[Symptomatic osteosynthesis in calcaneal fracture: implant colonization as a cause of pain]. / Osteosíntesis sintomática en fractura de calcáneo: colonización de implante como causa del dolor.

Calcaneal fracture is unusual and carries high costs at long term because its associated morbidity. Surgical treatment of this fracture by extended lateral approach has risks like wound healing up to 20%. One of the causes of chronic pain is subtalar arthropathy, but it is important to rule out other causes as implant associated infection. The aim of this study is to demonstrate the presence of germs in the implant through extraction, sonication and culture. Cases with evident infection, subtalar arthropathy, non union or subtalar fusion concomitant surgery were excluded. The data includes open fracture history, wound healing complication, time between surgeries, cause to implant extraction and cultures results. A positive culture rate of 33.3% was obtained. We consider it is important to have in mind the implant associated infection as a cause of pain in these patients, with the aim to study microbiologically each case and choose the right strategy of treatment.

La fractura de calcáneo es poco frecuente y tiene altos costos asociados a largo plazo por su morbilidad asociada. El tratamiento quirúrgico de estas fracturas mediante la vía de abordaje lateral extendido tiene riesgos de complicación de herida quirúrgica que pueden superar 20%. Dentro de las causas del dolor secuelar, la más frecuente es la artropatía subtalar, pero se deben descartar otras como la infección asociada al implante. El objetivo de este estudio es determinar la presencia de gérmenes en el implante mediante su extracción, sonicación y cultivo. Se excluyeron los casos con clínica de infección, artropatía subtalar, seudoartrosis y cirugía de artrodesis subastragalina concomitante. Se registró antecedente de fractura expuesta, complicación de herida operatoria, tiempo entre cirugías, motivo de la ablación del implante y resultados de cultivos con los gérmenes identificados. Se obtuvo una tasa de cultivos positivos de 33.3%. Consideramos que es importante tener en cuenta la infección asociada al implante como causa del dolor en este tipo de pacientes, con el fin de estudiar microbiológicamente los casos y entregar el tratamiento adecuado cuando corresponda.

Osteosíntesis sintomática en fractura de calcáneo: colonización de implante como causa del dolor / Symptomatic osteosynthesis in calcaneal fracture: implant colonization as a cause of pain

Resumen: La fractura de calcáneo es poco frecuente y tiene altos costos asociados a largo plazo por su morbilidad asociada. El tratamiento quirúrgico de estas fracturas mediante la vía de abordaje lateral extendido tiene riesgos de complicación de herida quirúrgica que pueden superar 20%. Dentro de las causas del dolor secuelar, la más frecuente es la artropatía subtalar, pero se deben descartar otras como la infección asociada al implante. El objetivo de este estudio es determinar la presencia de gérmenes en el implante mediante su extracción, sonicación y cultivo. Se excluyeron los casos con clínica de infección, artropatía subtalar, seudoartrosis y cirugía de artrodesis subastragalina concomitante. Se registró antecedente de fractura expuesta, complicación de herida operatoria, tiempo entre cirugías, motivo de la ablación del implante y resultados de cultivos con los gérmenes identificados. Se obtuvo una tasa de cultivos positivos de 33.3%. Consideramos que es importante tener en cuenta la infección asociada al implante como causa del dolor en este tipo de pacientes, con el fin de estudiar microbiológicamente los casos y entregar el tratamiento adecuado cuando corresponda.

Abstract: Calcaneal fracture is unusual and carries high costs at long term because its associated morbidity. Surgical treatment of this fracture by extended lateral approach has risks like wound healing up to 20%. One of the causes of chronic pain is subtalar arthropathy, but it is important to rule out other causes as implant associated infection. The aim of this study is to demonstrate the presence of germs in the implant through extraction, sonication and culture. Cases with evident infection, subtalar arthropathy, non union or subtalar fusion concomitant surgery were excluded. The data includes open fracture history, wound healing complication, time between surgeries, cause to implant extraction and cultures results. A positive culture rate of 33.3% was obtained. We consider it is important to have in mind the implant associated infection as a cause of pain in these patients, with the aim to study microbiologically each case and choose the right strategy of treatment.

Controversias en fracturas de tobillo: ¿es diferente la visión del especialista en pie y tobillo? / Ankle fracture controversies: do the foot and ankle specialists have a different vision?

