Análisis de tratamiento de la otitis media crónica simple con miringoplastía en el Hospital Barros Luco Trudeau

Resumen Introducción: La otitis media crónica simple (OMC) es una patología común en nuestra población y hasta la fecha no queda bien claro cuál técnica y material de injerto da mejores resultados. Objetivo: Determinar si existen diferencias en los resultados anatómicos y funcionales al utilizar fascia de músculo temporal (FMT) versus injerto de cartílago de trago (CT) en los pacientes con OMC en que se les realizó miringoplastía en el Hospital Barros Luco Trudeau. Material y Método: Estudio de cohorte no concurrente de datos obtenidos de la revisión de fichas clínicas. Resultados: De 227 fichas, 154 cumplieron criterios de inclusión. En 102 pacientes (66%) se utilizó FMT y en 52 pacientes (34%) CT. Con FMT 38 presentaron reperforación (37%) y 41 presentaron un éxito funcional (40%). Con CT 18 presentaron reperforación (35%) y 22 presentaron un éxito funcional (42%). 38 pacientes presentaban antecedente de tabaquismo activo y de ellos 53% presentaron reperforación, mientras que de los sin antecedentes de tabaquismo solo un 31%, siendo esta diferencia estadísticamente significativa (p < 0,05). Conclusión: No se obtuvieron diferencias estadísticamente significativas entre los resultados anatómicos y funcionales comparando el uso de injerto FMT y CT para el tratamiento quirúrgico de la OMC simple con miringoplastía.

Abstract Introduction: Simple chronic otitis media (COM) is a common pathology in our population, and it is currently unclear, which grafts technique and material gives the best results. Aim: To determine if there are differences in the anatomical and functional results, when using temporal muscle fascia (FMT) or tragus cartilage graft (CT) in patients with COM who underwent myringoplasty at the Barros Luco Trudeau Hospital. Material and Method: Retrospective analytical cohort study of data obtained from clinical records. Results: Of 227 medical records, 154 met inclusion criteria. FMT was used in 102 patients (66%) and CT in 52 patients (34%). With FMT, 38 had reperforation (37%) and 41 had functional success (40%). With CT 18 had reperforation (35%) and 22 had functional success (42%). 38 patients had a history of active smoking and 53% of them presented reperforation, while of those without a history of smoking only 31%, this difference being statistically significant (p < 0,05). Conclusion: No statistically significant differences were obtained when analyzing the anatomical and functional results comparing the use of FMT and CT graft, for the simple surgical treatment of COM with myringoplasty.

Short-term UV-B exposure induces metabolic and anatomical changes in peel of harvested lemons contributing in fruit protection against green mold.

UV-B radiation (UVBR) is a small fraction of the solar spectrum from 280 to 315nm. UVBR produces photomorphogenic acclimation responses in plants, modulating their cellular structure and physiology. Here, changes in the peel of harvested lemons after short time exposure to UVBR were analyzed and its potential effects against fungal infection were studied. In the flavedo, UVBR treatment induced variations in the respiratory profiles and increased the phenolic compound contents. Final products of the flavonoid pathway (flavones, flavonols and anthocyanins) increased more markedly than their precursors (flavanones and dihydroflavonols). The increased accumulation of soluble phenolics in the flavedo of treated lemons is associated with the high antioxidant activity found in the flavedo of these samples. Supporting the biochemical determinations, anatomical observations showed abundant intravacuolar deposits of phenolic compounds and an increase in the cell wall thickness in UVBR-treated samples. Metabolic and anatomical modifications associated to UVBR improved natural defenses against Penicillium digitatum, the causal agent of green mold disease. Our results suggest that mature postharvest lemons exposed to the artificial radiation showed phenotypic plasticity, allowing an acclimation response to UVBR which confers fruit resistance to pathogens. Thus, combination of UVBR with other treatments could represent an important improvement to control postharvest diseases on citrus.

Doppler ultrasound signal in Achilles tendinopathy reduces immediately after activity.

BACKGROUND: A relationship has been identified between vascularization on Doppler ultrasound (Doppler signal) and Achilles tendon pain. Doppler signal may increase minutes after prolonged activity, but the immediate effect is unknown. The aim of the study was to investigate the immediate effect of short term activity on Achilles tendon Doppler signal. Achilles tendinopathy patients (7 patients, 10 tendons) and asymptomatic controls (6 controls, 12 tendons) performed 2 activity tasks; a 2 minute continuous step task and one minute continuous calf raise task. Doppler signal was measured at rest and within a minute after each activity. The presence of Doppler signal was quantified using both semi quantitative (modified Ohberg scale; 0=no signal, 5 = > 90% of pathological area contains Doppler signal) and quantitative methods (pixel number). Doppler signal was present in 90% of symptomatic individuals and in none of the asymptomatic controls. The modified Ohberg scale and pixel number reduced significantly after both activity tasks and heart rate increased significantly (p < 0.05). Doppler signal in Achilles tendinopathy may decrease immediately after activities that load the calf muscle and increase heart rate, suggesting that this activity should be avoided prior to imaging to avoid false negative results.

