sex. Methods: Over a 6-month period, emergency requests for postexposure STD prophylaxis were reviewed. We recorded epidemiologic variables, type of sexual risk behavior, reason for coming to the emergency room, STD prophylaxis prescribed, and cost. Results: A total of 189 patients with a mean (SD) age of 32.5 (8.3) years were included; 162 (85.7%) were men and67.2% were Spanish. One hundred thirteen (59.8%) were men who had sex with men; the partner was seropositive for human immunodeficiency virus (HIV) in 30.7% of the cases or of unknown serostatus in 61.9%. Condoms were used by49.7%, but 45.5% reported breakage. The most frequent practice was anal penetration (active or passive) (53.4%).Twenty-eight days of preventive HIV antiretroviral therapy was prescribed for 85.2%; 77.2% also received prophylactic antibiotics for other STDs, and 22.8% started immunization against hepatropic viruses. The mean cost per visit and preventive treatment administered or prescribed in the emergency department was €858 (€275).Conclusions: Sexual risk behavior is a frequent reason for emergency department visits, particularly among men who have sex with men. A large proportion of patients come because a condom has broken, but nearly half do not use a condom even when they do not know the serostatus of the partner or know the partner is seropositive for HIV. Emergency care and pharmacologic treatment for these patients are costly (AU)

Valoración de la satisfacción de los padres en una unidad neonatal / Assessment of parental satisfaction in a neonatal unit

Introducción: La satisfacción de los padres en una unidad neonatal (UN) debe ser evaluada como elemento de calidad asistencial. Objetivos: 1/Determinar cómo influye el nivel de gravedad sobre la satisfacción de los padres. 2/Comparar los resultados antes y después de un traslado de centro. Material y métodos: Se aplicó una encuesta de satisfacción a los padres de los neonatos (RN) ingresados en la UN. Se recogieron datos de 87 de los RN ingresados durante 10 meses, distribuidos en 2 categorías según gravedad. Se valoró la satisfacción de los padres sobre aspectos humanos y físicos en la UN, estudiando si esta se afectó por la gravedad del RN. Se valoró el impacto del traslado sobre la satisfacción. Se realizaron análisis estadísticos descriptivos y modelos multivariantes. Resultados: Se observó una polarización entre los aspectos humanos y los relacionados con el medio. Fueron estadísticamente significativos la valoración del horario de acceso de los padres y la crítica sobre mobiliario, luz y espacio físico. Los padres de los RN más graves valoraron mejor el horario pero peor el entorno. La percepción de dolor en los procedimientos es mayor en niños más graves y un 66% de los padres preferiría estar presente en los mismos. Comparando entre la UN antigua y la nueva, el único parámetro significativo fue la percepción sobre la información suministrada, peor valorada en el nuevo hospital. La lactancia materna mejoró significativamente. La satisfacción general fue elevada. Conclusiones: Los padres de niños graves valoran la accesibilidad y son críticos con la comodidad. El horario de entrada de los padres y la ausencia de luz y ruido son predictores significativos de satisfacción en niños con estancias prolongadas. La percepción del acceso a la información empeoró con el traslado, probablemente por falta de adaptación al medio(AU)

Introduction: Parental satisfaction in a neonatal unit needs to be checked as a quality element in health care. Objectives: 1/To measure how the severity of the newborn condition influences parental satisfaction. 2/To compare the results before and after moving to a new building. Methods: Parental satisfaction in 87 of the newborns admitted to our neonatal unit over a 10 month period was documented using a questionnaire survey. The newborns were divided into 2 categories, depending on the severity of their condition. Parental satisfaction as regards human and environmental issues was checked as to whether it was affected by the severity of the illness. The impact of the move to a new building on satisfaction was also analysed. Statistical descriptive studies and multivariate models were used. Results: A polarised tendency was seen between human and environmental aspects. The following issues were statistically significant: visiting hours for parents, and criticisms about furniture, light and physical space. Parents of seriously ill children appreciated the visiting hours but judged the environment negatively. Pain perception in procedures was higher in serious illnesses, and 66% of parents would rather be present during those procedures. When comparing both hospitals, the only significant value regarding the new centre, was the lower perception of information given by the staff. Breastfeeding improved significantly. General satisfaction was high. Conclusions: Parents of seriously ill newborns are mainly concerned about access hours and comfort. Parent visiting hours and lack of noise and light are significant parameters predicting satisfaction in children with long stays. Perception of access to information got worse in the new hospital, probably due to lack of staff adaptation(AU)

[Assessment of parental satisfaction in a neonatal unit]. / Valoración de la satisfacción de los padres en una unidad neonatal.

