Effect of feed intake level on the body temperature of pigs exposed to heat stress conditions.

Feed intake (FI) level affects body heat production in thermo-neutral pigs; exposure of pigs to heat stress (HS) also increases body temperature (BT). However remains unclear whether the FI level affects the heat production of HS pigs. This study analyzed the effect of FI level on BT of 9 HS pigs (46.3 ±â€¯2.6 kg body weight) implanted with a thermometer set to register the BT at 5-min intervals into the ileum. Pigs were divided in two groups randomly allotted to two FI treatments: high FI (HFI, 1.20 kg/d), and low FI (LFI, 0.96 kg/d), according to a two-period crossover experimental design. Pigs were fed 3-times a day (0600, 1200, and 2200 h), same amount each time (400 g or 320 g). Ambient temperature (AT) ranged from 29.0 to 35.4 °C. The BT of both HFI and LFI pigs followed a similar pattern along a 24-h period, but the BT of HFI pigs was higher than that of LFI pigs (P < 0.05). Postprandial afternoon and evening BT was higher than that after the morning meal (P < 0.05). The postprandial BT increment differed between meal times and AT, but not between FI levels. The BT of HFI and LFI pigs increased up to 0.18 and 0.22 °C, 0.60 and 0.61 °C, and 0.24 and 0.35 °C after the morning, afternoon, and evening meal, respectively, compared with the preprandial BT (P < 0.05). Hence, the dissipation capacity of feeding-related body heat appears to depend on the thermal load of HS pigs before consuming their meals; presumably, the thermal load during 6-h before the morning meal (AT below 32 °C) was lower than before the evening meal (AT above 32 °C). In conclusion, FI level affects the postprandial BT of HS pigs and its magnitude is larger after the evening and afternoon meals. These data suggest that HS pigs may reduce the voluntary FI during the afternoon and evening hours.

Effect of feed intake level and dietary protein content on the body temperature of pigs housed under thermo neutral conditions.

Feed intake and diet composition appear to affect the body temperature of pigs. Two trials were conducted to analyse the effect of feed intake level and dietary protein content on the intestinal temperature (IT) of pigs housed under thermo neutral conditions. Ten pigs (64.1 ± 1.3 kg initial body weight) fitted with an ileal cannula were used. A thermometer set to register the IT at 5-min intervals was implanted into the ileum through the cannula. In both trials, the ambient temperature ranged from 19.1 to 21.6°C and the pigs were fed at 07:00 and 19:00 hr (same amount each time). In trial 1, the pigs were fed daily 1.2 or 1.8 kg of a wheat-soybean meal diet. The IT followed a similar pattern along a 24-hr period regardless the feed intake level. The IT rapidly increased up to 0.61 and 0.74°C after the morning meal and up to 0.53 and 0.47°C after the evening meal in pigs fed 1.2 and 1.8 kg/d respectively. The postprandial IT was higher in pigs fed 1.8 kg after each meal (p < .05). In trial 2, pigs were fed daily 1.8 kg of a low (11%) or a high (22%) crude protein diet. The IT followed a similar pattern along the 24-hr period regardless the dietary protein level. The postprandial IT did not differ between pigs fed the low protein or the high protein (p > .10). The IT rapidly increased up to 0.66 and 0.62°C after the morning meal in pigs fed the high- and low-protein diet (p < .05), but there was no change after the evening meal (p > .10). In conclusion, the feed intake level affected the IT of pigs housed under TN conditions, but the dietary protein content had no effect.

Recambio de polietileno mediante la cementación de un nuevo componente sobre el metal-back osteointegrado / Polyethylene replacement by cementing a new component over the osseointegrated metal-back

