Estudio antropométrico de la glena humana en una población española normal / Anthropometrical study of the human glenoid in a normal Spanish population

Objetivo: El objetivo de este estudio es evaluar el tamaño de la glena en una población española normal, compararla con resultados previos en otras poblaciones y relacionarlo con los tamaños de implante que se comercializan para la artroplastia invertida de hombro. Material y métodos: Estudio antropométrico de la glena humana utilizando tomografías computarizadas de 154 pacientes con edades superiores a 30 años, realizados entre enero de 2015 y diciembre de 2017. Se valoran tomografías computarizadas de hombro con cortes de 2mm de grosor y 0mm de intervalo entre cortes, en algoritmo óseo y de partes blandas, realizándose reconstrucción 3D sobre la cual se obtienen mediciones de longitud y anchura de la glena. El punto superior de la glena se determinó en la zona superior del ovoide de la glena, en el tubérculo supraglenoideo, justo por debajo del reborde circunferencial que rodea la glena. El punto inferior se determinó como el punto más alejado del punto superior en el contorno de la glena, a nivel superior del reborde circunferencial que rodea la glena. Los puntos anterior y posterior fueron determinados como los extremos del eje transversal mayor en un plano perpendicular al eje superoinferior, por dentro del reborde circunferencial que rodea la glena. Las diferencias entre sexos, edad, altura, peso y relaciones de tamaños fueron evaluados. Resultados: La glena tiene un eje longitudinal medio de 28,78mm y una anchura de 20,27mm. Los valores del tamaño de la glena son significativamente diferentes en hombres y mujeres, siendo mayor en hombres. El tamaño de la glena está bien correlacionado con la estatura del paciente, existiendo una asociación positiva entre la estatura y la longitud y anchura de la superficie glenoidea. Las metaglenas circulares disponibles hoy en el mercado presentan tamaños no inferiores a 24-25mm de diámetro. Conclusión: La población del sur de España presenta un tamaño de la superficie glenoidea inferior a la población americana y semejante a la cohorte asiática. Los datos antropométricos expresados pueden ser útiles para la elección de la metaglena más apropiada en la población del sur de España

Objective: To evaluate the size of the glenoid in a southern Spanish population, to compare it with previous results from other populations and determine the size of the implants that are marketed for shoulder arthroplasty. Material and methods: Between January 2015 and December 2017, an anthropometrical study of the human glenoid was performed using computed axial tomography scans (CT) of 154 patients over 30 years old. The glenoid dimensions were analysed 3-dimensionally using 2mm interval thicknesses, determining the average height and width of the glenoid. The upper point of the glenoid geometry was determined as the supraglenoid tubercle of the ovoid glenoid surface, where the long head of the biceps tendon is thought to originate. The lower point was then positioned at the furthest point from the upper point on the glenoid contour. Anterior and posterior points were determined such that the 3-dimensional anterior-posterior distance was maximized on the plane perpendicular to the upper-lower axis. Sex differences and correlations between sides and among the respective parameters in the glenohumeral dimensions were also evaluated. Results: The glenoid had an average height of 28.78mm and width of 20.27mm. The values were significantly different between the men and the women, being greater in the men. The glenoid size is well correlated with the patient's size. Direct correlations exist between the glenoid height and width and the glenoid size and the patient's height. The available metaglenoids currently on the market are no bigger than 25-24mm. Conclusion: In comparison, the southern Spanish population have a glenoid size similar to the Caucasian population, but smaller than that of the American population. The data shown could be useful to improve the design of shoulder prostheses for the southern Spanish population

Capacidad de marcha y dependencia funcional en adultos mayores con alteración visual / Gait capacity and functional dependency among older adults with vision disturbances / Capacidade de marcha e dependência funcional em idosos com alteração visual

