Arthroscopic stabilisation of an acute acromioclavicular dislocation grade III in a patient with ectopic insertion of the pectoralis minor: technical considerations

The different approaches used in arthroscopic stabilisation of the acromioclavicular joint are well known. However, and despite a great incidence of ectopic pectoralis minor insertion, an alternative choice for the use of arthroscopic portal has not being sufficiently described. Here, we describe a case of acute acromioclavicular dislocation grade III. The arthroscopic stabilisation was achieved using the TightRope (Arthrex, Naples, USA) implant. Through this technique, the approach to the articular portion of the coracoid process can be made intra-articularly or from the subacromial space. We accessed intra-articularly, by opening the rotator interval to reach the coracoid process from the joint cavity. After opening the rotator interval, an ectopic insertion of the pectoralis minor was observed. The choice of approach of the coracoid process from the subacromial space would have complicated the intervention, making it necessary to sever the ectopic tendon to complete the technique, lengthening the surgical time and increasing the chance of complications. For this reason, the use of a standard posterior portal providing intra-articular arthroscopic access through the rotator interval is recommended since the aforementioned anatomical variation is not infrequent. Level of evidence Therapeutic studies—investigating the results of treatment, Level V

A case of cholesteatoma in a medieval Hispano-Mudejar population (13th-14th centuries AD)

The case presented includes a left temporal bone from an individual exhumed from the Hispano-Mudejar necropolis in Uceda (Guadalajara, Spain) dated between the 13th and 14th centuries BC. External examination and computed tomography images show lesions in the external acoustic canal, in the form of diffuse widening, suggestive of a cholesteatoma originating in this canal, with invasion of the middle ear through the tympanic membrane. The difficulties with examining the internal elements of the ear are discussed, which causes the underestimation of these diseases in paleopathology studies

Génesis y desarrollo de UCR Índex en la Universidad de Costa Rica

This paper describes how UCR index has worked and it evidences an increase in visibility and prestige of the journals of the University of Costa Rica, as well as a greater compliance with the indicators through the years. The indicators used for UCR index are described and the compliance of the indicators between 2011 and 2015 is compared. UCR Index was designed to measure the quality of the journals and, in turn, to improve the allocation of funds and bonuses in an objective and equitable manner in the University. Five quality indicators were defined according to the bibliographic review of other index and national evaluation systems experiences in several countries. The indicators are evaluated annually. After 4 years of application, there is an improvement in the number of index in which the journals participate, an increase of the periodicity, a better Latindex rating of each journal, among others. It is concluded that the UCR index has been effective for the purposes in which it was created

Guía de autocuidados para el manejo de la nutrición enteral domiciliaria

Introducción: La nutrición enteral domiciliaria (NED) consiste en la administración de nutrientes al tubo digestivo en aquellos pacientes que no pueden satisfacer sus necesidades nutricionales por vía oral, pero mantienen la funcionalidad del tubo digestivo, en el hogar del paciente. Se indica con mayor frecuencia en pacientes con patologías neurológicas que cursan con afagia o disfagia. Se evidenció que es fundamental una buena formación de pacientes y cuidadores por parte de enfermería para mejorar la calidad de vida, aumentar la adherencia y disminuir el índice de complicaciones. Objetivo: Difundir los cuidados que requieren los pacientes portadores de NED para mejorar así, su calidad de vida. Metodología: Elaborar una guía de autocuidados siguiendo la propuesta por Hernández Zambrano et al. en Cómo elaborar Guías de Recomendaciones de Autocuidado para Pacientes y Cuidadores. Se trata aquellos temas que generaban más inquietud entre pacientes y cuidadores, recogidos en la bibliografía. Conclusiones: Una guía dirigida a los pacientes usuarios de NED y a sus cuidadores, empleando un lenguaje de fácil comprensión, difunde los cuidados de enfermería que requieren estos pacientes. Además, se ha conseguido mejorar la calidad de vida de los pacientes y disminuir su ansiedad por déficit de conocimientos. <br /

¿Disminuye el Estrés Generado en la Sala de Disección la Formación sobre la Muerte y el Moribundo?

Positive effects on reducing students’ stress have been reported across numerous university settings when anatomy preparatory seminars have been provided. To date, this type of preparation for coping with cadaver dissection has not been studied in Spanish universities. The aim of this study is to evaluate how first-year Spanish medical students face the dissecting room and whether previous preparation about death and dying reduces the stress generated. We performed an interventional study with students who received preparatory classes before the dissection practices (Experimental Group, EG) and with students who did not (Control Group, CG). Sociodemographic data and a self-assessment on stress symptoms were collected through a questionnaire completed before and after the dissection practices. No differences were found in the self-report of symptoms of stress among students who consider themselves religious or not, or between students who had a family member in the healthcare environment or not. However, in the EG, the students who had ample experience with terminally ill patients or death reported fewer stress symptoms. Unexpectedly, the number of self- reported stress symptoms after the dissection practice was higher in EG students. In conclusion the stress levels of first-year Spanish medical students not only did not improve after receiving preparatory classes about death and dying and discussion groups, but it gets worse. We found a relationship between student stress measured and experience with terminally ill patients or death. Additional studies are needed to identify the most suitable preparation for Spanish medical students.Se han informado efectos positivos en la reducción del estrés en los estudiantes de numerosos entornos universitarios cuando se han impartido seminarios preparatorios de anatomía. Hasta la fecha, este tipo de preparación para hacer frente a la disección del cadáver no se ha estudiado en las universidades españolas. El objetivo de este estudio es evaluar cómo los estudiantes de medicina españoles de primer año se enfrentan a la sala de disección y si la preparación previa sobre la muerte y el moribundo reduce el estrés generado. Realizamos un estudio de intervención con estudiantes que recibieron clases preparatorias antes de las prácticas de disección (Grupo Experimental, GE) y con estudiantes que no las recibieron (Grupo de Control, GC). Se recogieron datos sociodemográficos y síntomas de estrés mediante un cuestionario de autoevaluación antes y después de las prácticas de disección. No se encontraron diferencias en los síntomas de estrés valorados, entre los estudiantes que se consideran religiosos y los que no, ni tampoco entre los estudiantes que tenían o no un familiar en el entorno sanitario. Sin embargo, en el GE, en los estudiantes que tenían una amplia experiencia con pacientes con enfermedades terminales o con la muerte se observaron menos sín- tomas de estrés. Inesperadamente, el número de síntomas de estrés recogidos después de la práctica de disección fue mayor en los estudiantes del GE. En conclusión, los niveles de estrés de los es- tudiantes españoles de medicina de primer año no solo no mejora- ron después de recibir las clases preparatorias sobre la muerte y el moribundo y establecer grupos de discusión, sino que empeoraron. Encontramos una relación entre la medición del estrés en los estudiantes y la experiencia con pacientes con enfermedades ter- minales o con la muerte. Se necesitan estudios adicionales para identificar la preparación más adecuada para los estudiantes de medicina españoles.Unidad Docente de Anatomía y EmbriologíaFac. de Óptica y OptometríaTRUEUniversidad Complutense de Madridpu

Buenas prácticas en la valoración pericial de personas que sobreviven a la violencia sexual

La violencia sexual, en cualquiera de sus formas, supone una de las más terribles experiencias vitales que puede padecer un ser humano. Provoca, junto con el daño físico, un sufrimiento psíquico derivado de la vulneración del bienestar, de la autonomía, de la privacidad y de la seguridad (1), constituyendo un problema complejo con aspectos médicos, psicológicos y legales (2). Se trata de una forma de violencia omnipresente, que se produce en todas las culturas, en todos los niveles de la sociedad y en todos los países del mundo. Cualquier persona puede experimentar un asalto sexual en cualquier momento de su vida, si bien está documentado y ampliamente aceptado que las víctimas más frecuentes son mujeres y que la mayoría de los perpetradores son hombres, que en las mujeres el riesgo de ser atacadas sexualmente se da tanto en la infancia como en la edad adulta, mientras que en los hombres la mayor prevalencia se da en la niñez, y que la mayoría de las víctimas conocen a su atacante (3) (4). Este último dato es de gran interés, ya que cuanto más cercana es su relación con la víctima, más difícil le resulta a esta hablar sobre el asalto (5) (...

Comparison of Coracoid Graft Position and Fixation in the Open Versus Arthroscopic Latarjet Techniques: A Cadaveric Study.

Background: Since the description of the arthroscopic Latarjet technique, discussion about the superiority of the open or arthroscopic procedure has arisen. The appropriate placement of the coracoid graft (CG) on the anterior glenoid neck was reported to be the most important step of the Latarjet procedure. Purpose: To verify if there are differences in the parameters that may affect the final position and fixation of CG obtained from the open and arthroscopic Latarjet techniques. Study Design: Controlled laboratory study. Methods: Twenty fresh-frozen human paired cadaveric shoulder specimens were randomly distributed in 2 surgery groups (open group [OG] and arthroscopic group [AG]) with 10 specimens in each. Two surgeons, each with experience performing open and arthroscopic Latarjet techniques, executed these procedures in each of the respective groups[AQ: 2]. After surgery, a computerized tomography scan was performed. The surgical time, the position of each CG, a series of variables that might affect the CG fixation, and the level of the subscapularis split were evaluated. Results: The mean surgical time was significantly higher in the AG (mean, 26 minutes for OG and 57 minutes for AG). Three intraoperative complications (30%) were identified in the AG, consisting of graft fractures. The CG was determined to be in an optimal cranial-caudal position in 90% of specimens of the OG and 44% of the AG [AQ: 3](Fisher, P = .057). In both groups, the CG was placed in an optimal medial-lateral position in all specimens. In the OG, the degree of parallelism between the major axes of the glenoid surface and CG was significantly greater than in the AG (mean, 3.88 for OG and 15.18 for AG). No significant differences were observed in superior and inferior screw orientation between the groups. In the longitudinal and transversal directions, significant differences were found in the centering of the superior screw, being closer to the ideal point in the OG than in the AG[AQ: 4]. The location where the longitudinal subscapularis split was performed was significantly higher in the AG. Conclusion: The open Latarjet technique requires less surgical time; presents a lower number of intraoperative complications; and allows more adequate placement of the CG, better centering of the screws, and a subscapularis split closer to the ideal position.pre-print4132 K

Anatomic relationship of the proximal nail matrix to the extensor hallucis longus tendon insertion

[Abstract] Background The purpose of this study was to delineate the relationship of the terminal extensor hallucis longus tendon insertion to the proximal limit of the nail matrix of the great toe. Material and methods Fifty fresh-frozen human cadaver great toes with no evidence of trauma (average age, 62.5 years; 29 males and 21 females) were used for this study. Under 25X magnification, the proximal limit of the nail matrix and the terminal bony insertion of the extensor hallucis longus tendons were identified. The distance from the terminal tendon insertion to the nail matrix was ascertained using precision calipers, an optical microscope, and autocad® software for windows. Twenty-five great toes were placed in a neutral formalin solution and further analysed by histological longitudinal-sections. The specimens were stained with haematoxylin and eosin and examined microscopically to determine the presence of the extensor hallucis longus tendon along the dorsal aspect of the distal phalanx of each great toe. Results The main result we found in great toes was that the extensor tendon is between the matrix and the phalanx and extends dorsally to the distal aspect of the distal phalanx in all, 100%, specimens. The nail matrix of the great toe is not attached to the periosteum of the dorsal aspect of the base of the distal phalanx as is the case for fingers, because the extensor hallucis tendon is plantar or directly underneath the nail matrix and the tendon is dorsal to the bone. Conclusions We have found that the extensor tendon is between the matrix and the phalanx and extends dorsally to the distal aspect of the distal phalanx. The nail matrix of the great toe is not attached to the periosteum of the dorsal aspect of the base of distal phalanx as is the case in fingers, because the extensor hallucis tendon is plantar or directly underneath the nail matrix and the tendon is dorsal to the bone. Our anatomic study demonstrates that the proximal limit of the matrix and nail bed of the human great toe are dorsal and overlapping the terminal extensor hallucis longus tendon until its distal bony insertion in all specimens

Anatomic and Histological Features of the Extensor Digitorum Longus Tendon Insertion in the Proximal Nail Matrix of the Second Toe

[Abstract] Background: Anatomic and histological landmarks of the extensor digitorum longus (EDL) tendon insertion in the proximal nail matrix may be key aspects during surgery exposure in order to avoid permanent nail deformities. Objective: The main purpose was to determine the anatomic and histological features of the EDL’s insertion to the proximal nail matrix of the second toe. Methods: A sample of fifty second toes from fresh-frozen human cadavers was included in this study. Using X25-magnification, the proximal nail matrix limits and distal EDL tendon bony insertions were anatomically and histologically detailed. Results: The second toes’ EDLs were deeply located with respect to the nail matrix and extended superficially and dorsally to the distal phalanx in all human cadavers. The second toe distal nail matrix was not attached to the dorsal part of the distal phalanx base periosteum. Conclusions: The EDL is located plantar and directly underneath to the proximal nail matrix as well as dorsally to the bone. The proximal edge of the nail matrix and bed in human cadaver second toes are placed dorsally and overlap the distal EDL insertion. These anatomic and histological features should be used as reference landmarks during digital surgery and invasive procedures

Innovations through 5G-Crosshaul applications

Proceeding of: 2016 European Conference on Networks and Communications (EuCNC) 27-30 junio 2016 Athens, GreeceA transport network for 5G envisions integrating the fronthaul and backhaul segments (namely 5G-Crosshaul) into a single transport network. This requires a fully integrated and unified management of fronthaul and backhaul resources in a sharable, scalable and flexible way. The integrated and unified management of the transport network resources follows the Software Defined Networking (SDN) principles of centralization, decoupling between control and data plane and application ecosystem. Innovation to enable context-aware resource management and to provide system-wide optimization of QoS, as well as energy related objectives, lies on defining key applications as logical decision entities to program the underlying network and packet forwarding behaviour. This paper presents a set of 5G-Crosshaul SDN applications with the scope of (i) managing the 5G-Crosshaul resources, including not only network but also computing and storage resources, and (ii) offering efficient media distribution and traffic offloading solutions. In order to develop these applications in a real system, we identify the interactions between the applications and the control plane. Based on these interactions, we propose a two-layer application plane and specify the requirements of the applications on the Northbound Interface (NBI) of the control plane.This work has been supported by the H2020 project “5G-Crosshaul: The 5G Integrated fronthaul/backhaul” (671598)