Randomized and Open Trial to Assess the Effectiveness of the Guided Pelvic Floor Exercises Pre-Radical Robotic Prostatectomy on the Improvement of Urinary Incontinence. Initial Results

Introduction and Objectives: Radical prostatectomy has an impact on urinary continence. Many factors are involved in continence. The objective of this study is evaluate the effect of guided Pelvic Floor Exercises prior to robotic radical prostatectomy (RRP) on the rate of urinary incontinence compared with written information. Material and Method: randomized study of 62 patients who are waiting for PRR. They were rondomized in two groups: experimental group (exercises guided by a physiotherapist) or a control group (written information). Primary objective was the continence rate measured by pad test and ICIQ-SF one month after the intervention, Secondary objectives were incontinence severity, quality of life with SF-36 and KHQ questionnaires and the correlation between incontinence and quality of life. Results: We found no differences in continence rate between groups after the intervention. We found differences in “emotional problems” and “personal relationships”, in favor of the control group. There is a correlation between the amount of urine leakage and age, urgency and all the domains of the KHQ questionnaire except general quality of life, as well as in the areas “energy/fatigue” and “social function” of the SF-36. Conclusions: Physiotherapist-guided exercises before RRP do not seem to offer advantages compared to written information, in terms of the incontinence rate and its severity one month after the surgery. Urinary incontinence is correlated with age, urgency, and deterioration in quality of life (AU)

Introducción y Objetivos: La prostatectomía radicaltiene un gran impacto en la continencia urinaria. Muchosfactores intervienen en la continencia. El objetivo de esteestudio es evaluar el efecto en la tasa de incontinencia deorina de los Ejercicios de Suelo Pélvicos guiados previos ala prostatectomía radical robótica (PRR), frente a la información escrita.Material y Método: Ensayo clínico en el que se incluyen 62 pacientes en lista de espera para PRR, aleatorizándolos a un grupo experimental (ejercicios guiados porfisioterapeuta) o control (información escrita). El objetivoprimario fue la tasa de continencia medida por test de compresa y el cuestionario ICIQ-SF al mes de la intervención,Fueron objetivos secundarios, la severidad de incontinencia, la calidad de vida con cuestionarios SF-36 y KHQ, y lacorrelación entre la incontinencia y la calidad de vida.Resultados: No encontramos diferencias en la tasade incontinencia entre los grupos tras la intervención. Encontramos diferencias en “problemas emocionales” y “relaciones personales”, a favor del grupo control. Existe correlación entre la cantidad de las pérdidas de orina y la edad,la urgencia miccional y todos los dominios del cuestionarioKHQ excepto la calidad de vida general, así como en lasáreas “energía/fatiga” y “función social” del SF-36.Conclusiones: Los ejercicios guiados por fisioterapeuta antes de PRR no parecen ofrecer ventajas frente ala información escrita, en la tasa de incontinencia y severidad de la misma al mes de la intervención. La incontinenciade orina se correlaciona con la edad, la urgencia miccionaly el deterioro en la calidad de vida. (AU)