Resumen Introducción La alteración visual puede producir cambios en la marcha y afectar la autonomía del adulto mayor, entendida como la necesidad de ayuda de otras personas o aditamentos para realizar, adecuadamente, sus actividades de la vida diaria. Objetivo Conocer la relación entre la capacidad de marcha y dependencia funcional en adultos mayores con alteración de la agudeza visual. Material y métodos Estudio descriptivo y correlacional, en una población de adultos mayores con alteración de la agudeza visual, muestra conformada por 94 adultos mayores. La marcha se midió con el sistema GAITRite, para la dependencia en Actividades Básicas de la Vida Diaria, se utilizó el Índice de Barthel, para las Actividades Instrumentales de la Vida Diaria el índice de Lawton y Brody. Resultados La capacidad de marcha y dependencia funcional, presentó relación positiva entre la velocidad de marcha (p = 0.000) y longitud del paso (p = 0.000) con las ABVD; la velocidad de marcha (p = 0.000), cadencia (p = 0.023) y longitud del paso (p = 0.000) con las AIVD y relación negativa entre la amplitud del paso (p = 0.012) y AIVD. Conclusión La valoración de la marcha en los AM con alteración en la agudeza visual, desde el primer nivel de atención, permitirá desarrollar intervenciones y programas encaminados a preservar la independencia del adulto mayor, reducir las tasas de morbilidad, disminuir costos en salud y contribuir en una mejor calidad de vida.

Abstract Introduction Disturbances in the visual function of the elderly can lead to gait changes which can have an impact on their autonomy, leading to the need of appliances and help of other persons in order for them to adequately perform their daily activities. Objective To gain understanding on the relationship between gait capacity and functional dependence among older adults with vision disturbances. Materials and Methods This is a descriptive and correlational study on a sample of 94 older adults with vision disturbances. The gait was measured using the GAITRite System. The functional status in terms of Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL) were estimated using the Barthel, and the Lawton & Brody scales respectively. Results The gait capacity and functional dependence showed a positive relationship in terms of velocity (p = 0.000) and steps (p = 0.000) regarding the ADL; and in terms of velocity (p = 0.000), cadence (p = 0.023), and steps (p = 0.000) regarding the IADL. A negative relationship between step amplitude (p = 0.012) and IADL was also found. Conclusion From the primary healthcare point of view, accurate gait assessments on the older adults with vision disturbances will allow the development of programs and interventions aimed at preserving the independence, reducing the morbidity rates and costs, and contributing to maintain a better quality of life among older adults.

Resumo Introdução A alteração visual pode produzir câmbios na marcha e afetar a autonomia do idoso, entendida como a necessidade de ajuda de outras pessoas ou aditamentos para realizar, adequadamente, suas atividades da vida diária. Objetivo Conhecer a relação entre a capacidade de marcha e dependência funcional em idosos com alteração da agudeza visual. Material e métodos Estudo descritivo e correlacional, em uma população de idosos com alteração da agudeza visual, amostra conformada por 94 idosos. A marcha mediu-se com o sistema GAITRite, para dependência em Atividades Básicas da Vida Diária, utilizou-se o Índice de Barthel, para as Atividades Instrumentais da Vida Diária o índice de Lawton e Brody. Resultados A capacidade de marcha e dependência funcional, apresentou relação positiva entre a velocidade de marcha (p = 0.000) e longitude de passo (p = 0.000) com as ABVD; a velocidade de marcha (p = 0.000), cadência (p = 0.023) e longitude do passo (p = 0.000) com as AIVD e relação negativa entre a amplitude do passo (p = 0.012) e AIVD. Conclusão A valoração da marcha nos AM com alteração na agudeza visual, desde o primeiro nível de atenção, permitirá desenvolver intervenções e programas encaminhados a preservar a independência do idoso, reduzir as taxas de morbilidade, diminuir custos em saude e contribuir em uma melhor qualidade de vida.

Anthropometrical study of the human glenoid in a normal Spanish population. / Estudio antropométrico de la glena humana en una población española normal.

OBJECTIVE: To evaluate the size of the glenoid in a southern Spanish population, to compare it with previous results from other populations and determine the size of the implants that are marketed for shoulder arthroplasty. MATERIAL AND METHODS: Between January 2015 and December 2017, an anthropometrical study of the human glenoid was performed using computed axial tomography scans (CT) of 154 patients over 30 years old. The glenoid dimensions were analysed 3-dimensionally using 2mm interval thicknesses, determining the average height and width of the glenoid. The upper point of the glenoid geometry was determined as the supraglenoid tubercle of the ovoid glenoid surface, where the long head of the biceps tendon is thought to originate. The lower point was then positioned at the furthest point from the upper point on the glenoid contour. Anterior and posterior points were determined such that the 3-dimensional anterior-posterior distance was maximized on the plane perpendicular to the upper-lower axis. Sex differences and correlations between sides and among the respective parameters in the glenohumeral dimensions were also evaluated. RESULTS: The glenoid had an average height of 28.78mm and width of 20.27mm. The values were significantly different between the men and the women, being greater in the men. The glenoid size is well correlated with the patient's size. Direct correlations exist between the glenoid height and width and the glenoid size and the patient's height. The available metaglenoids currently on the market are no bigger than 25-24mm. CONCLUSION: In comparison, the southern Spanish population have a glenoid size similar to the Caucasian population, but smaller than that of the American population. The data shown could be useful to improve the design of shoulder prostheses for the southern Spanish population.

