[When to resume driving after primary total hip arthroplasty?] / ¿Cuándo se reanuda la conducción después del reemplazo total de cadera primario?

INTRODUCTION: the current literature relates the return to driving with multiple variables. For various reasons, the current data on the time to return to driving after a total hip arthroplasty (THA) are diverse and even contradictory. We have proposed the objective of determining the time required to drive a manual gear vehicle again in a group of patients who underwent primary THA through a posterolateral approach with focus on manual gear cars. MATERIAL AND METHODS: we have studied the functional results of 112 patients who underwent primary THA between January 2019 and January 2020 in a high level in Cadiz, Andalusia, Spain. RESULTS: the median return to driving was three weeks (IQR 2-4). We have identified that 89.3% of the patients were able to drive again before the sixth week after surgery and in 92% of the cases they did so feeling even safer than before the THA. CONCLUSION: we consider that after the sixth week of an THA it is safe to resume driving a vehicle.

INTRODUCCIÓN: la literatura actual relaciona el regreso a la conducción vehicular con múltiples variables. Sin embargo, los datos actuales sobre el tiempo de regreso a la conducción luego de una artroplastía total de cadera (ATC) son diversos e incluso contradictorios. Por lo tanto, nos hemos planteado el objetivo de determinar el tiempo requerido para volver a conducir en un grupo de pacientes sometidos a una ATC primaria mediante un abordaje posterolateral, centrándonos específicamente en vehículos de marcha manual. MATERIAL Y MÉTODOS: hemos estudiado los resultados clínico-funcionales de 112 pacientes sometidos a una ATC primaria entre Enero de 2019 y Enero de 2020 en un hospital de alta complejidad en Cádiz, Andalucía, España. RESULTADOS: la mediana del tiempo de regreso a la conducción fue de tres semanas (RIC 2-4). Hemos identificado que 89.3% de los pacientes pudo volver a conducir antes de la sexta semana posterior a la cirugía. Además, en 92% de los casos, los pacientes se sintieron aún más seguros al conducir después de la ATC que antes de la intervención. CONCLUSIÓN: consideramos que a la sexta semana de una ATC es seguro reanudar la conducción de un vehículo.

[Preliminary results of hybrid fixation modular implant in revision knee arthroplasty]. / Resultados preliminares de la artroplastía de revisión de rodilla con implante modular de fijación híbrida.

INTRODUCTION: revision total knee arthroplasty (TKA) is a challenging procedure that requires proper alignment, restoration of bone loss, and prevention of instability. Modern revision systems offer progressive implant constriction with multiple options for offset, augmentation, and fixation stems. OBJECTIVE: to evaluate the clinical outcomes of a modular implant with hybrid fixation in revision TKA with a minimum follow-up of two years. MATERIAL AND METHODS: we retrospectively included all revision TKA surgeries performed between September 2018 and September 2019, using the same implant. Patient demographics, comorbidities, and data on bone defects were recorded. Clinical outcomes were assessed using subjective roles and Maudsley scores and the Knee Society Score (KSS). Complications during follow-up were also documented. RESULTS: a total of 23 patients were analyzed, comprising 65% females and 35% males, with a median age of 71.1 years. Bone defects following implant removal were classified as F2.T2 in 39.13% of cases, F1.T2 in 8.69%, and F1.T1 in the remaining 52.17%. There were significant improvements in the KSS score (preoperative: 53 points, postoperative: 79 points; p < 0.001). Three (13%) complications were reported, two of which were directly related to the surgery, and two patients required subsequent revision surgery. The 2-year survival rate was 91.3%. CONCLUSION: the use of a modular implant with hybrid fixation in revision TKA demonstrated a high 2-year survival rate, significant improvements in clinical scores, and a low incidence of short-term complications. These findings support the efficacy and safety of this approach, providing favorable clinical outcomes and high patient satisfaction.

