"Validation of a spanish version of the 'Unité Rhumatologique Des Affections De La Main' (URAM) scale".

BACKGROUND: In health care, quality-of-life surveys and questionnaires related to care are becoming increasingly important as a measure of its quality. There is currently no Spanish version of the Unité Rhumatologique des Affections de la Main (URAM) scale, which makes it suitable for hand pathology. The purposes of this study are to develop a Spanish version of the URAM and perform a transcultural adaptation of it, analyzing the result for reliability, validity, and sensitivity to changes. METHODS: The questionnaire was evaluated for patients with Dupuytren's disease and Carpal Tunnel Syndrome. The cohort study subjects were interviewed at three points in time (baseline, three days after intervention, and one month after), administering the QuickDASH, URAM, and SF-12 (CF12 = physical component, CM12 = mental component) questionnaires at baseline and after intervention; and only the URAM at 3 days. Content validity was evaluated using Cronbach's α. The distribution of the factorial loads of the items and the pattern of the answers were checked. Responsiveness was evaluated by the size of the effect and the reliable rate of change. Convergent and divergent validity was performed using Spearman's r between the different questionnaires. RESULTS: The study was conducted with 106 patients. The mean baseline scores were: URAM = 14.8, QuickDASH = 41.6, CF12 = 39.3 and CM12 = 49.4. Ceiling or floor effects were not observed in the Spanish URAM. The Cronbach α = 0.853 explains 49.6% of the variance. The study had a high reproducibility (intraclass correlation coefficient (ICC) = 0.939). Size effect, measured as differences in scores, was moderate for URAM (-0.69) and QuickDASH (-0.51); and low for CF12 and CM12. The correlation of URAM with QuickDASH was high (r = 0.716), and moderate with DD and CTS. CONCLUSION: The Spanish version of the URAM is a valid and reliable tool for use in assessing hand pathology.

Arthroscopic transosseous rotator cuff repair: how to avoid damaging the axillary nerve-a cadaveric study.

INTRODUCTION: Arthroscopic transosseous rotator cuff repair can be performed with an external guide, although the proximity to the axillary nerve raises safety concerns. The aim of this study is to determine the safety of different drilling angles regarding the axillary nerve. MATERIALS AND METHODS: We performed a bone tunnel in the greater tuberosity in 17 fresh frozen shoulders, using an external guide at four different angles: 40°, 50°, 60°, and 70°. At each angle, we measured the distance between the drill and the axillary nerve, the distance from the acromion to the skin incision point, and the perimeter of the arm at the axilla. RESULTS: The distance to the axillary nerve was safe with the guide at an angle of 40°, 50° and 60°, but not at 70° (p = 0.001). We found significant differences between all four angles (p < 0.05). Regression analysis demonstrated the influence of the guide angle in all measurements assessed (p < 0.001). There was no association between the measurements taken and the axillary perimeter (p > 0.5). CONCLUSIONS: Arthroscopic transosseous rotator cuff repair with an external guide does not pose a risk for the axillary nerve using angles of 60° or less.

Recurrent Dupuytren's disease after fasciectomy and collagenase injection are histologically indistinguishable.

The aim of this study was to determine whether recurrent Dupuytren's disease after collagenase Clostridium histolyticum treatment differs histologically from recurrence in those treated with fasciectomy. We carried out a prospective cohort study of patients with Dupuytren's disease who underwent fasciectomy to treat disease recurrence after previous treatment with collagenase Clostridium histolyticum or fasciectomy. The pathologists and statistician were blinded to the previous treatment. Longitudinal biopsy sections were stained with haematoxylin-eosin and the nodular zones were examined. Fifteen patients were studied: nine previously treated with collagenase Clostridium histolyticum and six previously treated with fasciectomy. There were no histological differences between the samples from the two groups of patients. Dupuytren's disease recurrences after fasciectomy and collagenase Clostridium histolyticum are histologically indistinguishable.

Utilidad de una escala de riesgo basada en la procalcitonina sérica para la discriminación temprana entre fascitis necrosante y celulitis de las extremidades / Usefulness of a risk scale based on procalcitonin for early discrimination between necrotising fasciitis and cellulitis of the extremities

Fundamento y objetivo: Valorar la utilidad de una la escala de riesgo basada en la procalcitonina sérica (PCT) comparada con la escala Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) en la discriminación precoz entre la fascitis necrosante (FN) y la celulitis en las extremidades. Material y método: Estudio retrospectivo de pacientes consecutivos con diagnóstico confirmado de FN en una extremidad (n=11). Ese grupo de estudio fue comparado con 23 pacientes consecutivos con diagnóstico de celulitis severa en miembros en el mismo periodo. Se analizaron los datos clínicos y los parámetros rutinarios de laboratorio, siendo la variable principal el nivel sérico de PCT al ingreso. La capacidad de discriminación para el diagnóstico de FN de los dos métodos -nivel de PCT y puntuación de la escala LRINEC- fue evaluada mediante la curva COR y determinada por el cálculo del área bajo la curva (ABC). Resultados: El ABC fue significativamente mayor con la medición de la PCT, tanto como variable continua como cuando el riesgo era categorizado. El punto de corte para el nivel de PCT con mayor ABC bajo la curva fue a partir de 0,87ng/ml (sensibilidad 90,9%; especificidad 82,6%), mientras que alcanzaba una puntuación de 5 en la escala LRINEC (sensibilidad 72,7%; especificidad 82,6%). Conclusión: La medición de la PCT fue un método más efectivo que la escala LRINEC para discriminar precozmente entre FN y celulitis de las extremidades. Un nivel bajo de PCT, asociado al cuadro clínico y a la exploración física, es de especial utilidad para descartar el diagnóstico precoz de FN