Objetivo. Ante una cirugía de revisión de artroplastia total de cadera no cementada por desgaste de polietileno está indicado mantener el cotilo metálico cuando se compruebe intraoperatoriamente su estabilidad, sustituyendo únicamente el polietileno que se cementa si el anclaje no es posible. El objetivo del presente estudio fue evaluar los resultados clínicos y radiográficos a medio plazo de la cementación de polietileno dentro de un componente acetabular metálico osteointegrado. Material y método. Se analizaron retrospectivamente 15 pacientes cuya indicación para la cirugía fue el desgaste de polietileno, con un periodo de seguimiento medio de 6,1 años (rango 3,5-9,7 años). El Harris Hip Score se utilizó para valorar los resultados clínicos antes de la intervención y al final del seguimiento. Se realizaron radiografías anteroposteriores y axiales de cadera para descartar complicaciones. Resultados. La puntuación media en el Harris Hip Score mejoró, pasando de los 64,7 puntos en el preoperatorio a los 80,3 al final del seguimiento. Las lesiones osteolíticas desaparecieron, o al menos no aumentaron de tamaño, en los controles radiográficos. Una paciente (6,7%) sufrió 2 episodios de luxación, que se trataron sin necesidad de cirugía. Otro paciente presentó aflojamiento aséptico del vástago femoral, que requirió el recambio. Conclusiones. La cementación del polietileno, cuando no sea posible su anclaje, en un cotilo metálico no cementado osteointegrado es una técnica que ofrece buenos resultados a medio plazo, y que minimiza las complicaciones que conlleva el recambio del componente acetabular, sin comprometer su estabilidad (AU)

Objective. In uncemented revision total hip replacement due to polyethylene wear, the metal cup needs to be maintained when its stability is checked during surgery, only replacing the polyethylene that is cemented if anchoring is not possible. The aim of the present study was to evaluate the medium-term clinical and radiological results of a polyethylene liner cemented into an osseointegrated acetabular shell component. Material and method. A retrospective analysis was performed on 15 patients in whom the surgical indication was polyethylene wear, with a mean follow-up of 6.1 years (range 3.5-9.7 years). The Harris Hip Score was used to assess the clinical results before surgery and at the end of follow-up. Anteroposterior and axial X-rays of the hip were taken to rule out complications. Results. The mean Harris Hip Score improved, increasing from 64.7points before the surgery to 80.3 at the end of follow-up. The osteolytic lesions disappeared, or at least the size did not increase, in the follow-up X-rays. One patient (6.7%) suffered 2 dislocation episodes that were treated without the need for surgery. Another patient presented with aseptic loosening of the femoral stem that required a replacement. Conclusions. Cementing the polyethylene liner, when anchoring is not possible, in an uncemented osseointegrated metal shell is a technique that offers good results in the medium term, and which may minimise the complications that may occur with the replacement of the shell component, without compromising its stability (AU)

[Polyethylene replacement by cementing a new component over the osseointegrated metal-back]. / Recambio de polietileno mediante la cementación de un nuevo componente sobre el metal-back osteointegrado.

OBJECTIVE: In uncemented revision total hip replacement due to polyethylene wear, the metal cup needs to be maintained when its stability is checked during surgery, only replacing the polyethylene that is cemented if anchoring is not possible. The aim of the present study was to evaluate the medium-term clinical and radiological results of a polyethylene liner cemented into an osseointegrated acetabular shell component. MATERIAL AND METHOD: A retrospective analysis was performed on 15 patients in whom the surgical indication was polyethylene wear, with a mean follow-up of 6.1 years (range 3.5-9.7 years). The Harris Hip Score was used to assess the clinical results before surgery and at the end of follow-up. Anteroposterior and axial X-rays of the hip were taken to rule out complications. RESULTS: The mean Harris Hip Score improved, increasing from 64.7 points before the surgery to 80.3 at the end of follow-up. The osteolytic lesions disappeared, or at least the size did not increase, in the follow-up X-rays. One patient (6.7%) suffered 2 dislocation episodes that were treated without the need for surgery. Another patient presented with aseptic loosening of the femoral stem that required a replacement. CONCLUSIONS: Cementing the polyethylene liner, when anchoring is not possible, in an uncemented osseointegrated metal shell is a technique that offers good results in the medium term, and which may minimise the complications that may occur with the replacement of the shell component, without compromising its stability.

Corrosion inhibition of powder metallurgy Mg by fluoride treatments.

