Different anatomic patterns of the indirect tendon of the rectus femoris.

PURPOSE: The rectus femoris forms the anterior portion of the quadriceps muscle. It has a proximal tendinous complex, which is constituted by a direct tendon, an indirect tendon, and a variable third tendon. Direct and indirect tendons converge into a common tendon. The purposes of this study are to add anatomical knowledge about the proximal tendinous complex and describe anatomical variants of the indirect tendon and, on these basis, categorize different anatomical patterns. METHOD: In this study, 48 hemipelvis from bodies donated to the Universitat Autònoma de Barcelona have been dissected to examine the proximal tendinous complex of the rectus femoris. RESULTS: The following anatomical variants of the indirect tendon were described: inferior aponeurotic expansion in 23/48 cases (47.9%); superior aponeurotic expansion in 21/48 cases (43.7%); and an unusual origin of the myotendinous junction of the rectus femoris in the free portion of the indirect tendon in 19/48 cases (39.6%). On the basis of the aponeurotic expansions, the following anatomical patterns of the indirect tendon were defined: standard (19/48 cases, 39.6%), superior and inferior complex (15/48 cases, 31.2%), inferior complex (8/48 cases, 16.7%), and superior complex (6/48 cases, 12.5%). CONCLUSION: We can categorize four different anatomical patterns of the indirect tendon, three of which are complex. We suggest that complex patterns can cause an increased stiffness of the indirect tendon and so be considered non-modifiable risk factors for rectus femoris injuries. Finally, it would be useful to identify complex patterns and perform injury prevention actions through specific physical preparation programs.

A newly discovered membrane at the origin of the proximal tendinous complex of the rectus femoris.

PURPOSE: The rectus femoris (RF) forms the anterior portion of the quadriceps muscle group. It has a proximal tendinous complex (PTC) which is constituted by a direct tendon (DT), an indirect tendon (IT), and a variable third head. Direct and indirect tendons finally converge into a common tendon (CT). All the PTC shows a medially sloping in its proximal insertion.We investigated several anatomical specimens and discovered a new component: a membrane connecting the CT with the anterior superior iliac spine. Such membrane constitutes a new origin of the PTC. The aim of this study was to clarify whether this membrane was an anatomical variation of the PTC or a constant structure and to describe its morphology and trajectory. MATERIAL AND METHODS: We dissected 42 cadaveric lower limbs and examined the architecture of the PTC. We paid special attention to the morphology and interaction patterns between the tendons and the membrane. RESULTS: We demonstrated that the membrane is a constant component of the PTC. It has a lateral to medial trajectory and is in relation to the common tendon, the DT, and IT, which present a medial slope. This suggests that the membrane has an stabilizer role for the PTC, acting as a corrector of the inclined vector of the complex. CONCLUSION: The RF injuries are frequent in football. The newly discovered membrane is a constant component of the PTC and its integrity should be included in the algorithm to diagnose injuries.

Carta al director sobre «Eficacia y seguridad de la aplicación del ácido tranexámico tópico en la artroplastia primaria no cementada de cadera: estudio prospectivo, aleatorizado, doble ciego y controlado» / Letter to the Editor on «Efficacy and safety of the topical application of tranexamic acid in primary cementless hip arthroplasty: prospective, randomised, double-blind and controlled study»

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Bloqueo de los nervios periféricos a nivel de la muñeca guiado por ecografía para el tratamiento de la hiperhidrosis idiopática palmar con toxina botulínica / Ultrasound-guided peripheral nerve block at wrist level for the treatment of idiopathic palmar hyperhidrosis with botulinum toxin