Background and objective: To assess the usefulness of a risk scale based on serum procalcitonin (PCT) compared to the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) scale in the early discrimination between necrotising fasciitis (NF) and cellulitis of the extremities. Materials and methods: Retrospective study of consecutive patients with confirmed diagnosis of NF in one limb (n=11). This study group was compared with 23 consecutive patients with a diagnosis of severe limbs cellulitis during the same period. The clinical data and laboratory parameters were analysed, the main variable was the serum level of PCT upon admission. The capacity for NF diagnosis of the two methods, PCT level and LRINEC scale score, were evaluated by ROC curve and determined by the calculation of the area under the curve (AUC). Results: The AUC was significantly higher with PCT measurement, both as a continuous variable and when the risk was categorised. The cut-off point for the PCT level with the highest AUC under the curve was from 0.87ng/ml (sensitivity 90.9%, specificity 82.6%), whereas it was a score of 5 on the LRINEC scale (sensitivity 72.7%, specificity 82.6%). Conclusion: PCT measurement was a more effective method than the LRINEC score for early discrimination between NF and cellulitis of the extremities. A low level of PCT, associated with the patient's clinical status and physical examination is especially useful to rule out an early diagnosis of NF

Usefulness of a risk scale based on procalcitonin for early discrimination between necrotising fasciitis and cellulitis of the extremities. / Utilidad de una escala de riesgo basada en la procalcitonina sérica para la discriminación temprana entre fascitis necrosante y celulitis de las extremidades.

BACKGROUND AND OBJECTIVE: To assess the usefulness of a risk scale based on serum procalcitonin (PCT) compared to the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) scale in the early discrimination between necrotising fasciitis (NF) and cellulitis of the extremities. MATERIALS AND METHODS: Retrospective study of consecutive patients with confirmed diagnosis of NF in one limb (n=11). This study group was compared with 23 consecutive patients with a diagnosis of severe limbs cellulitis during the same period. The clinical data and laboratory parameters were analysed, the main variable was the serum level of PCT upon admission. The capacity for NF diagnosis of the two methods, PCT level and LRINEC scale score, were evaluated by ROC curve and determined by the calculation of the area under the curve (AUC). RESULTS: The AUC was significantly higher with PCT measurement, both as a continuous variable and when the risk was categorised. The cut-off point for the PCT level with the highest AUC under the curve was from 0.87ng/ml (sensitivity 90.9%, specificity 82.6%), whereas it was a score of 5 on the LRINEC scale (sensitivity 72.7%, specificity 82.6%). CONCLUSION: PCT measurement was a more effective method than the LRINEC score for early discrimination between NF and cellulitis of the extremities. A low level of PCT, associated with the patient's clinical status and physical examination is especially useful to rule out an early diagnosis of NF.

Necesitamos revisar las heridas en dorso de mano y antebrazo / Nécessité de la mise en charge des blessures du dos de la main et l'avant-bras / It is necessary to inspect the wounds in hand dorsum and forearm

INTRODUCCIÓN: Las lesiones en dorso de mano son urgencias frecuentes de un hospital. Estudiar la relación existente entre la clínica inicial y la afectación tendinosa subyacente en heridas localizadas en esta región. Así como valorar la localización exacta, tipo, y etiología de ellas, por medio de un estudio observacional. MÉTODOS: Se realizó un estudio transversal, en el que se valoran 51 pacientes con 55 heridas en dorso de mano y antebrazo, tratadas en urgencias de nuestro hospital durante el periodo de junio a diciembre de 2009. RESULTADOS: La exploración inicial nos ofrece una especificidad y un valor predictivo positivo del 100 por ciento, pero una sensibilidad del 17,14 por ciento y un valor predictivo negativo del 40,81 por ciento con respecto a la presencia de lesión tendinosa. CONCLUSIÓN: Ante la falta de correlación entre la clínica inicial con una posible lesión tendinosa extensora recomendamos la exploración quirúrgica de las heridas en dorso de mano, por su sencillez y aprovechamiento del acto quirúrgico(AU)

INTRODUCTION: Injuries in hand dorsum are frequent hospital emergences. It is necessary to study the relation between initial clinics and the tendinous injuries underlying in wounds present in this region, as well to assess its exact location, the type and etiology through observational study. METHODS: A cross-sectional study was conducted to assess 15 patients presenting with wounds in the hand dorsum and forearm, treated in emergency room of our hospital from June to December, 2009. RESULTS: The initial screening offer us a specificity and a positive predictive value of the 100 percent, but a sensitivity of 17,4 percent and a negative predictive value of 40,81 percent regarding the presence of the tendinous injury. CONCLUSION: Due to a lack of correlation between the initial clinics and a possible extensor tendinous injury, it is recommended the surgical exploration of hand dorsum injuries due to its simplicity and use of surgical act(AU)

INTRODUCTION: Les lésions du dos de la main sont des urgences fréquentes d'un hôpital. Le but de cette étude est d'étudier la relation existant entre la clinique initiale et l'affection tendineuse sous-jacente des blessures localisées à cette région, et d'évaluer la localisation exacte, le type et l'étiologie par une étude observationnelle. MÉTHODES: Une étude transversale, portant sur 51 patients atteints de blessures (55) au dos de la main et l'avant-bras, et traités au service des urgences de notre hôpital entre juin et décembre 2009, a été réalisée. RÉSULTATS: L'exploration initiale nous montre une spécificité et une valeur pronostique positive de 100 percent, mais une sensibilité de 17,14 percent et une valeur pronostique négative du 40,81 percent par rapport à la présence des lésions tendineuses. CONCLUSIONS: Devant l'absence de corrélation entre la clinique initiale et une possible lésion du tendon extenseur, il est conseillé de faire une exploration chirurgicale des blessures du dos de la main, car elle est simple et très utile(AU)