Picnodisostosis: una rara enfermedad con fracturas frecuentes / Pycnodysostosis: A rare disease with frequent fractures

La picnodisostosis es una enfermedad rara, producida por una disfunción de los osteoclastos, debida a una mutación en el gen de la catepsina K. Presentamos un caso de un paciente adulto joven con dicho síndrome que tras una caída de baja energía presenta una fractura atípica de tibia, al acudir a urgencias se observan unas alteraciones óseas predisponentes a la fractura. Al poco tiempo sufre la misma fractura en la otra tibia. Debido a las condiciones características de la picnodisostosis para el tratamiento de dicha fractura requirió un abordaje no convencional para una fractura diafisaria de tibia (placa de osteosíntesis), asociado a un mayor tiempo consolidación. Finalmente el caso se resolvió de forma satisfactoria (AU)

Pycnodysostosis is a rare disease caused by a dysfunction of the osteoclasts due to a mutation in the cathepsin K gene. We present a case of a young adult patient with the above mentioned syndrome, who suffered an atypical fracture of the tibia after a low energy fall. Some bone changes that could have predisposed the fracture were observed when examined in the Emergency Department. Not long afterwards he suffered the same type of fracture in another tibia. Due to the conditions typical of the pycnodysostosis, the above mentioned fracture required an unconventional approach for this mid-shaft tibial fracture (osteosynthesis plate), combined with a longer consolidation time. The case was finally resolved satisfactorily (AU)

Resultados del tratamiento de seudoartrosis de escafoides con injerto microvascularizado de arteria 1, 2 intercompartimental suprarretinacular y osteosíntesis / Results of treatment of scaphoid nonunion with microvascularized bone grafts of the 1, 2 intercompartmental supraretinacular artery and osteosynthesis

Objetivo. Estudiar los resultados del tratamiento de la seudoartrosis de escafoides, con dudosa viabilidad del fragmento proximal, pero sin deformidad ni colapso importante del mismo, mediante la utilización de un injerto óseo vascularizado de la arteria suprarretinacular 1,2 intercompartimental (1,2 ICSRA) y osteosíntesis posterior. Material y método. Estudio retrospectivo de 10 pacientes varones con diagnóstico radiográfico de seudoartrosis. Después del tratamiento se evaluó la funcionalidad, el dolor medido por la escala analógica visual (EVA), la fuerza de agarre, la satisfacción del paciente y la reintroducción a la vida laboral, utilizando las escalas de Mayo y QuickDASH específicas de muñeca y comprobándose radiográficamente la integración del injerto. Resultados. El seguimiento medio fue de 31,4 meses; un 90% de las encuestas fueron satisfactorias. La EVA descendió en 4,6 puntos y la ganancia de movilidad flexo-extensora fue de 5°. La tasa de consolidación completa del injerto alcanzó el 40% en 5,5 meses de media. Discusión. Diferentes estudios han demostrado mejores resultados utilizando injerto óseo vascularizado frente al no vascularizado. Desde la descripción por Zaidemberg en 1991, el injerto microvascularizado con arteria 1,2 ICSRA, de radio distal, ha sido el más utilizado para el tratamiento de seudoartrosis del escafoides. Conclusiones. Nuestros resultados, comparables con la bibliografía revisada, utilizando el injerto vascularizado de arteria 1,2 ICSRA y osteosíntesis con tornillo tipo Herbert, pueden ser una alternativa de tratamiento para la seudoartrosis proximal de escafoides, sin colapso ni deformidad importante (AU)