RENORT: a project to analyze patterns of care in radiation oncology in Spain

PurposeRENORT is an application (app) developed to assess the role of radiotherapy in the treatment of cancer using the oncology information systems (OIS).Methods/PatientsThe RENORT app was used to analyze the data for all patients seen and/or treated at six radiation oncology departments in Spain in 2019. This app can be used to extract the demographic data, treatment sequence, disease status, and radiotherapy treatments from the ARIA and Mosaiq OIS.ResultsA total of 6564 treatments were performed at these six centers in 2019. Most patients (56.9%) were males (females 43.1%). The mean patient age was 64.9 years. The most common treatment types and sites were as follows: metastases/palliative care (25.9%), followed by breast (19.0%), genitourinary (13.7%), lung (10.1%), head and neck (6.0%), rectal (6.0%), gynecological (4.9%), and other (< 4%) cancers. Distribution by disease stage was as follows: breast cancer: 75.5% early stage (stages 0, I, and II); lung: 63.1% advanced stage (III and IV); and head and neck: 72.1% advanced. Treatment intent was curative in 76.5% of cases and palliative in 23.5%. The most common techniques were intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) (41.4%), followed by three-dimensional conformal radiation therapy (3D-CRT) (39.2%); stereotactic body radiotherapy (SBRT) (8.1%); brachytherapy (5.5%); radiosurgery (2.1%); fractionated stereotactic radiotherapy to the brain (1.4%); and intraoperative radiotherapy (1.4%). Hypofractionation was used in 62.3% of curative treatments (mean number of fractions = 16.5).ConclusionsRENORT is a free app that is available for the two main oncology information systems used in most radiation oncology departments. This app has demonstrated the capacity to extract data from these systems, which in turns allows for a comprehensive analysis and better understanding of the role of radiotherapy in the treatment of cancer.

Hiperplasia endotelial papilar intravascular (tumor Masson) de localización ginecológica / Intravascular papillary endothelial hyperplasia (Masson's tumour) of gynaecological origin

La hiperplasia papilar endotelial intravascular o tumor de Masson es una lesión vascular no neoplásica de carácter reactivo. Se caracteriza por ser un tumor poco frecuente, clínicamente inespecífico y con localizaciones descritas muy diversas. Resulta fundamental tenerlo en consideración dentro del diagnóstico diferencial de los tumores vasculares malignos como el angiosarcoma, cuyo pronóstico es muy diferente. Para lograr su diagnóstico definitivo el estudio anatomopatológico resulta primordial. El tratamiento de elección es la exéresis quirúrgica asegurando márgenes libres de enfermedad. El presente caso reportado supone un hecho excepcional, al ser un tumor de Masson de localización pélvica, cuyo diagnóstico fue un hallazgo casual propiciado por el estudio de estadificación quirúrgica de un adenocarcinoma de ovario.

Intravascular papillary endothelial hyperplasia or Masson's tumour is a non-neoplastic vascular lesion of reactive character. It is a rare diagnosis, clinically non-specific and with diverse locations. It is essential to take it into consideration and make a differential diagnosis with malignant vascular tumours such as angiosarcoma. Pathological study is fundamental for diagnosis. Treatment consists of complete resection of the tumour, including sufficiently wide margins to avoid recurrence.The case reported is an exceptional event, because of the pelvic location of the Masson's tumour that was diagnosed as part of the surgical staging of an ovarian cancer.

RENORT: a project to analyze patterns of care in radiation oncology in Spain.

PURPOSE: RENORT is an application (app) developed to assess the role of radiotherapy in the treatment of cancer using the oncology information systems (OIS). METHODS/PATIENTS: The RENORT app was used to analyze the data for all patients seen and/or treated at six radiation oncology departments in Spain in 2019. This app can be used to extract the demographic data, treatment sequence, disease status, and radiotherapy treatments from the ARIA and Mosaiq OIS. RESULTS: A total of 6564 treatments were performed at these six centers in 2019. Most patients (56.9%) were males (females 43.1%). The mean patient age was 64.9 years. The most common treatment types and sites were as follows: metastases/palliative care (25.9%), followed by breast (19.0%), genitourinary (13.7%), lung (10.1%), head and neck (6.0%), rectal (6.0%), gynecological (4.9%), and other (< 4%) cancers. Distribution by disease stage was as follows: breast cancer: 75.5% early stage (stages 0, I, and II); lung: 63.1% advanced stage (III and IV); and head and neck: 72.1% advanced. Treatment intent was curative in 76.5% of cases and palliative in 23.5%. The most common techniques were intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) (41.4%), followed by three-dimensional conformal radiation therapy (3D-CRT) (39.2%); stereotactic body radiotherapy (SBRT) (8.1%); brachytherapy (5.5%); radiosurgery (2.1%); fractionated stereotactic radiotherapy to the brain (1.4%); and intraoperative radiotherapy (1.4%). Hypofractionation was used in 62.3% of curative treatments (mean number of fractions = 16.5). CONCLUSIONS: RENORT is a free app that is available for the two main oncology information systems used in most radiation oncology departments. This app has demonstrated the capacity to extract data from these systems, which in turns allows for a comprehensive analysis and better understanding of the role of radiotherapy in the treatment of cancer.