Pure Mg has been proposed as a potential degradable biomaterial to avoid both the disadvantages of non-degradable internal fixation implants and the use of alloying elements that may be toxic. However, it shows excessively high corrosion rate and insufficient yield strength. The effects of reinforcing Mg by a powder metallurgy (PM) route and the application of biocompatible corrosion inhibitors (immersion in 0.1 and 1M KF solution treatments, 0.1M FST and 1M FST, respectively) were analyzed in order to improve Mg mechanical and corrosion resistance, respectively. Open circuit potential measurements, polarization techniques (PT), scanning electrochemical microscopy (SECM) and electrochemical impedance spectroscopy (EIS) were performed to evaluate its corrosion behavior. SECM showed that the local current of attacked areas decreased during the F(-) treatments. The corrosion inhibitory action of 0.1M FST and 1M FST in phosphate buffered solution was assessed by PT and EIS. Under the experimental conditions assayed, 0.1M FST revealed better performance. X-ray photoelectron spectroscopy, energy dispersive X-ray and X-ray diffraction analyses of Mg(PM) with 0.1M FST showed the presence of KMgF(3) crystals on the surface while a MgF(2) film was detected for 1M FST. After fluoride inhibition treatments, promising results were observed for Mg(PM) as degradable metallic biomaterial due to its higher yield strength and lower initial corrosion rate than untreated Mg, as well as a progressive loss of the protective characteristics of the F(-)-containing film which ensures the gradual degradation process.

Plates made with solid waste from the recycled paper industry.

The results of assays carried out on plates used in the construction industry, manufactured entirely with solid wastes of a recycled paper plant, are presented and compared with the results obtained using agglomerated wood and plywood plates. Previous results had shown that wastes are composed essentially of polymers when these wastes are generated by recycled paper produced with the "waved type II" shavings. These solid wastes were placed in a mold that was heated and pressed with a hydraulic press in order to obtain the plates. The waste-produced plates were submitted to tests for humidity, swelling, water absorption, density, modulus of rupture-static bending, modulus of elasticity and direct screw withdrawal. These same assays had been carried out on two types of commercial wood plates, agglomerated wood and plywood, in order to compare the results with those obtained with the waste plate. Waste plates had similar behavior to the agglomerated wood plate, but it was possible to distinguish greater flexibility in the waste-produced plate and a significant difference in the tests for swelling and water absorption which showed the waste plate had a better performance than the agglomerated wood and plywood plates.

Corrosion behaviour of AZ31 magnesium alloy with different grain sizes in simulated biological fluids.

The corrosion behaviour of AZ31 magnesium alloy with different grain sizes immersed in simulated body fluids was compared in chloride solution (8 gl(-1)) and in phosphate-buffer solution (PBS). The influence of immersion time was also analyzed. Electrochemical techniques such as open circuit potential, polarization curves, transient currents and electrochemical impedance spectroscopy, complemented with scanning electron microscopy and energy dispersive spectroscopy, were used. Immediately after the immersion in the corrosive media the corrosion resistance was similar for both grain sizes of the AZ31 alloy and higher in NaCl solutions than in PBS. However, this corrosion behaviour was reversed after longer periods of immersion due to the stabilizing of the corrosion products of MgO by P-containing compounds. These P-compounds contribute to a higher level of protection by hindering the aggressive action of chloride ions. The best corrosion behaviour of the AZ31 alloy was obtained for the finest grain alloy associated with the highest transfer resistance value, after long periods of immersion in PBS.

An ecological risk assessment of the acute and chronic effects of the herbicide clopyralid to rainbow trout (Oncorhynchus mykiss).

Clopyralid (3,6-dichloro-2-pyridinecarboxylic acid) is a pyridine herbicide frequently used to control invasive, noxious weeds in the northwestern United States. Clopyralid exhibits low acute toxicity to fish, including the rainbow trout (Oncorhynchus mykiss) and the threatened bull trout (Salvelinus confluentus). However, there are no published chronic toxicity data for clopyralid and fish that can be used in ecological risk assessments. We conducted 30-day chronic toxicity studies with juvenile rainbow trout exposed to the acid form of clopyralid. The 30-day maximum acceptable toxicant concentration (MATC) for growth, calculated as the geometric mean of the no observable effect concentration (68 mg/L) and the lowest observable effect concentration (136 mg/L), was 96 mg/L. No mortality was measured at the highest chronic concentration tested (273 mg/L). The acute:chronic ratio, calculated by dividing the previously published 96-h acutely lethal concentration (96-h ALC(50); 700 mg/L) by the MATC was 7.3. Toxicity values were compared to a four-tiered exposure assessment profile assuming an application rate of 1.12 kg/ha. The Tier 1 exposure estimation, based on direct overspray of a 2-m deep pond, was 0.055 mg/L. The Tier 2 maximum exposure estimate, based on the Generic Exposure Estimate Concentration model (GEENEC), was 0.057 mg/L. The Tier 3 maximum exposure estimate, based on previously published results of the Groundwater Loading Effects of Agricultural Management Systems model (GLEAMS), was 0.073 mg/L. The Tier 4 exposure estimate, based on published edge-of-field monitoring data, was estimated at 0.008 mg/L. Comparison of toxicity data to estimated environmental concentrations of clopyralid indicates that the safety factor for rainbow trout exposed to clopyralid at labeled use rates exceeds 1000. Therefore, the herbicide presents little to no risk to rainbow trout or other salmonids such as the threatened bull trout.

