Piomiositis de los obturadores tratada con drenaje percutáneo guiado por ecografía en un niño. Presentación de un caso / Obturator pyomyositis in a pediatric patient resolved by ultrasound-guided percutaneous drainage. Case report

El objetivo de esta presentación es dar a conocer el manejo de la miositis piógena del músculo obturador interno en un paciente pediátrico que fue tratado mediante un drenaje percutáneo guiado por ecografía. Se trata de un niño de 5 años de edad, con manifestaciones clínicas y valores de laboratorio de infección muscular profunda en el obturador interno. Se identificó específicamente con resonancia magnética, es un área de difícil acceso quirúrgico, por lo cual se realizó un tratamiento percutáneo guiado por ecografía que permitió drenar el contenido purulento de la zona afectada. La resonancia magnética hizo posible lograr un diagnóstico más acertado en los casos de infección piógena temprana y, a su vez, decidir la vía de abordaje más adecuada. En ocasiones, se puede optar por la guía ecográfica con la cual se evita el abordaje quirúrgico formal y así disminuyen las complicaciones de la herida y la mayor morbimortalidad. La adición de procedimientos percutáneos guiados por imágenes es una herramienta muy útil para tratar enfermedades infecciosas y una gran ayuda para el ortopedista. Nivel de Evidencia: V

The objective of this case report is to present the management of a case of pyogenic myositis of the obturator muscle in a pediatric patient using ultrasound-guided percutaneous drainage. The patient is a 5-year-old pediatric patient with clinical and laboratory manifestations of deep muscular infection at the obturator level, an area of difficult surgical access, for which the least invasive treatment possible was used to drain purulent content from the affected area. The use of magnetic resonance imaging studies allows for a more accurate diagnosis in cases of early pyogenic infection, as well as determining the most effective approach to treatment. In some cases, ultrasound guidance can be used to avoid a formal surgical approach, reducing wound complications and morbidity and mortality. The addition of image-guided percutaneous procedures is a very useful tool for the treatment of infectious diseases and a great help to the orthopedist. Level of Evidence: V

Técnica de Livani-Belangero (MIPO) en el tratamiento de las fracturas diafisarias de húmero. Experiencia latinoamericana en tres centros hospitalarios / Belangero-Livani Technique (MIPO) in the treatment of humeral shaft fractures. A Latin American experience in three medical centers

Objetivo: Evaluar los datos demográficos, como edad, sexo, profesión, lado afectado, lesión única o múltiple, tipo de material utilizado, tiempo de cicatrización ósea y posibles complicaciones de los pacientes con fracturas diafisarias de húmero tratados mediante la técnica MIPO en tres centros hospitalarios de Ecuador, Paraguay y Brasil. Materiales y Métodos: Estudio retrospectivo, longitudinal, observacional de los datos de 133 pacientes recolectados en tres Servicios: de Quito (Ecuador), Asunción (Paraguay) y Passo Fundo (Brasil). Se compararon las distribuciones entre diferentes Servicios mediante la prueba x2 de Pearson. Resulta-dos: La edad de los pacientes varió entre 17 y 76 años, con una media de 36 años. El tiempo promedio hasta la consolidación fue de 11 semanas (126 de 132 pacientes). Predominó el sexo masculino (70,45%), el lado derecho era el más afectado (55,3%), la mayoría de las fracturas eran únicas (85,61%), se logró la consolidación en el 95,45%. Solo el 9,09% tuvo complicaciones y el 6,82% fueron severas. El 87,12% no tuvo complicaciones; el 0,76% sufrió neuropraxia posquirúrgica; el 3,03%, infección y el 4,55%, seudoartrosis. Conclusión: Con la técnica MIPO para el tratamiento de las fracturas diafisarias de húmero, las tasas de complicaciones y de morbilidad son bajas, y la tasa de consolidación es buena. Nivel de Evidencia: IV

Objective: To determine the demographic data of the patients in relation to age, sex, profession, affected side, single or multiple lesions, type of material used, bone healing time and possible complications of the treatment of diaphyseal fractures of the humerus treated using the MIPO technique in a series of patients from three hospital units in Ecuador, Paraguay, and Brazil. Materials and Methods: A retrospective, longitudinal, observational study of data from 133 patients collected in 3 services in Quito, Ecuador; Asunción, Paraguay; and Passo Fundo, Brazil. The distributions between different services were compared using Pearson's chisquare test. Results: The age of the patients ranged from 17 to 76 years, with a mean of 36 years. The median time to union which occurred in 126 of the 132 patients, was 11 weeks. Most of the patients were male (70.45%), the right side was the most affected (55.3%), most of the fractures were single (85.61%), consolidation occurred in 95.45% of cases, complications occurred only in 9.09% of patients, 6.82% of them were severe. In relation to complications, they were divided according to the absence (87.12%) or presence of the following: post-surgical neuropraxia (0.76%), infection (3.03%), and pseudarthrosis (4.55%). Conclusion: The MIPO technique for the treatment of diaphyseal fractures of the humerus presents low rates of complications and morbidity, demonstrating good rates of consolidation. Level of Evidence: IV

Synthesis and spectroscopic and structural characterization of spiro[indoline-3,3'-indolizine]s formed by 1,3-dipolar cycloadditions between isatins, pipecolic acid and an electron-deficient alkene.