Perforación intestinal tras ablación por radiofrecuencia de mioma uterino. Reporte de caso y revisión bibliográfica / Intestinal perforation after transvaginal radiofrequency ablation of uterine leiomyoma. Case report and literature review

El mioma uterino es la tumoración pélvica más frecuentemente diagnosticada en mujeres en edad reproductiva. En los últimos años se ha producido una búsqueda de tratamientos mínimamente invasivos que permitan conservar el útero. La ablación por radiofrecuencia vía transvaginal permite el tratamiento de los miomas uterinos de forma segura y efectiva.Presentamos un inusual caso clínico de perforación intestinal tras la ablación por radiofrecuencia de dos miomas y presentamos una revisión de la literatura existente en relación a esta complicación de la técnica.

Uterine leiomyoma are the most common pelvic tumours diagnosed in women of reproductive age. In recent years, the search for minimally invasive treatment that allows women to preserve their uterus has resulted in transvaginal radiofrequency ablation. This procedure is safe and effective.We present a case report of intestinal perforation after transvaginal radiofrequency ablation of two uterine leiomyomas. Finally, we present a review of the literature in relation to this complication of the technique.

Mastitis granulomatosa: desafío diagnóstico y terapéutico en paciente joven / Granulomatous mastitis: A diagnostic and therapeutic challenge in young people

La mastitis granulomatosa idiopática es una rara enfermedad que afecta sobre todo a mujeres jóvenes. Supone un importante desafío diagnóstico y terapéutico al presentarse en ocasiones como una lesión mamaria indicativa de malignidad. No se conoce su etiología ni existen pruebas de imagen que permitan diagnosticar con certeza la enfermedad, requiriendo de un estudio anatomopatológico para confirmar el diagnóstico. El tratamiento puede ir desde la mera observación, pasando por la toma prolongada de corticosteroides orales, hasta la cirugía. Dado que esta dolencia es infrecuente en la práctica clínica, no existen protocolos unificados acerca del mejor tratamiento y seguimiento de las pacientes. Presentamos un caso de mastitis granulomatosa idiopática diagnosticado en nuestro centro, así como el tratamiento propuesto y el seguimiento realizado. Por último, revisamos la literatura existente en relación con esta infrecuente entidad.

Granulomatous mastitis is an uncommon disease that primarily affects young women. It represents a diagnostic and therapeutic challenge, as it might be confused with breast carcinoma. There are no mammographic or ultrasonographic findings that correlate imaging features with histological results. Therapeutic management of this disease can range from simple observation to long-term corticosteroid treatment or surgery. Because granulomatous mastitis is infrequent in clinical practice, there are no standardised protocols regarding the best treatment and follow-up for these patients. We present the case of a women diagnosed in our department, and her treatment and follow-up. We also selectively examine the available literature to support our case.

Sugammadex in systemic mastocytosis : Case report and a systematic review of literature.

Perioperative management in patients suffering from systemic mastocytosis is challenging. Most recommendations regarding anesthetic management in these patients are based on clinical reports, and there are controversies about the use of rocuronium and sugammadex. We present a case report of a patient with systemic mastocytosis who was given sugammadex for rocuronium reversal. Tryptase levels were monitored during the first postoperative 24 h, without evidence of elevation. We also performed a systematic review to provide an overview of current evidence regarding the safety of using sugammadex in patients suffering from systemic mastocytosis. The search strategy included PubMed and Google Scholar. All studies published up to and including January 2021 concerning anesthetic management in systemic mastocytosis were included. Of the 122 articles located, 9 articles were included: 2 reviews and 7 case reports. Data from reviewed studies confirm that sugammadex can safely be administered in patients suffering from systemic mastocytosis.

