Artroplastia de superficie en coxartrosis secundaria a epifisiolisis de cadera: detalle técnico

La artroplastia de superficie en cadera se ha venido indicando con mayor frecuencia para el tratamiento de la coxartrosis en pacientes jóvenes. Se trata de una técnica quirúrgica exigente, que puede verse dificultada cuando existe una mayor deformidad de la cabeza femoral. Presentamos un caso clínico de un varón de 58 años con coxartrosis secundaria a epifisiolisis de cabeza de fémur. Describimos una modificación de la técnica quirúrgica con la colocación de la aguja guía bajo radioscopia y de forma percutánea, previo al abordaje de la cadera. Se analizan los resultados clínico-radiológicos y se revisa la literatura.Surface arthroplasty of the hip has been indicated more frequently for treatment of coxarthrosis in young patients. This is a demanding surgical technique, which can be difficult when there is a greater deformity of the femoral head. We report a case of a man aged 58 with coxarthrosis secondary to epiphysiolysis head of the femur. We describe a modification of the surgical technique for the placement of the wire guide under fluoroscopy and percutaneously, previously to the approach of the hip. Clinical and radiological results and review the medical literature were considered

Luxación inestable traumática trapeciometacarpiana.

Isolated dislocation of the carpal-metacarpal joint of the thumb or Trapezio-metacarpal (TMC) is a rare but challenging lesion, and represents 1% of all fractures of the hand. There is still controversy about the best treatment for this pathology. Acute TMC joint dislocation is usually managed by three treatment modalities: closed reductionand immobilization with a cast, closed or open reduction with Kirschner wires fixation,and reconstruction or repair of ligaments and capsulorrhaphy.Suture anchor repair is currently being used as the primary treatment for unstable dislocations.The aimof the present work is to review two cases of carpo-metacarpal dislocation of the thumb treatedby reduction and Kirschner wiresfixation,and show their evolution

Osteotomía de Weil percutánea en el tratamiento de las metatarsalgias: correlación clínico-radiológica

El objetivo del presente trabajo fue evaluar los resultados de la osteotomía de Weil percutánea para el tratamiento de la metatarsalgia de origen mecánico. Para ello, se revisaron de forma retrospectiva los primeros 28 casos consecutivos intervenidos mediante osteotomía de Weil percutánea en pacientes con metatarsalgia mecánica por sobrecarga de los metatarsianos centrales. Se entrevistó a la totalidad de los pacientes, evaluando los resultados radiológicos, estéticos y funcionales, utilizando para ello la Escala de Valoración funcional AOFAS (American Orthopaedic Foot and Ankle Society) para el antepié. Los resultados fueron considerados como buenos o excelentes desde el punto de vista funcional en 81% de los pies intervenidos y en el 89% desde el punto de vista estético. La puntuación final media en la escala AOFAS fue de 78,3. Tuvimos 3 casos de infección por estafilococo aureus que se resolvieron con tratamiento antibiótico específico. No se observaron pseudoartrosis. Por todo ello, consideramos que la osteotomía de Weil es una técnica adecuada y segura para tratar las metatarsalgias de causa mecánica.The aim of this retrospective study was to evaluate the short-term results after percutaneous Weil osteotomy for the treatment secondary metatarsalgia related to repetitive high-pressure loading under the metatarsal heads. We analyzed retrospectively clinical and radiological outcome of 28 consecutive patients who were treated with percutaneous, subcapital osteotomy for metatarsalgia with overload etiology. Analysis of the esthetic, functional and radiologic results was performed using AOFAS forefoot score. Good to excellent functional results were achieved in 81% of the feet, cosmetic in 89% with average score 78,3 points. Three patients developed a superficial wound infections, which responded to antibiotics. Union occurred in all cases. Percutaneous Weil osteotomy is safe and effective technique for treatment of secondary metatarsalgia with mechanic etiology

