Resección endoscópica la coalición calcaneonavicular / Endoscopic resection of the calcaneonavicular coalition

Las coaliciones tarsianas tienen una incidencia global en la población entre el 2 y el 5%. La coalición calcaneonavicular representa el 53% de ellas. El tratamiento inicial debe ser conservador, quedando relegada la cirugía al fracaso de éste. Como alternativa al tratamiento quirúrgico convencional se ha descrito la resección endoscópica, que supone una técnica con menor agresividad y más rápida recuperación funcional. MATERIAL Y MÉTODOS: Realizamos un estudio retrospectivo de todos los pacientes con coalición calcáneo-navicular intervenidos quirúrgicamente en nuestro hospital mediante resección endoscópica durante los años 2015 al 2018. Para la valoración de resultados se usó la escala AOFAS de pie y tobillo. RESULTADOS: Se revisaron siete pies durante un periodo mínimo de 12 meses. La escala AOFAS preoperatoria era de 42 y de 92 en la última revisión clínica. No hubo complicaciones mayores derivadas de la cirugía. Tuvimos un caso de disestesias en el dorso de pie que se resolvió al tercer mes de evolución y un paciente con tumefacción local que se solucionó con hielo y pie elevado. CONCLUSIONES: La resección endoscópica ofrece ciertas ventajas sobre la cirugía abierta convencional. Ofrece una visión óptima de las estructuras anatómicas y un buen control de la resección de la barra. Permite una rehabilitación precoz, la estancia hospitalaria disminuye, los efectos cosméticos se minimizan y la probabilidad de neuromas es prácticamente nula con un buen control de la técnica

Tarsal coalition has an incidence between 2-5% of the general population, and calcaneonavicular is the most frequent (53%). When conservative treatment fails, surgical resection must be indicated. Endoscopic resection is a less invasive technique and can be considered an alternative with better functional recovery. MATERIAL AND METHODS: We performed a retrospective study of the patients with calcaneonavicular coalition operated in our hospital between 2015 and 2018. We performed an endoscopic resection. We used AOFAS scale score for the results. RESULTS: We reviewed seven cases for a minimum of 12 months. AOFAS score improved from 42 before surgery to 92. There were no major complications from surgery. We had a patient with dysesthesias in the forefoot that improved at 3 months and a case of local swelling that solved with ice and rest. CONCLUSIONS: Endoscopic resection has advantages over open surgery. Offers a great vision and good control of the coalition resection, provides an early rehabilitation, decrease hospital stay, improves cosmetic results and the probability of neuroma is minimum with an adequate control of the technique

Endoscopic resection of the calcaneonavicular coalition. / Resección endoscópica la coalición calcaneonavicular.

Tarsal coalition has an incidence between 2-5% of the general population, and calcaneonavicular is the most frequent (53%). When conservative treatment fails, surgical resection must be indicated. Endoscopic resection is a less invasive technique and can be considered an alternative with better functional recovery. MATERIAL AND METHODS: We performed a retrospective study of the patients with calcaneonavicular coalition operated in our hospital between 2015 and 2018. We performed an endoscopic resection. We used AOFAS scale score for the results. RESULTS: We reviewed seven cases for a minimum of 12 months. AOFAS score improved from 42 before surgery to 92. There were no major complications from surgery. We had a patient with dysesthesias in the forefoot that improved at 3 months and a case of local swelling that solved with ice and rest. CONCLUSIONS: Endoscopic resection has advantages over open surgery. Offers a great vision and good control of the coalition resection, provides an early rehabilitation, decrease hospital stay, improves cosmetic results and the probability of neuroma is minimum with an adequate control of the technique.