Peripheral nerve reconstruction with epsilon-caprolactone conduits seeded with vasoactive intestinal peptide gene-transfected mesenchymal stem cells in a rat model.

OBJECTIVE: Attempts have been made to improve nerve conduits in peripheral nerve reconstruction. We investigated the potential therapeutic effect of a vasoactive intestinal peptide (VIP), a neuropeptide with neuroprotective, trophic and developmental regulatory actions, in peripheral nerve regeneration in a severe model of nerve injury that was repaired with nerve conduits. APPROACH: The sciatic nerve of each male Wistar rat was transected unilaterally at 10 mm and then repaired with Dl-lactic-ε-caprolactone conduits. The rats were treated locally with saline, with the VIP, with adipose-derived mesenchymal stem cells (ASCs) or with ASCs that were transduced with the VIP-expressing lentivirus. The rats with the transected nerve, with no repairs, were used as untreated controls. At 12 weeks post-surgery, we assessed their limb function by measuring the ankle stance angle and the percentage of their muscle mass reduction, and we evaluated the histopathology, immunohistochemistry and morphometry of the myelinated fibers. MAIN RESULTS: The rats that received a single injection of VIP-expressing ASCs showed a significant functional recovery in the ankle stance angle (p = 0.049) and a higher number of myelinated fibers in the middle and distal segments of the operated nerve versus the other groups (p = 0.046). SIGNIFICANCE: These results suggest that utilization of a cellular substrate, plus a VIP source, is a promising method for enhancing nerve regeneration using Dl-lactic-ε-caprolactone conduits and that this method represents a potential useful clinical approach to repairing peripheral nerve damage.

Marginal bone loss around implants placed in maxillary native bone or grafted sinuses: a retrospective cohort study.

OBJECTIVES: To assess differences in marginal bone loss around implants placed in maxillary pristine bone and implants placed following maxillary sinus augmentation over a period of 3 years after functional loading. MATERIAL AND METHODS: Two cohorts of subjects (Group 1: Subjects who received sinus augmentation with simultaneous implant placement; Group 2: Subjects who underwent conventional implant placement in posterior maxillary pristine bone) were included in this retrospective study. Radiographic marginal bone loss was measured around one implant per patient on digitized panoramic radiographs that were obtained at the time of prosthesis delivery (baseline) and 12, 24, and 36 months later. The influence of age, gender, smoking habits, history of periodontal disease, and type of prosthetic connection (internal or external) on marginal bone loss was analyzed in function of the type of osseous support (previously grafted or pristine). RESULTS: A total of 105 subjects were included in this study. Cumulative radiographic marginal bone loss ranged from 0 mm to 3.9 mm after 36 months of functional loading. There were statistically significant differences in marginal bone loss between implants placed in grafted and pristine bone at the 12-month assessment, but not in the subsequent progression rate. External prosthetic connection, smoking, and history of periodontitis negatively influenced peri-implant bone maintenance, regardless of the type of osseous substrate. CONCLUSIONS: Implants placed in sites that received maxillary sinus augmentation exhibited more marginal bone loss than implants placed in pristine bone, although marginal bone loss mainly occurred during the first 12 months after functional loading. Implants with external implant connection were strongly associated with increased marginal bone loss overtime.

Two-year outcomes of Elektra prosthesis for trapeziometacarpal osteoarthritis: a longitudinal cohort study.