INTRODUCCIÓN: la artroplastía total de rodilla (ATR) de revisión es un procedimiento desafiante que requiere alineación adecuada, restauración ósea y estabilidad. Los sistemas modernos de revisión ofrecen opciones de implantes modulares con fijación híbrida. OBJETIVO: evaluar los resultados clínicos de un implante modular de fijación híbrida con seguimiento mínimo de dos años. MATERIAL Y MÉTODOS: se incluyeron retrospectivamente cirugías de revisión de ATR realizadas entre Septiembre de 2018 y Septiembre de 2019 con el mismo implante. Se registraron datos demográficos, comorbilidades y se evaluaron los resultados clínicos utilizando puntuaciones subjetivas y la Knee Society Score (KSS). RESULTADOS: se analizaron 23 pacientes (65% mujeres, 35% hombres; edad mediana: 71.1 años). Los defectos óseos posteriores a la extracción del implante se clasificaron como F2.T2 en 39.13% de los casos, F1.T2 en 8.69%, y F1.T1 en 52.17%. Se observaron mejoras significativas en la puntuación de la KSS (preoperatoria: 53 puntos, postoperatoria: 79 puntos; p < 0.001). Se registraron tres (13%) complicaciones totales, dos relacionadas directamente con la cirugía, y dos casos requirieron una nueva cirugía de revisión. La tasa de supervivencia a los dos años fue de 91.3%. CONCLUSIÓN: el uso del implante modular con fijación híbrida en la revisión de ATR mostró una alta tasa de supervivencia a dos años, mejoras significativas en las puntuaciones clínicas y baja incidencia de complicaciones a corto plazo. Estos resultados respaldan la eficacia y seguridad de este enfoque, proporcionando resultados clínicos favorables y alta satisfacción del paciente.

¿Cuándo se reanuda la conducción después del reemplazo total de cadera primario? / When to resume driving after primary total hip arthroplasty?

Resumen: Introducción: la literatura actual relaciona el regreso a la conducción vehicular con múltiples variables. Sin embargo, los datos actuales sobre el tiempo de regreso a la conducción luego de una artroplastía total de cadera (ATC) son diversos e incluso contradictorios. Por lo tanto, nos hemos planteado el objetivo de determinar el tiempo requerido para volver a conducir en un grupo de pacientes sometidos a una ATC primaria mediante un abordaje posterolateral, centrándonos específicamente en vehículos de marcha manual. Material y métodos: hemos estudiado los resultados clínico-funcionales de 112 pacientes sometidos a una ATC primaria entre Enero de 2019 y Enero de 2020 en un hospital de alta complejidad en Cádiz, Andalucía, España. Resultados: la mediana del tiempo de regreso a la conducción fue de tres semanas (RIC 2-4). Hemos identificado que 89.3% de los pacientes pudo volver a conducir antes de la sexta semana posterior a la cirugía. Además, en 92% de los casos, los pacientes se sintieron aún más seguros al conducir después de la ATC que antes de la intervención. Conclusión: consideramos que a la sexta semana de una ATC es seguro reanudar la conducción de un vehículo.

Abstract: Introduction: the current literature relates the return to driving with multiple variables. For various reasons, the current data on the time to return to driving after a total hip arthroplasty (THA) are diverse and even contradictory. We have proposed the objective of determining the time required to drive a manual gear vehicle again in a group of patients who underwent primary THA through a posterolateral approach with focus on manual gear cars. Material and methods: we have studied the functional results of 112 patients who underwent primary THA between January 2019 and January 2020 in a high level in Cadiz, Andalusia, Spain. Results: the median return to driving was three weeks (IQR 2-4). We have identified that 89.3% of the patients were able to drive again before the sixth week after surgery and in 92% of the cases they did so feeling even safer than before the THA. Conclusion: we consider that after the sixth week of an THA it is safe to resume driving a vehicle.

Resultados preliminares de la artroplastía de revisión de rodilla con implante modular de fijación híbrida / Preliminary results of hybrid fixation modular implant in revision knee arthroplasty