Expression of xyloglucan endotransglucosylase/hydrolase (XTH) genes and XET activity in ethylene treated apple and tomato fruits

[EN] Xyloglucan endotransglucosylase/hydrolase (XTHs: EC 2.4.1.207 and/or EC 3.2.1.151), a xyloglucan modifying enzyme, has been proposed to have a role during tomato and apple fruit ripening by loosening the cell wall. Since the ripening of climacteric fruits is controlled by endogenous ethylene biosynthesis, we wanted to study whether XET activity was ethylene-regulated, and if so, which specific genes encoding ripening-regulated XTH genes were indeed ethylene-regulated. XET specific activity in tomato and apple fruits was significantly increased by the ethylene treatment, as compared with the control fruits, suggesting an increase in the XTH gene expression induced by ethylene. The 25 SlXTH protein sequences of tomato and the 11 sequences MdXTH of apple were phylogenetically analyzed and grouped into three major clades. The SlXTHs genes with highest expression during ripening were SlXTHS and SlXTHS from Group III-B, and in apple MdXTH2, from Group II, and MdXTH10, and MdXTH11 from Group III-B. Ethylene was involved in the regulation of the expression of different SlXTH and MdXTH genes during ripening. In tomato fruit fifteen different SlXTH genes showed an increase in expression after ethylene treatment, and the SlXTHs that were ripening associated were also ethylene dependent, and belong to Group III-B (SlXTHS and SlXTHS). In apple fruit, three MdXTH showed an increase in expression after the ethylene treatment and the only MdXTH that was ripening associated and ethylene dependent was MdXTH10 from Group III-B. The results indicate that XTH may play an important role in fruit ripening and a possible relationship between XTHs from Group III-B and fruit ripening, and ethylene regulation is suggested. (C) 2013 Elsevier GmbH. All rights reserved.This work was funded by GVA, PROMETEO/2009/075. We wish to thank Mr. D.A. Lindsay for correcting the English version of the manuscript.Muñoz Bertomeu, J.; Miedes, E.; Lorences, EP. (2013). Expression of xyloglucan endotransglucosylase/hydrolase (XTH) genes and XET activity in ethylene treated apple and tomato fruits. Journal of Plant Physiology. 170(13):1194-1201. https://doi.org/10.1016/j.jplph.2013.03.015S119412011701

Xyloglucan endotransglucosylase and cell wall extensibility

Transgenic tomato hypocotyls with altered levels of an XTH gene were used to study how XET activity could affect the hypocotyl growth and cell wall extensibility. Transgenic hypocotyls showed significant over-expression (line 13) or co-suppression (line 33) of the SlXTH1 in comparison with the wild type, with these results being correlated with the results on specific soluble XET activity, suggesting that SlXTH1 translates mainly for a soluble XET isoenzyme. A relationship between XET activity and cell wall extensibility was found, and the highest total extensibility was located in the apical hypocotyl segment of the over-expressing SlXTH1 line, where the XET-specific activity and hypocotyl growth were also highest compared with the wild line

Ácido tranexámico más bloqueo anestésico con adrenalina frente a recuperador de sangre en artroplastia total de rodilla primaria. : eficacia como protocolos en el ahorro de sangre

The aim of the present study was to compare two blood-saving protocols: the use of the postoperative blood recuperator for autotransfusion (RSPA), the use of intraoperative tranexamic intravenous (ATX) and intra-articular ATX, and anesthetic block with Adrenaline intrarticular. Material and method. Retrospective descriptive observational study of a series of 54 patients operated in our Center by Gonarthrosis, and who were implanted with a total primary knee prosthesis in 2015. They were divided into two groups: group A, patients treated with ATX and anesthetic block according to the protocol described below, and group B, patients in whom a blood recuperator was used during the immediate postoperative period for autotransfusion. Results. The ATX and RSPA groups were comparable in terms of demographic values (ATX 71.59 - recovery 68.63) and distribution by sex (ATX 66.7% women, 33.3% men / recuperator 59.3% women, 40.7% men) similar. The data analysis, the mean hemoglobin decrease was lower in the ATX group (2.23 g / dL), compared to 2.73 g / dL in the group of the recuperator, this difference being not statistically significant (p value of 0.15). Conclusion. The protocol for the use of ATX was more effective as a blood-saving program compared to the use of autologous blood recuperator in primary ATR, although it would be necessary to study a greater number of cases

Estrategias de ahorro de sangre en Artroplastia Total de Rodilla Primaria aplicadas en nuestra Comunidad

Antecedentes. El objetivo del presente estudio fue realizar una actualización sobre las diferentes estrategias en el ahorro de sangre en cirugía protésica de rodilla pri-maria, a través de una revisión bibliográfica; así como, conocer qué estrategias se siguen en diferentes centros hospitalarios de nuestro ámbito, mediante un estudio multicéntrico. Métodos. Se realizó un estudio observacional transversal descriptivo basado en una encuesta realizada a 64 cirujanos y una búsqueda bibliográfica sobre los distintos aspectos incluidos en la encuesta. Resultados. Los cirujanos refieren que cuentan con protocolos de ahorro sanguíneo prequirúrgicos implantados en su Hospital en un 48,4% (31/64). La utilización del ácido tranexámico es bastante generalizada 71,9% de los encuestados (46/64). Este se administra vía endovenosa previa a la cirugía en un 26,6% (17/64) de los casos, de manera intraarticular en un 21,9% (14/64) y en una combinación de ambas en un 23,4% (15/64). El momento preferido para la colocación de la isquemia por los cirujanos es en un 57,8% (37/64) previo a pintar el campo, mientras que un 39,1% (25/64) prefiere colocarla en estéril. Un 3,1% (2/64) de cirujanos afirma implantar las prótesis sin utilizar isquemia en la cirugía. Conclusiones. En los últimos años se está imponiendo la utilización de ATX como principal estrategia de ahorro de sangre en ATR, aunque no existe consenso en cuanto a la dosis óptima ni a su vía de administración. La eficacia del ATX está influyendo en la eliminación de los drenajes postquirúrgicos y en la implementación de programas de rehabilitación preco

Medidas de Tromboprofilaxis en Artroplastia Total de Rodilla. Práctica habitual en la Comunidad Valenciana y revisión bibliográfica.

Antecedentes: El tromboembolismo es una complicación de la cirugía de artroplastia total de rodilla. Para su prevención disponemos de múltiples medidas físicas y farmacológicas.Objetivo:Conocer quémedidas de prevención tromboembólica son las empleadas por los cirujanos ortopédicos en cirugía protésica de rodilla primaria en diferentes centros hospitalarios de nuestra región.Método: Estudio transversal descriptivo observacional basado en encuesta dirigida a especialistas COT de 9 hospitales públicos de la Comunidad Valenciana y búsqueda bibliográfica.Resultados: Se obtuvieron 64 encuestas. Todos los cirujanos eligen HBPM durante un mes como medida de tromboprofilaxis, descartando anticoagulantes orales o aspirina. El 29% también emplea dispositivos de movilización pasiva. Conclusiones: Los cirujanos ortopédicos de la comunidad valenciana optan por HBPM conforme a las mejores evidencias. Se estima, que la incidencia de eventos tromboembólicos sintomáticos desciende del 4,3 % al 1,8% con el uso de HBPM. El empleo de dispositivos de movilización pasiva y medias de compresión no están avaladas por las evidencias. La estratificación preoperatoria del riesgo de tromboembolismo, para emplear ácido acetil salicílico asociado a bombas de presión intermitente en caso de no existir alto riesgo es una tendencia cada vez más aceptada internacionalmente

Medidas para la prevención de la infección en la artroplastia de rodilla : prácticas habituales y evidencias