Tuberculosis de tobillo. A propósito de un caso en la infancia / Ankle tuberculosis. A case in childhood

La tuberculosis osteoarticular del tobillo es una presentación infrecuente de la tuberculosis ósea (10% de los casos). La baja frecuencia de presentación y la clínica inespecífica hace que sea habitual el retraso en el diagnóstico y en el tratamiento. El estudio radiológico es normal en fases iniciales, y la analítica no muestra alteraciones características. La TAC y la RM son útiles en el diagnóstico. La quimioterapia es la base del tratamiento, y la cirugía puede ser necesaria para obtener el diagnóstico y como parte del tratamiento. Presentamos el caso una niña de 22 meses afecta de tuberculosis de tobillo. El diagnóstico se confirmó mediante biopsia sinovial. No hubo antecedentes de contacto personales ni familiares con enfermos de tuberculosis. No existía ningún factor de riesgo para la enfermedad. No tuvo foco pulmonar. El diagnóstico fue tardío (un año tras el inicio de la clínica). El tratamiento fue médico (tuberculostáticos) y precisó cirugía para evitar actitud en equino y un mayor deterioro articular. El resultado clínico y funcional fue bueno tras un seguimiento de 20 años (AU)

Articular tuberculosis of the ankle joint is a rare presentation of skeletal tuberculosis (10% of cases). This unusual location and the low index of clinical suspicion leads to delays in diagnosis and treatment. Radiographic and analytic studies are unspecific in the first stage. CAT and MRI are useful in diagnosis. Chemotherapy is the mainstay of treatment and surgery is often required to establish the diagnosis and in the treatment. We report a case of ankle tuberculosis in a 22 month-old child. The diagnosis was confirmed by synovial biopsy. There was no patient or family contact with tuberculosis patients. There was no risk factor. There was no lung disease. Diagnosis was made 1 year after onset of symptoms. The treatment was with chemotherapy and surgery was performed as preventive treatment of equinus deformity and osteoarthritis. Good clinical and functional outcome was achieved after 20 years of follow up (AU)

Ankle tuberculosis. A case in childhood. / Tuberculosis de tobillo. A propósito de un caso en la infancia.

Articular tuberculosis of the ankle joint is a rare presentation of skeletal tuberculosis (10% of cases). This unusual location and the low index of clinical suspicion leads to delays in diagnosis and treatment. Radiographic and analytic studies are unspecific in the first stage. CAT and MRI are useful in diagnosis. Chemotherapy is the mainstay of treatment and surgery is often required to establish the diagnosis and in the treatment. We report a case of ankle tuberculosis in a 22 month-old child. The diagnosis was confirmed by synovial biopsy. There was no patient or family contact with tuberculosis patients. There was no risk factor. There was no lung disease. Diagnosis was made 1 year after onset of symptoms. The treatment was with chemotherapy and surgery was performed as preventive treatment of equinus deformity and osteoarthritis. Good clinical and functional outcome was achieved after 20 years of follow up.

Consumo de tabaco y patología psiquiátrica / Smoking and psychiatric disorders

RESUMEN. Introducción. Existe una relación directa entre la dependencia tabáquica (prevalencia e intensidad) con la presencia de patología psiquiátrica. A menor prevalencia de consumo de tabaco en población general más evidente y relevante se hace esta asociación. Material y métodos. Se ha realizado una búsqueda bibliográfica en distintas bases científicas, consiguiendo un amplio número de artículos relacionados con el tema del tabaquismo y la patología psiquiátrica. Resultados. Existe una relación directa y ampliamente comprobada por distintos estudios entre el consumo de tabaco y diferentes patologías psiquiátricas. Las patologías en las que más ampliamente ha sido estudiada esta comorbilidad han sido los trastornos psicóticos, los trastornos afectivos y de ansiedad y el consumo de otras sustancias psicoactivas. En el tratamiento del tabaquismo de pacientes que padecen alguna de estas patologías es conveniente: intensificar y prolongar las intervenciones, poner en práctica técnicas psicoeducativas y cognitivo-conductuales y la utilización de algún tratamiento farmacológico que ayude a controlar y/o reducir la aparición de recaídas en el consumo de tabaco o en la sintomatología psiquiátrica de base. Una pregunta que queda en el aire es el momento en el que iniciar el tratamiento de cesación, aunque se cree que el mejor momento es cuando la patología psiquiátrica esté estabilizada Conclusiones. Conviene abordar el consumo de tabaco en los pacientes que padecen patologías psiquiátricas ya que es un grave riesgo de morbimortalidad que, además, disminuye notablemente su calidad de vida (AU)