Resumen: Introducción: la artroplastía total de rodilla (ATR) de revisión es un procedimiento desafiante que requiere alineación adecuada, restauración ósea y estabilidad. Los sistemas modernos de revisión ofrecen opciones de implantes modulares con fijación híbrida. Objetivo: evaluar los resultados clínicos de un implante modular de fijación híbrida con seguimiento mínimo de dos años. Material y métodos: se incluyeron retrospectivamente cirugías de revisión de ATR realizadas entre Septiembre de 2018 y Septiembre de 2019 con el mismo implante. Se registraron datos demográficos, comorbilidades y se evaluaron los resultados clínicos utilizando puntuaciones subjetivas y la Knee Society Score (KSS). Resultados: se analizaron 23 pacientes (65% mujeres, 35% hombres; edad mediana: 71.1 años). Los defectos óseos posteriores a la extracción del implante se clasificaron como F2.T2 en 39.13% de los casos, F1.T2 en 8.69%, y F1.T1 en 52.17%. Se observaron mejoras significativas en la puntuación de la KSS (preoperatoria: 53 puntos, postoperatoria: 79 puntos; p < 0.001). Se registraron tres (13%) complicaciones totales, dos relacionadas directamente con la cirugía, y dos casos requirieron una nueva cirugía de revisión. La tasa de supervivencia a los dos años fue de 91.3%. Conclusión: el uso del implante modular con fijación híbrida en la revisión de ATR mostró una alta tasa de supervivencia a dos años, mejoras significativas en las puntuaciones clínicas y baja incidencia de complicaciones a corto plazo. Estos resultados respaldan la eficacia y seguridad de este enfoque, proporcionando resultados clínicos favorables y alta satisfacción del paciente.

Abstract: Introduction: revision total knee arthroplasty (TKA) is a challenging procedure that requires proper alignment, restoration of bone loss, and prevention of instability. Modern revision systems offer progressive implant constriction with multiple options for offset, augmentation, and fixation stems. Objective: to evaluate the clinical outcomes of a modular implant with hybrid fixation in revision TKA with a minimum follow-up of two years. Material and methods: we retrospectively included all revision TKA surgeries performed between September 2018 and September 2019, using the same implant. Patient demographics, comorbidities, and data on bone defects were recorded. Clinical outcomes were assessed using subjective roles and Maudsley scores and the Knee Society Score (KSS). Complications during follow-up were also documented. Results: a total of 23 patients were analyzed, comprising 65% females and 35% males, with a median age of 71.1 years. Bone defects following implant removal were classified as F2.T2 in 39.13% of cases, F1.T2 in 8.69%, and F1.T1 in the remaining 52.17%. There were significant improvements in the KSS score (preoperative: 53 points, postoperative: 79 points; p < 0.001). Three (13%) complications were reported, two of which were directly related to the surgery, and two patients required subsequent revision surgery. The 2-year survival rate was 91.3%. Conclusion: the use of a modular implant with hybrid fixation in revision TKA demonstrated a high 2-year survival rate, significant improvements in clinical scores, and a low incidence of short-term complications. These findings support the efficacy and safety of this approach, providing favorable clinical outcomes and high patient satisfaction.

Pigment, physicochemical, and microbiological changes related to the freshness of cracked table olives.

The changes in chloroplastic pigments, mineral nutrients, and characteristics related to freshness were studied during storage and packing of cracked seasoned olives. Cracking produced an initial loss in green pigments and color degradation. Later, storage caused a progressive degradation of chlorophylls and carotenoids, with a slower rate in refrigerated fruits (which preserved the greenish tones better), but after packing (and storage at room temperature), the differential effect disappeared and, at the end of the study, all olives showed similar pigment transformations, which were correlated with CIE a* and hue. Processing led to a Na content increase in olive flesh (and Ca and Zn, when added) but marked losses in the other mineral nutrients. Sodium metabisulfite and ZnCl2 promoted LAB growth while inhibiting yeast, thus enhancing product stability, and erythorbic acid caused yeast growth and firmness deterioration.

Mineral and sensory profile of seasoned cracked olives packed in diverse salt mixtures.

This work studies the effect of packing cracked seasoned olives with NaCl, KCl, and CaCl(2) mixture brines on their mineral nutrients and sensory attributes, using RSM methodology. The Na, K, Ca, and residual natural Mn contents in flesh as well as saltiness, bitterness and fibrousness were significantly related to the initial concentrations of salts in the packing solution. This new process led to table olives with a significantly lower sodium content (about 31%) than the traditional product but fortified in K and Ca. High levels of Na and Ca in the flesh led to high scores of acidity and saltiness (the first descriptor) and bitterness (the second) while the K content was unrelated to any sensory descriptor. The new presentations using moderate proportions of alternative salts will therefore have improved nutritional value and healthier characteristics but only a slightly modified sensory profile.