Objetivo. Evaluación del dolor y el grado de satisfacción en pacientes sometidos a bloqueo regional periférico guiado por ultrasonidos para el tratamiento de la hiperhidrosis palmar idiopática con toxina botulínica. Pacientes y métodos. Estudio descriptivo, observacional, de pacientes con hiperhidrosis palmar tratados con toxina botulínica A, a los que se les realizó un bloqueo regional periférico guiado por ecografía de los nervios mediano y cubital con 3 ml de mepivacaína al 1% en cada uno. El bloqueo del nervio radial se llevó a cabo con infiltración en abanico a nivel de la tabaquera anatómica. Tras establecer el bloqueo, el dermatólogo realizó un mapeo e inyectó alrededor de 100 UI de toxina botulínica distribuidas en toda la palma de la mano. Fueron evaluados el dolor experimentado en la inyección de toxina botulínica mediante la escala verbal numérica (de 0 a 10), el grado de satisfacción con la técnica anestésica y las posibles complicaciones postanestésicas. Resultados. Se incluyeron 40 pacientes, 11 hombres y 29 mujeres. La intensidad del dolor evaluado con la escala numérica verbal fue de 1,03 (desviación típica 1,37). Ninguno de los pacientes presentó un valor superior a 5. El grado de satisfacción de los pacientes con la técnica anestésica fue muy bueno para el 85% de los pacientes, y bueno para el 7,5%. No hubo complicaciones derivadas del procedimiento anestésico. Conclusiones. El bloqueo de los troncos nerviosos distales guiado por ultrasonidos puede ser una técnica sencilla, eficaz y segura para los pacientes sometidos a inyección palmar de toxina botulínica. La intensidad del dolor fue muy baja y proporcionó un grado de satisfacción muy bueno en la mayoría de los pacientes (AU)

ObjectiveEvaluation of pain and degree of satisfaction in patients undergoing ultrasound-assisted peripheral regional block for the treatment of idiopathic palmar hyperhidrosis with botulinum toxin.Patients and methodsA descriptive, observational study of patients with palmar hyperhidrosis treated with botulinum toxin A, who underwent ultrasound-guided peripheral regional block of the median and ulnar nerves with 3 ml of mepivacaine 1% in each one. The radial nerve block was injected in the anatomical snuffbox. After establishing blocking, the dermatologist performed a mapping and injected around 100 IU of botulinum toxin across the whole palm. The pain experienced during the injection of botulinum toxin was evaluated by verbal numerical scale (from 0 to 10), along with the degree of satisfaction with the anesthetic technique, and the post-anesthetic complications.ResultsA total of 40 patients were enrolled in the study, 11 men and 29 women with no significant differences. The pain intensity assessed with verbal numerical scale was 1.03 (standard deviation of 1.37). No patients had a value greater than 5. The degree of patient satisfaction with the anesthetic technique was very good for 85% of the patients, and good for 7.5%. There were no complications related to type of anesthesia.ConclusionsThe ultrasound-assisted peripheral regional block could be a simple, effective and safe technique for patients undergoing palmar injection of botulinum toxin. Pain intensity was very low, and it provided a very good level of satisfaction in most patients (AU)

[Ultrasound-guided peripheral nerve block at wrist level for the treatment of idiopathic palmar hyperhidrosis with botulinum toxin]. / Bloqueo de los nervios periféricos a nivel de la muñeca guiado por ecografía para el tratamiento de la hiperhidrosis idiopática palmar con toxina botulínica.

OBJECTIVE: Evaluation of pain and degree of satisfaction in patients undergoing ultrasound-assisted peripheral regional block for the treatment of idiopathic palmar hyperhidrosis with botulinum toxin. PATIENTS AND METHODS: A descriptive, observational study of patients with palmar hyperhidrosis treated with botulinum toxin A, who underwent ultrasound-guided peripheral regional block of the median and ulnar nerves with 3 ml of mepivacaine 1% in each one. The radial nerve block was injected in the anatomical snuffbox. After establishing blocking, the dermatologist performed a mapping and injected around 100 IU of botulinum toxin across the whole palm. The pain experienced during the injection of botulinum toxin was evaluated by verbal numerical scale (from 0 to 10), along with the degree of satisfaction with the anesthetic technique, and the post-anesthetic complications. RESULTS: A total of 40 patients were enrolled in the study, 11 men and 29 women with no significant differences. The pain intensity assessed with verbal numerical scale was 1.03 (standard deviation of 1.37). No patients had a value greater than 5. The degree of patient satisfaction with the anesthetic technique was very good for 85% of the patients, and good for 7.5%. There were no complications related to type of anesthesia. CONCLUSIONS: The ultrasound-assisted peripheral regional block could be a simple, effective and safe technique for patients undergoing palmar injection of botulinum toxin. Pain intensity was very low, and it provided a very good level of satisfaction in most patients.