An ecological risk assessment of the exposure and effects of 2,4-D acid to rainbow trout (Onchorhyncus mykiss).

Numerous state and federal agencies are increasingly concerned with the rapid expansion of invasive, noxious weeds across the United States. Herbicides are frequently applied as weed control measures in forest and rangeland ecosystems that frequently overlap with critical habitats of threatened and endangered fish species. However, there is little published chronic toxicity data for herbicides and fish that can be used to assess ecological risk of herbicides in aquatic environments. We conducted 96-h flowthrough acute and 30-day chronic toxicity studies with swim-up larvae and juvenile rainbow trout (Onchorhyncus mykiss) exposed to the free acid form of 2,4-D. Juvenile rainbow trout were acutely sensitive to 2,4-D acid equivalent at 494 mg/L (95% confidence interval [CI] 334-668 mg/L; 96-h ALC(50)). Accelerated life-testing procedures, used to estimate chronic mortality from acute data, predicted that a 30-day exposure of juvenile rainbow trout to 2,4-D would result in 1% and 10% mortality at 260 and 343 mg/L, respectively. Swim-up larvae were chronically more sensitive than juveniles using growth as the measurement end point. The 30-day lowest observable effect concentration (LOEC) of 2,4-D on growth of swim-up larvae was 108 mg/L, whereas the 30-day no observable effect concentration (NOEC) was 54 mg/L. The 30-day maximum acceptable toxicant concentration (MATC) of 2,4-D for rainbow trout, determined as the geometric mean of the NOEC and the LOEC, was 76 mg/L. The acute:chronic ratio was 6.5 (i.e., 494/76). We observed no chronic effects on growth of juvenile rainbow trout at the highest concentration tested (108 mg/L). Worst-case aquatic exposures to 2,4-D (4 mg/L) occur when the herbicide is directly applied to aquatic ecosystems for aquatic weed control and resulted in a 30-day safety factor of 19 based on the MATC for growth (i.e., 76/4). Highest nontarget aquatic exposures to 2,4-D applied following terrestrial use is calculated at 0.136 mg/L and resulted in a 30-day safety factor of 559 (e.g., 76/0.163). Assessment of the exposure and response data presented herein indicates that use of 2,4-D acid for invasive weed control in aquatic and terrestrial habitats poses no substantial risk to growth or survival of rainbow trout or other salmonids, including the threatened bull trout (Salvelinus confluentus).

Are urodynamic studies really needed during bladder augmentation follow-up?

OBJECTIVE: We assessed clinical and urodynamic outcomes, over a minimum 10-year follow-up period, of neuropathic bladder patients treated with a bladder augmentation (BA) to determine if periodic urodynamic studies are needed. MATERIAL AND METHODS: Thirty-two patients with poorly compliant bladders underwent BA at a mean age of 11 years (2.5-18). Mean follow-up was 12 years (10-14.5) and mean patient age at the end of the study was 22 years (12.2-33). During follow-up all patients were controlled at regular intervals with urinary tract imaging, serum electrolyte and creatinine levels, cystoscopy and urodynamic studies. Preoperative, 1-year post-BA and latest urodynamic studies results were compared. RESULTS: Urodynamic studies at 1-year post-BA showed a significant increase in bladder capacity and a decrease in end-filling detrusor pressure compared with preoperative values (396 vs 106 ml; 10 vs 50 cm H(2)O, P<0.0001). The increase in bladder capacity was more significant at the end of the study than after 1 year (507.8 vs 396 ml, P<0.002). Thirteen patients had phasic contractions after 1 year and 11 at the end (not significant, NS), and these contractions were more frequent with colon than with ileum (NS). At the end of follow-up, phasic contraction pressure had decreased while trigger volume had increased (35 vs 28 cm H(2)O; 247 vs 353 ml, NS). All patients are dry and have normal renal function, except one who had mild renal insufficiency before BA. CONCLUSION: BA improves bladder capacity and pressure, and these changes are maintained over time (although phasic contractions do not disappear). Repeated urodynamic studies are only necessary when upper urinary tract dilatation or incontinence does not improve.

