Use of semi-constrained total knee arthroplasty in gonarthrosis with collateral ligament insufficiency: Clinical and functional outcomes.

INTRODUCTION: Achieving stability in total knee arthroplasty (TKA) is crucial for long-term implant survival. In cases of severe deformity or ligament laxity, constrained implants may be required. Traditionally, increasing constraint involved intramedullary stems. However, there are intermediary alternatives, including employing a constrained polyethylene insert without stems, thereby avoiding complications related to them. The study aims to evaluate our experience with a non-modular constrained (NMC) implant in primary TKA. MATERIAL AND METHODS: We conducted a retrospective review of the clinical and radiographic outcomes of 108 non-stemmed primary TKAs performed at our institution between 2013 and 2021 in patients with at least 10° deformity or 10mm ligament laxity. Data included demographics, preoperative and postoperative deformities, clinical outcomes and revision rates. RESULTS: A total of 103 patients (108 knees) with a mean age of 74 were followed up for a minimum of 2 years. The mean postoperative range of motion was 105°/0°. The median Oxford Knee Score, Knee Society Score and Knee Society Function Score were 43.5, 92 and 90, respectively. 17 knees had varus deformity (mean tibiofemoral angle of 2.7°), and 87 knees had excessive valgus deformity (mean tibiofemoral angle of 15.1°). The remaining 4 knees had a neutral alignment. The mean postoperative tibiofemoral angle was 6.8°. The overall revision rate was 6.5% (7 patients): 3 deep periprosthetic infections, 2 patellar dislocations, 1 stiffness and 1 aseptic loosening. CONCLUSION: Our experience demonstrates favorable mid-term outcomes with the NMC implant, providing a safe alternative to stemmed implants in primary TKA, particularly in cases of severe deformity or ligament laxity.

IMPLEMENTACIÓN DE LA SIMULACIÓN IN SITU EN UN HOSPITAL PEDIÁTRICO DE ALTA COMPLEJIDAD DURANTE LA PANDEMIA COVID-19 / IMPLEMENTATION OF THE IN-SITU SIMULATION IN A HOSPITAL DISCHARGE PEDIATRIC COMPLEXITY DURING THE COVID-19 PANDEMIC

Introducción: El aprendizaje basado en simulación se ha usado ampliamente para mejorar la respuesta de los integrantes del equipo de salud ante situaciones de crisis. La pandemia por COVID-19 planteó el desafío de utilizar la simulación in situ como estrategia de capacitación. Objetivo: Describir el impacto del entrenamiento en RCP en pacientes COVID-19 mediante simulación in situ según la autopercepción del equipo de salud participante y comparar los resultados entre aquellos que hicieron un taller previo de manejo de vía aérea y RCP en pacientes con SARS-CoV -2 y los que no lo realizaron. Material y Método: Estudio exploratorio-descriptivo, desde marzo a junio de 2020, por medio de un cuestionario anónimo estandarizado a los participantes luego de 30 escenarios de simulación in situ. Las variables cualitativas se registraron con valores del 0 al 5 donde 1: nada; 2: bajo; 3: medio; 4: alto y 5:máximo. Resultados: De los 55 participantes, el 38 % (n=21) habían realizado previamente un taller de manejo de vía aérea avanzada y RCP en paciente COVID-19. El 40,7% expresó que disminuyó el temor a la asistencia de un paciente sospechoso o positivo en un nivel máximo (31,5% nivel alto) 81,5 % manifestó que le sirvió en grado máximo para reconocer la importancia del trabajo en equipo y designación de roles (13% grado alto). Para el 65% tuvo una utilidad máxima (18,5% alta) en adecuación del carro de paro y elaboración de un kit específico. Se halló diferencia significativa en la disminución del temor a la asistencia al comparar el nivel de respuesta entre los que habían realizado un taller previo versus los que no ( p= 0,013) Conclusión: La simulación in situ resultó ser una herramienta útil que ayudó en gran medida a disminuir el temor, mejorar habilidades comunicacionales y el trabajo en equipo Los resultados obtenidos fueron aún mejores cuando el escenario fue complementado con un taller de manejo de vía aérea avanzada y RCP