Osteotomía valguizante tibial en pacientes jóvenes con genu varo y cambios degenerativos incipientes / Valgus tibial osteotomy in young patients with genu varus and incipient degenerative changes

Objetivos: demostrar la relación de la posición de la placa de apertura con la corrección del varo y la pendiente, en ostetomías tibiales. Material y metodología: estudio retrospectivo, con dos grupos de pacientes, A: 29 pacientes (26 hombres y 3 mujeres ) con gonartrosis medial y genu varo, tratados con osteotomías de cierre. Edad media 53 años. B: 29 pacientes (25 hombres y 4 mujeres) con osteotomías de apertura. Edad media 42 años. Las osteotomías de cierre se fijaron con grapas y las de apertura con placas. Se midieron el eje anatómico, el ángulo de corrección y la pendiente del platillo tibial, previos a la cirugía y a la 10ª semana. En el grupo B, se analizó la posición de la placa en el plano lateral. Resultados: La corrección del eje anatómico fue de 4,7º en las osteotomías de cierre y 7º en las de apertura. El eje fémoro-tibial aumentó con las placas de mayor tamaño (p≤0,02). En las osteotomías de cierre disminuyó la pendiente tibial (0,32º) y en las de apertura aumentó (5,68º). Las placas situadas por delante aumentaron la pendiente tibial (p≤0,004). Conclusión: en la osteotomía tibial de apertura, conviene situar la placa lo más posterior posible, para evitar la traslación anterior de la tibia, aumentar la tensión sobre el LCA y conseguir mayor corrección del valgo (AU)

Objetives: To demonstrate the relationship between the position of the opening plate with respect to varus and slope correction in tibial osteotomies. Material and methods: A retrospective study was made involving two groups of patients, A: 29 patients (26 males and 3 females) with medial gonarthrosis and genu varus, subjected to closing osteotomies. The mean age was 53 years; B: 29 patients (25 males and 4 females) with opening osteotomies. The mean age was 42 years. The closing and opening osteotomies were fixed with staples and plates, respectively. Measurement was made of the anatomical axis, the correction angle and slope of the tibial plate before surgery and in week 10. In group B the position of the plate in the lateral plane was analyzed. Results: Correction of the anatomical axis was 4.7º and 7º in the closing and opening osteotomies, respectively. The femoral-tibial axis increased with the larger plates (p≤0.02). The tibial slope decreased (0.32º) and increased (5.68º) in the closing and opening osteotomies, respectively. The plates positioned anteriorly increased the tibial slope (p≤0.004). Conclusion: In opening tibial osteotomy it is advisable to position the plate as anterior as possible, in order to avoid posterior displacement of the tibia, increase tension upon the anterior cruciate ligament, and secure increased valgus correction (AU)

Reducción indirecta y fijación percutánea en fracturas del radio distal / Indirect reduction and percutaneous pinning as treatment of distal radius fractures

Introducción y objetivos: Las fracturas intraarticulares del radio distal se asocian a traumatismos de alta energía y se caracterizan por su complejidad y la dificultad de obtener una reducción estable, que precisa tratamiento quirúrgico. El objetivo del trabajo es presentar los resultados clínicos, radiológicos y laborales del tratamiento mediante reducción indirecta, fijación percutánea e inmovilización con yeso para este tipo de fracturas. Material y métodos: Se realiza un estudio prospectivo de 24 pacientes con fracturas intraarticulares desplazadas de la extremidad distal del radio tratados entre los años 2003 y 2005, con un seguimiento mínimo de 1 año. La edad media era 40 años (22-65 años) y todos tenian trabajos de alta demanda funcional. En el 40% se afectó la muñeca dominante. Se trataron mediante reducción indirecta con fijación percutánea con agujas de Kirschner en forma de triangulo de fuerzas y se inmovilización con yeso por 4 semanas, seguido de tratamiento rehabilitador. Se valora el dolor (escala analógico visual), rango de movilidad, parámetros radiológicos, fuerza (test isocinéticos), funcionalidad (escala DASH) y resultados laborales a los 3, 6 y 12 meses. Resultados: Se obtuvo la consolidación completa en todos los casos a las 7 semanas. 2 pacientes precisaron una reintervención. A los 12 meses los pacientes presentaron una escala analógico visual del dolor (0-10) de 2,9, 11º de pérdida de flexo-extensión con respecto a la muñeca contralateral y el 35% presentaban resultados radiológicos no aceptables. La puntuación obtenida en el cuestionario DASH fue de 29 puntos y presentaban un 23% de pérdida de fuerza isométrica. Todos volvieron a trabajar con el mismo nivel de actividad a las 14 semanas de media. Conclusiones: El tratamiento quirúrgico de las fracturas intraarticulares del radio distal mediante reducción indirecta y fijación percutánea ofrece unos excelentes resultados clínicos, radiológicos y laborales comparables a otras técnicas quirúrgicas