Cellular immunotherapy: a clinical state-of-the-art of a new paradigm for cancer treatment.

Cancer immunotherapy has opened a new chapter in Medical Oncology. Many novel therapies are under clinical testing and some have already been approved and implemented in cancer treatment protocols. In particular, cellular immunotherapies take advantage of the antitumor capabilities of the immune system. From dendritic cell-based vaccines to treatments centered on genetically engineered T cells, this form of personalized cancer therapy has taken the field by storm. They commonly share the ex vivo genetic modification of the patient's immune cells to generate or induce tumor antigen-specific immune responses. The latest clinical trials and translational research have shed light on its clinical effectiveness as well as on the mechanisms behind targeting specific antigens or unique tumor alterations. This review gives an overview of the clinical developments in immune cell-based technologies predominantly for solid tumors and on how the latest discoveries are being incorporated within the standard of care.

Descriptive retrospective study analyzing relevant factors related to dental implant failure.

BACKGROUND: The objective of this retrospective descriptive study was to analyze the characteristics of incident reports provided by dentists while using a specific brand of dental implants. MATERIAL AND METHODS: The study was carried out in collaboration with Oxtein Iberia S.L., with the company providing access to the incident database in order to evaluate the characteristics of incidents from January 2014 to December 2017 (a total of 917 over four years). The data sheet recorded different variables during each of the stages of implant treatment, from initial implant placement to subsequent prosthetic rehabilitation. These variables included age, sex, systemic pathologies, smoking habits, bone quality, implant type, prosthesis type, and type of load applied, among others. SPSS Statistics was used to perform statistical analysis of the qualitative variables (univariate logistic regressions, χ2 test, Haberman's adjusted standardized residuals). RESULTS: The total study sample consisted of 44,415 implants shipped from Oxtein warehouses on the dates indicated, of which 917 implants (2.1%) were flagged due to reports of lack of primary stability, failed osseointegration, or implant failure within one year of placement. When analyzing incident reports, it was observed that 61.6% of incidents occurred in male patients, compared to 38.4% in female patients. The average age of patients in the reported cases was 56.12 ± 12.15 years. A statistically significant correlation was discovered between incidents of implant failure and tobacco use, diabetes, heart disease, poor oral hygiene, previous infection, poor bone quality, and bruxism (p < 0.05). A (statistically significant) higher rate of incidents was also observed in tapered, internal connection, Grade IV titanium, narrow, and short implants. CONCLUSIONS: Analysis of these implants reveals a higher rate of complication in short, tapered, internal connection and narrow-diameter implants. These data can help and encourage clinicians to use the utmost surgical precautions when placing these implants.

Non-motor symptoms burden, mood, and gait problems are the most significant factors contributing to a poor quality of life in non-demented Parkinson's disease patients: Results from the COPPADIS Study Cohort.