Introduction: Simulation-based learning has been widely used to improve the response of health team members to crisis situations. The COVID-19 pandemic posed the challenge of using on-site simulation as a training strategy.Objective: Analyze the impact of CPR training in COVID-19 patients in situ simulation according to the self-perception of the health team and compare the results between those who did a previous workshop and those who did not. Material and Method: Exploratory-descriptive study, from March to June 2020, through a standardized anonymous questionnaire to the participants after 30 simulation scenarios in situ. The qualitative variables were registered with values from 0 to 5 where 1: nothing; 2: low; 3: medium; 4: high and 5: maximum. Results: Of the 55 participants, 21 (38%) have previously conducted a workshop on advanced airway management and CPR in a CO- VID-19 patient. 40,7% expressed that the fear of attending a suspicious or positive patient decreased at a maximum level (31,5% high level). 81,5% stated that it served them to a maximum degree to recognize the importance of teamwork and role designation (13% high degree). For 65% it had a maximum utility (18.5% high) in adapting the stop car and making a specific kit. When we compared the subgroup that carried out the previous workshop with the one that did not, differences were found in most of the variables, highlighting the decrease in fear. Conclusion: The in situ simulation turned out to be a useful tool that greatly helped reduce fear and improve communication skills and teamwork. The results were obtained even better when the scenario was complemented with an advanced airway management and CPR workshop

Use of biological treatments in patients with hidradenitis suppurativa.

INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic skin disease which causes a great impact in the quality of life. Multiple therapeutic options have been proposed, and recently the potential use of biological drugs in severe cases has been postulated. MATERIAL AND METHODS: A retrospective study from seven tertiary Spanish centers reviewing the charts of patients with HS treated with biological drugs was performed. Retrieved information included epidemiological data, clinical features, pain intensity, Hurley stage, laboratory data and therapeutic outcomes. RESULTS: Nineteen patients were included in the study; 10 men (52.6%) and 9 women. Eight patients (42%) showed a Hurley severity stage II and 11 a stage III (57.8%). Adalimumab was prescribed as the first biological treatment in nine out of 19 cases (47.3%), whereas infliximab was prescribed in seven cases (36.8%), ustekinumab in two cases (10.5%) and etanercept in one (5.2%). A complete response was observed in three patients (two cases with infliximab and one case with ustekinumab), a partial improvement in 10 patients and in six patients no clinical improvement was noted. One patient referred worsening of the skin symptoms. In 6 cases, a second biological treatment was prescribed. In three of such cases, a partial improvement was noted, whereas in three cases no clinical improvement was observed. In two cases a switch to a third biological drug was indicated, with a partial improvement in one case. DISCUSSION AND CONCLUSIONS: Biological drugs could be a potential and effective therapeutic option for patients with severe HS. Complete and persistent clinical responses are rarely obtained (15%) and partial responses are achieved in approximately 50% of patients. No specific markers for a therapeutic response have been identified. No definitive conclusions regarding the most effective biological drug for HS could be drawn. Higher dosage schedules seem to be associated with higher response rates. The lack of response of one particular drug does not preclude a potential efficacy to another biological treatment.

Evaluation of the antibacterial activity of Piperaceae extracts and nisin on Alicyclobacillus acidoterrestris.

Alicyclobacillus acidoterrestris is a gram-positive aerobic bacterium. This bacterium resists pasteurization temperatures and low pH and is usually involved in the spoilage of juices and acidic drinks. The objective of this study was to evaluate the antibacterial activities of nisin and the species Piper (Piperaceae) on A. acidoterrestris. The minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC) were determined by the broth microdilution method. The species Piper aduncum had the lowest MIC and an MBC of 15.6 µg/mL and was selected for fractionation. Six fractions were obtained, and the dichloromethane fraction (F.3) had the lowest MIC/MBC (7.81 µg/mL). The dichloromethane fraction was again fractionized, and a spectral analysis revealed that the compound was prenylated chromene (F.3.7). The checkerboard method demonstrated that the crude extract (CE) of P. aduncum plus nisin had a synergistic interaction (fractional inhibitory concentration [FIC] = 0.24). The bactericidal activity of (F.3.7) was confirmed by the time-kill curve. P. aduncum, nisin, and prenylated chromene exhibited strong antibacterial activity against the spores and vegetative cells of A. acidoterrestris. The results of this study suggest that extracts of the genus Piper may provide an alternative to the use of thermal processing for controlling A. spoilage.

Arthrodesis in septic knees using a long intramedullary nail: 17 consecutive cases.