Introduction and objectives: Intraarticular fractures of distal radius are associated with high energy mechanisms, are severe and difficult to obtain a surgical reduction. The aim of this study is to compare the clinical, radiographically and activity results in workers treated with indirect reduction and percutaneous pinning. Material and methods: A prospective study was organized in 24 heavy-labour workers with unstable fractures of distal radius. The minimal follow-up was of one year. The mean age were 40 years (22-65 years) and dominant limb was involved in 40% of the cases. All patients were surgically treated with indirect reduction and percutaneous fixation with K-wires and cast immobilization. Pain (visual analogue score), mobility and radiograhs were evaluated and also strength (isokinetics), functionality (DASH score) and, finally, the return to work at 3, 6 and 12 months. Results: Fracture healing was obtained at 7 weeks but. Pain score, at 12 months, were 2,9 points. The flexion - extension mobility loss, in relation to the contralateral wrist, was 11º. Radiographs corrections were non-anatomically in 35% of the cases. The mean DASH score was 29 and the loss of grip strength related to contralateral wrist was 23%. All the patients return to the same work activity 14 weeks after surgery. Conclusions: Indirect reduction with percutáneous pinning with triangle fixation frame, allows excellents clinical, X-ray and laboral results, comparable with another surgical techniques

¿El siglo XXI nos exige una nueva forma de comunicación con el paciente? / No disponible

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Serum pepsinogen before and after proximal gastric vagotomy in duodenal ulcer treatment.

Serum pepsinogen (SP) behavior was evaluated under basal conditions and under betazole stimulation in 59 patients: 14 controls, nine unoperated duodenal ulcers (DU) and 36 DU after proximal gastric vagotomy (PGV), 14 with and 22 without recurrent ulcer. The mean follow-up of the 36 patients who underwent PGV was 38.7 months. SP was higher in unoperated DU than in the control group (p less than 0.05). After PGV in DU, there is a significant decrease of SP for both the patients with and without recurrent ulcer (p less than 0.05), being statistically similar to the control group. No difference of SP was observed between DU with and without recurrent ulcer after PGV. We concluded that SP can differentiate normal subjects from DU patients, although it is not a sensitive indicator of recurrent ulcer after PGV.

Epidemiological aspects of acute viral hepatitis in Säo Paulo, Brazil

A necessidade de maior número de dados sobre prevalência das hepatites por vírus em nosso meio levou-nos a estudar a freqüência das hepatites por vírus na Unidade de Fígado de Säo Paulo. Foram estudados 154 pacientes atendidos consecutivamente de novembro de 1980 a novembro de 1984. O emprego de marcadores para hepatite A (anti-VHA-IgM), hepatite B (AgHBs, anti-HBc e anti HBs) e a ausência dos mesmos para hepatite näo-A, näo-B (NANB), permitiu verificar a freqüência das mesmas que foi respectivamente, de 52,6%, 27,3% e 20,1%. A hepatite A caracterizou-se pela maior freqüência em jovens, contacto prévio com doente ou ingestäo de alimento suspeito. Na hepatite B os dados epidemiológicos preponderantes foram transmissäo parenteral näo-transfusional, contacto prévio e alta incidência em profissionais de saúde. Na hepatite NANB predominaram os casos pós-transfusionais (34,5%). Ausência de antecedentes epidemiológicos foi observada em 30-40% dos pacientes dos três grupos

[Psychological aspects of rheumatoid arthritis. Attempt at a better understanding of the problem]. / Aspects psychologiques de l'arthrite rhumatoïde. Essai pour une meilleure compréhension du problème.

This study is an attempt to identify the principle causes of stress in patients affected with rheumatoid arthritis. It is based on personal experience with 62 patients treated in a multidisciplinary manner over a time period of two years. The psychological impact of these stress factors on the patients were evaluated in an effort to further the treatment methodologies in this area. Among the factors considered are: the disease as a chronic process and as a result the progressive destruction of bodily function, the limitations produced by a disease of the joints, the presence of pain and the side effects produced by the medications. As a step to lessen the mental distress caused by RA, it is proposed that the physician team should seek to inform the patient in a clear and concise manner about RA to establish a working doctor-patient line of communication, and to encourage activities that promote the maintenance of patient self esteem.