OBJECTIVE: To identify factors related to a poor health-related and global quality of life (QoL) in a cohort of non-demented Parkinson's disease (PD) patients and compare to a control group. METHODS: The data correspond to the baseline evaluation of the COPPADIS-2015 Study, an observational, 5-year follow-up, multicenter, evaluation study. Three instruments were used to assess QoL: (1) the 39-item Parkinson's disease Questionnaire (PDQ-39), (2) a subjective rating of global QoL (PQ-10), and (3) the EUROHIS-QOL 8-item index (EUROHIS-QOL8). Multiple linear regression methods were used to evaluate the direct impact of different variables on these QoL measures. RESULTS: QoL was worse in PD patients (n = 692; 62.6 ±â€¯8.9 years old, 60.3% males) than controls (n = 206; 61 ±â€¯8.3 years old, 49.5% males): PDQ-39, 17.1 ±â€¯13.5 vs 4.4 ±â€¯6.3 (p < 0.0001); PQ-10, 7.3 ±â€¯1.6 vs 8.1 ±â€¯1.2 (p < 0.0001); EUROHIS-QOL8, 3.8 ±â€¯0.6 vs 4.2 ±â€¯0.5 (p < 0.0001). A high correlation was observed between PDQ-39 and Non-Motor Symptoms Scale (NMSS) (r = 0.72; p < 0.0001), and PDQ-39 and Beck Depression Inventory-II (BDI-II) (r = 0.65; p < 0.0001). For health-related QoL (PDQ-39), non-motor symptoms burden (NMSS), mood (BDI-II), and gait problems (Freezing Of Gait Questionnaire [FOGQ]) provided the highest contribution to the model (ß = 0.32, 0.28, and 0.27, respectively; p < 0.0001); whereas mood and gait problems contributed the most to global QoL (PQ-10, ß = -0.46 and -0.21, respectively; EUROHIS-QOL8, ß = -0.44 and -0.23, respectively). CONCLUSIONS: QoL is worse in PD patients than in controls. Mood, non-motor symptoms burden, and gait problems seem to be the most relevant factors affecting health-related and global perceived QoL in non-demented PD patients.

Time for radioimmunotherapy: an overview to bring improvements in clinical practice.

Harnessing the patient's own immune system against an established cancer has proven to be a successful strategy. Within the last years, several antibodies blocking critical "checkpoints" that control the activation of T cells, the immune cells able to kill cancer cells, have been approved for the use in patients with different tumours. Unfortunately, these cases remain a minority. Over the last years, radiotherapy has been reported as a means to turn a patient's own tumour into an in situ vaccine and generate anti-tumour T cells in patients who lack sufficient anti-tumour immunity. Indeed, review data show that the strategy of blocking multiple selected immune inhibitory targets in combination with radiotherapy has the potential to unleash powerful anti-tumour responses and improve the outcome of metastatic solid tumours. Here, we review the principal tumours where research in this field has led to new knowledge and where radioimmunotherapy becomes a reality.

Prophylactic use of non-invasive mechanical ventilation in lung resection.

OBJECTIVE: To evaluate if the prophylactic application of BiPAP previous to lung resection and 17 hours postoperatively improves respiratory function. In order to do this, we studied the results of arterial blood gases and portable spirometry in the immediate postoperative period and at the first and third postoperative day. Secondary objectives included evaluating whether this same pattern decreases the incidence of postoperative pulmonary complications (PPC) and hospital stay. PATIENTS AND METHODS: This was a prospective, randomized clinical study. Between January 2012 and June 2013, 50 patients who had undergone lung resection with posterolateral thoracotomy were assigned to one of two groups by a random number generator according to whether or not they would receive prophylactic BiPAP pre- and postoperatively. RESULTS: The results of the gasometric and spirometric values were similar in both groups. There were no statistically significant differences (p > 0.05). There was not a decrease in the incidence of PPC in the group that received prophylactic BiPAP. Likewise, postoperative stay was similar in both groups. The BiPAP group was 6.60 ± 4 days and the non BiPAP group was 6.84 ± 3.94 days (p = 0.63). CONCLUSIONS: One drawback of this work was the limited number of hours that BiPAP was employed, and when compared to other studies, the application of low-pressure support. We did not find any significant differences between using prophylactic BiPAP or not, suggesting that such treatment should not be performed indiscriminately. More investigations are needed with a larger number of patients in order to better evaluate the possible benefits of using prophylactic BiPAP in thoracic surgery.

Gene therapy approaches in the non-human primate model of Parkinson's disease.