BACKGROUND: Intramedullary nailing using long or modular nails is the most reliable mean of achieving femorotibial fusion. Here, we report the operative, clinical, functional, and radiological outcomes of 17 long intramedullary nail arthodeses in patients with infection. HYPOTHESIS: Clinical and functional outcomes after long intramedullary nailing are at least as good as those obtained using other implants. MATERIALS AND METHODS: We retrospectively reevaluated 17 patients after unilateral two-stage knee arthrodesis with a long titanium intramedullary nail and autologous bone grafting. We evaluated satisfaction, leg length discrepancy, and function (Lequesne and WOMAC indices). Radiographs were obtained to assess fusion, time to fusion, and femorotibial angles. RESULTS: No cases of material failure were recorded. One or more complications occurred in seven patients. Mean limb shortening was 27.6mm. Of the 17 patients, 15 were satisfied with the procedure. The mean Lequesne index was 10.5/24 and the mean overall WOMAC score was 26/88. Fusion was achieved in 16 patients, with a mean time to fusion of 5 months. Mean femorotibial angles were 178.6° of varus and 1.9° of flexion. DISCUSSION: This simple and rapid surgical technique provides functional outcomes similar to those obtained using modular nails. The fusion rate is high. Nail extraction is simple and causes minimal damage, in contrast to modular nails. Increased attention to misalignment is needed. LEVEL OF EVIDENCE: Level IV, retrospective study.

[Extrapulmonary and extraspinal presentation of osteoarticular tuberculosis]. / Tuberculosis osteoarticular de presentación extrapulmonar y extraespinal.

BACKGROUND: How to overcome the difficulty in diagnosing extrapulmonary and extraspinal osteoarticular tuberculosis? What is the most appropriate way to manage the patient? MATERIAL AND METHODS: Retrospective series of four cases of extrapulmonary and extraspinal osteoarticular tuberculosis (two patients with knee involvement, one patient with involvement of the carpus, and a fourth patient who presented with tenosynovitis of the anterior tibial tendon of the ankle). The time elapsed from the onset of the clinical picture to the diagnosis ranged between 7 months and 2 years. The definitive diagnosis resulted from the presence of caseating granulomas in the biopsy (3 cases), and the isolation of the bacillus in culture (3 cases) or with staining (one case). Only in one case was there lung involvement after the extrapulmonary presentation. One patient had spinal involvement in the form of epidural abscess months after the extraspinal presentation. All patients received chemotherapy. Surgery was performed in 3 of the 4 cases. The Martini assessment was used to evaluate the functional outcome. RESULTS: In all patients the lesion was cured, with two excellent and two poor functional outcomes. CONCLUSIONS: A high clinical suspicion index is needed to prevent a delayed diagnosis. Chemotherapy is the cornerstone of treatment. Surgery is indicated mainly as a diagnostic procedure, but partial resection of the lesion may be performed at the same time.

The effect of successful kidney transplantation on ventricular dysfunction and pulmonary hypertension.

BACKGROUND: Heart disease is a frequent complication of chronic kidney disease and the major cause of death in patients on renal replacement therapy. The purpose of this study was to evaluate the impact of successful kidney transplantation on systolic and diastolic ventricular dysfunction and pulmonary arterial hypertension in patients with chronic kidney disease (CKD). METHODS: The study included 35 patients >18 years of age with CKD who had successful kidney transplantations. Ventricular function and pulmonary arterial pressure were evaluated by echocardiography before and 1 year after transplant. RESULTS: The mean age of subjects was 40 ± 14 years, and 63% were men. Mean left ventricular ejection fraction (LVEF) was 52 ± 16%. Before transplant, 28 (80%) of the patients had ventricular dysfunction (34.3% diastolic and 45.7% systolic). Pulmonary arterial hypertension was found in 48.6%. Ventricular dysfunction was associated with dialysis of >2 years duration before transplant. The LVEF of the entire group increased from 52% to 64% (P < .001) by 12 months after kidney transplant. Left ventricular diameters, wall thickness, and pulmonary arterial systolic pressure decreased significantly after transplantation Echocardiograms became normal 1 year after transplant in 8 (66.7%) of the patients with diastolic dysfunction and 9 (56.2%) with systolic dysfunction, and diastolic dysfunction persisted in 5 (31.2%). CONCLUSIONS: Because kidney transplantation led to considerable improvement in left ventricular systolic and diastolic function as well as pulmonary arterial pressure of patients with CKD, optimal treatment for dysfunction and transplant as soon as possible is recommended.

