Implicaciones del hiperparatiroidismo primario en cirugía ortopédica y traumatología: presentación de dos casos y revisión de la bibliografía

El hiperparatiroidismo primario es una patología en relación con el metabolismo del calcio con el resultado de niveles de calcio séricos elevados y un incremento en el nivel de hormona paratifoidea (PTH). Los pacientes suelen encontrarse asintomáticos al diagnóstico, basándose en un diagnóstico bioquímico, al observarse un nivel de calcio sérico elevado. Los avances en imagen, mediciones de hormona paratiroidea y la técnica quirúrgica permite un abordaje sin necesidad de la exploración de las cuatro glándulas paratiroideas. El objetivo de nuestro trabajo es realizar una revisión retrospectiva de pacientes afectos de hiperparatiroidismo primario en nuestro centro y mostrar su implicación en cirugía ortopédica y traumatología.Primary hyperparathyroidism is a generalized disorder of calcium metabolism resulting from abnormally high levels of serum calcium and an increased level of parathyroid hormone (PTH). Are most often diagnosed when routine biochemical testing shows an elevated serum calcium levels. Advances in imaging technology, intraoperative parathyroid hormone measurement, and surgical technique now allow parathyroidectomy to be performed using a focused approach without the absolute need of a four-gland exploration. We have done a retrospective revision of patients with hyperparathyroidism and his implication in orthopaedics surgery

Linchamientos y conflicto político en Los Andes

En 2004, los alcaldes de dos municipalidades de la región aimara de los Andes fueron linchados en la aparente culminación de agudos conflictos políticos internos y entre las respectivas comunidades y el Estado central. En este artículo se discuten ambos casos con el fin de ilustrar las transformaciones experimentadas en años recientes en la organización y la dinámica interna de las comunidades andinas, y de la articulación conflictiva de la política local en los procesos e instituciones de más amplio alcance. Precariedad social e incapacidad o renuencia del Estado para responder con eficacia a demandas básicas de determinados grupos de población configuran enmarcamientos socioeconómicos e institucionales de los linchamientos. En contraste con enfoques que enfatizan en factores culturales tradicionales o en un supuesto nacionalismo indígena, en el artículo se destaca la gravitación de fenómenos y procesos político-institucionales recientes en la transformación cultural y política de las comunidades, en el modo en que éstas procesan sus conflictos internos y con el Estado central

Congenital absence of the pedicles and the neural arch of L2

Congenital pedicle abnormalities are rare. Unilateral aplastic and hypoplastic lumbar pedicles have been reported, but these were usually discovered incidentally and did not need surgical treatment. We present a case of absence of both pedicles and the neural arch of L2, with associated kyphoscoliosis with neurological involvement, that needed a two-stage corrective surgery. An L1-L4 fusion was achieved with relief of the symptom

Middle Ordovician strophomenoid brachiopods from the high latitude Gondwanan shelves (Central Spain) and their travel route.

Two strophomenoid brachiopods from the Middle Ordovician of the Toledo Mountains, Central Spain, representing the first arrival of the group to the high latitude Gondwanan shelves are described. They are the new genus and species Oretanomena meloui, from the Navas de Estena Shales and Río Shales, Oretanian (mid Darriwilian) in age, and Dactylogonia asturica, from the Guindo Shales, Dobrotivian (late Darriwilian) in age. Oretanomena is a primitive strophomenid of concavo-convex, dorsally geniculate profile, very close to the Iranian Semnanostrophia. They both settled during mid Darriwilian times on the high latitude Gondwanan shelves, much probably originating from South China ancestors after a migration along the western Gondwanan coast. Dactylogonia asturica settled on the Iberian platform slightly later, during the late Darriwilian, as the result of the dispersion of its genus from Laurentia, crossing the Iapetus Ocean up to Avalonia, and then also the Rheic Ocean, up to the Mediterranean margin of Gondwana. Dactylogonia is added to other rare rhynchonelliform brachiopods that succeeded in crossing the Rheic Ocean, during a time of strong faunal isolation of the high latitude margin of Gondwan

Interplay Between Yu-Shiba-Rusinov States and Multiple Andreev Reflections

Motivated by recent scanning tunneling microscopy experiments on single magnetic impurities on superconducting surfaces, we present here a comprehensive theoretical study of the interplay between Yu-Shiba-Rusinov bound states and (multiple) Andreev reflections. Our theory is based on a combination of an Anderson model with broken spin degeneracy and nonequilibrium Green's function techniques that allows us to describe the electronic transport through a magnetic impurity coupled to superconducting leads for arbitrary junction transparency. Using this combination we are able to elucidate the different tunneling processes that give a significant contribution to the subgap transport. In particular, we predict the occurrence of a large variety of Andreev reflections mediated by Yu-Shiba-Rusinov bound states that clearly differ from the standard Andreev processes in non-magnetic systems. Moreover, we provide concrete guidelines on how to experimentally identify the subgap features originating from these tunneling events. Overall, our work provides new insight into the role of the spin degree of freedom in Andreev transport physics.Comment: 15 pages, 10 figure

Bone lengthening by physial distraction. An experimental study.

