Osteoma osteoide a nivel de una falange proximal de la mano

El osteoma osteoide es un tumor óseo benigno que aparece fundamentalmente en adolescentes, y aunque con menor frecuencia, también en adultos jóvenes. El fémur y la tibia son las localizaciones más frecuentes, hallándose raramente a nivel de la mano. Presentamos un caso de osteoma osteoide de la localización infrecuente sobre la primera falange del 4º dedo de la mano derecha en un paciente de 22 años de edad. El paciente presentaba dolor y tumefacción de dos meses de evolución en la base del 4º dedo que aumentaban progresivamente. Tras las pruebas complementarias se diagnosticó un osteoma osteoide yuxtacortical que se trató mediante resección en bloque y autoinjerto.Osteoid osteoma is a benign bone tumour that appears most frequently in adolescents. The tibia and femur are the most frequent locations, and the hand is very uncommon. We present the case of a 22 year-old-man, without relevant antecedents, who presented in the base of the 4th finger. Bye means of complementary tests, juxtacortical osteoid osteoma was diagnosed. The treatment consisted in surgical resection in bloc and bone graft

Respuesta de hipersensibilidad retardada en pacientes candidatos a artroplastia de cadera

Se estudiaron 100 pacientes escogidos de manera aleatoria de entre los candidatos a artroplastia de cadera (47 por fractura subcapital de fémur Garden IV, y 53 por coxartrosis). En el momento del ingresos se determinaron en sangre niveles de albúmina, proteínas totales y hemoglobina; y se midió la respuesta de hipersensibilidad retardada mediante la inoculación de siete antígenos de memoria con un aplicador Multitest® (Mérieux). La lectura de la reacción de induración se realizó a las 48 horas. Los pacientes fueron clasificados en: normoérgicos (+) a dos o más antígenos) y anérgicos (una o ninguna respuesta (+). La población normoérgica representó el 61% de los pacientes, con una edad 12,5 años menor que la población anérgica (p<0,001). Los pacientes normoérgicos presentaron cifras significativamente más altas de hemoglobina (p<0,001), proteínas totales (p<0,05) y albúmina (p<0,001). La situación de anergia fue más frecuente en el grupo de mujeres (29/57) frente al de hombres (10/43; p<0,001), y en el grupo de fracturas subcapitales (31/47) que en el de coxartrosis (8/53) (p<0,001). No se hallaron relaciones estadísticamente significativas entre los distintos parámetros estudiados y la aparición de infección en el postoperatorio. Las diferencias aparecidas reflejan alteraciones en la respuesta inmunológica que, sin embargo, no resultan pronósticas frente a la aparición de infección en nuestra serie.One hundred candidates for hip arthroplasty were chosen at random (47 Garden IV femoral neck fractures, and 53 osteoarthrosis). Before surgery, serum albumin, total proteins and haemoglobin were determined in peripheral blood. All patients were skin tested with seven memory antigens (Multitest®, Mérieux) in order to measure the delayed hypersensitivity response. The diameter of the resulting induration was measured 48 hours after injection. Patients were classified as reactive if they responded to one antigen or showed no response. Reactive patients supposed 61% of total, and anergic patients were 12,5 years older (p<0,001). Levels of haemoglobin (p<0,001), total proteins (p<0,05) and albumin (p<0,001) were higher in reactive patients. Anergy was more frequent in women (29/57) than in men (10/43; p<0,001), and in fractures (31/47) than in osteoarthrosis (8/53) (p<0,001). No association between the variables studied and postoperative infection was found. These differences show immunologic alterations. However, they have no prognostic value for postoperative infection in hip arthroplasty patients

Complicaciones tras la artrotomía en el tratamiento de las fracturas desplazadas del cuello del radio en la infancia