The aim of this study was to evaluate clinical and radiographic outcomes of Elektra® trapeziometacarpal prostheses after 2 years. We present a longitudinal cohort study of 19 prostheses for the treatment of Eaton stage II and III osteoarthritis (mean follow-up of 29 months). QuickDASH score, pinch strength and mobility were determined, and radiographs were analysed. Isotope scans were taken in patients with persistent pain or suspected loosening. Although the QuickDASH score was 69 before and 38 after surgery, nine patients had pain at the trapeziometacarpal joint with radiographic osteolysis around the trapezium component and a positive bone scan uptake at subsequent follow-up. The implant was revised in three of these nine patients and another patient underwent surgery for periprosthetic fracture. Only ten of the 19 implants showed no sign of failure. Most problems derived from the trapezium cup. Because of these poor outcomes after only 2 years, we cannot recommend this implant.

Digital flexion contracture and severe carpal tunnel syndrome due to tophaceus infiltration of wrist flexor tendon: first manifestation of gout.

The authors report an unusual case of flexor tenosynovitis, severe carpal tunnel syndrome, and triggering at the carpal tunnel as the first manifestation of gout. A 69-year-old man presented with digital flexion contracture and severe carpal tunnel syndrome of his right hand and was treated surgically. A flexor tenosynovectomy and a median nerve neurolysis were performed through an extended carpal tunnel approach. The sublimis and the profundus tendons were involved. Partial ruptures and multiple whitish lesions suggestive of tophacceous infiltration of the flexor tendons were seen. Macroscopically, the removed synovial tissue was involved by multiple whitish nodules that were milimetric in size and was suggestive of monosodium urate crystals deposits. By light microscopy examination, numerous nonnecrotizing granulomas of different sizes were observed that were compounded by large aggregations of acellular nonpolarized material, surrounded by epithelioid histiocytes, mononuclear cells, and foreign body multinucleated giant cells. Postoperatively, the patient recovered with resolution of the median nerve symptoms and a near-to-full range of motion of the affected digits.To the authors' knowledge, this patient is the first case report with flexor tendons tophacceous infiltration as the first clinical sign of gout. Gouty flexor tenosynovitis can occur in the absence of a long history of gout. A high index of suspicion is paramount to the initiation of proper management. Operative treatment of gouty flexor tenosynovitis is mandatory to debulk tophaceous deposits, improve tendon gliding, and decompress nerves. Routine uric acid determination could be helpful in the preoperative evaluation of patients with flexor tenosynovitis.

Osteosíntesis de fracturas pertrocantéreas de cadera con placa de compresión percutánea / Pertrochanteric hip fracture osteosynthesis with percutaneous compression plate

Objetivo. Evaluar los resultados obtenidos en el tratamiento de fracturas intertrocantéreas de cadera con placa de compresión percutánea (PCCP). Material y método. Analizamos 611 pacientes, intervenidos mediante PCCP, con una edad media de 79 años (65 a 99 años). El seguimiento mínimo fue de 10 meses (10 a 24). Se midieron datos relativos a la pérdida sanguínea, relacionándolos con la recuperación postoperatoria del paciente. Resultados. La duración media de la cirugía fue de 32min (15 a 75min). La caída media en el valor de la Hb fue de 1,9g/dl (0,3 a 8,4). El 14,7% de los pacientes precisó una transfusión sanguínea, con una media de 0,25 unidades transfundidas (0 a 3). La estancia hospitalaria media fue de 8 días. Ocurrió un 12,6% de complicaciones médicas y un 5% de complicaciones radiológicas. La mortalidad total en el primer año fue del 3,8% (23 pacientes). Conclusiones. Con la PCCP se consigue una recuperación funcional precoz del paciente asociada a una escasa morbilidad, siendo una alternativa para el tratamiento de las fracturas intertrocantéreas de cadera (AU)

Objective. To evaluate the results obtained in the treatment of intertrochanteric hip fractures with a percutaneous compression plate (PCCP). Material and method. We analysed 611 patients, operated on using PCCP, with a mean age of 79 years (65 to 99 years). The minimum follow up was 10 months (10 to 24). Data associated with blood loss and the post-operative recovery of the patients were analysed. Results. The mean duration of surgery was 32minutes (15 to 75min). The mean drop in the haemoglobin value was 1.9g/dl (0.3 to 8.4). A blood transfusion was required by 14.7% of patients, with a mean of 0.25 transfusion units (0 to 3). The mean hospital stay was 8 days. There were 12.6% medical complications and 5% radiological complications. The overall mortality in the first year was 3.8% (23 patients). Conclusions. An early functional recovery of the patient associated with a low morbidity was achieved with PCCP, making it an alternative for the treatment of intertrochanteric hip fractures (AU)

Human adipose-derived mesenchymal stem cells reduce inflammatory and T cell responses and induce regulatory T cells in vitro in rheumatoid arthritis.