Objective. To analyze the results of treatment of scaphoid nonunion with questionable viability of the proximal fragment, but without significant deformity or collapse, using a vascularized bone graft of 1,2 intercompartmental supraretinacular artery (1.2 ICSRA) and subsequent osteosynthesis. Material and method. A retrospective study was performed on 10 male patients with a radiographic diagnosis of nonunion. Functionality, pain using Visual Analog Score (VAS), grip strength, patient satisfaction and reintroduction to working life, using QuickDASH and May specific wrist scales were assessed after the treatment. The integration of the graft was checked by radiography. Results. The mean follow-up was 31.4 months, and 90% of the questionnaires were satisfactory. The VAS decreased by 4.6 points and the flexor-extensor mobility gain was 5°. The total graft consolidation rate reached 40% in 5.5 months on average. Discussion. Several studies have demonstrated better results using vascularized bone graft versus non-vascularized. From the description by Zaidemberg in 1991, the vascularized graft with 1.2 ICSRA artery, distal radius, has been the most widely used for the treatment of scaphoid nonunion. Conclusions. Our results are comparable with the literature reviewed, thus using vascular graft of the 1.2 ICSRA and osteosynthesis with Herbert-type screw, may be an alternative treatment for proximal scaphoid nonunion, without collapse or significant deformity (AU)

[Results of treatment of scaphoid nonunion with microvascularized bone grafts of the 1, 2 intercompartmental supraretinacular artery and osteosynthesis]. / Resultados del tratamiento de seudoartrosis de escafoides con injerto microvascularizado de arteria 1,2 intercompartimental suprarretinacular y osteosíntesis.

OBJECTIVE: To analyze the results of treatment of scaphoid nonunion with questionable viability of the proximal fragment, but without significant deformity or collapse, using a vascularized bone graft of 1,2 intercompartmental supraretinacular artery (1.2 ICSRA) and subsequent osteosynthesis. MATERIAL AND METHOD: A retrospective study was performed on 10 male patients with a radiographic diagnosis of nonunion. Functionality, pain using Visual Analog Score (VAS), grip strength, patient satisfaction and reintroduction to working life, using QuickDASH and May specific wrist scales were assessed after the treatment. The integration of the graft was checked by radiography. RESULTS: The mean follow-up was 31.4 months, and 90% of the questionnaires were satisfactory. The VAS decreased by 4.6 points and the flexor-extensor mobility gain was 5°. The total graft consolidation rate reached 40% in 5.5 months on average. DISCUSSION: Several studies have demonstrated better results using vascularized bone graft versus non-vascularized. From the description by Zaidemberg in 1991, the vascularized graft with 1.2 ICSRA artery, distal radius, has been the most widely used for the treatment of scaphoid nonunion. CONCLUSIONS: Our results are comparable with the literature reviewed, thus using vascular graft of the 1.2 ICSRA and osteosynthesis with Herbert-type screw, may be an alternative treatment for proximal scaphoid nonunion, without collapse or significant deformity.

[Pycnodysostosis: a rare disease with frequent fractures]. / Picnodisostosis: una rara enfermedad con fracturas frecuentes.

Pycnodysostosis is a rare disease caused by a dysfunction of the osteoclasts due to a mutation in the cathepsin K gene. We present a case of a young adult patient with the above mentioned syndrome, who suffered an atypical fracture of the tibia after a low energy fall. Some bone changes that could have predisposed the fracture were observed when examined in the Emergency Department. Not long afterwards he suffered the same type of fracture in another tibia. Due to the conditions typical of the pycnodysostosis, the above mentioned fracture required an unconventional approach for this mid-shaft tibial fracture (osteosynthesis plate), combined with a longer consolidation time. The case was finally resolved satisfactorily.

