The Menisco-Tibio-Popliteus-Fibular Complex: Anatomic Description of the Structures That Could Avoid Lateral Meniscal Extrusion.

PURPOSE: To analyze, quantify, and redefine the anatomy of the peripheral attachments of the lateral meniscal body to further understand how the structures might play a part in preventing meniscal extrusion and how it might be applied to surgical techniques. METHODS: Ten nonpaired fresh-frozen cadaveric knees without prior injury, a surgical history, or gross anatomic abnormality were included. There were 5 right and 5 left knees, and 50% were from male donors and 50% were from female donors. All the dissections were performed by a group of 3 experts in knee surgery (2 knee surgeons and 1 anatomy professor who oversaw the design of the dissection protocol and guided this protocol). The main peripheral structures associated with the lateral meniscus body were dissected to determine the insertion, size, thickness, and location of the lateral meniscotibial ligament (LMTL), popliteofibular ligament (PFL), and popliteomeniscal ligament (PML). The distance to various landmarks in the lateral compartment was also determined using an electronic caliper. Moreover, a histopathologic study was carried out. RESULTS: The average thickness of the LMTL was 0.62 ± 0.18 mm (95% confidence interval [CI], 0.49-0.75 mm); that of the PFL-PML area was 1.05 ± 0.27 mm (95% CI, 0.85-1.24 mm). The anteroposterior distance measured 15.80 ± 4.80 mm (95% CI, 12.40-19.30 mm) for the LMTL and 10.40 ± 1.70 mm (95% CI, 9.21-11.63 mm) for the PFL-PML area. The anteroposterior distance of the whole menisco-tibio-popliteus-fibular complex (MTPFC) was 28.20 ± 4.95 mm (95% CI, 24.70-31.70 mm). The average distance from the MTPFC to the posterior horn of the lateral meniscal root was 29.30 ± 2.29 mm (95% CI, 27.60-30.90 mm), whereas that to the anterior horn was 32.00 ± 4.80 mm (95% CI, 28.60-35.50 mm). The average distance from the tibial insertion of the LMTL to the articular surface was 5.59 ± 1.22 mm (95% CI, 4.72-6.46 mm). In all the anatomic components of the knee, a consistent morphologic and histologic pattern was observed between the fibers of the LMTL, PFL, and PML and those of the lateral meniscal body, making up the proposed MTPFC. CONCLUSIONS: A consistent anatomic pattern has been identified between the lateral meniscal body and the LMTL, PFL, and PML, forming an interconnected complex that would seem appropriate to denominate the MTPFC. A precise study of this region and appropriate nomenclature for it could contribute to a better understanding of the mechanism of lateral meniscal injuries at this level, as well as the development of surgical techniques to treat these lesions and prevent extrusion. CLINICAL RELEVANCE: This study contributes to the understanding of the lateral meniscal body attachments and the functions they serve. This will lead to improvements in the treatment of lesions in this region, including the development of surgical techniques.

Rehabilitación oral maxilar y mandibular con prótesis híbridas, utilizando implantes convencionales de una y dos fases e implantes zigomáticos en paciente con displasia ectodérmica. Caso clínico

La rehabilitación oral de un paciente edéntulo, especialmente con reabsorción severa, no deja de ser un reto para el clínico. En múltiples casos se requiere de procedimientos adicionales como injertos óseos con el objetivo de obtener volumen óseo y, finalmente, poder colocar los implantes dentales. En este artículo se aborda un caso de un paciente con displasia ectodérmica, el cual tiene algunas piezas dentales incluidas y reabsorción ósea severa. Se practicó exodoncias múltiples y la colocación de implantes dentales y zigomáticos, esto con el fin de eliminar los injertos óseos y poder realizar una rehabilitación bimaxilar de menor morbilidad, costo y tiempo.

The edentulous patient and his oral rehabilitation, specially with severe bone reabsorption is really a challenge for the clinician. In many situations the clinician requires additional procedures such as bone grafting in order to gain bone volume and finally be able to place the dental implants. In this article, we describe a patient with ectodermic dysplasia, who has some impacted teeth and severe bone reabsorption. In this case multiple dental extractions were performed and the placement of zygomatic implants with propose to avoid any bone grafting and be able to rehabilitated the patient at much less morbility, less cost and time.