ABSTRACT. Introduction. Relationships between tobacco consumption (and nicotine dependence) and the presence of different psychiatric pathologies have been described. The lower smoking prevalence in one population, the stronger this association is. Material and methods. A bibliographic search on different scientific sources has been performed on the association between smoking and psychiatric disorders. Results. A direct, strong and thoroughly examined association has been observed on this topic. Psychiatric disorders most strongly associated with tobacco consumption (especially cigarette consumption) are schizophrenia, mayor depression and bipolar disorder, anxiety disorders, and other chemical dependencies. Smoking treatment in these patients requires longer and more intense interventions, where psycho-educative and cognitive-behavioural techniques are performed and where useful pharmacological treatments for smoking cessation are applied. Additional, the evolution of the basal psychiatric disorder should be monitored during the quitting process. Although it has not been clearly established, quitting should be tried when patients are stable in their psychiatric condition. Conclusions. Smoking consumption should be taken into account in patients with psychiatric pathologies. It is responsible for a high risk of morbidity and mortality in these patients and it greatly decreases their life quality

[Predictors of behavioural disorders and consultation-liaison psychiatry in patients with HIV disorders]. / Predictores de trastornos de conducta e interconsulta psiquiátrica en hospitalizados por trastornos-VIH.

OBJECTIVE: The aim was to identify the features of patients admitted into an Infectious Disease Unit in a Hospital due to pathology related to HIV and/or addiction that originate the demand for consultation liaison psychiatry. METHOD: During the first six months of 1997, 232 admissions into the Infectious Disease Unit at Ramón y Cajal Hospital (191 patients) were systematically evaluated by the nursery staff. A specific questionnaire was designed for this interview. After having performed univariants analysis, a logistic regression was used to identify the most relevant variables in the claim for consultation liaison. RESULTS: The claim for consultation liaison was associated to: consume in the unit OR (yes/no)= 7.9, confusional syndrome OR (yes/no)= 5.6, social worker consultation liaison OR (yes/no)= 2.1. use of benzodiazepines OR (yes/no)= 2.4. No medical treatment respect to bad accomplishment OR= 3.6. Only taking into account the known features after the first examination: use of benzodiazepines OR (yes/no)= 2.1, use of cocaine OR (yes/no)= 1.8, recognized income (yes/no)= 2.2, no medical treatment due to bad accomplishment OR= 2.1. CONCLUSIONS: In our environment the demand for consultation liaison psychiatry is related to behavioural problems due to the use of substances and marginality. The variables which predict the demand and may be identified at the time of admission are: the use of benzodiazepines, cocaine, the lack of a recognized income and the absence of medical treatment for the HIV infection. Recognizing these features will allow us to identify patients who are going to have behavioural problems and demand psychiatric assistance.

A reinforced rigid fixation device for unstable intertrochanteric fractures.

A 120 degrees blade plate reinforced by a strut is introduced for the treatment of unstable intertrochanteric and proximal subtrochanteric fractures. Mechanical tests showed that the strength of this reinforced resistance device was 11,758 N. This strength is two and three times greater than that of the Gamma nail and sliding hip screw, respectively, and five times greater with the strut than without it. Three hundred fifty-eight patients older than 60 years of age were treated with this method between 1987 and 1991 (mean followup, 16 months). Six months after surgery the fracture had united in 82% of the patients who were walking without aid or using only a cane. Weightbearing began when the patient's general overall condition allowed such activity (average, 5 days; mode, 3 days). A chi squared test showed no difference regarding the results between stable and unstable fractures. Intraoperative and postoperative complication rates were 3% and 7.1%, respectively. The failure of fixation rate was 5.4%. Mechanical tests and clinical results showed that immediate weightbearing can be allowed in all types of intertrochanteric fractures. This reinforced device is effective in treating unstable intertrochanteric fractures and is especially indicated for the most unstable types (Evans' Grades 4 and 5).