Fractura por estrés del cuello femoral en una niña con síndrome de Down / Femoral neck stress fractures in a young girl with Down’s syndrome

Las fracturas por estrés son lesiones que suelen estar en relación con ciclos repetidos de carga sobre un hueso normal sometido a un exceso de solicitaciones mecánicas, o bien sobre un hueso con resistencia menor. Se presenta el caso de una niña de 5 años con síndrome de Down que acude a la consulta por dificultad de la marcha y dolor inguinal izquierdo de 3-4 días de evolución. En la anamnesis, destaca la tendencia de la niña a realizar saltos repetidos con apoyo monopodálico sobre la extremidad inferior izquierda. La exploración radiológica reveló la existencia de una fractura por estrés del cuello femoral izquierdo. Tras un tratamiento conservador, la paciente presentó una evolución satisfactoria(AU)

Stress fractures are injuries that are often related to repeated cycles of loading on a normal bone subjected to excessive mechanical stress, as well on a bone of less resistance. We report the case of a 5 year old girl with Down syndrome and consults because of her walking difficulty and a left groin pain of 3-4 days duration. In the history highlights the tendency of the girl to make repetitive jumps in monopodal support on the left lower extremity. Radiographic examination revealed a stress fracture of the left femoral neck. After conservative treatment the patient had a satisfactory outcome(AU)

[Critical study of spanish adult consumer profile of antibiotics on the basis of National Surveys of Health in 1993, 1995, 1997, 2001 and 2003]. / Estudio crítico del perfil del consumidor español adulto de antibióticos, en base a las Encuestas Nacionales de Salud de 1993, 1995, 1997, 2001 y 2003.

OBJECTIVE: The objective of this study has been to examine antibiotic consumption in Spain through the use of the National Surveys of Health (NSH) . MATERIAL AND METHODS: Taking the NSH, between 1993 and 2003, certain variables regarding the consumption of antibiotics have been analyzed; putting these into groups according to their typology, habits, comorbidity and the utilization of health resources. This information has been compared with published data by other authors. RESULTS: The consumption of antibiotics was approximately 3%, and 9-19% of this was not prescribed. Significant statistical associations have been observed between the consumption of antibiotics and other aspects such as academic and income levels, habits such as smoking, general health, certain chronic diseases, being bed-ridden due to disease; and also the use of certain medicines and the anti-influenza vaccine. CONCLUSIONS: Consumption of antibiotics coincides with described data by other authors, and this was always higher than prescribed. The association with other variables may be limited by the inadequate NSH design in order to know the exact consumption of antibiotics.

Condromatosis sinovial de cadera en un niño con síndrome de Down / Synovial chondromatosis of the hip in a child with down syndrome

La condromatosis sinovial de la cadera es una patologíapoco frecuente, generalmente benigna que se caracterizapor múltiples cuerpos libres intraarticulares.Se presenta el caso clínico de un paciente de 14 añoscon síndrome Down, afecto de condromatosis sinovialsintomática de cadera, intervenido mediante artrotomíacon control radiológico intraoperatorio para confirmarla exéresis de todos los cuerpos libres.Se revisa la bibliografía sobre las opciones terapéuticas,y los puntos más controvertidos de esta patología (AU)

Synovial chondromatosis of the hip is a rare benigncondition characterized by multiple intraarticular loosebodies. We report the case of a fourteen-year-old childwith Down syndrome who suffered symptomatic synovialchondromatosis of the hip, treated by means ofarthrotomy and intraoperative radiological assessmentto confirm the removal of all loose bodies.The literature about treatment options is reviewed,and controversial points of this condition are discussed (AU)

Comparative molecular and three-dimensional analysis of the peptide-MHC II binding region in both human and Aotus MHC-DRB molecules confirms their usefulness in antimalarial vaccine development.

A vaccine against malaria is desperately needed, and Aotus monkeys are highly susceptible to experimental infection with malarial parasites. A thorough analysis of this monkey's immune system molecules was thus undertaken in our institute. Cloning and sequencing, followed by three-dimensional analysis, has revealed high homology with some HLA-DRB1 molecules in terms of their peptide binding region pockets. Molecules such as HLA-DRB1*03, 11, 08, and HLA-DRB1*04 are so similar to Aotus MHC-DRB molecules that peptides identified as binding to these molecules and inducing protective immunity in these monkeys could be used in humans without further refinement, while small modifications seem to be needed for those binding to HLA-DRB1*07, HLA-DRB1*15, 16, and HLA-DRB1*10-like molecules, making this New World monkey an excellent model for tailor-made vaccine development, especially against malaria.

