Experiencia y resultados preliminares en el uso de cilindros intersomáticos para la artrodesis lumbar

El dolor lumbar crónico es una patología que puede llegar a ser incapacitante y en la que a menudo fracasan los tratamientos conservadores. Como alternativa entre las cirugías que pretenden atajar este problema mediante una artrodesis está la fusión intersomática con cilindros, que presenta algunas ventajas respecto a otras técnicas de fijación. Esta técnica ha sido introducida recientemente en nuestro país. Se presentan los primeros resultados obtenidos tras esta cirugía en los primeros 16 pacientes operados. Desde 1997 a diciembre de 2000 se han implantado 11 cilindros BAK y 5 LIFEC. Diez pacientes tenían un seguimiento mínimo de 1 año y éstos constituyen la serie evaluada. Siete pacientes (70%) no presentaban dolor. Cuatro pacientes (40%) se habían incorporado a sus trabajos respectivos. Seis pacientes (60%) no precisaban tratamiento médico. Los buenos resultados obtenidos hasta el momento nos invitan a pensar que esta técnica, de menor agresividad y que no cierra la puerta a otros tipos de instrumentación, es una opción válida para el tratamiento del dolor lumbar crónico.Chronic low back pain is a medical cause of disability in which conservative management is often not effective. As an alternative, interbody fusion with cylinders offers several advantages as compared to other surgical methods of fusion. This technique has been recently introduced in our Country. The preliminary results of 16 patients managed in our Department are shown. From 1997 to December 2000, eleven BAK devices and 5 LIFEC have been implanted. Ten patients had a minimum follow-up of 1 year and these constitute the series evaluated. Seven patients (70%) were free of pain. Four patients (40%) returned to their previous job. Six patients (60%) did not need medical treatment. The good results with this technique encourage us and suggest that these devices are a valid option for the management of chronic low back pain

Prótesis unicondílea de rodilla: Valoración clínica preliminar

Los pacientes afectados de artrosis unicompartimetal de rodilla pueden ser tratados con diferentes métodos quirúrgicos. Los más habituales son la osteonomía tibial en jóvenes y la prótesis total de rodilla en ancianos. Una alternativa que va adquiriendo adeptos es la prótesis unicondílea. Tras un período inicial de gran euforia se pasó a otro de escepticismo, dando los resultados. El propósito del presente estudio es evaluar un nuevo diseño de prótesis de rodilla unicondílea (Alpina, IQL) a corto plazo siguiendo criterios clínicos y de calidad de vida. Se revisan 13 pacientes intervenidos entre Junio de 2000 a Marzo del 2002. Siete eran varones y seis mujeres. La edad media fue de 65 años (r=55-72ª). En doce casos la etiología fue artrosis y en uno necrosis del cóndilo interno. La evaluación clínica se realizó mediante el cuestionario sobre la calidad de vida SF-12. Todos los pacientes consiguieron una flexión de 110º y extensión completa. Sólo un paciente presentó molestias leves.Patients who have unicompartimental knee osteoarthritis can be manager by different surgical techniques. Young people are usually treated by tibial osteotomy and elderly people by total knee replacement. Unicondylar knee prosthesis is becoming an attractive recognized alternative. After a period of enthusiastic regarding this technique, scepticism took place based on the clinical results. The aim of this study is to evaluate, in firs instance, a new knee unicondylar knee prosthesis design (Alpine, IQL) following clinical criteria and quality of life. Thirteen patients, managed in between June 2000 and March 2002, are reviewed. Seven were males and six females. The mean age was 65 years (range 55-77 years). Osteoarthritis was the aetiology in twelve cases and necrosis of the medial condyle in one patient. The clinical evaluation was based on quality of life through a questionnaire SF-12. All patients improved a knee flexion of 110º and a complete extension. Only one patient had slight pain and had some limitation

Fracturas de Astrágalo: Evaluación Clínico-Quirúrgica

Se han revisado 13 pacientes diagnosticados de fractura de astrágalo recogidos en nuestro Servicio de Urgencias y tratados quirúrgicamente en todos los casos. De ellos se ha realizado un seguimiento clínico y radiológico. En el 46% de los casos se obtuvieron resultados satisfactorios (23% excelentes y 23% buenos). Los restantes se repartieron entre regulares (38%) y malos (16%). La necrosis avascular apareció en 3 de los 13 casos, discutiéndose el origen de esta seria complicación. Siguiendo la clasificación de WEBER, los tipos de fractura más frecuentes fueron el tipo III (38%) y el II (31%). La congruencia articular postquirúrgica del astrágalo fracturado y el tiempo de demora en la cirugía que debe ser de urgencia, se muestran como factores a considerar en la evolución ulterior del "Aviators astragalus". Se discute así mismo el valor del signo de Hawkins.Areview of 13 patients diagnosed of Talus fracture has been colected in our service of trauma emergency. All of them have been managed by surgical methods and clinical and radiologically followed up. Satisfactory results wer e obtained in 46% of the cases (23%, excellents and 23%, good results). The rest wer e regular (38%) and bad (16%). Avascular necrosis was observed in 3 of the 13 cases, discussing the origin of this serious complication. The most frequent types of fracture were type III (38%) ant type II (31%) following Weber's classification. The postsurgical articular congruency of the fractured talus and the delayed time on the surgery which must be an emergency, seem to be factors to conside r in the later evolution of the "aviators astragalus". The value of Hawkins sign is also discussed