Pitiriasis rubra pilaris aguda postinfecciosa: una dermatosis mediada por superantígenos / Acute Postinfectious Pityriasis Rubra Pilaris: A Superantigen-Mediated Dermatosis

La pitiriasis rubra pilaris (PRP) aguda post infecciosa es una variante de la forma juvenil de PRP (tipo III de Griffiths) caracterizada por la ausencia de antecedentes familiares, curso agudo relacionado con un episodio febril previo y buen pronóstico. Clínicamente puede simular otras enfermedades mediadas por superantígenos, como los exantemas escarlatiniformes o el síndrome de la escaldadura estafilocócica; sin embargo, su histología y tratamiento son distintos. Presentamos 4 casos de PRP aguda post infecciosa que ilustran las características clínicas de este proceso infrecuente y revisamos los posibles mecanismos fisiopatogénicos subyacentes (AU)

Acute postinfectious pityriasis rubra pilaris (PRP) is a variant of juvenile PRP (Griffiths type III) characterized by no family history, an acute course associated with a prior fever, and good prognosis. Clinical features may resemble other superantigen-mediated diseases, such as scarlatiniform rash or staphylococcal scalded skin syndrome, but its histology and treatment are different. We present 4 cases of acute postinfectious PRP that illustrate the clinical features of this uncommon disease and we review possible underlying pathogenic mechanisms (AU)

[Acute postinfectious pityriasis rubra pilaris: a superantigen-mediated dermatosis]. / Pitiriasis rubra pilaris aguda postinfecciosa: una dermatosis mediada por superantígenos.

Acute postinfectious pityriasis rubra pilaris (PRP) is a variant of juvenile PRP (Griffiths type III) characterized by no family history, an acute course associated with a prior fever, and good prognosis. Clinical features may resemble other superantigen-mediated diseases, such as scarlatiniform rash or staphylococcal scalded skin syndrome, but its histology and treatment are different. We present 4 cases of acute postinfectious PRP that illustrate the clinical features of this uncommon disease and we review possible underlying pathogenic mechanisms.

Comprehensive lung injury pathology induced by mTOR inhibitors

Interstitial lung disease is a rare side effect of temsirolimus treatment in renal cancer patients. Pulmonary fibrosis is characterised by the accumulation of extracellular matrix collagen, fibroblast proliferation and migration, and loss of alveolar gas exchange units. Previous studies of pulmonary fibrosis have mainly focused on the fibroproliferative process in the lungs. However, the molecular mechanism by which sirolimus promotes lung fibrosis remains elusive. Here, we propose an overall cascade hypothesis of interstitial lung diseases that represents a common, partly underlying synergism among them as well as the lung pathogenesis side effects of mammalian target of rapamycin inhibitors (AU)

Notch signalling in cancer stem cells.

A new theory about the development of solid tumours is emerging from the idea that solid tumours, like normal adult tissues, contain stem cells (called cancer stem cells) and arise from them. Genetic mutations encoding for proteins involved in critical signalling pathways for stem cells such as BMP, Notch, Hedgehog and Wnt would allow stem cells to undergo uncontrolled proliferation and form tumours. Taking into account that cancer stem cells (CSCs) would represent the real driving force behind tumour growth and that they may be drug resistant, new agents that target the above signalling pathways could be more effective than current anti-solid tumour therapies. In the present paper we will review the molecular basis of the Notch signalling pathway. Additionally, we will pay attention to their role in adult stem cell self-renewal, and cell fate specification and differentiation, and we will also review evidence that supports their implication in cancer.

Notch signalling in cancer stem cells

A new theory about the development of solid tumours is emerging from the idea that solid tumours, like normal adult tissues, contain stem cells (called cancer stem cells) and arise from them. Genetic mutations encoding for proteins involved in critical signalling pathways for stem cells such as BMP, Notch, Hedgehog and Wnt would allow stem cells to undergo uncontrolled proliferation and form tumours. Taking into account that cancer stem cells (CSCs) would represent the real driving force behind tumour growth and that they may be drug resistant, new agents that target the above signalling pathways could be more effective than current anti-solid tumour therapies. In the present paper we will review the molecular basis of the Notch signalling pathway. Additionally, we will pay attention to their role in adult stem cell self-renewal, and cell fate specification and differentiation, and we will also review evidence that supports their implication in cancer (AU)

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Postoperative pyoderma gangrenosum: diagnostic value of 16s ribosomal RNA sequencing and review of the literature.

