Spontaneous osteonecrosis of the knee. Treatment and evolution

We performed a retrospective study on 21 patients affected by unilateral spontaneous osteonecrosis of the femoral condyle. Fifteen were women and 6 men. Their average age was 66.9 years. In ten cases the onset of pain was sudden, with a clear previous history of trauma in two of them. Gait pain, effusion, and joint locking were the most frequent clinical symptoms. At the time of diagnosis, 7 patients presented with grade I necrosis, 8 grade II, 1 grade III, and 5 grade IV, following Koshino's classification [11]. The average percentage of osteonecrosis was 36.8%. Six patients underwent conservative treatment with physical exercises and nonsteroidal anti-inflammatory drugs. We performed arthroscopy alone in 4 patients, arthroscopy and drilling in 8, valgus high tibial osteotomy in 2, and total knee arthroplasty in 1. The overall results after an average follow-up 41 months were excellent and good in 76.2% of the cases, fair in 14.3%, and poor in 9.5%. An associated medial meniscus tear was found in half of the patients who underwent surgery. In patients diagnosed with grade III and IV osteonecrosis, no increase in the percentage of necrosis was observed

Angioleiomioma de nervio periférico

Se realiza una revisión bibliográfica y se presenta un caso de angioleiomioma localizado en borde cubital de muñeca izquierda, en el ramo dorsal sensitivo del nervio cubital. Este tumor debe ser considerado en el diagnóstico diferencial de los nodulos subcutáneos dolorosos localizados en extremidades. No hemos encontrado descrito este tipo de tumor en un nervio periférico.A cas e of angioleiomyoma on the medial aspec t of the left wrist in the dorsal sensitive branch of the ulnar nerve, and a review of the literatur e are presented. This tumor should be considered in the differential diagnosis of patients who have a painful subcutaneous nodul e at the extremities. Ther e is no report in the literatur e on this type of tumor affecting a peripheral nerve

Consolidation of massive bone allografts in limb-preserving operations for bone tumours

This study analysed the influence of several factors affecting the consolidation time of 83 massive bone allografts in 79 patients with malignant bone tumours: osteosarcoma 57; Ewing's sarcoma 8; malignant fibrous histiocytoma 3; chondrosarcoma 4; fibrosarcoma 5; and giant cell tumours 2. The mean age of the patients was 19 years and the mean length of the allografts was 18 cm. The minimum follow up was for 12 months. The mean consolidation time for metaphyseal and diaphyseal osteotomies was 6.5 and 16 months respectively. Fifteen diaphyseal osteotomies required autologous cancellous grafting. There were 8 allograft fractures after consolidation. The following factors which might influence consolidation were analysed: age of the host and donor; allograft length and site; type of osteotomy and osteosynthesis; intra-arterial and systemic chemotherapy; intraoperative and external radio-therapy. In diaphyseal osteotomies there were statistically significant differences in consolidation time with the use of systemic chemotherapy, external radiotherapy and the recipient's age

Distraction osteogenesis of the lower extremity with use of monolateral external fixation