Deep gluteal space problems: piriformis syndrome, ischiofemoral impingement and sciatic nerve release.

BACKGROUND: Deep gluteal syndrome (DGS) is an underdiagnosed entity characterized by pain and/or dysesthesias in the buttock area, hip or posterior thigh and/or radicular pain due to a non-discogenic sciatic nerve entrapment in the subgluteal space. Multiple pathologies have been incorporated in this all-included "piriformis syndrome", a term that has nothing to do with the presence of fibrous bands, obturator internus/gemellus syndrome, quadratus femoris/ischiofemoral pathology, hamstring conditions, gluteal disorders and orthopedic causes. METHODS: This article describes the subgluteal space anatomy, reviews known and new etiologies of DGS, and assesses the role of the radiologist and orthopaedic surgeons in the diagnosis, treatment and postoperative evaluation of sciatic nerve entrapments. CONCLUSION: DGS is an under-recognized and multifactorial pathology. The development of periarticular hip endoscopy has led to an understanding of the pathophysiological mechanisms underlying piriformis syndrome, which has supported its further classification. The whole sciatic nerve trajectory in the deep gluteal space can be addressed by an endoscopic surgical technique. Endoscopic decompression of the sciatic nerve appears useful in improving function and diminishing hip pain in sciatic nerve entrapments, but requires significant experience and familiarity with the gross and endoscopic anatomy. LEVEL OF EVIDENCE: IV.

MEDICIÓN DEL EQUILIBRIO LIQUIDO-VAPOR DEL SISTEMA METANOL-ACETATO DE METILO A 580 mmHg / EXPERIMENTAL LIQUID VAPOUR EQUILIBRIUM OF THE BINARY SYSTEM METHANOL-METHYL ACETATE AT 580 mmHG

En este trabajo se midió experimentalmente el equilibrio líquido vapor para el sistema binario Metanol - Acetato de Metilo a 580 mmHg. Las mediciones experimentales fueron realizadas utilizando un equipo con recirculación tipo Cottrell. Los datos obtenidos fueron comparados con los resultados adquiridos de la simulación del equilibrio líquido vapor del sistema bajo estudio. En la simulación se empleó el modelo de actividad NRTL para representar la no idealidad de la fase líquida (con parámetros encontrados en la literatura), y la ecuación de estado de Hayden O´Connel para la no idealidad de la fase vapor. De igual manera, se correlacionaron los datos para encontrar nuevos parámetros del modelo de actividad en NRTL. Además, a partir de datos experimentales medidos a 760 mmHg encontrados en la literatura para el sistema estudiado, se verificó la ley de Vresky, la cual permite sin necesidad de cálculos rigurosos predecir la dirección de desplazamiento de un azeótropo binario cunado se varía la presión del sistema.

In this work the liquid - vapor binary equilibrium for the system Methanol - Methyl Acetate was measured at 580 mmHg using equipment with recirculation that also can be employed for reactive mixtures. The obtained data was compared with liquid vapor equilibrium prediction employing NRTL activity model for the liquid phase (using parameters found in the literature) and the Hayden O´Connel's equation of state for the non ideality of vapor phase. New parameters of NRTL activity model were obtained. The Vresky law that permits without rigorous calculations to predict qualitatively the displacement of binary azeotropes by pressure changes was confirmed, using various experimental data that is reported in the literature for this system at 760 mm Hg.

Traqueostomía percutánea por dilatación: experiencia con 30 pacientes electivos en Unidad de Cuidados Intensivos (UCI) / Dilatational percutaneus tracheostomy: experience with 30 elective patients at Intensive Care Units

En los últimos años, la traqueostomía percutáanea por dilatación se ha perfeccionado hasta convertirse en una herramienta útil, eficaz y de bajo riesgo en el manejo definitivo de la vía aérea en pacientes con intubación prolongada en la unidad de cuidados intensivos, siendo una alternativa a la técnica quirúrgica. En el presente artículo se muestra la experiencia del grupo de vía aérea de la Universidad de Antioquia-Hospital Universitario San Vicente de Paul y se describe la técnica utilizada actualmente para realizar este procedimiento.