Enterocystoplasty in children with neuropathic bladders: long-term follow-up.

OBJECTIVE: This study assesses clinical outcome, after at least 8 years, of augmentation done before or at puberty in neuropathic bladders. PATIENTS AND METHODS: A total of 29 children with neuropathic bladders who did not respond satisfactorily to clean intermittent catheterisation and anti-cholinergic therapy underwent enterocystoplasty at a mean age of 11.8 years (range 3-18). Twenty-one children (72.4%) had vesicoureteral reflux (VUR) and/or ureterohydronephrosis and 22 (75.8%) had dimercapto-succinic acid scars, but all had normal renal function. All patients were followed at regular intervals with urinary tract imaging, serum electrolytes, creatinine, urodynamic evaluation and 24-h urine collection. Urine cytology, cystoscopy and biopsy were performed at the end of follow-up. RESULTS: Mean follow-up was 11 years (range 8-14.5) and mean age at the end of follow-up was 22.2 years (range 13.2-31). Urodynamic studies showed a significant improvement in bladder compliance in all patients. Upper urinary tract dilatation disappeared in all, VUR in 13/17 (76.4%), and no new renal scarring occurred in any patient. At the end of follow-up, renal function was normal in all according to serum creatinine, but cystatin C levels were normal in 27 and elevated in two. Significant proteinuria and low concentrations of renin and aldosterone were present in 80% and 82%, respectively. Only one patient had urinary tract infection, three had bladder stones, and in another a catheterisable channel was made. All patients were dry with normal urine cytology and cystoscopy, and no malignant lesions have been found in the biopsy specimens. CONCLUSION: Enterocystoplasty has preserved renal function and resolved VUR and/or hydronephrosis in most patients. The future implications of proteinuria and the low serum levels of renin and aldosterone, as well as the best indicator for measuring renal function, have yet to be determined. Close, life-long follow-up, including cystoscopy, is necessary to prevent complications.

Creciendo con una ampliación vesical / Growing up with a bladder augmentation

Las estenosis esofágicas son una de las complicaciones más frecuentes de la corrección quirúrgica de las atresias de esófago. Su tratamiento consiste en la dilatación de la estenosis, precisando en la mayoría de los casos más de 1 procedimiento para su corrección. Introducción: Analizamos la evolución a largo plazo de nuestros pacientes con vejiga neuropática a los que se realizó una ampliación vesicalantes de la pubertad. Pacientes y métodos: A 21 pacientes con vejigas neuropáticas de baja acomodación y mala respuesta al sondaje intermitente y/o anticolinérgicos se les realizó una ampliación vesical (edad media 8.3 años, rango;2,5-12). Dieciocho de ellos (86%) tenían RVU y/o ureterohidronefrosis y 17 (81%) cicatrices renales sin afectación de la función renal salvo en un caso. Todos los pacientes fueron seguidos regularmente con estudios de función renal, pruebas de imagen, análisis de orina de 24horas y estudios urodinámicos. A los 18 pacientes ampliados con intestino se les realizó citología urinaria, cistoscopia y biopsia. Resultados: El seguimiento medio fue de 11 años (8-14,5) y la media de edad al final del estudio fue de 19 años (13,2-26,8). Los estudios urodinámicos demostraron una mejoría significativa de la acomodación vesical. La ureterohidronefrosis desapareció en todos los pacientes, el RVU en13 de 15 (86%) y ninguno presentó nuevas cicatrices renales. Al final del estudio, la función renal era normal en 20 de ellos. Un paciente tuvo una ITU y otro un cálculo vesical. Todos están secos y 2 de ellos no necesitan sondaje intermitente. La citología y la cistoscopia fueron normales y no se encontraron lesiones malignas en las biopsias. Conclusión: La ampliación vesical antes de la pubertad preserva la función renal y corrige el RVU y/o la ureterohidronefrosis en la mayoría de los pacientes, sin reimplantar los uréteres. Un seguimiento de por vida, incluyendo la realización de cistoscopias periódicas, es necesario para mejorar los resultados y prevenir las complicaciones (AU)