El quiste óseo esencial en la infancia. Estudio retrospectivo de 15 casos y revisión de la literatura / Simple bone cyst in childhood. Retrospective study of 15 cases and review of literature

Se presenta una revisión de 15 años de quistes óseos esenciales tratados mediante curetaje más injerto, o infiltración intralesional de corticoides. Se ha analizado la localización, la actividad del quiste, el número de cavidades y el área ocupante valorando los resultados mediante la clasificación de Neer y Chigira. Se han objetivado un mayor índice de curación mediante el curetaje y relleno de injerto respecto a la infiltración con corticoides (p: 0,01). La actividad del quiste, la unimultilocularidad y el área se encuentran relacionadas con un mayor índice de recidiva y de no respuesta en los casos tratados con infiltración de corticoides, aunque en los tets estadísticos no tenga significancia (AU)

[Simple bone cysts in childhood. Retrospective study of 15 cases and review of literature]. / El quiste óseo esencial en la infancia. Estudio retrospectivo de 15 casos y revisión de la literatura.

We present a review of 15 cases of simple bone cyst treated by curettage and bone grafting or intralesional steroids injection. We analysed the localisation, cyst activity, the number of cavities and the occupied area, valuing the results according to the Neer and Chigira classification. We have noticed a higher rate' of cure with curettage and bone grafting than with steroids injection (p: 0.01). The activity of the cyst, the uni-multilocutarity and the area related to a greater index of recurrence and failure in the cases treated by steroids injection, although this is statistically non significant.

Risk stratification and outcomes of transluminal endografting for abdominal aortic aneurysm: 7-year experience and long-term follow-up.

PURPOSE: To determine early and late outcomes of transluminal endografting (TE) in patients with abdominal aortic aneurysm (AAA), stratified by predicted risk of procedure-related mortality with conventional operation. MATERIALS AND METHODS: A retrospective study was conducted in consecutive risk-stratified AAA patients undergoing TE at a not-for-profit cardiovascular referral center from March 1994 through November 2000 with follow-up through February 2001. With use of conventional risk strata (0 = low, 1 = minimal, 2 = moderate, and 3 = high), predicted procedure-related mortalities were 0%-1% in stratum 0 (n = 40), 1%-3% in stratum 1 (n = 118), 3%-8% in stratum 2 (n = 116), and 8%-30% in stratum 3 (n = 31). Main outcome measures were: (i) TE procedural success, (ii) procedure-related mortality, (iii) major nonfatal complications, (iv) composite adverse outcome (ii + iii), (v) length of stay (LOS), (vi) freedom from AAA rupture, (vii) late survival, (viii) late complications, and (ix) endoleaks and their classification and management. RESULTS: Women were significantly less likely than men to qualify for and undergo endografting: 24 of 91 (26.4%) women underwent TE, compared to 281 of 684 (41.1%) men. Of 305 attempted TE procedures, 291 (95.4%) were successful, four (1.3%) were urgently converted to open repair, and 10 (3.3%) were aborted. Procedure-related mortalities occurred in eight cases (2.6%) overall and one of 40 (2.5%), one of 118 (0.8%), four of 116 (3.4%), and two of 31 (6.5%) cases for risk strata 0-3, respectively. Perioperative survivors were significantly younger than nonsurvivors (74.3 y +/- 9 vs 81.6 y +/- 5.1; P =.0087). Forty-six patients (15.1%) had major complications. Composite adverse outcome was worse for patients in stratum 3 than those in stratum 1 (P =.0296) and those in strata 0, 1, and 2 combined (P =.026). Procedure-related mortality declined with institutional experience, from 4% among the first 100 patients undergoing TE to 1% among the last 105. For strata 0-3, median LOS were 2, 3, 3, and 4 days, respectively. Seventy patients (22.9%) had 75 endoleaks, of which 30 necessitated additional procedures, 17 self-resolved, and 22 were untreated as of March 1, 2001. Five patients with endoleak died of unrelated causes. One late-onset type IA endoleak (26 mo) resulted in the only AAA rupture and death in the follow-up period among the 291 patients who underwent successful transluminal endograft implantation. Actuarial survival rates at 1 year after TE were 90.3% +/- 1.9% for the overall study group and 97.5% +/- 2.5%, 94% +/- 2.5%, 86.9% +/- 3.3%, and 81.3% +/- 7.7% for risk strata 0-3, respectively. At 5 years, overall actuarial survival was 69.6% +/- 6.1%. Thirty-eight late deaths were attributable to post-TE AAA rupture (n = 1), AAA rupture late after failed TE with no further treatment (n = 1), other cardiovascular disorders (n = 7), cancer (n = 15), other causes (n = 10), and unknown causes (n = 4). Late deaths occurred in risk strata 0-3 at the following rates: two of 40 (5%), 10 of 118 (8.5%), 16 of 116 (13.8%), and 10 of 31 (32.3%), respectively (stratum 0 vs stratum 3, P =.0017; stratum 1 vs stratum 3, P =.003). CONCLUSIONS: TE is safe and confers durable protection against AAA rupture in treated populations. Still, protection is not absolute in patients with endoleaks, because late AAA enlargement and even rupture can occur. Given current knowledge, technology, and practice, careful patient selection and close surveillance of patients after implantation of transluminal endografts is essential.