Experimental physial distraction was carried out in the distal part of the femur in 45 two-month old lambs in order to study the basic mechanisms of lengthening as well as the viability of the growth cartilage after using this method. The animals were divided into three groups (A, B and C), and each group into three subgroups (1, 2 and 3) according to the rate of distraction used (2 mm/day, 1 mm/day, 0.5 mm/day) and the time of sacrifice. The results obtained show that the basic lengthening mechanisms consists, firstly, in the production of a fracture between the metaphysis and the epiphysis and, secondly, that the lower the distraction speed employed, the greater is the short-term and long-term viability of the growth cartilage. Optimum viability was observed at a distraction rate of 0.5 mm/day. On this basis we conclude that in clinical practice physical distraction could be indicated for children at an early stage of skeletal growth and repeated later provided that the rate of distraction is kept within reasonable limits

Ultrasound biomicroscopy in deep sclerectomy: case report

Relato do caso de um paciente com diagnóstico de glaucoma primário de ângulo aberto, que foi submetida a esclerectomia profunda em olho direito, com sucesso. No pós-operatório de 3 meses, o procedimento cirúrgico foi avaliado com biomicroscopia ultra-sônica (UBM) utilizando-se dois equipamentos distintos (UBM 840-Zeiss; UBM-VUMAX-Sonomed) com transdutores de 50 MHz. O método diagnóstico com biomicroscopia ultra-sônica pode ser usado como método não invasivo para avaliar a arquitetura interna ocular na topografia da esclerectomia profunda. Permite identificar as estruturas do segmento anterior, sua relação anatômica, bem como a membrana trabéculo-Descemet íntegra e o espaço intra-escleral. Biomicroscopia ultra-sônica demonstrou utilidade na avaliação pós-operatória do procedimento cirúrgico.Case report of a woman with the diagnosis of primary open-angle glaucoma who was submitted to a successful surgical procedure of deep sclerectomy in the right eye. In the postoperative period, at month 3, the surgical procedure was evaluated with ultrasound biomicroscopy (UBM) utilizing two distinct equipments (UBM 840-Zeiss; UBM-VUMAX-Sonomed), with 50-MHz transducers. The diagnostic method of ultrasound biomicroscopy can be utilized as a non invasive method to evaluate the internal architecture of the eye at the topography of deep sclerectomy. It allows to identify the anterior segment structures, their anatomical relationship, and also the intact trabecular-Descemet membrane and the intrascleral space. Ultrasound biomicroscopy showed to be useful in evaluating postoperative status of the surgical procedure

Pure cervical radiculopathy due to spontaneous spinal epidural haematoma (SSEH): report of a case solved conservatively

Abstract Introduction: Spontaneous spinal epidural haematoma (SSEH) is widely recognised throughout the literature as a cause of myelopathy, radicular compression being very rarely reported. Surgical management is almost always recommended, especially in the cases of spinal cord compression. Conservative treatment is reported as a curiosity and only in the case of spontaneous improvement. This report presents the particular case of a 64-year-old patient undergoing anticoagulant therapy that had a cervical radiculopathy due to a SSEH confirmed by MRI. The patient improved spontaneously and symptoms were solved with unconventional conservative treatment and without stopping the anticoagulant therapy. Conclusions: Spontaneous epidural haematoma must be kept in mind when patients undergoing anticoagulant therapy have a sudden onset of cervicobrachialgia. Even though most spinal surgeons advocate surgical treatment, a conservative approach may lead to a complete recovery and may be considered as a good option in the case of radicular involvement. Discontinuation of the anticoagulant therapy may not always be needed, especially when the clinical syndrome improves spontaneously

Síndrome de cauda equina por hernia discal gigante

La aparición de forma aguda o rápidamente progresiva de un cuadro de ciatalgia bilateral, con disminución completa de la fuerza de los pies y ocasionalmente del cuádriceps acompañado de retención y/o incontinencia urinaria e hipoestesia en silla de montar debe hacernos sospechar de la existencia de un síndrome de compresión de la cola de caballo, generalmente a causa de una hernia discal. Se trata de una urgencia quirúrgica absoluta en la patología del raquis. La identificación del síndrome por el médico de Urgencias y la confirmación de la lesión mediante resonancia magnética permiten una cirugía mediante descompresión en las primeras 24-48 horas que es el único factor pronóstico en la recuperación de las lesiones neurológicas y urológicas que presentan estos pacientes que, si existe demora en la descompresión, pueden llegar a ser permanentes. Presentamos el caso de un paciente afecto de síndrome de cauda equina agudo por hernia discal gigante visto unos días antes en consulta por lumbalgia mecánica y realizamos una revisión bibliográfica sobre el tema.In cases of acute or progressive development in a few hours of bilateral sciatica, severe foot and occasional quadriceps weakness and/or retention or incontinence of urine with perineal hypalgesia or anesthesia, acute compression of the cauda equina should be suspected, which is usually due to a lumbar disc herniation. Cauda equina syndrome requires emergency spinal surgery. To identify and confirm this syndrome by MR, Ismanoatory. Early surgical decompression must be achieved. Decompression within 24-48 hours significantly improves the neurological and urological outcome. We present the case of a patient who had previously been treated for low back pain who developed a cauda equina syndrome a few days later