Presentamos un estudio retrospectivo de los resultados obtenidos en una serie de 14 fracturas del cuello del radio desplazadas con más de 30º de inclinación (Judet grados 3 y 4) en niños entre 7 y 14 años tratados mediante artrotomía y fijación con agujas. La distribución por sexos fue de 9 niñas y 5 niños. El seguimiento medio fue de 47 meses. Cabe destacar que no hemos encontrado relación entre el retraso en el tratamiento quirúrgico y los resultados funcionales. Por otro lado, sí aparece una relación entre la angulación residual de la cabeza del radio y peores resultados funcionales.We report the retrospective results of 14 displaced radial neck fractures with >30ºof tilt (Judet grades 3-4) in children aged between 7 and 14 years treated with arthrotomy and pinning. Sex distribution was 9 girl and 5 boys. The average follow-up was 47 months. We found no relationship between delay in the surgical treatment and functional results. On the other hand, a relationship between residual final tilt and poorer functional results appears

Granzyme-A deficiency attenuates experimental osteoarthritis in mice, but perforin deficiency does not

Objectives: This study aims to assess the development of osteoarthritis (OA) in granzyme A- (gzmA) and B- (gzmB) and perforin- (perf) knockout mice. Materials and methods: A total of 75 male and female C57BL/6 (eight to nine-week-old) mice were allocated to: gzmA-deficient (gzmA-/-) (11 females, 8 males), gzmB-deficient (gzmB-/-) (9 females, 8 males), perf-deficient (perf-/-) (10 females, 9 males), and control group (10 females, 10 males). Osteoarthritis was induced in the right knee by instability of the meniscus medial ligament. Sham surgery was practiced in the left knee. Knee samples obtained eight weeks after surgery were stained (Safranin-O) and blindly scored in lateral and medial femur and tibia using the Osteoarthritis Research Society International scale (OARSI) (from Grade 0, cartilage intact to 6, deformation), (five stages from 0, no OA to 4, >50% surface involvement); OARSI score (grade x stage); and a semi-quantitative scale from Grade 0 (normal) to 6 (cartilage erosion >80%). Results: Significantly higher values in all scales in the right knees compared to the left knees in male and female mice were observed (p<0.05). Males of all strains showed in the right knee higher values than females on all scales. Deficiency of perforin did not modify OA severity in any sex. The gzmA-/- females presented less degenerative changes than the other groups. Conclusion: Our study results show that sex plays an important role in the development of experimental OA in mice. Deficiency of gzmA can protect from the development of OA in female mice

Non-vertebral hydatidosis in bone: Difficulties in management

Objectives: This study presents our experience in surgical treatment of extravertebral bone hydatidosis and aims to investigate the utility of specific immunoglobulin E (IgE) in diagnosis and prognosis of the disease. Patients and methods: Between January 1990 and December 2019, a total of 10 patients (6 males, 4 females; mean age: 47.2±14.7 years; range, 27 to 71 years) with non-vertebral bone hydatidosis surgically treated in our hospital were retrospectively included. Curettage or wide resection was performed in all cases, followed by medical antihelminthic therapy. Specific IgE p2 was studied in seven patients during and at final follow-up. Results: At the time of diagnosis, secondary infection of the cyst was observed as the initial symptom in two patients mimicking an abscess and, in both cases, more surgeries were required without final healing. In two cases, over five specific IgE presented a false negative at the time of diagnosis and it was not correlated with clinical evolution in three cases over seven. In six cases, diagnosis was obtained before surgery. In treatment, pelvic disease had the worst prognosis (none healed) and bacterial overinfection was a common complication after surgery. At the final follow-up, only two femoral cases (20%) were free of disease. Other four cases (three in iliac bone, one in proximal femur) needed several surgeries without healing. The other four patients showed no progression or refused a new surgical treatment. Conclusion: Location, bone defect, when it is possible to perform a radical surgery, and associated bacterial overinfection after surgery make cystic hydatidosis in bone an infection very difficult to treat definitively in humans. Negative specific IgE does not exclude bone hydatidosis

El implante de células mesenquimales disminuye el rechazo celular agudo en el trasplante de intestino

Objective: The objective of the study was to show adipose tissue-derived mesenchymal stem cells (AD-MSCs) immunomodulatory effects in small bowel transplantation (SBTx). Materials and methods: Forty Wistar Han rats (age: 10-12 weeks): were allogenic receptor rats and were allotted in 2 groups. Control group: rats undergoing orthopic SBTx ; AD-MSCs group: rats undergoing orthotopic SBTx plus AD-MSCs. Male Lewis rats were allogeneic small bowel donors. Rejection was confirmed by histological study of the explanted intestine, enterocyte apoptosis was determined in crypts and the lamina propria of the small bowel. Cytokine concentration levels (enzyme-linked immunosorbent assay) (interleukin [IL]-4, IL-10, IL-12, IL-17, IL-21, IL-23, tumor necrosis factor-alpha, and transforming growth factor [TGF]-b1) and cell percentages (flow cytometry) (CD3+ CD4+, CD8+, CD4+/25+, CD8+/25+, CD4+/25+/Foxp3+, and CD8+/25+/Foxp3+) were assessed in peripheral blood preoperatively and after death. Results: Treatment with AD-MSCs produced a significantly lower risk of rejection in the first 7 post-operative days (five rejection cases among 20 rats in the control group and only one case in the AD-MSCs group). Treg cells and TGFb1 levels showed a significant increase in the AD-MSCs group. Conclusions: The local implantation of AD-MSC in the anastomosis and the intestinal lumen can induce a regulatory immune response, by increasing the percentages of Treg cells and TGb-1 levels, leading to a lower risk of acute rejection by cell mediation, in the first 7 days of the intestinal transplant. We think that the implantation of AD-MSCs, in the anastomoses and in the lumen of the donor intestine, could give rise to a chimera of donor-recipient cells.Objetivo: Mostrar el efecto inmunomodulador de las células madre mesenquimales (AD-MSCs) en el trasplante de intestino delgado (SBTx). Método: 40 ratas Wistar Han (edad: 10-12 semanas): grupo control (SBTx) y grupo AD-MSCs (SBTx + AD-MSCs implantadas en las anastomosis distal y proximal del intestino delgado y en la luz intestinal). El intestino delgado provino de ratas Lewis. El rechazo se confirmó histológicamente. Se estudió la apoptosis de los enterocitos en las criptas y en la lámina propia del intestino delgado. Se determinaron por ELISA las citocinas (IL-4, IL-10, IL-12, IL-17, IL-21, IL-23, TNF-α, TGF-b1) en sangre periférica y por citometría de flujo los porcentajes celulares (CD3+ CD4+, CD8+, CD4+/25+, CD8+/25+, CD4+/25+/Foxp3+, CD8+/25+/Foxp3+) en el preoperatorio y después de la muerte. Resultados: El empleo de AD-MSCs se asoció a una disminución significativa del riesgo de rechazo en los primeros 7 días posoperatorios (cinco casos de rechazo de 20 ratas en el grupo control y un solo caso en el grupo AD-MSCs). Las células Treg y los valores de TGFb1 mostraron un incremento significativo en el grupo AD-MSCs. Conclusiones: El implante local de AD-MSCs en las anastomosis del trasplante de intestino delgado podría disminuir el rechazo celular agudo. Pensamos que la implantación de AD-MSCs, en las anastomosis y en el lumen del intestino donante, podría dar lugar a un quimera de células donante-receptor.Fil: Navarro Zorraquino, Marta. Universidad de Zaragoza; EspañaFil: Pastor, Cristina. Instituto Aragonés de Ciencias de la Salud; EspañaFil: Stringa, Pablo Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Estudios Inmunológicos y Fisiopatológicos. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Estudios Inmunológicos y Fisiopatológicos; ArgentinaFil: Soria, Joaquín. Universidad de Zaragoza; EspañaFil: Hernández, Francisco. Hospital Universitario La Paz; EspañaFil: López Santamaría, Manuel. Hospital Universitario La Paz; EspañaFil: García Alvarez, Felícito. Universidad de Zaragoza; Españ