Modificaciones fisarias en el conejo inducidas por campos electromagnéticos

Se efectúa un estudio experimental para valorar los efectos de campos electromagnéticos de dos intensidades diferentes (2,4 y 10 Gauss) sobre la fisis de huesos largos. Se emplearon 45 conejos de 4 semanas divididos en tres grupos de 15 animales, a los que se colocó unas bobinas de Helmholtz en la rodilla derecha durante ocho horas diarias. Cinco animales de cada grupo fueron estimulados (subgrupo testigo). El primer grupo se sacrificó tras cuatro semanas, el segundo tras 12 semanas y el tercero llevó las bovinas durante 12 semanas y luego se sacrificó 12 semanas después para comprobar la duración de los efectos de la corriente. Los resultados demuestran que la diferencia en longitud entre los huesos estimulados y sus contralaterales fue mayor en el subgrupo sometido a 10 Gauss, aunque en ningún caso superior al 2,5%. La altura fisaria fue mayor en los huesos estimulados que en sus contralaterals, aunque no se apreciaron otras diferencias histológicas. No obstante, el cierre de la fisis se retrasó en todos los huesos estimulados con 10 Gauss y evolucionó normalmente en el resto. Los huesos de los subgrupos testigo no mostraron diferencias entre ellos.This study was carried out to compare the effects of two different electromagnetic fields (2,4 and 10 Gauss) on the growth plate of long bones. Forty five 4-week-old rabbits were divided in three groups of 15 animals each. All of them wore two Helmholtz coils on their right knee for 8 hours daily and then were sacrificed, the first after for 4 weeks, the second one after 12 weeks and the third one after 24 weeks. In this last group the coils were removed after 12 weeks and the animals allowed to live other 12 weeks to study the evolution of the growth plate after cesation of the stimulation. In each group, animals were not stimulated (sham subgroup). Results showed a greater difference in length in those bones stimulated with 10 Gauss, in respect to their contralateral, than the other subgroups. However these differences were less than 2,5% of the total length of the bone. Growth plate height of stimulated bones was greater than their contralateral in all subgroups with no other remarkable histological differences. Closure of the growth plate was delayed in the 10 Gauss stimulated bones but not in the rest. No differences were found among bones of sham subgroups at any time

Evolution after Anti-TNF Discontinuation in Patients with Inflammatory Bowel Disease: A Multicenter Long-Term Follow-Up Study

OBJECTIVES:The aims of this study were to assess the risk of relapse after discontinuation of anti-tumor necrosis factor (anti-TNF) drugs in patients with inflammatory bowel disease (IBD), to identify the factors associated with relapse, and to evaluate the overcome after retreatment with the same anti-TNF in those who relapsed.METHODS:This was a retrospective, observational, multicenter study. IBD patients who had been treated with anti-TNFs and in whom these drugs were discontinued after clinical remission was achieved were included.RESULTS:A total of 1, 055 patients were included. The incidence rate of relapse was 19% and 17% per patient-year in Crohn''s disease and ulcerative colitis patients, respectively. In both Crohn''s disease and ulcerative colitis patients in deep remission, the incidence rate of relapse was 19% per patient-year. The treatment with adalimumab vs. infliximab (hazard ratio (HR)=1.29; 95% confidence interval (CI)=1.01-1.66), elective discontinuation of anti-TNFs (HR=1.90; 95% CI=1.07-3.37) or discontinuation because of adverse events (HR=2.33; 95% CI=1.27-2.02) vs. a top-down strategy, colonic localization (HR=1.51; 95% CI=1.13-2.02) vs. ileal, and stricturing behavior (HR=1.5; 95% CI=1.09-2.05) vs. inflammatory were associated with a higher risk of relapse in Crohn''s disease patients, whereas treatment with immunomodulators after discontinuation (HR=0.67; 95% CI=0.51-0.87) and age (HR=0.98; 95% CI=0.97-0.99) were protective factors. None of the factors were predictive in ulcerative colitis patients. Retreatment of relapse with the same anti-TNF was effective (80% responded) and safe.CONCLUSIONS:The incidence rate of inflammatory bowel disease relapse after anti-TNF discontinuation is relevant. Some predictive factors of relapse after anti-TNF withdrawal have been identified. Retreatment with the same anti-TNF drug was effective and safe

Anti-tumour necrosis factor discontinuation in inflammatory bowel disease patients in remission: study protocol of a prospective, multicentre, randomized clinical trial

Background: Patients with inflammatory bowel disease who achieve remission with anti-tumour necrosis factor (anti-TNF) drugs may have treatment withdrawn due to safety concerns and cost considerations, but there is a lack of prospective, controlled data investigating this strategy. The primary study aim is to compare the rates of clinical remission at 1?year in patients who discontinue anti-TNF treatment versus those who continue treatment. Methods: This is an ongoing, prospective, double-blind, multicentre, randomized, placebo-controlled study in patients with Crohn?s disease or ulcerative colitis who have achieved clinical remission for ?6?months with an anti-TNF treatment and an immunosuppressant. Patients are being randomized 1:1 to discontinue anti-TNF therapy or continue therapy. Randomization stratifies patients by the type of inflammatory bowel disease and drug (infliximab versus adalimumab) at study inclusion. The primary endpoint of the study is sustained clinical remission at 1?year. Other endpoints include endoscopic and radiological activity, patient-reported outcomes (quality of life, work productivity), safety and predictive factors for relapse. The required sample size is 194 patients. In addition to the main analysis (discontinuation versus continuation), subanalyses will include stratification by type of inflammatory bowel disease, phenotype and previous treatment. Biological samples will be obtained to identify factors predictive of relapse after treatment withdrawal. Results: Enrolment began in 2016, and the study is expected to end in 2020. Conclusions: This study will contribute prospective, controlled data on outcomes and predictors of relapse in patients with inflammatory bowel disease after withdrawal of anti-TNF agents following achievement of clinical remission. Clinical trial reference number: EudraCT 2015-001410-1

Quiste óseo esencial : infiltración local con corticoides

Five cases of solitary bone cysts treated by local intracavity inyection of methilprednisolone acetate are reported. AHcases presented a pathological fracture on the c1inical examination. Three cases reached a complete clinical and radiological suecess. One case got a fair result and the last one had a poor result, with relapse and new fracture, three years after the initial treatment

Fracturas diafisarias de antebrazo : estudio clínico

The results obtained in 268 cases presenting with diafisar}· fracture of the forearm, double or isolated in radius or ulna, at the same or different leve!, including fractures of Monteggia and Galeazzi, are here presented. In this series 169 out of the 268 cases wcrc children 89%. of them treated orthopedically and 11 % quirurgically, 7'Yo with intramedullary nailing, 0'8% with screwd plates and 3'2% using thc both latter techniques. In thc 99 adults presenting these fractures, orthopedical treatment was only adopted in 33'3% of the cases and 66'7% were treated quirurgically, using screwed plates in 53, intramedullary nailing in 7 and combined techniques in 9. Global results in children were excellent, presented light late complications only in 5'3% of the cases, consisting mainly in secondary displacements and delayed union. Though the adult group offered also very satisfactory functional results the number of complications were significantly higher, with special reference to pseudoarthrosis present in 7% of cases and with lower incidence when screwed plates were use

Fractura de stress en peroné con apariencia tumoral

A case of fracture from stress in the right fibula of a fifteen-year old birl is reported. The X-Ray film is deceiving about the appearance of a bone tumor. Diagnosis by the scanner sol ves all doubts