The field of gene therapy has recently witnessed a number of major conceptual changes. Besides the traditional thinking that comprises the use of viral vectors for the delivery of a given therapeutic gene, a number of original approaches have been recently envisaged, focused on using vectors carrying genes to further modify basal ganglia circuits of interest. It is expected that these approaches will ultimately induce a therapeutic potential being sustained by gene-induced changes in brain circuits. Among others, at present, it is technically feasible to use viral vectors to (1) achieve a controlled release of neurotrophic factors, (2) conduct either a transient or permanent silencing of any given basal ganglia circuit of interest, (3) perform an in vivo cellular reprogramming by promoting the conversion of resident cells into dopaminergic-like neurons, and (4) improving levodopa efficacy over time by targeting aromatic L-amino acid decarboxylase. Furthermore, extensive research efforts based on viral vectors are currently ongoing in an attempt to better replicate the dopaminergic neurodegeneration phenomena inherent to the progressive intraneuronal aggregation of alpha-synuclein. Finally, a number of incoming strategies will soon emerge over the horizon, these being sustained by the underlying goal of promoting alpha-synuclein clearance, such as, for instance, gene therapy initiatives based on increasing the activity of glucocerebrosidase. To provide adequate proof-of-concept on safety and efficacy and to push forward true translational initiatives based on these different types of gene therapies before entering into clinical trials, the use of non-human primate models undoubtedly plays an instrumental role.

Análisis de la vulnerabilidad a infecciones respiratorias integrando metodologías / Multidisciplinary analysis of the vulnerability to severe respiratory infections in the infancy

Existen estudios que buscan determinantes clínicos, epidemiológicos y sociosanitariosde la vulnerabilidad ante enfermedades respiratorias graves de lainfancia y estudios de epidemiología molecular para caracterizar cepas circulantesdel Virus Sincicial Respiratorio (VSR). Sin embargo, pocos trabajos intentan integrarambos tipos de información sobre la misma población en estudio.ObjetivosEstablecer mapas de seguimiento espacio-temporal de cepas del VSR mediantesecuencias específicas y relacionar su diseminación con aspectos de vulnerabilidadindividual o del contexto epidemiológico o socio-sanitario.MétodosSe incorporan al estudio pacientes pediátricos internados con presentacióncompatible con IRAB en los cuatro centros de salud, se completa una encuestaque incluye más de 60 entradas recopilando datos clínicos, demográficos y sociosanitarios.Se colectan muestras de aspirado nasofaringeo para ser sometidas aun análisis rutinario de detección de patógenos virales y su posterior análisis desecuencia en caso de tratarse de VSR.ResultadosAl momento de la última centralización de muestras se han colectado 1105muestras de las cuales 248 fueron positivas para algún agente viral por IFI. De estas200 (80,6%) han resultados positivas para VSR. Las tendencias analizadas comoestacionalidad, edades, datos socio sanitarios fueron los típicos para los agentesinvolucrados y las muestras están siendo actualmente sometidas a los estudiosmoleculares propuestos.ConclusionesLas conclusiones finales integrando toda la información serán el resultado deanálisis que comenzarán al finalizar la colección de muestras (10 de Julio de2015), la carga de datos y las tareas de secuenciación para establecer marcadoresmoleculares de cepa (firmas moleculares). Los datos de firma molecular permitirántrazar orígenes y vías de diseminación, lo cual, integrado con datos clínicos,sanitarios y de hábitat permitirán señalar zonas y situaciones de vulnerabilidad.

Disección aórtica crónica tipo A en un paciente con obesidad mórbida y preeclampsia / Type A chronic aortic dissection with obesity and preeclampsia

La disección aórtica es una dolencia potencialmente letal, con una incidencia en la gestante hasta 100 veces superior comparada con la de la población adulta. Suele presentarse con un cortejo típico caracterizado por dolor torácico. Presentamos el caso de una mujer de 37 años con antecedente gestacional y obesidad mórbida, diagnosticada de disección aórtica crónica tipo A por un hallazgo radiológico documentado a los 10 meses posparto (AU)

Aortic dissection is a potentially lethal disease whose incidence in pregnant women can be up to 100 times that of the remaining adult population. In most cases, it presents as typical chest pain. We report the case of a 37yo obese woman diagnosed with chronic type A aortic dissection documented by a radiological finding 10 months after delivery (AU)

Type A chronic aortic dissection with obesity and preeclampsia. / Disección aórtica crónica tipo A en un paciente con obesidad mórbida y preeclampsia.

Aortic dissection is a potentially lethal disease whose incidence in pregnant women can be up to 100 times that of the remaining adult population. In most cases, it presents as typical chest pain. We report the case of a 37yo obese woman diagnosed with chronic type A aortic dissection documented by a radiological finding 10 months after delivery.

Bioremoval of arsenic (V) from aqueous solutions by chemically modified fungal biomass.

The biosorption of arsenic (V) on nine chemically modified biomasses (with iron oxide coated) of mycelia fungi: Aspergillus flavus III, IV and V, Aspergillus fumigatus I-II, Paecilomyces sp., Cladosporium sp., Mucor sp-1 and 2 was studied in this work. This study provides evidence that the biomasses of the fungi A. flavus, IV, III and V, Paecilomyces sp., and A. fumigatus I were very efficient at removing 1 mg/L of the metal in solution, using atomic absorption spectroscopy (AAS), achieving the following percentage of removals: 97.1, 92.3, 90.3, 89.0, and 83.4%, respectively. The results of adsorption were obtained at pH 6.0, 30 °C after 24 h of incubation, with 1 g/100 mL of fungal biomass. These results suggest the excellent potential of almost all isolated strains for bioremediation and removal of metals from contaminated sites.

[Pulmonary function assessment in juvenile idiopathic scoliosis managed with posterior instrumentation with a sublaminar hook system]. / Evaluación de la función pulmonar en escoliosis idiopática del adolescente manejado con instrumentación posterior con sistema de ganchos sublaminares.

INTRODUCTION: Scoliosis is a spine deformity diagnosed using Cobbs method when the AP X-ray view shows an angulation greater than 10º. Scoliosis exceeding 50º results in restrictive pulmonary alterations. Surgical management improves the angulation and the pulmonary restrictive process. The pre- and post-operative pulmonary function values were compared using spirometry. MATERIAL AND METHODS: 27 patients of both genders, ages 11-15 years, underwent corrective surgery using posterior instrumentation with sublaminar hooks, rods and posterolateral arthrodesis. Spirometry was done preoperatively and six months after the surgery. Patients without a postoperative spirometry and/or a postoperative episode of pulmonary infection were excluded. The pre- and postoperative Cobb index was calculated. Spirometry: lung function at forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). Descriptive statistics, Student t test. RESULTS: Females, 78%; males, 22%; 13.7 ± 1.22 years. Cobb method 40 - 110º, preoperative angle 64.48 ± 17.79º and postoperative angle 30.44 ± 10.90º. There were no 0º values. Lung function: preoperative FVC for the values of the scoliosis curve (p 0.0001) and significant marginal FEV1 (p = 0. Baseline: 40.6-122.0%, mean: 76.3 ± 18.8%, postoperative: 40.75-112.6%, mean: 76.5 ± 16.8%. Preoperative FEV1: 39.8-111.59%, mean: 73.9 ± 16.8%, postoperative: 42.86-120.79%, mean: 69.7 ± 16.5. The difference was statistically significant, 0.064). CONCLUSIONS: The sublaminar hook system with a posterior approach provides improvement of the idiopathic scoliosis curve of adolescents assessed with the Cobb method. It stops the progression of lung function impairment, with a significant improvement in forced expiratory volume in one second.

La escoliosis es una deformidad de la columna vertebral; se diagnostica por el método de Cobb presentando una angulación mayor de 10º en proyección radiográfica anteroposterior. Produce alteraciones pulmonares de tipo restrictivo en angulaciones mayores a 50º. Su manejo puede ser quirúrgico, mejorando la angulación y el proceso restrictivo pulmonar. Se comparó la función pulmonar pre- y postquirúrgica con espirometría.