Introduction: This study assesses long-term outcome of patients with neuropatic bladders who underwent a bladder augmentation before puberty. Patients and methods: A total of 21 patients with low compliant neuropathic bladders who did not respond satisfactory to clean intermittent catheterization and/or anticholinergic therapy underwent bladder augmentation(mean age 8.3 yr, range; 2.5-12). Eighteen patients (86%)had VUR and/or ureterohydronephrosis and 17 (81%) had DMSA renal scars. Renal function was normal in all cases except one. All patients were followed at regular intervals with serum electrolyte and creatinine determination, urinary tract imaging, urodynamic evaluation and 24-hour urine collection. In the 18 cases augmented with intestine, urinecytology, cystoscopy and biopsy were also performed. Results: Mean follow-up was 11 yr (8-14.5) and mean age at the end of follow-up was 19 yr (13.3-26.8). Urodynamic studies showed a significant improvement in bladder compliance. Upper urinary tract dilatation disappeared in all patients, VUR in 13/15p (86%) and no new renal scarring occurred. Renal function was normal at the end of followupin 20. Only 1 patient had UTI and another had a bladder stone. All patients are dry and 2 of them do not need clean intermittent catheterization. Urine cytology and cystoscopy were normal and no malignant lessions have been found in the biopsy specimens. Conclusions: Bladder augmentation done pre-puberty preserves renal function and resolves VUR and/or hydronephrosis in most cases without reimplanting the ureters. Close lifelong follow-up, including a cystoscopy, improves the results and prevents complications (AU)

[Growing up with a bladder augmentation]. / Creciendo con una ampliación vesical.

INTRODUCTION: This study assesses long-term outcome of patients with neuropatic bladders who underwent a bladder augmentation before puberty. PATIENTS AND METHODS: A total of 21 patients with low compliant neuropathic bladders who did not respond satisfactory to clean intermittent catheterization and/or anticholinergic therapy underwent bladder augmentation (mean age 8.3 yr, range; 2.5-12). Eighteen patients (86%) had VUR and/or ureterohydronephrosis and 17 (81%) had DMSA renal scars. Renal function was normal in all cases except one. All patients were followed at regular intervals with serum electrolyte and creatinine determination, urinary tract imaging, urodynamic evaluation and 24-hour urine collection. In the 18 cases augmented with intestine, urine cytology, cystoscopy and biopsy were also performed. RESULTS: Mean follow-up was 11 yr (8-14.5) and mean age at the end of follow-up was 19 yr (13.3-26.8). Urodynamic studies showed a significant improvement in bladder compliance. Upper urinary tract dilatation disappeared in all patients, VUR in 13/15p (86%) and no new renal scarring occurred. Renal function was normal at the end of follow-up in 20. Only 1 patient had UTI and another had a bladder stone. All patients are dry and 2 of them do not need clean intermittent catheterization. Urine cytology and cystoscopy were normal and no malignat lessions have been found in the biopsy specimens. CONCLUSIONS: Bladder augmentation done pre-puberty preserves renal function and resolves VUR and/or hydronephrosis in most cases without reimplanting the ureters. Close lifelong follow-up, including a cystoscopy, improves the results and prevents complications.

Isolated fracture of the coronoid process.

Approximately 2% to 15% of the patients with dislocated elbows are thought to present a fracture of the coronoid process of the ulna, but such a fracture does not often present in isolation. Its exact incidence is difficult to ascertain given the lack of studies on the subject. One case is presented of an isolated fracture of the coronoid process and it is placed in the context of the existing literature.

Fracturas supracondíleas de húmero infantiles: remodelación rotacional / Pediatric supracondylar humerus fractures: rotational remodelling

Objetivo. Determinar si en las fracturas supracondíleas de húmero en niños es posible cierto grado de remodelación rotacional y los factores que pueden influir en la misma. Material y método. Se revisaron un total de 62 niños intervenidos quirúrgicamente en nuestro hospital desde diciembre de 1988 hasta enero de 1999, por fractura supracondílea de húmero. De ellos, 52 fueron incluidos en el estudio. El tiempo medio de seguimiento fue de 9,1 años (rango 3-14años). Se estudió mediante análisis de regresión la evolución de la deformidad rotacional y su relación con diferentes parámetros: edad, sexo, tipo de fractura, tratamiento, tiempos de inmovilización y de rehabilitación, grado de movilidad, ángulo de transporte y complicaciones. Resultados. La deformidad rotacional disminuyó independientemente de la reducción obtenida, no existiendo relación significativa entre el componente rotacional en el postoperatorio inmediato y en el momento de la revisión, aunque existió cierta tendencia a tener menor rotación final cuanto mayor fue la reducción conseguida de este componente(p = 0,093). El sexo mostró relación significativa con la deformidad rotacional residual en el momento de la revisión en el análisis de regresión logística (p = 0,003).Conclusiones. La reducción obtenida es ciertamente importante en el tratamiento, pero existen probablemente otros factores todavía no bien conocidos que influyen en la remodelación de la fractura. Es posible esperar cierto grado de remodelación rotacional en este tipo de fracturas, según nuestro estudio. Las niñas presentaron una menor corrección espontánea del componente rotacional

Aim. To determine if a degree of rotational remodelling is possible in supracondylar fractures in children and influential factors. Materials and methods. A review was made of a total of 62children who underwent surgery at our hospital from December1988 to January 1999 for supracondylar fracture of the humerus. Of them, 52 were included in the study. The mean follow-up time was 9.1 years (range 3-14 years). Regression analysis was used to study the evolution of the rotational deformity and its relation with different parameters: age, sex, type of fracture, treatment, immobilization and rehabilitation times, degree of mobility, carrying angle, and complications. Results. The rotational deformity decreased independently of the reduction achieved, and there was no significant relation between the rotational component in the immediate postoperative period and at the time of review, although the final rotation tended to be smaller when reduction of this component was greater (p = 0.093). Sex was significantly related with residual rotational deformity at the time of review in logistic regression analysis (p = 0.003).Conclusions. The reduction achieved is important in treatment, but there are probably other, less known factors that influence fracture remodelling. Our study showed that a certain degree of rotational remodeling can be expected in supracondylar fractures. Girls had less spontaneous correction of the rotational component

Anestesia espinal, un factor protector en la enfermedad tromboembólica. Estudio de cohortes retrospectivo de 484 artroplastias / Spinal anesthesia: a protective factor in thromboembolic disease. A retrospective study of 484 arthroplasties

OBJETIVOS. Valorar la relación entre la anestesia general y espinal con la enfermedad tromboembólica en el postoperatorio de cirugía ortopédica de pacientes tratados profilácticamente con heparinas de bajo peso molecular. PACIENTES Y MÉTODO. Se realizó un estudio de cohortes retrospectivo sobre 484 artroplastias, de las que 209 fueron prótesis totales de cadera, 111 prótesis parciales de cadera y 164 prótesis totales de rodilla. En 328 casos se realizó anestesia espinal (epidural o subaracnoidea) y en 156 anestesia general. Se consideró que existía enfermedad tromboembólica cuando el paciente presentaba sintomatología clínica compatible con la misma, confirmada mediante eco-Doppler y/o venografía para la trombosis venosa profunda, y mediante gammagrafía para el embolismo pulmonar. Se estudió la relación con la edad, peso, fracturas previas del miembro inferior, tromboembolismo previo, diabetes, hipertensión arterial, enfermedad cardíaca y medicación. RESULTADOS. Se observaron complicaciones tromboembólicas en 21 pacientes, en 12 de ellos tras cirugía con anestesia general y en nueve tras anestesia espinal, siendo significativamente menor la incidencia en esta última (p < 0,01) (odds ratio de 3,23 e IC del 95 por ciento). El análisis multivariante también demostró un aumento significativo de la enfermedad tromboembólica (p < 0,05) en los pacientes mayores de 70 años (odds ratio de 2,67 e IC del 95 por ciento).CONCLUSIONES. La anestesia espinal se comporta como un factor de protección frente a la enfermedad tromboembólica en la cirugía artroplástica. La edad avanzada es un factor de riesgo (AU)

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Treatment of osteoarthritis of the knee with valgus deformity by means of varus osteotomy.

Nineteen cases of osteoarthritis of the knee with valgus deformity in 17 patients were treated by femoral supracondylar varus osteotomy (17 cases) or by high tibial varus osteotomy (2 cases) over the last 15 years. Fixation was performed using a 95 degrees AO blade-plate in 13 of the femoral osteotomies and a straight plate in the other four. The mean follow-up time was 6.5 years. The valgus deformity was idiopathic in 14 cases, secondary to rheumatoid arthritis in 2 cases and to tibial valgus in one case. The Hospital for Special Surgery (HSS) score was used to evaluate the clinical results: nearly 75% were excellent or good. The causes related to poor results are analyzed regarding indication and surgical technique. It appears that varus osteotomy is an effective procedure for the treatment of osteoarthritis of the knee with valgus deformity, above all in order to alleviate pain, although the operation requires precision, and correct selection of patients is of prime importance.