Dolor y tumefacción de la tuberosidad tibial proximal / Pain and tumefaction of tibial tuberosity

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Antinociceptive and uterine relaxant activities of Viburnum toronis alive (Caprifoliaceae).

Petroleum ether, ethyl acetate and methanolic leaf extracts of Viburnum toronis Killip et Smith were studied. From the petroleum ether extract, fatty acids of methyl esters such as methyl myristate, methyl palmitate, methyl stearate and methyl araquidonate were identified by means of GC-MS. From the ethyl acetate extract, 2-methylbutanoic, 2-methyl-2-butenoic, 3-methylbutanoic acids and 4-hydroxy-4-methylpentanone were identified by means of GC-MS. Through the isolated organ technique, uterine relaxant was verified; and through the method of writhings induced by acetic acid, the antinociceptive activity of methanolic extracts and the extract in ethyl acetate were verified. It was found that the extract in ethyl acetate showed the greatest in both uterine relaxant and antinociceptive activity at doses of 250 mg/kg.

The adapter protein Grb10 associates preferentially with the insulin receptor as compared with the IGF-I receptor in mouse fibroblasts.

To identify receptor-associated proteins that may contribute to the specificity of insulin and IGF-I signaling responses, a mouse embryo library was screened using the yeast two-hybrid system. Multiple receptor-interactive clones encoding the SH2 domain of the adapter protein Grb10 were isolated. Subsequent cloning of the full-length Grb10 sequence from a mouse fat cDNA library defined a previously unknown Grb10 variant, that appears to be the predominant isoform in mouse tissues. Receptor-deficient R- cells (fibroblasts from mice with homologous disruption of the IGF-I receptor gene) and transfected R- cells expressing either insulin receptors (R-IR cells) or IGF-I receptors (R+ cells) were used to investigate the specificity of Grb10 interaction with the two related receptors. Hormone-activated insulin receptors in R-IR cells coprecipitated with three species, all recognized as Grb10 isoforms by specific Grb10 antibody. Under the same conditions, Grb10 was essentially undetectable in IGF-I receptor immunoprecipitates from stimulated R+ cells. Grb10 association with insulin receptors was maximal at 10 nM insulin stimulation and sustained from 5-10 min after hormone stimulation in R-IR cells. In conclusion, Grb10 interacts preferentially with insulin vs. IGF-I receptors in intact cells and, thus, may have a role in mediating insulin receptor-specific cellular responses.

Periodic paralysis and ventricular tachycardia: possible role of calcium channel blockers.

Few patients have been reported with familial periodic paralysis and ventricular tachycardia. The natural history of these cases was unfavorable, with most dying because of a presumed cardiac dysrhythmia. We report for the first time the results of an electrophysiologic study of a similar case and the successful use of calcium channel blockers, shedding light on the possible mechanism and management of these patients.