Objetivo. Analizar las diferencias en el manejo de las fracturas de tobillo entre cirujanos ortopédicos/traumatólogos y especialistas en enfermedad de pie y tobillo. Material y método. Se realizó una encuesta vía correo electrónico que planteaba cuestiones controvertidas a propósito del análisis de 5 casos clínicos de diferentes fracturas de tobillo a cirujanos ortopédicos del país. Resultados. Setenta y dos cirujanos respondieron la encuesta (tasa de respuesta del 24,2%): 37 especialistas en pie y tobillo y 35 cirujanos ortopédicos no especialistas. En el caso de la fractura trimaleolar, el 40,5% de los especialistas solicitarían una tomografía computarizada frente al 14% de los no especialistas (p=0,01). El 94% de todos los que respondieron sintetizaría el maléolo posterior; el 91% de los no especialistas, con tornillos vía anteroposterior, mientras que el 43% de los especialistas utilizarían la vía posteroanterior, bien con placa o con tornillos (p=0,006). No se hallaron diferencias entre grupos en el tratamiento de las lesiones sindesmales (p>0,05). En las fracturas transindesmales (B de Weber) con signos de inestabilidad medial, el 54% de los no especialistas revisarían el ligamento lateral interno frente a solo el 32% de los especialistas (p=0,06). Conclusiones. Los especialistas en pie y tobillo solicitan más pruebas complementarias para el diagnóstico de las fracturas de tobillo. A su vez, utilizan una mayor diversidad de técnicas quirúrgicas en la síntesis de los maléolos posterior (vía posterior-placas) y medial (cerclajes). Por último, indican una menor tasa de revisión del ligamento lateral interno (AU)

Objective. To analyse the differences in the management of ankle fractures between orthopaedic/trauma surgeons and foot and ankle specialists. Material and method. An e-mail survey was performed asking some of the country's orthopaedic surgeons controversial questions regarding the analysis of 5 clinical cases of different ankle fractures. Results. Seventy-two surgeons responded to the questionnaire (response rate of 24.2%): 37 foot and ankle specialists and 35 non-specialist orthopaedic surgeons. For trimalleolar fracture, 40.5% of the specialists would request a computed tomography scan compared to 14% of the non-specialists (P=.01). Ninety-four percent of all the respondents would synthesise the posterior malleolus; 91% of the non-specialists would use an antero-posterior approach, either with a plate or with screws (P=.006). No differences were found between groups in the treatment of syndesmotic injuries (P>.05). For trans-syndesmotic fracture (Weber B) with signs of medial instability, 54% of the non-specialists would revise the internal lateral ligament compared to only 32% of the specialists (P=.06). Conclusions. The foot and ankle specialists ask for more complementary tests to diagnose ankle fractures. In turn, they use a greater diversity of surgical techniques in synthesis of the posterior malleolus (posterior plate) and the medial malleolus (cerclage wires). Finally, they indicated a lower revision rate of the internal lateral ligament (AU)

Ankle fracture controversies: Do the foot and ankle specialists have a different vision? / Controversias en fracturas de tobillo: ¿es diferente la visión del especialista en pie y tobillo?

OBJECTIVE: To analyse the differences in the management of ankle fractures between orthopaedic/trauma surgeons and foot and ankle specialists. MATERIAL AND METHOD: An e-mail survey was performed asking some of the country's orthopaedic surgeons controversial questions regarding the analysis of 5 clinical cases of different ankle fractures. RESULTS: Seventy-two surgeons responded to the questionnaire (response rate of 24.2%): 37 foot and ankle specialists and 35 non-specialist orthopaedic surgeons. For trimalleolar fracture, 40.5% of the specialists would request a computed tomography scan compared to 14% of the non-specialists (P=.01). Ninety-four percent of all the respondents would synthesise the posterior malleolus; 91% of the non-specialists would use an antero-posterior approach, either with a plate or with screws (P=.006). No differences were found between groups in the treatment of syndesmotic injuries (P>.05). For trans-syndesmotic fracture (Weber B) with signs of medial instability, 54% of the non-specialists would revise the internal lateral ligament compared to only 32% of the specialists (P=.06). CONCLUSIONS: The foot and ankle specialists ask for more complementary tests to diagnose ankle fractures. In turn, they use a greater diversity of surgical techniques in synthesis of the posterior malleolus (posterior plate) and the medial malleolus (cerclage wires). Finally, they indicated a lower revision rate of the internal lateral ligament.

Effect of NSAIDs on the aminopeptidase activity of cultured human osteoblasts.

Aminopeptidases (APs) are involved in various physiological and pathological processes. In tumor tissues the expression of APs, cyclooxygenase-2 and its metabolites are increased. The objective was to determine the effect of certain NSAIDs on the AP activity of osteoblasts. Primary cultures of osteoblast were treated with different concentrations of indomethacin, meloxicam, naproxen, nimesulide, and piroxicam. The AP activity was fluorimetrically determined using aminoacyl-ß-naphthylamides (aa-ßNAs) as substrates: Ala-ßNA, Arg-ßNA, Gly-ßNA, Leu-ßNA, Lys-ßNA, Met-ßNA, and Phe-ßNA. The five NSAIDs showed an inhibitory effect of AP activity against the study substrates depending on the dose tested. Meloxicam and piroxicam had the highest inhibitory effect on enzymatic activity, with an IC50 of around 70 µM. Our results suggest that the physiological alteration of osteoblasts in the presence of NSAIDs may be a consequence of AP inhibition, suggesting a potential clinical role for these drugs against cancer in combination with chemotherapeutic agents.