Nuestra experiencia en el tratamiento de la epifisiolisis femoral proximal. Algunos aspectos controvertidos / Our experience in the treatment of slipped capital femoral epiphysis. Controversial points

Se presenta una revisión de 17 casos de epifisiolisis de cadera en 14 pacientes (tres de ellos con afectación bilateral). Se analizan los resultados obtenidos: a) en la fijación con agujas de Kirschner y con tornillos y b) en tres casos que fueron tratados con osteotomías arciformes tridimensionales. Se emplearon las escalas de valoración clínica de Heyman y Herndon y la radiológica de Boyer. Se analiza también la fijación de la cadera contralateral de manera profiláctica. Por otro lado se revisa la bibliografía referente a la presentación con carácter familiar, a raíz de tres casos acontecidos en nuestra casuística (AU)

[Alpha-1-antitrypsin in early infections after hip prosthesis surgery]. / L'alpha-1-antitrypsine dans les infections précoces après prothèse de hanche.

PURPOSE OF THE STUDY: The aim of this work was to determine whether erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and alpha-1-antitrypsin (A1AT) levels are correlated significantly with early postoperative infectious complications after hip prosthetic surgery. MATERIALS AND METHODS: This prospective study was conducted on 100 total hip replacements performed between 1994 and 1995. ESR, CRP and A1AT were obtained before surgery then at 1, 2 and 6 weeks after surgery. RESULTS: Seven bacteriologically proven cases of infection were reported. Infection was considered to be superficial if it did not extend deeper than the muscles fascia. There was a strong statistical correlation between A1AT level and infection for all postoperative times (p<0.0001). A1AT was highly sensitive (87.5 p. 100) and specific (85.8 p. 100) for infection compared with ESR (sensibility 70 p. 100 and specificity 65.9 p. 100) and CRP (sensitivity 63.6 p. 100 and specificity 80.1 p. 100). DISCUSSION AND CONCLUSION: In our hands, A1AT can be a most useful diagnostic tool for infection after prosthesis hip surgery. Although not totally specific, it is highly sensitive for infection compared with other tools such as ESR and CRP more frequently used. These findings suggest an avenue of research on the role of A1AT in infectious complications after prosthetic joint surgery.

[Screening of cancer of the prostate: study in a Spanish population]. / Screening del cáncer de próstata: estudio en una población española.

OBJECTIVES: A population of Spanish men aged over 49 years were screened for prostate cancer. The detection rate and the clinical features of the tumors found are analyzed. METHODS: The study comprised two phases: Phase I: Subjects were evaluated by digital rectal examination (DRE) and prostate-specific antigen (PSA) was determined. Phase II: Subjects with a positive DRE or PSA > 4 ng/ml were evaluated by transrectal US. If PSA was > 10 ng/ml or DRE or transrectal US were abnormal, a transrectal biopsy was performed; most of these were sextant. PSA density was used as a criterion for biopsy in subjects with PSA 4-10 ng/ml and normal DRE and transrectal US. From June, 1993 to August 1994, 1091 subjects have been evaluated. RESULTS: 1) The mean age was 59.32 years; 379 (34.7%) had low voiding symptoms. 2) 5.07% and 9.07% had abnormal DRE and PSA, respectively; 135 subjects (12.4%) with a questionable DRE and/or PSA were evaluated by transrectal US. 3) Of the 97 biopsies (8.8%) performed, prostate cancer was detected in only 11 (1%); 8.8 biopsies were required to detect one case of prostate cancer. 4) Clinically, 7 tumors (63.6%) were localized and 4 (36.3%) were in the advanced stages. CONCLUSIONS: 1) The participation rate was low (21%). 2) The PSA mean increased with age. Prostate volume was the factor that most influenced PSA changes. 3) PSA detected more tumors (10 cases; 90.9%) than DRE (8 cases; 72.7%). Approximately 27.27% of the lesions were detected by PSA and not by DRE, while 9.09% were detected by DRE alone. 4) The detection rate was low (1.008%); 0.91% for PSA, 0.73% for DRE and 51% (n = 135) for transrectal US. 5) We have detected more tumors in the clinically advanced stages (36.6%) than other series, perhaps because this is the first time this type of study has been performed in this population. In view of the foregoing results, we do not advocate performing these studies routinely. Perhaps in subsequent studies with a longer follow up, a higher detection rate can be achieved for localized tumors that are potentially curable.