OBJECTIVES: Adult mesenchymal stem cells were recently found to suppress effector T cell and inflammatory responses and have emerged as attractive therapeutic candidates for immune disorders. In rheumatoid arthritis (RA), a loss in the immunological self-tolerance causes the activation of autoreactive T cells against joint components and subsequent chronic inflammation. The aim of this study is to characterise the immunosuppressive activity of human adipose-derived mesenchymal stem cells (hASCs) on collagen-reactive T cells from patients with RA. METHODS: The effects of hASCs on collagen-reactive RA human T cell proliferation and cytokine production were investigated, as well as effects on the production of inflammatory mediators by monocytes and fibroblast-like synoviocytes from patients with RA. RESULTS: hASCs suppressed the antigen-specific response of T cells from patients with RA. hASCs inhibited the proliferative response and the production of inflammatory cytokines by collagen-activated CD4 and CD8 T cells. In contrast, the numbers of IL10-producing T cells and monocytes were significantly augmented upon hASC treatment. The suppressive activity of hASCs was cell-to-cell contact dependent and independent. hASCs also stimulated the generation of FoxP3 protein-expressing CD4(+)CD25(+) regulatory T cells, with the capacity to suppress collagen-specific T cell responses. Finally, hASCs downregulated the inflammatory response and the production of matrix-degrading enzymes by synovial cells isolated from patients with RA. CONCLUSIONS: The present work identifies hASCs as key regulators of immune tolerance, with the capacity to suppress T cell and inflammatory responses and to induce the generation/activation of antigen-specific regulatory T cells.

Aplicación de periostio en un modelo experimental de cicatrización tendinosa en conejo / Use of periosteum in tendon healing; an experimental model in rabbits

Objetivo. Evaluar la formación de adherencias, labiomecánica y la calidad de la cicatriz tendinosa en un modelo experimental de lesión tendinosa en conejo tras la aplicación de periostio en comparación con ácido hialurónico y politetrafluoroetileno (PTFE). Material y método. Sección y sutura del tendón de Aquiles del conejo de Nueva Zelanda con interposición de ácido hialurónico, PTFE y periostio. Períodos de sacrificio: 1, 3 y 6 semanas. Intervención de 72 conejos. Se realizó análisis macroscópico de la adherencia, análisis biomecánico (fuerza de ruptura), análisis histológico (colágeno) y análisis digital de imagen (calidad de cicatrización). Resultados. Los tendones tratados con periostio mostraron menos adherencias que los tratados con ácido hialurónico o PTFE (p < 0,05). En la primera semana aumentó la fuerza de ruptura con respecto al control, excepto en el grupo del PTFE. Los tendones tratados con periostio presentaron una mayor fuerza de ruptura (p < 0,001). También mostraron una mayor superficie de colágeno en la cicatriz (p < 0,05). El perímetro de colágeno en la cicatriz fue menor en los tratados con PTFE. La menor dispersión del colágeno se observó en los tratados con periostio (p < 0,01). Conclusiones. El periostio disminuyó la formación de adherencias con respecto a los otros grupos de tratamiento. Las sustancias empleadas aumentaron la fuerza de ruptura, y el periostio aún más con respecto a los otros grupos de tratamiento. El análisis digital de imagen puso de manifiesto diferencias en la calidad de la cicatrización de las heridas, de forma que los tendones tratados con periostio mostraron una mayor colagenización que los tratados con ácido hialurónico o PTFE

