One-stage versus two-stage prosthesis replacement for prosthetic knee infections.

INTRODUCTION: Periprosthetic knee infection is a severe complication. Confirmed criteria are lacking to choose between one-stage or two-stage prosthesis replacement to treat the infection. The one-stage replacement could lead to a satisfactory control of the infection and to better functional results. METHOD: Retrospective study conducted between January 1, 2009 and December 31, 2014. The objectives of this study were to compare the infection outcome and functional results between the one-stage and two-stage replacement procedures. Functional results were evaluated using the IKS score, KOOS score, and SF-12 quality of life score. RESULTS: Forty-one patients underwent a two-stage replacement procedure and 21 patients a one-stage replacement. The average follow-up was 22 months after surgery. The infection was cured in 78% of patients who underwent a two-stage replacement and 90% of patients who underwent a one-stage replacement (P=0.3). The flexion range of motion was significantly better in the one-stage group than in the two-stage group (P=0.04). Results of the IKS score and of the KOOS score were better in the one-stage group. No difference was observed for the SF-12 score. CONCLUSION: The one-stage replacement procedure for periprosthetic knee infection was associated with a similar healing frequency as the two-stage replacement procedure, and with better knee function.

Uso del parche de lidocaína al 5% para el tratamiento del dolor postquirúrgico en cirugía de torax / The use of a 5% lidocaine patch for the treatment of postoperative pain in thoracic surgery

Una analgesia inadecuada en cirugia toracica facilita las complicaciones respiratorias potencialmente graves y se asocia al sindrome de dolor cronico post-toracotomia. El cateter epidural y el cateter paravertebral son los tratamientos que resultan mas efectivos, dentro de una estrategia multimodal. El parche de lidocaina 5 % esta indicado para el dolor en la neuropatia post-herpetica. Existe literatura sobre su utilidad en otros modelos de dolor. Presentamos tres pacientes con dolor postquirurgico en cirugía de torax, a pesar del tratamiento convencional, y su buena respuesta analgesica tres la aplicacion de parche de lidocaina 5% (AU)

Sub-optimal management of acute post-thoracotomy pain is associated to pulmonary complications and has been identified as an independent factor for a post-thoracotomy pain syndrome. Epidural analgesia and paravertebral catheter are the most effective in a multimodal analgesia regime. Lidocaine patch 5 % is for a treatment for post-herpetic neuralgia. Some literature suggests its use in other types of pain. We present three patients after different thoracic procedures with uncontrolled pain despite conventional treatment, and their good pain response to lidocaine patch 5 % (AU)

Terapia celular hepática en el tratamiento de las metabolopatías congénitas en niños / Liver cell therapy in the treatment of inborn errors of metabolism in children

El trasplante hepático (TH) es el único tratamiento efectivo existente para las enfermedades hepáticas en fase terminal. La desproporción entre demanda y oferta de órganos constituye su principal limitación, planteando la necesidad de buscar alternativas de tratamiento. El trasplante de hepatocitos humanos o trasplante celular hepático (TCH) constituye, en el momento actual, la mejor opción terapéutica puente al restablecimiento de la función hepática o al trasplante hepático. Consiste en trasplantar hepatocitos humanos totalmente diferenciados a un órgano receptor, en cantidad suficiente para que estos sobrevivan y restauren la función hepática normal, basándose en la capacidad de regeneración hepática. El TCH consta básicamente de 4 pasos: el aislamiento de los hepatocitos a partir de injertos hepáticos descartados para TH, la preparación de las suspensiones celulares, la criopreservación de los hepatocitos aislados y, finalmente, su implante en el receptor. Esta terapia se ha llevado a cabo en pacientes con insuficiencia hepática aguda de distintas etiologías con intención de sustituir o servir de puente al TH y en el tratamiento de pacientes pediátricos con errores congénitos del metabolismo con objetivo de reemplazar el déficit enzimático causante de la enfermedad. En el Hospital La Fe de Valencia hemos puesto en marcha una Unidad de Terapia Celular Hepática y llevado a cabo el primer TCH en España, abriendo una nueva línea de trabajo dentro del Programa de Trasplante Hepático (AU)

