Validación del algoritmo para el tratamiento de Hallux Valgus sintomático / Validation of the treatment protocol for symptomatic hallux valgus

Objective: To evaluate clinical outcomes in Hallux Valgus surgery and suggest clinical guidelines. Materials and Methods: Between 2005 and 2007, 60 surgeries were realized in 39 patients. Exclusion criteria were RA, HV revision and Neuropathic Foot. Two different procedures were performed: Chevron osteotomy (if IM angle < 16°) or First Cuneo-metatarsal arthrodesis (Modified Lapidus, if IM > 16°). Akin Osteotomy was realized if HV angle was > 30°, regardless of IM angle. Pre and postoperatively IM and HV angles were compared using weight bearing radiographs. Functional outcomes were evaluated using AOFAS score. Results: Mean follow up was 25 months. Mean IM angle correction was 4.3º and 9.2ºwith Chevron osteotomy and Lapidus procedure, respectively. Isolated Chevron corrected HV angle in 7.7°, Chevron with Akin: 18.5°, isolated Lapidus:12.4° and Lapidus with Akin: 20.2°. Isolated Chevron group improved their AOFAS score in 35 points, Chevron with Akin group in 32 points, Isolated Lapidus in 28 points and Lapidus with Akin group in 37 points. Discussion: Chevron osteotomy and Lapidus arthrodesis provide a reliable procedure with good functional outcomes in the mid term follow up.

Objetivo: Evaluar los resultados obtenidos en el manejo del hallux valgusy sugerir protocolos de manejo que faciliten la toma de decisiones. Materiales y Métodos: Se recolectó información completa en 39 pacientes en los cuales se realizaron 60 cirugías entre el 2005 al 2007, excluyendo aquellos con diagnóstico de AR, Pie Neurológico y HV Recidivante. Se realizaron 2 tipos de procedimientos: Osteotomía de Chevron cuando el ángulo Intermetatarsiano era menor de 16° y Artrodesis Cuneo-Metatarsiana tipo Lapidus Modificado cuando era mayor de 16°. Cuando se encontró un ángulo Metatarso-Falángico mayor de 30°, se realizó la Osteotomía de Akin como procedimiento complementario. Los pacientes fueron estudiados con radiografías convencionales con carga en el post operatorio. Resultados: Con Chevron, la corrección del ángulo IMT fue de 4,3° y con Lapidus fue de 9,2°. En el subgrupo de Chevron aislado, se logró corregir el ángulo MTF en 7,7°, en Chevron + Akin: 18,5°, en Lapidus aislado: 12,4° y en Lapidus + Akin: 20,2°. En la evaluación de la escala AOFAS, el grupo de Chevron aislado mejoró un promedio de 35 puntos, Chevron + Akin mejoró 32,1 puntos, Lapidus aislado mejoró 28,4 puntos y el grupo de Lapidus + Akin mejoró 37 puntos. Como complicación, un evento aislado de Infección de Sitio Operatorio en uno de los pacientes del grupo Chevron aislado (tasa infección total: 1,6 por ciento). La Osteotomía de Chevron, así como la Artrodesis tipo Lapidus, son seguros, tienen baja tasa de complicaciones y presentan buenos resultados funcionales en el seguimiento a corto y mediano plazo.

Papel de los polimorfismos -238 y -308 del promotor del factor de necrosis tumoral alfa en la patogenia y respuesta al tratamiento anti- factor de necrosis tumoral alfa en artritis reumatoide / The influence of -238 and -308 TNF alpha polymorphisms on the pathogenesis and response to treatment in rheumatoid arthritis

Rheumatoid arthritis (RA) is a systemic autoimmune disease that affects 0.8 percent of the world population, it affects the synovial membrane of joints and the clinical presentation encompasses a wide spectrum, ranging from a mild to a severe and erosive disease that causes joint and cartilage destruction which finally provokes irreversible structural damage and patient disability. In the last years, there have been important advances in the pathogenesis of this disease, the efforts have been concentrated on pro-inflammatory cytokines such as tumor necrosis factor alpha (TNFalpha). This protein guides numerous events in the synovial and systemic inflammatory process and is encoded in the Major Histocompability Complex (MHC), one of the most polymorphic of the genome. Polymorphisms affecting the TNFalpha gene and its regulatory regions are associated with RA prevalence and course. There is a possible association between these polymorphisms and the clinical response to the use of monoclonal antibodies anti-TNFalpha. The possibility that the determination of genotypes -238 and -308 may have prognostic and therapeutic consequences is debated nowadays (Rev Méd Chile 2005; 133: 1089-95).

Techniques of treatment of peritoneal endometriosis: the cavitational ultrasonic surgical aspirator.

The efficacy of medical therapy in endometriosis-associated infertility has been called into question. For decades, surgery has been used in the treatment of endometriosis. However, before the 1960s it consisted of either excision or hysterectomy and bilateral adnexectomy. Although controversy exists about whether laparotomy or operative laparoscopy is the more efTective therapeutic approach for endometriosis, the efficacy of surgery in reducing implants, relieving dysmenorrhea and pelvic pain, and improving fertility has been well-established.

Cytochalasin D inhibits penetration of hamster eggs by guinea pig and human spermatozoa.

Fertilization experiments using zona-free hamster eggs and spermatozoa from both guinea pig and human were conducted in the presence of cytochalasin D to evaluate the possible role of actin filaments in fertilization processes. When the actin filament inhibitor, cytochalasin D, was added to fertilization media at concentrations of 10 to 30 microM, penetration of eggs was significantly inhibited. Preincubation of the eggs with cytochalasin D and washing prior to addition of spermatozoa had no effect on penetration as quantitated by the number of swollen heads in the egg cytoplasm. However, spermatozoa preincubated with cytochalasin D and subsequently washed prior to egg addition showed reduced penetration of the same magnitude as when spermatozoa and eggs were coincubated with cytochalasin D. Both the percentage of zona-free eggs showing decondensed sperm heads and the penetration indices (total decondensed spermatozoa/total eggs) were significantly affected when spermatozoa were exposed to cytochalasin D. The DMSO vehicle used to dissolve cytochalasin D had little effect on the number of decondensed heads. When the concentration of cytochalasin D was increased (DMSO remaining constant) in human sperm experiments, percent penetration decreased and progressively fewer decondensed spermatozoa were recorded, indicating dose-responsiveness to cytochalasin D. Motility parameters of human spermatozoa were not altered at any of the concentrations of cytochalasin D tested. Neither guinea pig sperm motility nor acrosome reaction was altered significantly by cytochalasin D or the DMSO vehicle. These experiments suggest that cytochalasin D may be an inhibitor of some fertilization processes such as sperm penetration or sperm head decondensation.