Purpose. To assess the formation of adhesions, the biomechanics and the quality of tendon healing, at the repair site of a tendon lesion, in an experimental rabbit model, comparing the use of periosteum, Hyaluronic Acid (HA) and Polytetrafluoroethylene (PTFE). Materials and methods. Transection and suture of the Achilles tendon in New Zealand white rabbits through the application of Hyaluronic Acid, Polytetrafluoroethylene and periosteum. The rabbits were put down at: 1, 3 and 6 weeks. We studied the adhesions macroscopically, carried out a biomechanical analysis (rupture strength), studied the histology (collagen), and analysed digital images (quality of healing). Results. The tendons treated with periosteum had fewer adhesions than those treated with HA or PTFE (p < 0.05). During the first week rupture strength increased in all groups when compared to the control group-with the exception of the PTFE group. The tendons treated with periosteum showed a higher rupture strength (p < 0.001), they also had a larger area of collagen at the repair site (p < 0.05). The perimeter of the collagen area at the healing site was smaller in cases treated with PTFE. The smallest dispersion of collagen was seen in cases treated with periosteum (p < 0.01).Conclusions. The use of periosteum decreased the formation of adhesions when compared to other treatment groups. All three substances increased rupture strength, but periosteum did so most of all, compared to the other treatment groups. The analysis of digital images clearly showed differences in the quality of wound healing, tendons treated with periosteum showed a greater deposit of collagen than those treated with HA or PTFE

Eficacia del uso del drenaje de autotransfusión en la cirugía primaria de prótesis de cadera y rodilla / Efficacy of autotransfusion of recovered blood in primary hip and knee arthroplasty

Objetivo. Estudio retrospectivo para evaluar la eficacia del drenaje recuperador para evitar transfusiones en pacientes en los que no se ha tomado ninguna otra medida preventiva y conocer el valor predictivo de la hemoglobina prequirúrgica, como indicador de transfusiones de hemoderivados, durante el postoperatorio de pacientes intervenidos de prótesis total de cadera y rodilla. Material y métodos. Se compararon 200 pacientes intervenidos, durante dos años, de artroplastias primarias de rodilla y cadera, con y sin drenaje recuperador, analizando la utilización de drenaje recuperador, la necesidad de transfusión y la cantidad de autotransfusión. Resultados. En los pacientes intervenidos de rodilla se transfundieron el 19% en los que se utilizó drenaje recuperador y el 69% de los pacientes en los que no se utilizó. En las caderas las cifras fueron del 26% frente al 64%. Se produjo una caída de 1 g en el valor de la hemoglobina prequirúrgica en los pacientes transfundidos en los que se utilizó drenaje recuperador, hecho que no ocurre en los pacientes tratados anteriormente con antiinflamatorios no esteroideos (AINE). Conclusiones. El drenaje recuperador es una medida eficaz para disminuir la necesidad de transfusiones en las intervenciones de artroplastia de cadera y rodilla. La hemoglobina prequirúrgica tiene un valor predictivo de transfusiones en dichos pacientes

Aim. Retrospective study to evaluate the efficacy of blood recovery in avoiding blood transfusion in patients in which no other preventive measures were used and to determine the predictive value of preoperative hemoglobin concentration as an indicator of postoperative blood product transfusions in patients undergoing total hip or knee arthroplasty. Materials and methods. A comparison was made of 200 patients who underwent surgery over a two-year period for primary knee or hip arthroplasty, with and without blood recovery. The use of blood recovery, transfusion needs, and the autotransfusion volume were evaluated. Results. In patients undergoing knee surgery, blood transfusions were required in 19% of patients in which blood recovery was used and in 69% in which blood recovery was not used. In hip arthroplasty, 26% of patients with blood recovery and 64% without blood recovery required blood transfusion. Hemoglobin concentration fell by 1 g with respect to preoperative hemoglobin concentration in patients who underwent blood recovery and required blood transfusion; this was not the case in patients treated previously with nonsteroid anti-inflammatory drugs. Conclusions. Blood recovery is effective in reducing blood transfusion requirements in patients who undergo hip and knee arthroplasty. Preoperative hemoglobin concentration was predictive of blood transfusion requirements in these patients

Rotura espontánea de los tendones extensores de la muñeca y la mano en pacientes con artritis reumatoide. Estudio retrospectivo / Spontaneous rupture of extensor tendons in the hands of patients with rheumatoid arthritis. A retrospective study

Fundamento: La rotura espontánea de los tendones extensores de la mano es una complicación relativamente frecuente en pacientes con artritis reumatoide (AR) de larga evolución. Por ello es importante conocer los factores locales predisponentes para la rotura espontánea, así como las posibilidades quirúrgicas, las complicaciones y los resultados de la reconstrucción de los tendones afectados. Material y métodos: Estudio retrospectivo de todos los pacientes con AR seguidos en nuestro hospital y diagnosticados de rotura espontánea de tendones extensores de la mano desde octubre de 1995 hasta diciembre de 2000. Se identificó un total de 18 pacientes intervenidos quirúrgicamente con un seguimiento adecuado de al menos un año. Se describen los factores locales predisponentes, el tiempo de evolución de la enfermedad desde el diagnóstico hasta que ocurrió la rotura, el tiempo de espera hasta la cirugía, las opciones quirúrgicas, las complicaciones y el resultado funcional (basado en el test de función de la mano de Jebsen). Resultados: Los factores locales predisponentes más frecuentes fueron la inestabilidad cubital distal y la tenosinovitis crónica de extensores (presentes en el 61% de los casos). El tiempo medio de evolución de la enfermedad hasta que ocurrió la rotura espontánea fue de 122 ± 73,19 meses, con un tiempo medio de espera desde el diagnóstico de la rotura hasta la cirugía reparadora de 2,38 ± 1,75 meses. La opción quirúrgica más frecuentemente realizada consistió en la transferencia del tendón extensor propio del índice al cabo roto y sutura término-lateral (en el 55,5% de los pacientes). Las complicaciones posquirúrgicas se observaron en 3 pacientes (16,6%). El resultado funcional fue excelente o bueno en 16 pacientes (89%) y se consideró regular en 2 pacientes (11%). Discusión: Es importante identificar a los pacientes con AR que presentan inestabilidad radiocubital distal y tenosinovitis crónica de extensores de la mano por el riesgo de rotura espontánea de dichos tendones. Una valoración conjunta y consensuada con un cirujano ortopédico y un rehabilitador con especial dedicación a enfermos con AR ayuda a una cirugía temprana y unos resultados favorables en la mayoría de los casos (AU)

Background: Spontaneous rupture of extensor tendons in the hand is a relatively frequent complication in patients with rheumatoid arthritis (RA). Consequently, it is important to consider local risk factors, treatment options, complications, and functional results after surgery. Material and methods:: A retrospective study of all the patients with RA diagnosed with spontaneous extensor tendon ruptures in the hand in our hospital between October 1995 and December 2000 was performed. Eighteen patients with a follow-up of at least one year after surgery were selected. The following data were analyzed: local risk factors, interval between diagnosis and rupture, time to reconstructive surgery, treatment options, and complications and functional results after surgery (according to Jebsen’s test of hand function). Results: The most common risk factors were distal ulnar instability and chronic dorsal tenosynovitis (61%). The mean disease duration until tendon rupture was 122 ± 73.19 months, whereas the mean period before surgery was 2.38 ± 1.75 months. The preferred surgical option was terminolateral suture and extensor indicis proprius transfer for ruptured tendon (55%). Postsurgical complications were observed in 3 patients (16.6%). Functional results were excellent or good in 16 patients (89%). Discussion: In patients with RA, distal ulnar instability and chronic dorsal tenosynovitis are significant risk factors for spontaneous tendon rupture in the hand. A multidisciplinary approach, involving the rheumatologist, orthopedic surgeon and therapist, is crucial for prompt surgery and good functional results (AU)

Hydroxyapatite-coated stems with metaphyseal and diaphyseal press-fit. Eleven-year follow-up results.

We report the 11-year follow-up results of 52 unilateral primary hip arthroplasties performed with hydroxyapatite-coated stems. The femoral prosthesis used was a collarless titanium alloy implant, with proximal circumferential hydroxyapatite coating and increased distal thickness to fit the proximal diaphyseal region of the femur. Clinical evaluation was performed using the Merle d'Aubigné Hip Score. Anteroposterior and lateral radiographs were obtained and compared with previous postoperative films. Radiographic evaluation was carried out following Engh's criteria for uncemented implant fixation and using Livermore's method for measurement of polyethylene wear. At the end of the follow-up period, excellent and good clinical results were recorded in 40 arthroplasties (77%). The incidence of thigh pain at one year was 32.7%, but it decreased to 4.2% after the first post-operative year. The 11-year survival rate was 92.3%. Seven arthroplasties were revised because of aseptic loosening of the cup in one case, aseptic loosening of the stem, in one case, septic loosening of the stem in one case, periprosthetic fracture in two cases and polyethylene wear in three cases. Forty-two (87.5%) of the nonrevised stems met the criteria for radiographic osseointegration. Cortical hypertrophy was observed around the mid-part and tip of the stem in 22 patients of the series. This sign tends to be related to thigh pain (p < 0.1). Calcar osteolysis was present in 8 cases. There was only one case of distal femoral osteolysis. We found a strong and significant relationship between long-term wear rates and the occurrence of osteolysis (p < 0.001). We concluded that thigh pain is in relation to the distal diameter of the stems and significantly decreases after the first postoperative year. There was a low incidence of osteolysis in our series in comparison with other series of noncemented implants with 32-mm femoral heads and with similar follow-up.