X-ray survey for pulmonary tuberculosis and chest diseases in the Ok Tedi region of Western Province, Papua New Guinea.

X-ray photofluorography is a relatively expensive way to detect pulmonary tuberculosis (PTB). Those patients with suggestive positive chest X-ray still require Mantoux skin testing, blood tests and a positive sputum smear for the acid-fast bacillus Mycobacterium tuberculosis to make a definitive diagnosis of PTB. Photofluorography does detect most pulmonary pathological conditions, including lesions suggestive of PTB, and possible cardiac abnormalities. It is more cost-effective for large numbers in urban areas where there is poverty and overcrowding; and it is useful in early detection of cases of PTB. It is impractical to use in the isolated mountainous areas in the highlands region of Papua New Guinea and in Western Province, and where there is no road system. It cannot detect other forms of TB. In children and infants it is difficult to obtain good quality films and to interpret them. The scoring chart devised by Biddulph and Edwards is an excellent alternative where a diagnosis is not obvious in a chronically ill child. Active case detection by health workers in the field offers an excellent chance of finding TB cases. Although the cost of staining and looking at sputum smears and performing Mantoux tests can also be time consuming, these methods are relatively less expensive and more accurate. A simple method of processing sputum before Ziehl-Neelsen staining using ordinary household bleach vastly improves the detection rate of acid-fast bacilli. The new technology of demonstrating positive TB antigens in the blood of patients with active disease is still being assessed.

Consideraciones sobre hongos levaduriformes / Yeasts

Se examinaron 250 muestras de materiais fecales de adultos y niños, para determinar el número de colonias por gramo de materia fecal (peso húmedo), con su correspondiente tipificación. Mediante el interrogatorio previo se excluyeron aquellos individuos que presentaban molestias de cualquier tipo o que padecían manifestaciones alérgicas; la ingestión de antibióticos fue también tenida en cuenta. Si bien la literatura estima como valores normales de 5.000 a 10.000 colonias por gramo de materia fecal peso húmedo, nuestros valores son considerablemente menores (AU)

Consideraciones sobre hongos levaduriformes / Yeasts

Se examinaron 250 muestras de materiais fecales de adultos y niños, para determinar el número de colonias por gramo de materia fecal (peso húmedo), con su correspondiente tipificación. Mediante el interrogatorio previo se excluyeron aquellos individuos que presentaban molestias de cualquier tipo o que padecían manifestaciones alérgicas; la ingestión de antibióticos fue también tenida en cuenta. Si bien la literatura estima como valores normales de 5.000 a 10.000 colonias por gramo de materia fecal peso húmedo, nuestros valores son considerablemente menores

Relationship between skin reactions to common allergens and non-specific bronchial reactivity in young healthy subjects.

In patients with respiratory symptoms, several studies have provided data supporting the hypothesis that there is a casual relationship between allergen exposure and variations in bronchial reactivity. In order to determine if this relationship holds when atopy is defined only on the basis of positive skin tests to common allergens, we compared bronchial reactivity in a group of twelve healthy subjects with positive skin tests and twenty-eight healthy subjects with negative tests. The two groups were comparable in terms of gender, age, smoking habits and family history of atopic diseases. The slopes of the dose-response curves, using airway conductance as an index of response, were similar in the two groups. Thus, in this healthy group of subjects, there was no relationship between skin and bronchial reactivity. It can be hypothesized that, if genetic factors determine bronchial reactivity, such reactivity might not be revealed until skin-test positive subjects have received repeated bronchial stimulation through inhalant allergens.

Adjuvant effect on maintenance and escape from tolerence.

When mice are injected with deaggregated human gamma globulin (HGG), and HGG-tolerant state ordinarily is produced and persists despite subsequent challenges with an immunizing dose of HGG in saline or with an immunizing dose of HGG in Mycobacterium adjuvant. Subsequent administration of an immune elimination dose of radiolabeled HGG, at 27 days and 47 days does not break the tolerant state. Of special interest is the observation that when complete adjuvant containing increasing amounts of mycobacterial components was administered in conjunction with antigen very early in the tolerance induction phase 5 days after TID, it appears to prevent tolerance production. Mice challenged 5 and 17 days after the tolerance-inducing inoculation exhibit a statistically significant increase in circumvention of tolerance when compared with individuals challenged on the 7 and 17 day schedule. This increased circumvention of tolerance, as evidenced by 5 day challenge mice, seems to be related both to the mycobacterial content of the adjuvant and murine strain.