Aislamiento de un extracto de BMP y estudio anatomopatológico del fenómeno de inducción ósea tras su implante en defectos óseos

El objetivo del presente trabajo fue determinar el potencial osteogénico de la proteína morfogenética ósea (BMP) en la reparación de grandes defectos diafisarios. Además, se investiga la acción coadyuvante de la fibronectina (FN). La BMP fue extraída a partir de hueso cortical bovino. Se utilizaron un total de 108 ratas Sprague Dawley. En cada animal, se resecó un segmento de diáfisis femoral de 1.5 cm, siendo inmovilizado el defecto óseo con una aguja en omega. Se rellenó el defecto implantando 25 mg de BMP con o sin 0.5 mg de FN en una cápsula de gelatina (36 animales en ambos grupos). Los resultados se compararon con los obtenidos en otro grupo (36 animales) en el que sólo se implantó FN que sirvió como grupo control. El proceso de reparación se evaluó mediante métodos histológicos y ultraestructurales. La aparición del fenómeno de inducción ósea con reconstrucción del defecto óseo fue mayor en el grupo con implante de BMP más FN (23 animales, 64%) que en el grupo en el que sólo se implantó BMP (20 animales, 56%). Ningún animal del grupo control manifestaba signos de inducción ósea.The aim of the present work was to evaluate the osteogenic potential of Bone Morphogenetic Protein (BMP) for reparation of large segmental bone defects. In addition, the coadjuvant efect of fibronectin (FN) was investigated. BMP was partially purified from bovine cortical bone. A total of 108 Sprague Dawley rats were used in the experiment. Diaphyseal segments of the femur (1.5 cm) were removed in each animal, manteinant the bone defect with a wire. A gelatine capsula containing 25 mg of BMP without or with 0.5 mg of FN, were implanted into the bone defect (36 animal in each group). Results were compared to those obtained in a control group (36 animals) in which FN alone was implanted. The bone repair process was assessed by histologic and ultrastructural methods. Bone induction with reconstruction of the defect was found more of ten in the group with both BMP and FN implanted (23 animals, 64%) than in the group with BMP implant alone (20 animals, 56%). Animals of the control group showed no bone induction. The results suggest that BMP augments the capacity of the host bed to sucessfully regenerate large segmental bone defects. FN seens to increase bone induction. This protein migth stabilize BMP locally improving contact between BMP and the surrounding cells

Indicaciones Límite de las Fracturas de Húmero con Clavo Endomedular Cerrojado

El tratamiento de las fracturas diafisarias del húmero ha entrado en controversia en los últimos años, como lo refleja la literatura internacional. La problemática aumenta cuando se trata de fracturas diafisarias límites que alcanzan la zona metafisaria superior e inferior. En un intento de mejora terapéutica este grupo de autores ha testado un clavo cerrojado para el húmero diseñado por Seidel. El promedio de seguimiento ha sido de 12 meses con un mínimo de 6 meses. El número de casos evaluados ha sido 6. Siguiendo la cotación de Stewart, 4 de los seis pacientes obtuvieron resultados buenos o excelentes. Todos los pacientes consolidaron sus fracturas en un período de tiempo normal, entre 3 y 5 meses, con una media de 4 meses, 4 de los seis pacientes no se inmovilizaron con yeso en ningún momento. La bondad y sencillez del método hace augurar buenos resultados en otros grupos ampliando sus indicaciones.Treatment of dyaphyseal fractures of the humerus has been the source of considerable controversy in recent years. The problem increases in dimension when one is dealing with limiting diaphyseal fractures that invole the upper and lower metaphyseal zone. In an attempt to improve the therapy of this circunstance, the members of this research team have tested a locking nail for the humerus designed by Seidel. The mean follow-up time has been 12 months, with a minimum of six months. The number of cases evaluated was 6. According to the scale of Stewart, four of the cases obtained good or excellent results. All the patients consolidated their fractures within a normal period of time -between 3 and 5 months-, with a mean of 4 months. Four of the 6 patients wer e not immobilized with paster at any time. The goodness and simplicity of the method are suggestive of promising results in other groups by broadening its indications

Study of reactions induced by 6He on 9Be

We present the results of experiments using a 6He beam on a 9Be target at\ud energies 7 − 9 times the Coulomb barrier. Angular distributions of the elastic, inelastic\ud scattering (target breakup) and the -particle production in the 6He+9Be collision have\ud been analysed. Total reaction cross sections were obtained from the elastic scattering\ud analyses and a considerable enhancement has been observed by comparing to stable systems.FAPESPFundação Araucári

Current Research into Applications of Tomography for Fusion Diagnostics

Retrieving spatial distribution of plasma emissivity from line integrated measurements on tokamaks presents a challenging task due to ill-posedness of the tomography problem and limited number of the lines of sight. Modern methods of plasma tomography therefore implement a-priori information as well as constraints, in particular some form of penalisation of complexity. In this contribution, the current tomography methods under development (Tikhonov regularisation, Bayesian methods and neural networks) are briefly explained taking into account their potential for integration into the fusion reactor diagnostics. In particular, current development of the Minimum Fisher Regularisation method is exemplified with respect to real-time reconstruction capability, combination with spectral unfolding and other prospective tasks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks