Long-term results of the retrocapital metatarsal percutaneous osteotomy for hallux valgus

Producción CientíficaThe current trend in hallux valgus surgery is directed toward percutaneous procedures. However, no evidence that any of these methods of treatment are superior to the others has been described, excepting studies in the long term. The aim of this study was to analyse a series of patients who had undergone a percutaneous distal retrocapital osteotomy of the first metatarsal, and had been followed up for ten years. METHODS: We carried out a clinical and radiological evaluation of 115 feet ten years after surgery. RESULTS: The AOFAS scale results in the tenth postoperative year remained significantly favourable compared to their corresponding values in the preoperative period, yielding an improvement of 42.2 points overall on average. In relation to radiological findings, the mean hallux angle was maintained below 20 °, with a mean intermetatarsal angle of 8.1 °. CONCLUSION: Percutaneous retrocapital metatarsal osteotomy for treatment of mild to moderate hallux valgus is effective in the long term, with the advantages of a minimally invasive procedure

Oxford phase 3 unicondylar knee arthroplasty through a minimally invasive approach: long-term results

Producción CientíficaSurgical treatment options for medial compartment osteoarthritis of the knee include high tibial osteotomy, total knee arthroplasty or unicompartmental knee arthroplasty (UKA), depending on the patient's age, level of physical activity and the degree of deformity. METHODS:In this study, we evaluated the long-term results of patients who underwent the Oxford cemented meniscal-bearing unicondylar knee prosthesis through a minimally invasive approach including a clinical, functional and radiographic assessment. RESULTS:Favourable clinical and radiological outcomes were registered overall at ten years after surgery. Overall results of UKA according to the American Knee Society (AKS) using Insall's criteria showed an excellent or good outcome for 492 knees (96.28 %), fair for 11 (2.15 %) and poor for eight (1.57 %) in the post-operative long term. CONCLUSIONS:We believe that with appropriate surgical technique, patient selection, prosthetic design and specific training, surgeons should achieve good outcomes with the added advantages of a minimally invasive approach. High volume for this technique is important in our opinio

Latent tuberculosis infection, tuberculin skin test and vitamin D status in contacts of tuberculosis patients: a cross-sectional and case-control study

<p>Abstract</p> <p>Background</p> <p>Deficient serum vitamin D levels have been associated with incidence of tuberculosis (TB), and latent tuberculosis infection (LTBI). However, to our knowledge, no studies on vitamin D status and tuberculin skin test (TST) conversion have been published to date. The aim of this study was to estimate the associations of serum 25-hydroxyvitamin D₃(25[OH]D) status with LTBI prevalence and TST conversion in contacts of active TB in Castellon (Spain).</p> <p>Methods</p> <p>The study was designed in two phases: cross-sectional and case-control. From November 2009 to October 2010, contacts of 42 TB patients (36 pulmonary, and 6 extra-pulmonary) were studied in order to screen for TB. LTBI and TST conversion cases were defined following TST, clinical, analytic and radiographic examinations. Serum 25(OH)D levels were measured by electrochemiluminescence immunoassay (ECLIA) on a COBAS^®410 ROCHE^®analyzer. Logistic regression models were used in the statistical analysis.</p> <p>Results</p> <p>The study comprised 202 people with a participation rate of 60.1%. Only 20.3% of the participants had a sufficient serum 25(OH)D (≥ 30 ng/ml) level. In the cross-sectional phase, 50 participants had LTBI and no association between LTBI status and serum 25(OH)D was found. After 2 months, 11 out of 93 negative LTBI participants, without primary prophylaxis, presented TST conversion with initial serum 25(OH)D levels: a:19.4% (7/36): < 20 ng/ml, b:12.5% (4/32):20-29 ng/ml, and c:0%(0/25) ≥ 30 ng/ml. A sufficient serum 25(OH)D level was a protector against TST conversion a: Odds Ratio (OR) = 1.00; b: OR = 0.49 (95% confidence interval (CI) 0.07-2.66); and c: OR = 0.10 (95% CI 0.00-0.76), trends p = 0.019, adjusted for high exposure and sputum acid-fast bacilli positive index cases. The mean of serum level 25(OH)D in TST conversion cases was lower than controls,17.5 ± 5.6 ng/ml versus 25.9 ± 13.7 ng/ml (p = 0.041).</p> <p>Conclusions</p> <p>The results suggest that sufficient serum 25(OH)D levels protect against TST conversion.</p

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Rhizarthrosis fourth grade of eaton with hyperextension of themetacarpophalangeal joint

Producción CientíficaRestoration of thumb function with a painfree, stable, and mobile joint with preserved strength are the main goals of treatment of painful arthritis of the thumb. We present our clinical experience in surgical treatment of this disease, in its highest degree of affectation. PRESENTATION OF CASE:A 57-year-old woman presents with a 2-year history of worsening pain at the base of her right, dominant, trapezial-metacarpal (TM) joint. Her thumb metacarpophalangeal (MCP) joint hyperextends 30° with lateral pinch. Radiographs demonstrate Eaton stage IV degenerative changes of her TM joint and no arthritis of her thumb MCP joint. She was successfully treated with a modified Burton-Pellegrini arthroplasty and sesamoidesis to the metacarpal head. DISCUSSION:In cases of advanced rhizarthrosis conventional surgery does not serve to correct deformities of the metacarpophalangeal joint that may affect to the postsurgical outcomes. CONCLUSION:rhizarthrosis management must be carried out in a global way. When a surgical treatment is planned, all deformities must be taken into account

The role of bone marrow mononuclear cell-conditioned medium in the proliferation and migration of human dermal fibroblasts

Abstract Background Several recent studies have demonstrated the great potential of bone marrow cells in regenerative medicine, not only for their ability to differentiate to match a damaged cell type, but also because they synthesize and release various growth factors and cytokines. We examined the effect of bone marrow cell-conditioned medium in the healing process, especially in terms of fibroblast proliferation and migration. Methods These in vitro studies consisted of co-culture (without direct contact) of dermal fibroblasts with mononuclear bone marrow cells and the use of conditioned medium obtained from these cultures in a scratch wound model. Results Mononuclear cells were found to increase the proliferation of fibroblasts, and the conditioned medium showed a stimulatory effect on the migration of fibroblasts. Conclusion When considered together with the observed increase in growth factor levels in conditioned medium, it appears that these cells act through a paracrine mechanism

Abordaje posterior vs lateral en artroplastia total de cadera: estudio prospectivo, aleatorio y ciego

Estudio prospectivo, ciego y aleatorizado sobre 54 pacientes comparando abordaje lateral y posterior en artroplastia total de cadera en dos grupos con la misma distribución en cuanto a sexo, edad, peso, IMC, diagnóstico de indicación, Harris Hip Score preoperatorio. Resultados: no se encontraron diferencias significativas en la función global postoperatoria, en la evolución parámetros hemáticos, en las transfusiones sanguíneas, en la estancia postoperatoria ni en las mediciones radiográficas postoperatorias. Se encontraron diferencias a favor de la vía lateral en el dolor postoperatorio con un menor consumo analgésico y en la vía posterior se detectaron cotilos significativamente más grandes. Conclusiones: aunque ambas vías son excelentes para la colocación de la prótesis total de cadera, el abordaje posterior permite colocar cotilos más grandes con seguridad y el abordaje lateral resulta menos doloroso.Prospective, blinded and randomized study with 54 patients comparing posterior and lateral approaches for THA, two groups were created with similar age, gender, weight, BMI, diagnosis, Harris Hip Score, type of prosthesis and postoperatively management. Results: no differences were found in postoperatively global function, blood loss, blood transfusions, postoperatively stay, radiographic results or complications. We have found differences between both groups in postoperatively pain with less pain-killers consumed in the lateral approach, and bigger acetabular cups in posterior approach. Conclusions: both approaches are excellent for THA but bigger cups was implanted with posterior approach with less risk and patients operated by lateral approach consumed less pain-killers

Valvuloplastia aórtica de urgencia por fallo cardiaco biventricular refractario, secundario a estenosis aórtica crítica.

ResumenLa estenosis valvular aórtica se ha convertido en la causa más importante de enfermedad valvular cardiaca en Europa y Norteamérica.  La valvuloplastia aórtica con balón constituye una opción de tratamiento con indicaciones limitadas en adultos. Se reporta el primer caso realizado en nuestro centro de valvuloplastia aórtica de urgencia, por fallo bi-ventricular refractario, secundario a estenosis valvular crítica. Se hace revisión actualizada acerca de las indicaciones del tratamiento percutáneo  de esta patología. Palabras clave: Estenosis valvular aórtica, valvuloplastia aórtica, fallo bi-ventricular Summary Valvular aortic stenosis is considered the most important cause of cardiac valvular disease in North America and Europe. The aortic valvuloplasty with balloon has limited indications in adult´s patients. We report the first case (made in our center) of urgent aortic valvuloplasty due to bi-ventricular acute heart failure secondary to critical valvular aortic stenosis. A recent review of the percutaneus  treatment is presented. Key words: Valvular aortic stenosis, aortic valvuloplasty, bi-ventricular failur