Liver transplantation has been remarkably effective in the treatment of patients with end-stage liver disease. However, disparity between solid-organ supply and increased demand is the main limitation, resulting in longer waiting times and an increase in the mortality of transplant recipients. This situation creates the need to seek alternatives to orthotopic liver transplantation. Hepatocyte transplantation or liver cell transplantation has been proposed as the best method to support patients, a bridge to restore liver function or liver transplant. The procedure consists in transplanting individual cells in a recipient organ in enough quantity to survive and restore the function. The capacity of hepatic regeneration constitutes the biological basis of hepatocyte transplantation. Liver cell transplantation is carried out by means of the isolation of hepatocytes from donor liver rejected for orthotopic transplantation, to prepare a cell suspension for infusion, cryopreservation and, finally, hepatocytes are implanted into the recipient. This may be an optional therapeutic procedure in some patients with inborn errors of metabolism, fulminant hepatic failure, and acute and chronic liver failure, as a bridge to orthotopic liver transplantation. The first hepatocyte transplantation in Spain was performed in the Cell Therapy Unit of the Hospital La Fe of Valencia, creating a new research line in the transplant program (AU)

[Liver cell therapy in the treatment of inborn errors of metabolism in children]. / Terapia celular hepática en el tratamiento de las metabolopatías congénitas en niños.

Liver transplantation has been remarkably effective in the treatment of patients with end-stage liver disease. However, disparity between solid-organ supply and increased demand is the main limitation, resulting in longer waiting times and an increase in the mortality of transplant recipients. This situation creates the need to seek alternatives to orthotopic liver transplantation. Hepatocyte transplantation or liver cell transplantation has been proposed as the best method to support patients, a bridge to restore liver function or liver transplant. The procedure consists in transplanting individual cells in a recipient organ in enough quantity to survive and restore the function. The capacity of hepatic regeneration constitutes the biological basis of hepatocyte transplantation. Liver cell transplantation is carried out by means of the isolation of hepatocytes from donor liver rejected for orthotopic transplantation, to prepare a cell suspension for infusion, cryopreservation and, finally, hepatocytes are implanted into the recipient. This may be an optional therapeutic procedure in some patients with inborn errors of metabolism, fulminant hepatic failure, and acute and chronic liver failure, as a bridge to orthotopic liver transplantation. The first hepatocyte transplantation in Spain was performed in the Cell Therapy Unit of the Hospital La Fe of Valencia, creating a new research line in the transplant program.

[High resolution MR imaging of the skin: normal imaging features]. / IRM haute résolution de la peau: aspects normaux.

PURPOSE: To describe the qualitative and quantitative MR imaging features of normal skin. MATERIALS AND METHODS: Thirty-one normal subjects underwent MR evaluation on a 1.5 Tesla magnet using a dedicated coil. Several skin sites were evaluated (back at the scapular level, posterior calf and inferior heel). Two pulse sequences were acquired: a SE T1W and a gradient-echo sequence (FIESTA). Qualitative and quantitative analysis was performed for all three sites. RESULTS: In normal subjects, the different skin layers (callus, epidermis, dermis, hypodermis and pilosebaceous follicles) can be separated and measured on MR. Epidermis and hypodermis are hyperintense whereas dermis is hypointense. Our results confirm the presence of qualitative and quantitative variations between different skin regions. In some cases, a differentiation between papillary and reticular dermis can be achieved. Pilosebaceous follicles and the deep vascular network were clearly depicted on the FIESTA sequence. Measurements for each skin layer were compared based on sex, site and MR pulse sequence. CONCLUSION: MRI provides evaluation of the different skin layers, epidermis, dermis, and hypodermis, and their different components.

The study of phenolic compounds as natural antioxidants in wine.