[Cerebrovascular disease in young adults. A study of its course in 167 patients]. / Enfermedad vascular cerebral en el adulto joven. Estudio evolutivo en 167 pacientes.

INTRODUCTION: Few studies have been made of the prognosis of ictus in the young adult. The objective of this paper is to study the short term evolution of 167 patients, aged between 15 and 45 years, with cerebral vascular disease. MATERIAL AND METHODS: Since 1986 a protocolized study has been made of all patients aged between 15 and 45 who were admitted to the Neurology Department of the Hospital General Universitario in Valencia for a cerebral vascular incident. The results obtained up to 1993 have been recorded in a data base. In this paper the demographic data and information as to intrahospital evolution have been used with the Canadian, modified Rankin and Barthel Scales in the various ictus groups. RESULTS: 28.7% of the patients were AIT and 71.3% were diagnosed as established ictus, of whom 38.8% were haemorrhagic and 61.2% were ischaemic. 29.8% of the HIP, 33.3% of the embolic infarcts and 18.2% of the atherothrombotic infarcts were severely disabled on discharge from hospital. Mortality was 4.2% when AIT were excluded. DISCUSSION: Most studies are basically aetiopathological and much fewer include evaluation of prognosis. In our series, the patients had a satisfactory clinical course and low short-term mortality. As in the other series, the two groups with the worst prognosis were the HIP and the cardioembolic infarcts. Patients with HSA and HIV made outstandingly good progress.

Influencia de la prótesis parcial removible en la incidencia de caries de las piezas dentarias naturales remanentes / Influence of partial removable dentures in increase of caries of remanent natural tooth

Se estudió en un grupo de 102 pacientes portadores de prótesis parciales removibles los efectos producidos por éstas en el aumento de la incidencia de caries, después de 4 a 5 años de uso. Encontrándose un aumento de lesiones en las piezas pilares directas en relación al resto de las piezas que presentaban un índice de placa similar, se plantea hipótesis al respecto

Tendencia a la mortalidad por cáncer bucofaringeo en Chile sexenio 1980-1985 / Mortality trends by oral and pharyngeal cancer in Chile: 1980-1985

Se trata de un estudio de prevalencia del universo de las defunciones por cáncer bucofaríngeo durante el sexenio 1980-1985, para determinar la tendencia de esta patología en el país. Para este propósito se revisaron todos los certificados de defunción del país separando los diagnósticos de cáncer bucofaríngeo (140-149 de la CIE). Los resultados confirmaron la hipótesis, observando un aumento del riesgo del 10,6%. La tasa más alta se observa en el hombre. Por edad, el 90% de las defunciones se produce en el mayor de 45 años. La localización más frecuente es la de lengua

El implante subperióstico en la rehabilitación del paciente desdentado parcial de extremo libre uni o bilateral (comunicación preliminar / Subperiosteal implant in partial edentate patients with uni or bilateral free end (preliminary communication)

Se utiliza el implante subperióstico circunferencial en pacientes desdentados parciales de extremo libre uni o bilateral, para proporcionar un pilar distal a cada extremo libre. La obtención de la impresión ósea se realiza mediante una impresión compuesta utilizando cubeta quirúrgica. El diseño del implante es conservador en cuanto a la ubicación de los conectores mayores, limitándolos sólo a las zonas de soporte, lo que hace menos agresivas las intervenciones quirúrgicas. Se modifica la extensión del conector mayor lingual, suprimiéndolo de la zona anterior (en relación a las piezas remanentes). Se elimina también el cuello del pilar del implante quedando cilíndrico en toda su extensión, y se modifica su extremo terminal con un escalón que sierve de guía de inserción y limita la intrusión de la prótesis. No se utilizan dispositivos de retención primaria. El paciente es luego rehabilitado mediante prótesis removible implantada, a la que se le da oclusión orgánica