BACKGROUND: Pyoderma gangrenosum (PG) is an uncommon condition, but can lead to the diagnosis of an underlying systemic disease. It can appear spontaneously or as a result of the pathergy phenomenon after trauma or surgery. METHODS: We review three patients with postoperative PG (PPG) and the relevant literature. We also report an accurate method for microbial detection by 16S ribosomal (r)RNA sequencing. RESULTS: A 47-year-old woman and two men aged 54 and 48 years, respectively, presented with sterile ulcerations after surgery. Associated conditions (Crohn's disease and leukaemia) were present. Surgical wound infection was suspected and systemic empirical antibiotics were prescribed. After infection was excluded, PPG was diagnosed and corticosteroids were started. DISCUSSION: PPG should be considered in the differential diagnosis of postsurgical wound complications. Recognition of this condition may prevent unnecessary administration of antimicrobial treatment and development of more extensive ulcerations. It may also be the clue for the diagnosis of an underlying systemic disease. We discuss the usefulness of 16S rRNA sequencing for microbial detection and identification in order to exclude a causative infection in patients who have previously received antibiotic treatment.

Blast2GO goes grid: developing a grid-enabled prototype for functional genomics analysis.

The vast amount in complexity of data generated in Genomic Research implies that new dedicated and powerful computational tools need to be developed to meet their analysis requirements. Blast2GO (B2G) is a bioinformatics tool for Gene Ontology-based DNA or protein sequence annotation and function-based data mining. The application has been developed with the aim of affering an easy-to-use tool for functional genomics research. Typical B2G users are middle size genomics labs carrying out sequencing, ETS and microarray projects, handling datasets up to several thousand sequences. In the current version of B2G. The power and analytical potential of both annotation and function data-mining is somehow restricted to the computational power behind each particular installation. In order to be able to offer the possibility of an enhanced computational capacity within this bioinformatics application, a Grid component is being developed. A prototype has been conceived for the particular problem of speeding up the Blast searches to obtain fast results for large datasets. Many efforts have been done in the literature concerning the speeding up of Blast searches, but few of them deal with the use of large heterogeneous production Grid Infrastructures. These are the infrastructures that could reach the largest number of resources and the best load balancing for data access. The Grid Service under development will analyse requests based on the number of sequences, splitting them accordingly to the available resources. Lower-level computation will be performed through MPIBLAST. The software architecture is based on the WSRF standard.

Estudio de minimización de costes en la prescripción de inhibidores de la bomba de protones intravenosos: pantoprazol versus omeprazol / Cost-minimization study on the prescription of intravenous proton pump inhibitors: pantoprazole versus omeprazole

Objetivo: Comparar y cuantificar el hábito prescriptor del omeprazol frente al del pantoprazol intravenoso en las enfermedades relacionadas con el ácido más frecuentes, enfermedad por reflujo gastroesofágico, úlcera duodenal y úlcera gástrica. Material y métodos: Diseñamos un estudio de minimización de costes, observacional, longitudinal prospectivo y multicéntrico, realizado en hospitales españoles. Resultados: La pauta de tratamiento de pantoprazol fue de 40 mg/día (mediana), la mitad que la de omeprazol, con 80 mg/día en el conjunto de patologías (p 0,05). El coste que implican dichas pautas hace que los tratamientos con pantoprazol sean un 54 por ciento más baratos que los de omeprazol. Por indicaciones, el coste de los tratamientos de la úlcera duodenal fue un 65 por ciento más barato, y en la úlcera gástrica un 53 por ciento más barato. Conclusiones: Existe una diferencia de coste de aproximadamente la mitad en los tratamientos con pantoprazol, debido fundamentalmente al empleo de dosis superiores a las indicadas en los tratamientos con omeprazol intravenoso. Para reducir el gasto que implica el uso inadecuado de los inhibidores de la bomba de protones por vía intravenosa, se presenta como opción válida la utilización de pantoprazol (AU)

Characterisation of Aeromonas spp. isolated from frozen fish intended for human consumption in Mexico.