Técnica de sacrectomía para resección de metástasis de leiomiosarcoma uterino / The use of sacrectomy for the resection of uterine leiomyosarcoma methastases

Las metástasis son probablemente los tumores malignos de sacro más frecuentes. Su detección suele ser habitualmente tardía. La resección de los tumores metastáticos malignos es siempre compleja, especialmente cuando afecta al sacro por su proximidad con órganos y estructuras vasculonerviosas importantes. Se presenta el caso de un sarcoma de sacro derecho con extensión intrapélvica y a masa muscular glútea, en una mujer de 49 años de edad con antecedentes de histerectomía y salpingooforectomía bilateral por leiomiosarcoma uterino pT1N0M0, G1 en 1996. La paciente es tratada quirúrgicamente mediante hemisacrectomía derecha y resección de masa tumoral. El interés del trabajo es aportar información sobre una técnica quirúrgica infrecuente

Methastases are probably the most frequent malignant tumors of the sacrum. They are more often than note detected at a late phase in their development. The resection of methastatic malignant tumors is invariably complex, especially when they involve the sacrum, which in the vicinity of vital organs and vascular-nervous structures. The case presented is a right sacrum sarcoma that extends to the intrapelvic area and to the gluteus muscle in a 49-year-old woman with a history of hysterectomy and bilateral salpingoophorectomy resulting from a pT1N0M0-G1 uterine leiomyosarcoma developed in 1996. The patient was treated surgically by means of a right hemisacrectomy and the resection of the tumoral mass. The purpose of this study was to shed light on this infrequent surgical technique

Eficacia de la hemostasia tras retirada del torniquete en la artroplastia de rodilla / Effectiveness of hemostasis after tourniquet removal in total knee replacement

Objetivo. El objetivo de este trabajo es comprobar si la hemostasia quirúrgica que se realiza tras la retirada del torniquete en las prótesis totales de rodilla es efectiva para reducir las pérdidas sanguíneas. Material y método. Se seleccionaron 30 pacientes, a los que se les realizó hemostasia con electrobisturí una vez retirado el torniquete (grupo A) y otros 30 pacientes a los que se les retiró el torniquete una vez cerrada la herida y aplicado el vendaje compresivo (grupo B). Se midieron las pérdidas sanguíneas recogidas por el drenaje aspirativo, los descensos de hemoglobina y hematocrito a las 24 y 48 horas después de la cirugía comparados con los preoperatorios, tiempos de isquemia e intervención y necesidades transfusionales. Resultados. No se encontraron diferencias estadísticamente significativas en cuanto a las pérdidas sanguíneas (p = 0,836) y requerimientos transfusionales (p= 0,618) entre ambos grupos. Conclusiones. La hemostasia quirúrgica que se realiza una vez retirado el torniquete no es efectiva para reducir las pérdidas sanguíneas en la artroplastia de sustitución de la rodilla

Purpose. The purpose of this study is to determine if surgical hemostasis carried out after tourniquet removal in total knee replacement (TKR) surgery is effective in reducing bleeding. Materials and methods. In 30 selected patients (Group A) undergoing TKR hemostasis was carried out with electrocautery once the tourniquet was deflated intraoperatively; in another 30 selected patients (Group B) the incision was closed and compressive dressing was applied before tourniquet removal. Blood loss was measured by aspiration drainage, and hemoglobin levels and hematocrit were measured at 24 and 48 hours after surgery and compared with preoperative values, ischemic time was also measured and any transfusions required registered. Results. No statistically significant differences were found between both groups regarding blood loss (p=0.836) or transfusions required (p= 0.618). Conclusions. Surgical hemostasis carried out after tourniquet removal is not effective as a way of reducing blood loss in total knee replacement (TKR)

[Freud's contribution to medical methodology]. / La aportacion de Freud a la metodologia medica.

Freud's contribution to the history of medicine may be centred upon his conception of the human subject and the method used for study and treatment. This method is not, as Freud claimed, that of the natural sciences. This is because Freud considered the psychic system to be divided in two superimposed planes compared to the conception of the unified subject (very widespread in medical anthropology). These two planes are the preconscious-conscious (whose fuctioning tends to be ruled by logical relations) and the subconscious (whose functioning is based on relations of resemblace and contiquity comparable to those described by Frazer in magical thougt). The method Freud contributed to Medicine is the interpretative listening to discourse on two planes (simultaneous and superimposed) with which this divided subject expresses the intra-psychic conflict.