Tratamiento quirúrgico de las roturas del tendón de Aquiles

El objetivo del trabajo fue valorar los resultados y complicaciones obtenidos tras tratamiento quirúrgico de las rupturas subcutáneas del tendón de Aquiles. Se revisaron 26 pacientes, con un seguimiento mínimo de 1 año. Detallamos nuestra metodología en cuanto a técnica quirúrgica y manejo postoperatorio. Se valoró el resultado clínico según los siguientes parámetros: movilidad de tobillo, potencia muscular tríceps, engrosamiento tendinoso, claudicación a la marcha, atrofia gemelar, incorporación a actividades deportivas y alteraciones residuales. Los resultados fueron muy buenos en 21 casos (80,7%); buenos en 5 (19,3%), y ningún caso con resultado regular o malo. Destacamos 5 complicaciones postoperatorias inmediatas y 1 caso de reruptura, con resultado final satisfactorio. Dados los buenos resultados obtenidos, recomendamos el tratamiento quirúrgico en pacientes activos, con buen estado general, independientemente de la edad.The objective of this work was to asess the clinical results and complications with the surgical treatment for subcutaneous Achilles tendon ruptures. Twenty six patients were clinically revised with a minimal follow up of one year. We detailed the surgical technique and postoperative management of the patients. Clinical results were assessed with the next parameters: ankle joint motion; triceps muscle strength; Achilles tendinous thickened; walking limp; triceps muscle atrophy, possibility of sports practice and definitive changes. We had excellent results in 21 cases (80,7%); good results in 5 cases (19,3%) and none with fair or poor results. We detached 5 cases with immediate postoperative complications and one case of relapse, all of them with good clinical result. Our excellent and good clinical results with the surgical technique for the Achilles tendon ruptures allow us to recommend this treatment in active patients, with appropriate health conditions in spite of the age

Rotura traumática del tendón del supraespinoso en un niño de seis años

Presentamos un caso de un niño de seis años que sufrió un traumatismo por caída sobre su hombro derecho, con rotura completa del tendón del supraespinoso. Comprobado con Resonancia Magnética. Se operó para efectuar una reinserción transósea del tendón mediante cirugía abierta. Después de un mes de inmovilización se comenzaron los ejercicios activos progresivos con recuperación completa a los tres meses de la intervención.A six year old boy sustained a right shoulder injury after a causal fall. Magnetic Resonance Imaging showed a complete rupture of the supraespinatus tendon. Open surgery was indicated by transosseus reinsertion of the tendon on the humeral head. After one month of shoulder immobilization, the patient physical therapy with progressive active exercises. The patient achivied complete joint motion and function three months after surgery

Incidencia de tuberculosis osteoarticular en el área sanitaria del Hospital de León. 1997-2001

Introducción y objetivos: Nos proponemos en este trabajo estudiar la incidencia de tuberculosis en su forma osteoarticular en el área sanitaria del Hospital de León durante los años 1997 a 2001, ambos inclusive. Material y método: Dieciséis casos de tuberculosis osteoarticular confirmados por cultivo microbiológico y/o análisis anatomopatológico fueron incluidos. De ellos, cinco afectaron a columna vertebral, cuatro a rodilla y el resto a otras localizaciones más inusuales. Resultados: De las cinco columnas vertebrales afectadas, tres requirieron tratamiento quirúrgico para descomprimir y estabilizar. En una rodilla se realizó sinovectomía abierta y en otra por artroscopia. Se drenaron abscesos fríos en diferentes localizaciones. Todos los casos recibieron tratamiento médico. Se reflejan los diferentes resultados, desde la restitución ad integrum hasta la anquilosis. Discusión y conclusiones: La incidencia de tuberculosis osteoarticular en nuestra área sanitaria en el periodo 1997-2001 fue del 2% al 4% de todos los cascos de tuberculosis. Hubo una alta incidencia de localizaciones inusuales (muñeca, codo, sacroilíaca).Introduction: Current issue is to study the incidence of osteoarticular tuberculosis, within the sanitary area of the Hospital of Leon. Material and Method: Sixteen cases of osteoarticular tuberculosis confirmed by culture and pathological analysis were included. Five of them involved the raquis and knee. Another cases in unusual local sites. Results: Three of five raquis were managed by decompression and stabilization. One knee was treated by open synovectomy and another one by arthroscopy synovectomy. Cold abscesses were drained in different sites. All cases were treated with drugs. Different results are showed since restitutio ad integrum to anquilosis. Discussion: Osteoarticular tuberculosis incidence in our sanitary area between 1997 to 2001 was 2% to 4%. There was a high incidence for unusual localizations (wrist, elbow and sacroiliaca joints)