A total of 82 strains of presumptive Aeromonas spp. were identified biochemically and genetically (16S rDNA-RFLP). The strains were isolated from 250 samples of frozen fish (Tilapia, Oreochromis niloticus niloticus) purchased in local markets in Mexico City. In the present study, we detected the presence of several genes encoding for putative virulence factors and phenotypic activities that may play an important role in bacterial infection. In addition, we studied the antimicrobial patterns of those strains. Molecular identification demonstrated that the prevalent species in frozen fish were Aeromonas salmonicida (67.5%) and Aeromonas bestiarum (20.9%), accounting for 88.3% of the isolates, while the other strains belonged to the species Aeromonas veronii (5.2%), Aeromonas encheleia (3.9%) and Aeromonas hydrophila (2.6%). Detection by polymerase chain reaction (PCR) of genes encoding putative virulence factors common in Aeromonas, such as aerolysin/hemolysin, lipases including the glycerophospholipid-cholesterol acyltransferase (GCAT), serine protease and DNases, revealed that they were all common in these strains. Our results showed that first generation quinolones and second and third generation cephalosporins were the drugs with the best antimicrobial effect against Aeromonas spp. In Mexico, there have been few studies on Aeromonas and its putative virulence factors. The present work therefore highlights an important incidence of Aeromonas spp., with virulence potential and antimicrobial resistance, isolated from frozen fish intended for human consumption in Mexico City.

[Cost-minimization study on the prescription of intravenous proton pump inhibitors: pantoprazole versus omeprazole]. / Estudio de minimización de costes en la prescripción de inhibidores de la bomba de protones intravenosos: pantoprazol versus omeprazol.

OBJECTIVE: To compare and quantify intravenous omeprazole versus intravenous pantoprazole prescription habits in common acid-related diseases such as gastro-esophageal reflux disease, duodenal ulcer, and gastric ulcer. MATERIAL AND METHODS: We designed an observational, longitudinal prospective and multicenter cost-minimization study to be carried out in Spanish hospitals. RESULTS: The pantoprazole regimen consisted of 40 mg/day (median), one half of that of omeprazole with 80 mg/day overall for these conditions (p < 0.05). This dosage was significantly different for duodenal ulcer (40.0 +/- 0.0 versus 90.6 +/- 22.5 mg/day, p < 0.05), and gastric ulcer (50.3 +/- 17.8 versus 85.8 +/- 39 mg/day, p < 0.05), but not for gastro-esophageal reflux disease (50.9 +/- 18.7 versus 62.2 +/- 21.1, p > 0.05). Costs for these regimens make treatments using pantoprazole 54% less expensive than treatments using omeprazole. By indication, the cost of duodenal ulcer treatment was 65% less expensive, and that of gastric ulcer 53% less expensive. CONCLUSIONS: Cost differences amount to approximately one half in treatments using pantoprazole, which is primarily due to the use of doses higher than indicated in treatments using intravenous omeprazole. To reduce expenses stemming from the inadequate use of intravenous proton pump inhibitors the use of pantoprazole is brought forward as a valid option.

Vegetant bromoderma in an Infant.

Bromoderma is a cutaneous reaction caused by the use of products containing bromide. In this report we describe a 2-month-old girl who was admitted to our institution with vegetative lesions on the face and scalp owing to the administration of a syrup containing sodium bromide.

Neglected traumatic posterior dislocations of the shoulder: controversies on indications for treatment and new CT scan findings.

We report seven missed traumatic posterior dislocations of the shoulder in six patients. In all seven shoulders, anteroposterior radiographs did not provide the diagnosis in the emergency room after the trauma (epileptic seizure in four patients) and diagnosis was delayed for at least 24 h. The final diagnosis was reached by clinical suspicion and computed tomography (CT) scan of the seven shoulders. Two shoulders were treated by closed reduction and three were treated by closed reduction and percutaneous pinning, although four of these five shoulders presented a defect in the humeral head involving 20%-25% of the articular surface. Two shoulders dislocated for more than 6 months were treated according to Mc Laughlin's technique modified by Hawkins instead of an arthroplasty. At a minimum follow-up of 2 years and 2 months, the functional results according to Hawkins were good in all seven shoulders. There was no recurrence of the dislocation in any patient. Radiographs showed mild degenerative changes. The establishment of indications for treatment, based on the proportion of articular surface of the humeral head involved and the time of evolution of the dislocation, needs more clinical or experimental evidence. In epileptic patients, strict control of medication is of the utmost importance.