We reviewed the results of distraction osteogenesis of 114 femora and 147 tibiae that had been lengthened to treat a variety of diagnoses. The femora had been lengthened an average of eleven centimeters (range, 3.5 to 17.0 centimeters), or 48 per cent (range, 8 to 86 per cent) of the original femoral length. The average total time for the treatment of the femora (use of the fixator and any subsequent immobilization) was 257 days (range, 105 to 420 days). There were 114 complications related to the femoral lengthenings, which led to eighty-seven additional operations. The tibiae were lengthened an average of nine centimeters (range, 3.0 to 15.6 centimeters), or 41 per cent (range, 9 to 100 per cent) of the original tibial length. The average total time for the treatment of the tibiae was 268 days (range, 110 to 497 days). There were 196 complications related to the tibial lengthenings, which led to 219 additional operations. The Achilles tendon was lengthened during or after seventy-three (50 per cent) of the tibial lengthenings. The femoral lengthenings that were performed to treat a limb-length discrepancy were associated with significantly higher rates of complications overall (p = 0.010) and additional operations (p = 0.023) for each percentage of length gained than those that were performed to treat achondroplasia or another skeletal dysplasia. The femoral lengthenings that were performed to treat short stature (of an endocrine or idiopathic etiology) were also associated with higher rates of complications overall and additional operations than those performed to treat skeletal dysplasias, but the rates were lower than those for lengthenings performed to treat limb-length discrepancy. The rate of complications overall associated with femoral lengthening in patients who were fourteen years old or more was significantly higher than that associated with lengthening in patients who were less than fourteen years old (p = 0.047). Femoral lengthening through the metaphysis was associated with significantly higher rates of complications overall (p = 0.031) and additional operations (p = 0.042) for each percentage of length gained than femoral lengthening through the diaphysis. The tibial lengthenings that were performed to treat Turner syndrome and idiopathic short stature were associated with significantly higher rates of complications overall (p = 0.026) and additional operations (p = 0.003) for each percentage of length gained than those performed to treat skeletal dysplasias. The rate of joint-related problems (p = 0.044) and that of additional operations (p = 0.053) after tibial lengthening in patients who were fourteen years old or more were significantly higher than those rates after tibial lengthening in patients who were less than fourteen years old. The site of the tibial osteotomy did not affect the rate of complications or additional operations. The femoral healing indices (in terms of both days per centimeter [p = 0.002] and days for each percentage of length gained [p = 0.019]) were significantly higher in the patients who were fourteen years old or more than in those who were less the fourteen years old. These values could not be used to predict an increase in the complications because of poor bone formation. The results of the present review suggest that the use of healing indices to gauge the final outcome of distraction osteogenesis is questionable; we were unable to discern significance or clinical importance from appropriately adjusted values

Quiste sinovial en articulación interapofisaria lumbar. Una causa infrecuente de lumbociática

Los quistes sinoviales de las articulaciones facetarias pueden ser asintomáticos o provocar dolor lumbar, con o sin clínica radicular. Se considera que son secundarios a traumatismos o a degeneración articular, y ocurren con mayor frecuencia en pacientes con espondi lolistesis. El diagnóstico se establece con la tomografía axial computarizada o la resonancia magnética, que mues tran una lesión quísti ca adyacente a la faceta articu lar. Realizamos una revis ión de la literatura y presenta mos un paciente con radiculopatí a S1 izquierda cau sada por un quiste sinovial de la articulación facetaria L5 - S1. El tratamiento fue curativo y consistió en la resección del quiste

Transient hypothyroidism after iodine-131 therapy for Grave's disease

We studied 355 patients with Grave's disease to characterize transient hypothyroidism and its prognostic value following 131I therapy. Methods: the patients received therapeutic 131I treatment as follows: 333 received a dose 10 mCi (12.8 +/- 2.9 mCi). Diagnosis of transient hypothyroidism was based on low T4, regardless of TSH within the first year after 131I followed by recovery of T4 and normal TSH. Results: after administration of 10 mCi) of 131I. Iodine-131 uptake > 70% at 2 hr before treatment was a risk factor for developing transient hypothyroidism (Odds ratio 2.8, 95% confidence interval 0.9-9.4). At diagnosis of transient hypothyroidism, basal TSH levels were high (51%), normal (35%) or low (14%); therefore, the transient hypothyroidism was not centralized. If hypothyroidism developed during the first 6 mo after basal TSH > 45 mU/liter ruled out transient hypothyroidism. Conclusion: the development of transient hypothyroidism and its hormonal pattern did not influence long-term thyroid function. Since no prognostic factors reliably predicted transient hypothyroidism before 131I or at the time of diagnosis, if hypothyroidism appears within the first months after 131I, the reevaluation of thyroid function later is warranted to avoid unnecessary chronic replacement therapy