Prevalencia de la depresión en pacientes con artritis reumatoide o espondilitis anquilosante / Prevalence of depression in patients with rheumatoid arthritis or ankylosing spondylitis

Objetivo: Estudiar la frecuencia de depresión en pacientes con artritis reumatoide y espondilitis anquilopoyética.Pacientes y métodos: Estudio transversal. Se estudiaron 164 pacientes con artritis reumatoide, 44 con espondilitis anquilopoyética y 143 controles vistos consecutivamente durante un año. Todos rellenaron los ítems del cuestionario Zung-Conde para el diagnóstico de la depresión, considerándose con depresión aquéllos cuya puntuación era mayor o igual a 48, normales si era menor o igual a 32 y como estado intermedio entre 33 y 47. Las medias de las puntuaciones en los tres grupos se compararon entre sí mediante el test de la t de Student.Resultados: En las artritis reumatoide, espondilitis anquilopoyética y grupo control, los resultados fueron, respectivamente: 19 por ciento, 32 por ciento y 59 por ciento normales; 43 por ciento, 50 por ciento, 35 por ciento en un estadio intermedio; 38 por ciento, 32 por ciento y 6 por ciento depresivos. La media de puntuación fue para la artritis reumatoide, espondilitis anquilopoyética y controles de 44ñ12,9 (rango 20-75); 39ñ9,6 (rango 20-59) y 31ñ9,5 (rango 20-61 ), respectivamente, con una p<0,001 para la artritis reumatoide y espondilitis anquilopoyética frente al grupo control.Conclusiones: Los pacientes con artritis reumatoide y espondilitis anquilopoyética padecen depresión con mayor frecuencia que la población general (AU)

[Angioma of the glans, report of 2 cases]. / Angioma del glande, a propósito de dos observaciones.

We present two cases of angioma of the glans penis and we reviewed this disease entity from a clinical and therapeutic points of view, classically understood as a proliferative process of a malformative nature. However, both cases that are described can be interpreted as true vascular tumors of a benign nature.

[Sexually transmitted recurrent urinary infection of the male]. / Infección urinaria recurrente del varón transmitida sexualmente.

We describe a case of recurrent urinary tract infection in a male patient that had been repeatedly associated with sporadic sexual intercourse with his partner. The timing of the episodes and the bacteriological findings indicate this to be another uncommon case of urinary tract infection sexually transmitted by the female to the male.

[Double renal tumor: histogenetic implications]. / Doble tumor renal: implicaciones histogenéticas.

Presentation of a new case of synchronic concurrence of renal adenocarcinoma and papillar carcinoma of renal pelvis on the same kidney. The origin of this double malignant renal tumour remains unknown, although several hypothesis have been raised. We believe that coexistence of both tumours is more than casual and we would underscore the morphogenetic interpretation of such coincidence.

Increased alanine aminotransferase (ALT-SGPT) activity in Puerto Rican blood donors.

Data was obtained from 4189 volunteer blood donation records in two hospital-based blood banks in Puerto Rico to determine whether Hispanics have higher serum alanine aminotransferase (ALT-SGPT) activity than donors from other racial-ethnic groups. The overall mean value of ALT-SGPT in the study population was 36.84 u/l (range 1-910, standard deviation 37.8). When the logarithm of ALT-SGPT (log ALT) was calculated for all subjects, the overall, mean for log ALT was 1.47 (range 1-2.96, standard deviation 0.27). Analysis of each blood bank's donation records at two different time periods showed a consistently high ALT-SGPT activity even when donations positive for hepatitis B surface antigen or other serologic markers were excluded. Though the causal factor of this finding is not clear, non-infectious environmental such as alcohol consumption should be considered as a probable explanation.

[Neuro-psychological disorders in hypothyroid dementia. Description of case]. / Trastornos neuropsicológicos de la demencia hipotiroidea. Descripción de un caso.

Hypothyroidism is one of the most frequent causes of treatable symptomatic dementia. However a detailed description of its neuropsychologic characteristics in the medical literature is lacking. We have studied a 70 year old patient suffering severe mental deterioration, cerebellopathy, myopathy and hypothyroidism with a complete set of neuropsychologic and psychometric tests: mental mini-examination, Blessed's scale, neuropsychologic examination, WAIS, Bento visual retention test, Rey's picture, words learning, delayed recall of words, verbal fluency, reaction times and maintained attention. This type of dementia is characterized by a low score in all tests which improves progressively with the treatment and it is also accompanied by a lack of language defects, nonconstructive apraxia or agnosia. The recovery involves the attentional field and the memory as well as the two intelligence indices. However this improvement is more apparent in the tests related to attention and visuospatial information processing. It is concluded that hypothyroid dementia in this patient had characteristics "subcortical dementia" and a neuropsychologic deterioration pattern rather nonspecific with a slight predominance of the attentional and visuospatial defects.