Plant phenolics present in fruit and vegetables, and that are particularly rich in red wine, have received considerable attention because of their potential antioxidant activity. Human consumption of antioxidants has many alleged health benefits, including protection against cardiovascular diseases, and, most recently, cancer. Red wines contain a variety of polyphenolic antioxidants. Five samples of commercial red wines from Spain and four phenolic compounds of red wine: gallic acid, trans-resveratrol, quercetin and rutin, have been studied. The total phenolics content and the total antioxidant activity (TAA) of wines was determined. The total phenolic content, determined according to the Folin-Ciocalteu method, varied from 1800 to 2300 mg/L, expressed as gallic acid equivalents (GAE). The antioxidative effects of wine phenolics were determined using a system based on the inhibition by antioxidants of the absorbance of the radical cation. The relationship between antioxidant activity of phenolic comounds, as hydrogen donating free radical scavengers, and their chemical structures was studied. Furthermore, the total antioxidant activity of the wines investigated was well correlated with phenol content. Thus, the results confirm that red wine polyphenols are, in vitro, significant antioxidants.

Efficacy and safety of a phytoestrogen preparation derived from Glycine max (L.) Merr in climacteric symptomatology: a multicentric, open, prospective and non-randomized trial.

A multicentric, open, prospective, observational and no-randomized clinical trial was carried out in Spain with 190 postmenopausal women receiving a soy preparation rich in isoflavones (PHYTO SOYA, capsules containing 17.5 mg isoflavones). The main object of the present study was to investigate its efficacy in alleviating the symptomatology derived from the lack of estrogen, mainly hot flushes, but also other symptoms such as sleep disorder, anxiety, depression, vaginal dryness, loss of libido and bone pain. Each patient received 35 mg isoflavones per day in two doses. During the four months' treatment, a statistically significant decrease in the number of hot flushes with PHYTO SOYA was experienced by 80.82% women; only 5,48% patients did not improve with the treatment. The average reduction was 47.8%, which is equivalent to 4 hot flushes. All the other studied parameters also showed a statistically significant decrease. No severe side-effects were reported and tolerance was excellent. Treatment with PHYTO SOYA resulted in a significant improvement of the symptomatology that accompanies the lack of estrogen during menopause.

Venous endothelial function in postmenopausal women after six months of tibolone therapy.

STUDY OBJECTIVE: To test venous endothelial function in long-term climateric therapy with tibolone. DESIGN: Measurement of dorsal hand-vein diameter by venous occlusion plethysmography during infusion of norepinephrine (NE), bradykinin (BK), NG-monomethyl L-arginine (L-NMMA) and sodium nitroprusside (SNP). SETTING: Plethysmography and Menopause Units. University Hospital Valdecilla. Santander. Spain. PATIENTS: Eleven postmenopausal women having continuous treatment with oral tibolone (2.5 mg/day) for 6 months. INTERVENTIONS: Three plethysmography studies were made: at baseline, and at three and six months of treatment. MAIN OUTCOME MEASURES: Dorsal hand-vein diameter measured by venous occlusion plethysmography during infusion of NE, BK, L-NMMA and SNP. RESULTS: (a) Baseline study: maximum dilation with BK was 54.2+/-10.2%. (b) Three-month study: BK dilation of 71.5+/-11.9%, with a significant increase of 17.3% (P=0.019) compared with baseline. (c) Six-month study: BK dilation of 77.5+/-11.9%, with a significant increase 23.3% (P=0.002) compared with baseline. Maximal vasodilation was reached with SNP in the three studies and L-NMMA infusion has a similar vasoconstrictor response in the three studies. CONCLUSIONS: Long-term climateric therapy with tibolone improves vein endothelium-dependent vasodilation suggesting a positive impact of this drug on endothelial function.

Venous endothelial function in postmenopausal women who are receiving long-term estrogen and progestagen therapy.

