La movilidad intrínseca del cotilo

El cotilo o acetábulo es de todos conocido como una de las piezas fundamentales del anillo pelviano y junto con el fémur forma la articulación de la cadera. El anillo pelviano consta de 2 alas ilíacas y el sacro; tiene forma ojival con bóveda a nivel de este último. El soporte del tronco y sus componentes reciben lógicamente las intensas presiones de la parte superior del cuerpo, así como asumir las demandas que la bipedestación lleva consigo

Aplicaciones de la biología molecular en el aparato locomotor (proteína morfogenética ósea)

La biología molecular constituye actualmente la base de la investigación biomédica. Gracias a la moderna técnica de transcripción inversa es posible obtener in Vitro proteínas humanas en gran cantidad. Un ejemplo de ello es la proteína morfogenética ósea recombinante humana (rhBMP), utilizada hasta ahora en forma experimental debido la disparidad de resultados observados en animales de experimentación y en humanos. Existen aún preguntas importantes que se deben responder antes de poder usar estas moléculas en la práctica clínica habitual. Los nuevos avances de la biología molecular hacen pensar que en el futuro la medicina cambiará dramáticamente, siendo le campo de la manipulación genética el horizonte inmediato.Currently, molecular biology is the base of biomedical research. Thanks to reverse transcription techniques, it is possible to obtain in vitro large amounts of human proteins. One example is the recombinant human bone morphogenetic protein (rhBMP), which is now used only in experimental and clinical research due to the disparity observed between the results on animal models and humans. There are important questions that must be answered before rhBMPs can be routinely used. New advances in molecular biology indicate a dramatic change in future medical practice, with genetic manipulation in the immediate sight

Prótesis sin cementar: resultados a más de 10 años

Se revisan 50 prótesis totales de cadera no cementadas con vástago autobloqueante 3V, cotilo impactado de tres pivotes y cabeza de cerámica (Zirconio) en 47 pacientes, con un seguimiento medio de 11 años y 4 meses. Clínicamente se ha prestado especial atención al dolor, limitaciones para la vida diaria, capacidad para la marcha y la actividad realizada en estos años, obteniendo unos resultados entre buenos y excelentes del 98% en unos pacientes en los que se implantó la prótesis a una edad media de 58 años y de los que el 76,5% han mantenido una buena vida activa o muy activas. Se propone una clasificación para valorar radiográficamente la anteversión del cotilo protésico. No se ha apreciado ningún desgaste del polietileno y hay una tasa de supervivencia al aflojamiento aséptico de vástagos y cotilos del 100%. Se analizan los resultados, las ventajas del cotilo, del vástago y la diferencia entre imágenes de doble contorno y radiolucencias.A totality of 50 non cemented hip prosthesis with a self blocking model 3V stemand, tri-spiked impactation acetabulum and head of ceramic (Zicronium) are revised on 47 patients, the average of following was of 11 years and 4 months. Special attention has been played clinically to pain, to daily out in these yeats, having allowed as to obtain 98% of good and excellent results in some patients to whom the prosthesis was implanted at an average age of 58, 76,5% of them led active of very life. We propose a classification to evaluate radiologycally the anteversion of the prosthesic cups. It has not been noticed any wear in the polyethylene of any. The percentage of survival after aseptic loosening of the stems and spikes was of 100%. The results, the advantages of the cups, stem and the difference between images of double contour and radio-luciencies, are commented with their clinical relevance

Vástago femoral sin cementar 3V: Estudio retrospectivo de más de 10 años de seguimiento

De los 482 vástagos 3V implantados entre 1986 y 1992 en el Servicio de Cirugía Ortopédica del Hospital de Liendres se realiza un estudio retrospectivo clínico y radiológico de 162 casos con un tiempo medio seguimiento de 12 años y 10 meses. Se ha encontrado una excelente osteointegración con una supervivencia del 100% y unos resultados clínicos entre excelentes y buenos de un 98,22%, no observando diferencias en pacientes con edades entre 28 y 74 años de los que el 49,6% han tenido una importante actividad física. Radiológicamente no se ha encontrado ningún signo de aflojamiento. Se discuten las condiciones puestas por Dorr para los vástagos femorales no cementados y se comenta la disminución de densidad ósea, la vascularización endostal y la osteointegración.From 482 femoral componen 3V implanted in the Ortopedic Surgery Service at the Liendres Hospital between 1986 and 1992, a clinical and radiological retrospective study is performed on 162 cases with a media follow up of 12 years and 10 months. An excelent osteointegration was found with 100% of survival. Clinical results showed 98,22% of patients with good or excellent assessment with no differences among patients of 24 and 74 years with relevant physical activity the 49,6% of them. Ander radiographic evaluation no findings of aseptic loosening were found. Criteria stabilised by Dorr for no cemented femoral components are discussed emphasing the bone mass alterations, the medullar vascular system and osteointegration

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Strategies and performance of the CMS silicon tracker alignment during LHC Run 2

The strategies for and the performance of the CMS silicon tracking system alignment during the 2015–2018 data-taking period of the LHC are described. The alignment procedures during and after data taking are explained. Alignment scenarios are also derived for use in the simulation of the detector response. Systematic effects, related to intrinsic symmetries of the alignment task or to external constraints, are discussed and illustrated for different scenarios