Infection after knee arthroplasty is one of the most feared complications and routine measures are applied to prevent it. The objective of this study is to identify which are the measures applied by the surgeons of the Valencian Community (CV) and know if the scientific evidence supports them or not. Methods. A descriptive cross-sectional observational study based on a survey of 64 surgeons and bibliographic searches on the aspects included in the survey were conducted. Results. 18.8% of the surgeons perform screening for SARM carriers and decolonization. 98.4% use cefazoline and 1.6% cefuroxime as antibiotic prophylaxis. With respect to the duration of antibiotic prophylaxis, 51% of surgeons administer three doses (24 hours prophylaxis), 23.4% use 2 doses and 17.2% of them use only one dose. 67.2% use 2% alcoholic chlorhexidine gluconate solution for surgical site preparation and 71.9% use adhesive incision drapes. Routine cement with antibiotics is used by 65.6% of respondents. The current scientific evidence supports antibiotic prophylaxis as performed by 100% of respondents; however there is no evidence for the superiority of the preparation of the skin with alcoholic chlorhexidine versus other antiseptics. There is also no evidence to support the use of adhesive incision drapes or the use of cement with antibiotics in a routine manner. Conclusions. It would be advisable for the CV surgeons to avoid the use of incision adhesive drapes and the application of cement with antibiotics in all cases. The preparation of the skin with alcoholic chlorhexidine does not seem to be more effective than other antiseptics in orthopaedic surgery. The screening of SAMR carriers and their decolonization seems to reduce the infection rate; its use can be recommended today, but studies with the largest number of patients that confirm their benefit are needed

Alteration of cell wall xylan acetylation triggers defense responses that counterbalance the immune deficiencies of plants impaired in the β-subunit of the heterotrimeric G-protein

Arabidopsis heterotrimeric G-protein complex modulates pathogen-associated molecular pattern-triggered immunity (PTI) and disease resistance responses to different types of pathogens. It also plays a role in plant cell wall integrity as mutants impaired in the Gβ- (agb1-2) or Gγ-subunits have an altered wall composition compared with wild-type plants. Here we performed a mutant screen to identify suppressors of agb1-2 (sgb) that restore susceptibility to pathogens to wild-type levels. Out of the four sgb mutants (sgb10-sgb13) identified, sgb11 is a new mutant allele of ESKIMO1 (ESK1), which encodes a plant-specific polysaccharide O-acetyltransferase involved in xylan acetylation. Null alleles (sgb11/esk1-7) of ESK1 restore to wild-type levels the enhanced susceptibility of agb1-2 to the necrotrophic fungus Plectosphaerella cucumerina BMM (PcBMM), but not to the bacterium Pseudomonas syringae pv. tomato DC3000 or to the oomycete Hyaloperonospora arabidopsidis. The enhanced resistance to PcBMM of the agb1-2 esk1-7 double mutant was not the result of the re-activation of deficient PTI responses in agb1-2. Alteration of cell wall xylan acetylation caused by ESK1 impairment was accompanied by an enhanced accumulation of abscisic acid, the constitutive expression of genes encoding antibiotic peptides and enzymes involved in the biosynthesis of tryptophan-derived metabolites, and the accumulation of disease resistance-related secondary metabolites and different osmolites. These esk1-mediated responses counterbalance the defective PTI and PcBMM susceptibility of agb1-2 plants, and explain the enhanced drought resistance of esk1 plants. These results suggest that a deficient PTI-mediated resistance is partially compensated by the activation of specific cell-wall-triggered immune responses.Viviana Escudero, Lucía Jordá, Sara Sopeña-Torres, Hugo Mélida, Eva Miedes, Antonio Muñoz-Barrios, Sanjay Swami, Danny Alexander, Lauren S. McKee, Andrea Sánchez-Vallet, Vincent Bulone, Alan M. Jones, and Antonio Molin