Nuestra experiencia con el minivástago femoral de disco a compresión y el cotilo Hedrocel (tantalio)

Durante los años 2000 a 2002 intervinimos 18 pacientes de artrosis o necrosis sintomática de cadera, con minivástago de fijación metafisiaria de Disco a Compresión (Sulzer) y cotilo monobloque de tantalio Hedrocel (Zimmer), con par de fricción alúmina-polietileno. La edad media de los pacientes fue de 46,7 años (rango 35-61), y el seguimiento medio de 42 meses. La valoración clínica se realizó con la escala de Merle D'Augbigné Postel obteniendo 38,8% de resultados excelentes, 22,2 de resultados buenos, 11,1% regulares y 27,4% malos (5 casos). Cuatro casos necesitaron reintervención por aflojamiento del tallo femoral. No hubo ningún fracaso del cotilo. La sustitución protésica de la cadera en los pacientes jóvenes requieren soluciones con la menor resección del hueso, pero este modelo de tallo femoral, no da un resultado satisfactorio, por lo que lo hemos abandonado.Between 2000 2002 we treated 18 patients with symptomatic osteoarthritis or osteonechrosis of hip, with uncemneted Thrust Plate Protesis (Sulzer) and tantalium acetabular componente Hedrocel (Zimmer), with ceramic-pol- yethylene pair. The average age of the patients was 46,7 years (range:35-61), and the average follow-up of 42 months. Clinical evaluation was done with Merle D'Augbigné Postel's scale obtaining 38,8 % of excellent results, 22,2 % of good results, 11,1 % fair and 27,4 % poor (5 cases). Four cases needed re-operation for loosening of the femoral stem. There was no failure of the acetabular component. The hip artrhroplasty in the young patients need solutions with the minor resection of bone, but this model of femoral stem does not give a satisfactory result, therefore we have abandoned it

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The prognostic significance of tumor-infiltrating lymphocytes, PD-L1, BRCA mutation status and tumor mutational burden in early-stage high-grade serous ovarian carcinoma. A study by the Spanish Group for Ovarian Cancer Research (GEICO)

Early stages are under-represented in studies on the molecular and immune features of high-grade serous ovarian carcinoma (HGSOC), and specific studies focused on early-stage HGSOC are required for a better prognostic stratification and to personalize chemotherapy. The aim of this study was to determine the prognostic significance of CD8+ and CD4+ tumor-infiltrating lymphocytes (TILs), tumoral cell PD-L1 expression, BRCA mutational status and tumor mutation burden (TMB) in early-stage HGSOC. A retrospective study was performed on stage I and II HGSOC from the Molecular Reclassification of Early Stages of Ovarian Cancer (RECLAMO) cohort from the Spanish Group of Ovarian Cancer Research (GEICO). Centralized histological typing was performed based on morphological and immunohistochemical features. Intraepithelial (i) and stromal (s) CD8+ and CD4+ T cells and PD-L1 were evaluated on tissue microarrays by immunohistochemistry. BRCA1 and BRCA2 mutation status and TMB were analyzed in tumor DNA using next-generation sequencing. The study included 124 tumors. High iCD8+ (>20 TILs/core), low/intermediate CD4+ (35/core) were associated with favorable outcomes. Tumor cell PD-L1 expression (TPS ≥ 1) was present in only 8% of tumors. In total, 11 (16%) and 6 (9%) out of 69 HGSOC tested carried pathogenic or likely pathogenic BRCA1 or BRCA2 mutations, respectively. Median TMB of 40 tumors analyzed was 5.04 mutations/Mb and only 6 tumors had 10 or more mutations/Mb. BRCA status and TMB were not associated with TILs or prognosis. When compared with studies on advanced HGSOC, our results suggested that prognostic variables differed according to stage and that more studies focused on early stages of HGSOC are needed to better stratify these tumors: This work was supported by Instituto de Salud Carlos III (ISCIII) (grants PI19/01331, PI22/01892 and PMP22/00054); CIBERONC (grant CB16/12/00316); European Development Re gional Fund ‘A way to achieve Europe’ (FEDER), Spanish Group of Research in Ovarian Cancer (GEICO group); and by the Spanish Association Against Cancer Scientific Foundation (AECC)