INTRODUCTION: Parental satisfaction in a neonatal unit needs to be checked as a quality element in health care. OBJECTIVES: 1/To measure how the severity of the newborn condition influences parental satisfaction. 2/To compare the results before and after moving to a new building. METHODS: Parental satisfaction in 87 of the newborns admitted to our neonatal unit over a 10 month period was documented using a questionnaire survey. The newborns were divided into 2 categories, depending on the severity of their condition. Parental satisfaction as regards human and environmental issues was checked as to whether it was affected by the severity of the illness. The impact of the move to a new building on satisfaction was also analysed. Statistical descriptive studies and multivariate models were used. RESULTS: A polarised tendency was seen between human and environmental aspects. The following issues were statistically significant: visiting hours for parents, and criticisms about furniture, light and physical space. Parents of seriously ill children appreciated the visiting hours but judged the environment negatively. Pain perception in procedures was higher in serious illnesses, and 66% of parents would rather be present during those procedures. When comparing both hospitals, the only significant value regarding the new centre, was the lower perception of information given by the staff. Breastfeeding improved significantly. General satisfaction was high. CONCLUSIONS: Parents of seriously ill newborns are mainly concerned about access hours and comfort. Parent visiting hours and lack of noise and light are significant parameters predicting satisfaction in children with long stays. Perception of access to information got worse in the new hospital, probably due to lack of staff adaptation.

Seguimiento del neurodesarrollo de niños nacidos por técnicas de reproducción asistida / Monitoring neurodevelopment in children born as a result of using assisted reproduction techniques

Introducción. En los últimos años algunas publicaciones han demostrado una mayor incidencia de defectos congénitoso anomalías cromosómicas vinculadas a la fecundación in vitro (FIV) convencional, y otras publicaciones sugieren unaposible influencia negativa de la microinyección espermática (ICSI) sobre el neurodesarrollo. Objetivo. Determinar si habíadiferencias en el desarrollo médico y en el neurodesarrollo entre niños concebidos por técnicas de FIV convencional y niñosconcebidos por técnicas de ICSI. Sujetos y métodos. La muestra se compone de 17 infantes nacidos por FIV (nueve niños yocho niñas) y de 40 infantes nacidos por ICSI (23 niños y 17 niñas). Todos ellos procedían de embarazos de FIV y de ICSI obtenidosen el servicio de reproducción asistida de nuestro hospital y controlados por el mismo equipo de obstetricia y perinatología.A todos los pacientes se les realizó una exploración pediátrica a los 24 meses de edad cronológica y una exploraciónneuropsicológica. La exploración se realizó en una única sesión. Se evaluó específicamente el neurodesarrollo mediante lasescalas de Bayley de desarrollo infantil. Resultados y conclusiones. Los infantes de FIV convencional y e ICSI de nuestro estudiomostraron una salud y un neurodesarrollo similares a los de la población general a la edad de 2 años. La ICSI, comparadacon la FIV convencional, se muestra tan segura como ésta en relación con la evolución médica y cognitiva de los niños (AU)

Introduction. In recent years a number of publications have reported a higher incidence of congenital defects or chromosome abnormalities linked to conventional in vitro fertilisation (IVF), and some other publications have suggested that intracytoplasmic sperm injection (ICSI) may have a negative influence on neurodevelopment. Aim. To determine whether there were any differences in the medical development and the neurodevelopment of children conceived using conventionalIVF techniques and those conceived using ICSI techniques. Subjects and methods. Our sample consisted of 17 babies born after IVF (nine males and eight females) and 40 infants born after ICSI (23 males and 17 females). All of them were the resultof pregnancies induced by IVF and ICSI achieved in the assisted reproduction service at our hospital and followed up by the same team of obstetricians and specialists in maternal-foetal medicine. At the chronological age of 24 months all the patients were submitted to a paediatric examination and a neuropsychological examination. The examination was performed in onesingle session. Neurodevelopment was evaluated specifically by means of the Bayley scales of infant development. Results and conclusions. The health and neurodevelopment of infants from conventional IVF and from ICSI in our study were similar to those of the general population at the age of two years. ICSI proved to be as safe as conventional IVF as regards the children’s medical and cognitive progression (AU)

[Monitoring neurodevelopment in children born as a result of using assisted reproduction techniques]. / Seguimiento del neurodesarrollo de niños nacidos por tecnicas de reproducción asistida.

INTRODUCTION: In recent years a number of publications have reported a higher incidence of congenital defects or chromosome abnormalities linked to conventional in vitro fertilisation (IVF), and some other publications have suggested that intracytoplasmic sperm injection (ICSI) may have a negative influence on neurodevelopment. AIM. To determine whether there were any differences in the medical development and the neurodevelopment of children conceived using conventional IVF techniques and those conceived using ICSI techniques. SUBJECTS AND METHODS: Our sample consisted of 17 babies born after IVF (nine males and eight females) and 40 infants born after ICSI (23 males and 17 females). All of them were the result of pregnancies induced by IVF and ICSI achieved in the assisted reproduction service at our hospital and followed up by the same team of obstetricians and specialists in maternal-foetal medicine. At the chronological age of 24 months all the patients were submitted to a paediatric examination and a neuropsychological examination. The examination was performed in one single session. Neurodevelopment was evaluated specifically by means of the Bayley scales of infant development. RESULTS AND CONCLUSIONS: The health and neurodevelopment of infants from conventional IVF and from ICSI in our study were similar to those of the general population at the age of two years. ICSI proved to be as safe as conventional IVF as regards the children's medical and cognitive progression.