Surgical treatment of three-part proximal humeral fractures.

The majority of proximal humeral fractures may be managed with nonsurgical treatment. However, three-part displaced fractures require surgery with two goals: obtaining an anatomic reduction and providing enough stability to allow an early rehabilitation program. This article describes a simple technique of internal fixation with Kirschner wires that can be applied in fracture-dislocations and three-part fractures of the proximal humerus. A retrospective study of 29 consecutive cases of three-part fractures of the proximal humerus treated with this procedure is presented. Excellent or satisfactory results were achieved in 79.3% of cases using Neer's criteria at minimum 12 months follow-up. Eighteen patients (62.1%) had no pain or had only mild pain not interfering with daily activities. Twenty-four shoulders (75.9%) had more than 130 degrees active elevation, and 15 patients (51.7%) had at least 130 degrees active abduction. The complications were one avascular necrosis, one osteitis and one early loss of reduction that required a new operation. In conclusion we recommend this technique for operative treatment of three-part fractures of the humerus because of its simplicity and satisfactory results.

Expresión inmunohistoquímica de glicoproteína P como factor pronóstico en sarcomas óseos / Immunohistochemical expression of glycoprotein P as a prognostic factor in bone sarcomas

Se presenta un estudio inmunohistoquímico de expresión de glicoproteína P en 44 tumores óseos malignos (32 osteosarcomas y 12 condrosarcomas) con el propósito de analizar la inmunorreactividad por estirpe histológico y su valor pronóstico potencial. El principio del procedimiento es la determinación de la molécula de glicoproteína P mediante un método inmunohistoquímico que emplea un cóctel de anticuerpos monoclonales específicos (JSB1 y MRK16) prediluidos y el procedimiento estándar de la fosfatasa-antifosfatasa alcalina, con incubación doble de anticuerpo secundario y ese complejo. Las muestras de tejido fueron obtenidas antes de la quimioterapia. La inmunoexpresión se clasificó en seis grados según una escala semicuantitativa de positividad celular.Hay que destacar la expresión intensa y constante de glicoproteína P en la membrana celular de los condrosarcomas (positividad del 100 por ciento y puntuación semicuantitativa de 3,83ñ 1,03). En los osteosarcomas la tinción fue menos constante (positividad del 59,37 por ciento y puntuación semicuantitativa de 2,79 ñ 1,81). Los pacientes con osteosarcomas localizados de alto grado (IIB) y que expresaban glicoproteína P tenían una menor supervivencia (log rank; p < 0,05) e intervalo libre de enfermedad (log rank; p < 0,001). Los hallazgos sustentan a la expresión de glicoproteína P como factor pronóstico en el osteosarcoma (AU)

Trypsin from Pacifastacus leniusculus hepatopancreas: purification and cDNA cloning of the synthesized zymogen.

Trypsin was purified from crayfish, Pacifastacus leniusculus, hepatopancreas, and the gene that encoded this enzyme was cloned from a hepatopancreas cDNA library. Crayfish trypsin is synthesized as a zymogen according to the sequence of the putative precursor peptide. The authenticity of the trypsinogen is supported by the deduced amino acid sequence and confirmed by the N-terminal amino acid sequence of the mature protein. The enzyme has features characteristic of a trypsin, such as a specific binding pocket. Sequence comparison shows that crayfish trypsin is similar to those of other species, with the exception that six cysteine residues present in vertebrates are missing. Some structural characteristics, such as the length of the signal peptide and a calcium binding site, are similar to bacterial trypsin.