All-Inside Partial Epiphyseal Anterior Cruciate Ligament Reconstruction Plus an Associated Modified Lemaire Procedure Sutured to the Femoral Button

Anterior cruciate ligament (ACL) tears in skeletally immature patients are on the rise; pediatric athletes are now in constant year-round sports participation. Nonoperative treatment may lead to poor functional outcomes and an increase in associated intra-articular lesions and sometimes can cause drop-out from sports activity. The treatment of these injuries is not at all clear, and appropriate guidelines do not exist. Physeal-sparing and partial physeal-sparing techniques have been described. Concerns about restoring normal knee kinematics with the previously described ACL reconstruction (ACLR) techniques are open to debate. We describe a partial epiphyseal ACLR to be done in skeletally immature patients involved in highly demanding sport activities. This technique is performed with an extraphyseal femoral tunnel drilled retrograde, a transphyseal tibial tunnel, and a retrograde tibial drilling without trespassing the tibial physis. We added a modified Lemaire procedure to improve rotational instability to the previously performed ACLR

Prevención de los consumos problemáticos: generando prácticas institucionales para la visibilización, la reflexión y el cambio de actitud en el ámbito educativo

El presente trabajo propone compartir y reflexionar a partir de la experiencia educativa realizada en el contexto de la pandemia, durante la cursada la asignatura “Análisis e intervención en situaciones de convivencia escolar” en el último año del profesorado de Inglés, del Instituto Superior de Formación Docente y Técnica (ISFDyT) N° 18 de gestión pública del conurbano bonaerense. En el transcurso de las clases y a partir de las experiencias de lxs estudiantes en sus prácticas docentes, que se replicaban en diferentes historias, surgió la necesidad de generar un dispositivo pedagógico de articulación con otras instituciones de gestión pública, especializadas en el abordaje de situaciones de consumos problemáticos en escuelas, con el fin de socializarlo y brindar herramientas a la comunidad educativa del instituto.Universidad Nacional de La Plat

Promoción del empleo de las videoconferencias como elemento de potenciación dela calidad en el aprendizaje en la ETSEIAT

En esta comunicación se describen dos experiencias de aplicación de las videoconferencias en asignaturas de elevado contenido tecnológico, dentro de la titulación de Ingeniería Aeronáutica que se imparte en la Escuela Técnica Superior de Ingenierías Industrial y Aeronáutica de Terrassa (ETSEIAT).Postprint (published version

Desenvolupament de metodologies prèvies per a la millora de les sessions presencials

Els objectius principals d’aquest treball s’han dissenyat al voltant d’una voluntat d’augmentar la proximitat entre l’estudiantat i professorat en assignatures de cursos alts de les titulacions d’Enginyeria Industrial, Aeronàutica i en Organització Industrial, i molt especialment per a la titulació d’Enginyeria en Organització Industrial semipresencial. Aquesta proximitat afavoreix l’assoliment dels objectius específics en les diferents matèries associades a aquest projecte, sobretot en aquests moments d’adaptació de les titulacions, en què cal encaixar el paradigma de l’ensenyament-aprenentatge en totes les titulacions que s’imparteixen a la UPC. Així, es podrien recollir els objectius considerats en els punts següents: • Proporcionar a l’estudiantat material docent alternatiu al que s’utilitza habitualment, adaptat a les habilitats d’aprenentatge del nou estudiantat i adient per al desenvolupament d’algunes de les competències genèriques. • Millorar la motivació de l’estudiantat en aquelles matèries que, per continguts o per metodologia convencional, poden resultar poc atraients o poc motivadores. • Crear una xarxa de Canals de video streaming dins de les diferents titulacions impartides actualment a l’ETSEIAT, tot identificant nous entorns de comunicació i nous recursos tecnològics a l’abast de l’estudiantat. • Millora del rendiment acadèmic personal dels estudiants durant les sessions presencials mitjançant la introducció d’un material docent alternatiu.Peer Reviewe