Evaluación de la función pulmonar en escoliosis idiopática del adolescente manejado con instrumentación posterior con sistema de ganchos sublaminares / Pulmonary function assessment in juvenile idiopathic scoliosis managed with posterior instrumentation with a sublaminar hook system

Resumen: Introducción: La escoliosis es una deformidad de la columna vertebral; se diagnostica por el método de Cobb presentando una angulación mayor de 10o en proyección radiográfica anteroposterior. Produce alteraciones pulmonares de tipo restrictivo en angulaciones mayores a 50o. Su manejo puede ser quirúrgico, mejorando la angulación y el proceso restrictivo pulmonar. Se comparó la función pulmonar pre- y postquirúrgica con espirometría. Material y métodos: 27 pacientes, cirugía correctiva mediante instrumentación posterior con ganchos sublaminares, barras y artrodesis posterolateral. Ambos géneros. 11-15 años. Espirometría prequirúrgica y postquirúrgica a los seis meses. Fueron excluidos quienes carecían de espirometría postquirúrgica y/o aquéllos con evento infeccioso pulmonar postquirúrgico. Índice de Cobb, pre- y postquirúrgico. Espirometría: función pulmonar, la capacidad vital forzada (VCF) y el volumen espiratorio forzado en un segundo (FEV1). Estadística descriptiva, t Student. Resultados: Femenino 78% y masculino 22%, 13.7 ± 1.22 años. Método de Cobb 40 a 110o; prequirúrgico, 64.48 ± 17.79o y postquirúrgico, 30.44 ± 10.90o. No hubo valor de 0o. Capacidad pulmonar: prequirúrgico VCF para los valores de la curva de escoliosis (p < 0.0001) y significativa marginal para FEV1 (p = 0; inicial 40.6-122.0%, media 76.3 ± 18.8%; postquirúrgico 40.75-112.6%, media 76.5 ± 16.8%. FEV1 prequirúrgico 39.83-111.59%, media 73.9 ± 16.8%; post­quirúrgico 42.86-120.79%, media de 69.7 ± 16.5. Diferencia estadísticamente significativa 0.064). Conclusiones: El sistema de ganchos sublaminares en abordaje posterior ofrece mejoría de la curva de la escoliosis idiopática del adolescente evaluada por método de Cobb, detiene el progreso del deterioro de la función pulmonar, con mejoría significativa para el volumen espiratorio forzado en un segundo.

Abstract: Introduction: Scoliosis is a spine deformity diagnosed using Cobb's method when the AP X-ray view shows an angulation greater than 10o. Scoliosis exceeding 50o results in restrictive pulmonary alterations. Surgical management improves the angulation and the pulmonary restrictive process. The pre- and post-operative pulmonary function values were compared using spirometry. Material and methods: 27 patients of both genders, ages 11-15 years, underwent corrective surgery using posterior instrumentation with sublaminar hooks, rods and posterolateral arthrodesis. Spirometry was done preoperatively and six months after the surgery. Patients without a postoperative spirometry and/or a postoperative episode of pulmonary infection were excluded. The pre- and postoperative Cobb index was calculated. Spirometry: lung function at forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). Descriptive statistics, Student t test. Results: Females, 78%; males, 22%; 13.7 ± 1.22 years. Cobb method 40 - 110o, preoperative angle 64.48 ± 17.79o and postoperative angle 30.44 ± 10.90º. There were no 0o values. Lung function: preoperative FVC for the values of the scoliosis curve (p < 0.0001) and significant marginal FEV1 (p = 0. Baseline: 40.6-122.0%, mean: 76.3 ± 18.8%, postoperative: 40.75-112.6%, mean: 76.5 ± 16.8%. Preoperative FEV1: 39.8-111.59%, mean: 73.9 ± 16.8%, postoperative: 42.86-120.79%, mean: 69.7 ± 16.5. The difference was statistically significant, 0.064). Conclusions: The sublaminar hook system with a posterior approach provides improvement of the idiopathic scoliosis curve of adolescents assessed with the Cobb method. It stops the progression of lung function impairment, with a significant improvement in forced expiratory volume in one second.