OBJECTIVE: To test venous endothelial function during long-term hormone replacement therapy (HRT) and after treatment withdrawal. DESIGN: Measurement of dorsal hand-vein diameter by venous occlusion plethysmography during infusion of norepinephrine, bradykinin, NG-monomethyl L-arginine, and sodium nitroprusside. SETTING: Plethysmography and menopause units, University Hospital Marqués de Valdecilla, Santander, Spain. PATIENT(S): Twenty postmenopausal women, of whom 10 were assigned to receive no hormone replacement therapy (HRT) for 6 months after plethysmography (group A) and 10 were assigned to receive HRT for 6 months (group B). After 6 months, HRT was administered to group A and withdrawn from group B for another 6 months. INTERVENTION(S): Plethysmography at baseline and at 6 and 12 months. MAIN OUTCOME MEASURE(S): Dorsal hand-vein diameter measured by venous occlusion plethysmography during infusion of norepinephrine, bradykinin, NG-monomethyl L-arginine, or sodium nitroprusside. RESULT(S): At 6 months, the maximum dilation obtained with bradykinin was 48.8 +/- 7.58% in group A and 76.7 +/- 12.9% in group B. At 12 months, maximum bradykinin dilation increased to 74.3 +/- 14.2% in group A and decreased to 54.0 +/- 15.9% in group B. CONCLUSION(S): Long-term HRT with estrogen plus progestin improves endothelium-dependent vasodilation, but this effect is lost in a relatively short time. Endothelial function in dorsal hand veins is an easy-to-use plethysmography model that can be used in serial studies.

Erythema elevatum diutinum associated with celiac disease: response to a gluten-free diet.

An 11-year-old girl with a history of insulin-dependent diabetes mellitus had erythema elevatum diutinum (EED) associated with a celiac disease related to a possible kidney disease. Dapsone did not improve the skin manifestations. However, the lesions disappeared after a gluten-free diet was begun. To our knowledge, this report describes the first case of EED in a patient with celiac disease.

Seasonal variations in plasma luteinizing hormone and testosterone levels in the European badger Meles meles L.

Although active spermatogenesis occurs throughout the year in the male European badger Meles meles L., seasonal fluctuations of testicular activity were observed. The present study compared the pattern of luteinizing hormone (LH) and testosterone (T) secretions throughout the annual cycle. LH secretion was investigated by means of a heterologous radioimmunoassay using anti-ovine LH beta antiserum and canine reference standard. Seasonal and nycthemeral changes in LH and T secretions were observed. During the year a period of maximal values for both hormones is well correlated with the breeding. Moreover, episodic LH releases occurs during the period of minimal testosterone values, indicating resumption of hypothalamo-pituitary activity well before the breeding period.

[Diagnostic errors in nephroblastoma]. / Errores diagnósticos en el nefroblastoma.

We review 37 patients diagnosed of Wilms' tumor at the Clinica Infantil "La Fe", in the last ten years, looking at the misdiagnosed cases. In two children, histological study showed a multilocular renal cyst. We also report a case previously diagnosed as being a multicystic kidney; the histological study revealed, however, a cystic partially differentiated nephroblastoma. No case of extrarenal tumors was present in the misdiagnosed patients. We comment the difficulties to make a correct diagnosis when confronted with the above mentioned entities and before histological data are available.

[Pharmacologic evaluation of penicillin in children with meningococcal meningitis]. / Evaluación farmacológica de la penicilina en niños con meningitis meningocócica.

Levels of penicillin both in blood and CSF are determined in 11 children with meningococcal meningitis. Authors compare these values with MIC. The therapeutic pattern was 500.000 Ul/Kg/day of benzylpenicillin, in six doses, with a single initial doses of 200.000 Ul/Kg. The results recommend not to use a lower doses in order to assure a permanently efficient penicillin concentration.

[Behavior, in organ culture, of inactive corpus luteum of the European badger (Meles meles L.)]. / Comportement en culture organotypique du corps jaune asthénique de Blaireau européen (Meles meles L.).

Badger luteal tissue fragments harvested and cultivated during the inactive phase do not resemble active corpus luteum as do granulosa cells in vitro. Production of oestrogen and progesterone by these fragments was examined. Amounts produced are much smaller than in the case of granulosa cells and are slightly influenced by the nature of the serum used in culture medium.

Plasma progesterone levels during delayed implantation in the European badger (Meles meles).

There was a biphasic pattern of progesterone secretion during the year. Delayed implantation was characterized by low concentrations from February to June, a significant (P less than 0.001) increase during July, August and September, and a return to low levels in October-November. A second significant increase (P less than 0.001) was observed in December and early January just before the presumed time of implantation.