Five new spiro[indoline-3,3'-indolizine]s have been synthesized with high regio- and stereospecificity in one-pot three-component reactions between a substituted indole-2,3-dione, (S)-pipecolic acid and trans-3-benzoylacrylic acid, and subsequently characterized using a combination of elemental analysis, IR and 1H and 13C NMR spectroscopy, mass spectrometry and crystal structure analysis. (1'SR,2'SR,3RS,8a'RS)-2'-Benzoyl-5-fluoro-2-oxo-1',5',6',7',8',8a'-hexahydro-2'H-spiro[indoline-3,3'-indolizine]-1'-carboxylic acid, C23H21FN2O4, (I), and (1'SR,2'SR,3RS,8a'RS)-2'-benzoyl-5-methyl-2-oxo-1',5',6',7',8',8a'-hexahydro-2'H-spiro[indoline-3,3'-indolizine]-1'-carboxylic acid, C24H24N2O4, (II), are isomorphous, as are (1'SR,2'SR,3RS,8a'RS)-2'-benzoyl-1-methyl-2-oxo-1',5',6',7',8',8a'-hexahydro-2'H-spiro[indoline-3,3'-indolizine]-1'-carboxylic acid, C24H24N2O4, (III), and (1'SR,2'SR,3RS,8a'RS)-2'-benzoyl-5-chloro-1-methyl-2-oxo-1',5',6',7',8',8a'-hexahydro-2'H-spiro[indoline-3,3'-indolizine]-1'-carboxylic acid, C24H23ClN2O4, (IV). Within each isomorphous pair, the spiro ring systems show some conformational differences. In each of (I) and (II), the molecules are linked into complex sheets by a combination of four types of hydrogen bond, and in each of (III) and (IV), a combination of O-H...O and C-H...π(arene) hydrogen bonds links the molecules to form a chain of centrosymmetric rings. In (1'SR,2'SR,3RS,8a'RS)-2'-benzoyl-1-hexyl-2-oxo-1',5',6',7',8',8a'-hexahydro-2'H-spiro[indoline-3,3'-indolizine]-1'-carboxylic acid, C29H34N2O4, (V), a combination of five hydrogen bonds links the molecules into sheets of alternating R22(16) and R66(46) rings. A mechanism is proposed for the formation of compounds (I)-(V) and some comparisons with related structures are made.

Regio- and stereospecific assembly of dispiro[indoline-3,3'-pyrrolizine-1',5''-thiazolidines] from simple precursors using a one-pot procedure: synthesis, spectroscopic and structural characterization, and a proposed mechanism of formation.

The synthesis and characterization of three new dispiro[indoline-3,3'-pyrrolizine-1',5''-thiazolidine] compounds are reported, together with the crystal structures of two of them. (3RS,1'SR,2'SR,7a'SR)-2'-(4-Chlorophenyl)-1-hexyl-2''-sulfanylidene-5',6',7',7a'-tetrahydro-2'H-dispiro[indoline-3,3'-pyrrolizine-1',5''-thiazolidine]-2,4''-dione, C28H30ClN3O2S2, (I), (3RS,1'SR,2'SR,7a'SR)-2'-(4-chlorophenyl)-1-benzyl-5-methyl-2''-sulfanylidene-5',6',7',7a'-tetrahydro-2'H-dispiro[indoline-3,3'-pyrrolizine-1',5''-thiazolidine]-2,4''-dione, C30H26ClN3O2S2, (II), and (3RS,1'SR,2'SR,7a'SR)-2'-(4-chlorophenyl)-5-fluoro-2''-sulfanylidene-5',6',7',7a'-tetrahydro-2'H-dispiro[indoline-3,3'-pyrrolizine-1',5''-thiazolidine]-2,4''-dione, C22H17ClFN3O2S2, (III), were each isolated as a single regioisomer using a one-pot reaction involving L-proline, a substituted isatin and (Z)-5-(4-chlorobenzylidene)-2-sulfanylidenethiazolidin-4-one [5-(4-chlorobenzylidene)rhodanine]. The compositions of (I)-(III) were established by elemental analysis, complemented by high-resolution mass spectrometry in the case of (I); their constitutions, including the definition of the regiochemistry, were established using NMR spectroscopy, and the relative configurations at the four stereogenic centres were established using single-crystal X-ray structure analysis. A possible reaction mechanism for the formation of (I)-(III) is proposed, based on the detailed stereochemistry. The molecules of (I) are linked into simple chains by a single N-H...N hydrogen bond, those of (II) are linked into a chain of rings by a combination of N-H...O and C-H...S=C hydrogen bonds, and those of (III) are linked into sheets by a combination of N-H...N and N-H...S=C hydrogen bonds.

Tratamiento de fractura subtrocantérica multifragmentaria de alta energía en niño mediante osteosíntesis con placa de reconstrucción. Reporte de caso / Treatment of a high-energy multifragmentary subtrochanteric fracture in a child using osteosynthesis with a reconstruction plate. Case report

El objetivo del estudio es dar a conocer el uso del método de osteosíntesis mediante placa de reconstrucción moldeada para tratar fracturas subtrocantéricas pediátricas. Se trató a un paciente pediátrico de 7años de edad con el diagnóstico de fractura subtrocantérica de trazo multifragmentario producto de un trauma de alta energía. Fue intervenido mediante osteosíntesis con una placa 4,5 convencional moldeada colocada mediante técnica mínimamente invasiva. El modelo de la fijación derivó del propuesto por Moustafa. Se realizó planificación preoperatoria, tratamiento quirúrgico y seguimiento clínico y radiológico por consulta externa cada 2semanas hasta apreciar consolidación clínica y radiológica. Además, se registró si existió o no dolor, acortamiento patológico, pérdida de reducción o aparición de alguna complicación. Se logró obtener consolidación clínica y radiológica completa al cabo de 6semanas, dolor mínimo, no existió acortamiento residual de la extremidad, no existió pérdida de reducción y tampoco se dieron complicaciones. El método propuesto podría llegar a ser la mejor alternativa para tratar este grupo específico de pacientes en los que el antecedente de la lesión por alta energía y la característica del trazo fracturario pueden derivar en resultados subóptimos con otras técnicas.

The aim of this study is to present the use of the osteosynthesis method using a moolded reconstruction plate to treat paediatric subtrochanteric fractures. The case concerns a 7year-old paediatric patient with the diagnosis of a multifragmented tracer subtrochanteric fracture resulting from a high-energy trauma. Osteosynthesis was performed using a conventional 4.5 moulded plate using minimally invasive surgery. The fixation model used was the one proposed by Moustafa. Pre-operative planning, surgical treatment, and clinical and radiological follow-up were performed in the outpatient clinics every 2weeks until clinical and radiological consolidation. In addition, it was recorded whether or not there was pain, pathological shortening, loss of reduction or appearance of complication. It has been possible to obtain complete medical and radiological attention after 6weeks, minimal pain, there was no residual shortening of the limb, there was no loss of reduction and no complications occurred. The method may be the best alternative to treat this specific group of patients in whom the antecedent of high energy injury and the characteristic of the fracture tract may result in suboptimal results with other techniques.

Synthesis of spiro[indoline-3,3'-pyrrolizines] by 1,3-dipolar reactions between isatins, L-proline and electron-deficient alkenes.

Two spiro[indoline-3,3'-pyrrolizine] derivatives have been synthesized in good yield with high regio- and stereospecificity using one-pot reactions between readily available starting materials, namely L-proline, substituted 1H-indole-2,3-diones and electron-deficient alkenes. The products have been fully characterized by elemental analysis, IR and NMR spectroscopy, mass spectrometry and crystal structure analysis. In (1'RS,2'RS,3SR,7a'SR)-2'-benzoyl-1-hexyl-2-oxo-1',2',5',6',7',7a'-hexahydrospiro[indoline-3,3'-pyrrolizine]-1'-carboxylic acid, C28H32N2O4, (I), the unsubstituted pyrrole ring and the reduced spiro-fused pyrrole ring adopt half-chair and envelope conformations, respectively, while in (1'RS,2'RS,3SR,7a'SR)-1',2'-bis(4-chlorobenzoyl)-5,7-dichloro-2-oxo-1',2',5',6',7',7a'-hexahydrospiro[indoline-3,3'-pyrrolizine], which crystallizes as a partial dichloromethane solvate, C28H20Cl4N2O3·0.981CH2Cl2, (II), where the solvent component is disordered over three sets of atomic sites, these two rings adopt envelope and half-chair conformations, respectively. Molecules of (I) are linked by an O-H...·O hydrogen bond to form cyclic R66(48) hexamers of \overline{3} (S6) symmetry, which are further linked by two C-H...O hydrogen bonds to form a three-dimensional framework structure. In compound (II), inversion-related pairs of N-H...O hydrogen bonds link the spiro[indoline-3,3'-pyrrolizine] molecules into simple R22(8) dimers.

Anxiety and depression predict musculoskeletal disorders in health care workers.

Incidence of musculoskeletal disorders (MSDs) is high among health care workers (HCWs). To determine whether MSDs are associated with preexisting anxiety and/or depression, a case-control study was carried out in female HCWs (56 cases/55 controls). Cases were HCWs with a first-time clinical diagnosis of MSD within the previous 2 years. Occupation, workplace, work shift, direct patient assistance, and anxiety/depression scores (Goldberg scale) were assessed. Increased risk of incident MSDs (multivariate logistic regression) was found in workers with preexisting anxiety/depression compared to those without (OR 5.01; 95% CI 2.20-12.05; p < .01). Other significant risk factors were direct patient assistance (OR 2.59; 95% CI 1.03-6.92; p = .04) and morning work shift (OR 2.47; 95% CI 0.99-6.48; p = .05). Preexisting anxiety/depression was associated with incident MSDs in HCWs, adjusting for occupational exposure risk factors.