Incidencia de tuberculosis osteoarticular en el área sanitaria del Hospital de León. 1997-2001

Introducción y objetivos: Nos proponemos en este trabajo estudiar la incidencia de tuberculosis en su forma osteoarticular en el área sanitaria del Hospital de León durante los años 1997 a 2001, ambos inclusive. Material y método: Dieciséis casos de tuberculosis osteoarticular confirmados por cultivo microbiológico y/o análisis anatomopatológico fueron incluidos. De ellos, cinco afectaron a columna vertebral, cuatro a rodilla y el resto a otras localizaciones más inusuales. Resultados: De las cinco columnas vertebrales afectadas, tres requirieron tratamiento quirúrgico para descomprimir y estabilizar. En una rodilla se realizó sinovectomía abierta y en otra por artroscopia. Se drenaron abscesos fríos en diferentes localizaciones. Todos los casos recibieron tratamiento médico. Se reflejan los diferentes resultados, desde la restitución ad integrum hasta la anquilosis. Discusión y conclusiones: La incidencia de tuberculosis osteoarticular en nuestra área sanitaria en el periodo 1997-2001 fue del 2% al 4% de todos los cascos de tuberculosis. Hubo una alta incidencia de localizaciones inusuales (muñeca, codo, sacroilíaca).Introduction: Current issue is to study the incidence of osteoarticular tuberculosis, within the sanitary area of the Hospital of Leon. Material and Method: Sixteen cases of osteoarticular tuberculosis confirmed by culture and pathological analysis were included. Five of them involved the raquis and knee. Another cases in unusual local sites. Results: Three of five raquis were managed by decompression and stabilization. One knee was treated by open synovectomy and another one by arthroscopy synovectomy. Cold abscesses were drained in different sites. All cases were treated with drugs. Different results are showed since restitutio ad integrum to anquilosis. Discussion: Osteoarticular tuberculosis incidence in our sanitary area between 1997 to 2001 was 2% to 4%. There was a high incidence for unusual localizations (wrist, elbow and sacroiliaca joints)

Pseudoartrosis de húmero en la enfermedad de Paget: presentación de un caso

Presentamos un paciente diagnosticado de enfermedad de Paget que sufrió una fractura patológica del húmero. El tratamiento ortopédico de la fractura deparó una pseudoartrosis. El resultado del tratamiento quirúrgico de ésta fue bueno. Se discute la incidencia de la afectación del húmero en la enfermedad de Paget y aspectos relativos a la curación de las fracturas del mismo.A patient with Paget's disease who had a pathological fracture of the humerus was presented. The fracture was orthopedically treated and developed non-union. Good result was achieved with surgical treatment. Incidence of Paget's disease on the humerus and healing in these fractures are discussed

Nuestra experiencia con el minivástago femoral de disco a compresión y el cotilo Hedrocel (tantalio)

Durante los años 2000 a 2002 intervinimos 18 pacientes de artrosis o necrosis sintomática de cadera, con minivástago de fijación metafisiaria de Disco a Compresión (Sulzer) y cotilo monobloque de tantalio Hedrocel (Zimmer), con par de fricción alúmina-polietileno. La edad media de los pacientes fue de 46,7 años (rango 35-61), y el seguimiento medio de 42 meses. La valoración clínica se realizó con la escala de Merle D'Augbigné Postel obteniendo 38,8% de resultados excelentes, 22,2 de resultados buenos, 11,1% regulares y 27,4% malos (5 casos). Cuatro casos necesitaron reintervención por aflojamiento del tallo femoral. No hubo ningún fracaso del cotilo. La sustitución protésica de la cadera en los pacientes jóvenes requieren soluciones con la menor resección del hueso, pero este modelo de tallo femoral, no da un resultado satisfactorio, por lo que lo hemos abandonado.Between 2000 2002 we treated 18 patients with symptomatic osteoarthritis or osteonechrosis of hip, with uncemneted Thrust Plate Protesis (Sulzer) and tantalium acetabular componente Hedrocel (Zimmer), with ceramic-pol- yethylene pair. The average age of the patients was 46,7 years (range:35-61), and the average follow-up of 42 months. Clinical evaluation was done with Merle D'Augbigné Postel's scale obtaining 38,8 % of excellent results, 22,2 % of good results, 11,1 % fair and 27,4 % poor (5 cases). Four cases needed re-operation for loosening of the femoral stem. There was no failure of the acetabular component. The hip artrhroplasty in the young patients need solutions with the minor resection of bone, but this model of femoral stem does not give a satisfactory result, therefore we have abandoned it

La toma de muestras intraoperatorias con hisopo para el diagnóstico precoz de una infección de prótesis total de cadera es una práctica ineficaz

El diagnóstico de infección articular periprotésica es motivo de reuniones y consensos internacionales. Sin embargo, no hay consenso sobre cuál es la prueba más adecuada para identificar de manera profiláctica el o los microorganismos responsables. En este trabajo se realiza un estudio retrospectivo de 1.022 pacientes a los que se les implantaron 1.045 prótesis totales de cadera entre los años 2009-2013, ambos inclusive. Se analizan los resultados del cultivo de muestras tomadas intraoperatoriamente identificándose los microorganismos aislados y su correlación con la clínica de infección. Se calcularon la sensibilidad, especificidad, valores predictivos positivos y negativos de la prueba. Se identificaron los pacientes con complicaciones infecciosas, la clasificación de los mismos según criterios de Tsukayama y el tratamiento realizado. Concluimos que la toma rutinaria de muestras intraoperatorias en la artroplastia primaria de cadera para intentar adelantar el diagnóstico de una infección periprotésica es una práctica ineficaz e ineficiente y, por ello, hay que abandonarla.There are many international meetings and consensus about the diagnosis of periprosthetic joint infection. However, there aren´t consensus about the most appropriate test to identify the prophylactically microorganisms responsible of infection. This paper is a retrospective study of 1.022 patients with 1.045 total hip replacements between 2009-2013. We analyzed the results of intraoperative culture samples, identified the microorganisms and the patients with clinical infection. We calculated the sensitivity, specificity, positive and negative predictive values of the test. The patients with infectious were identified and classified according to criteria Tsukayama and treatment performed. We conclude that intraoperative culture samples in primary hip arthroplasty to try to advance the diagnosis of periprosthetic infection are an ineffective and inefficient practice and we have to stop doing it

Estudio comparativo de la funcionalidad de los condrocitos articulares y los derivados de células madre del tejido adiposo infrapatelar embebidos en matrices tridimensionales de fibrina y ácido hialurónico.

[ES] Esta tesis tiene como objetivo comparar la funcionalidad in vitro (proliferación celular y mantenimiento del fenotipo condrocítico) de las poblaciones celulares obtenidas durante el cultivo tridimensional en gel de fibrina y ácido hialurónico de condrocitos articulares y células madre del tejido adiposo infrapatelar (grasa de Hoffa) diferenciadas a fenotipo condrocítico y deducir de ello un sustitutivo biológico para la estructura del cartílago[EN] The main objective of this thesis is comparing the functionality in vitro (cell proliferation and maintenance of chondrocyte phenotype) of cell populations obtained during the three-dimensional cultive in fibrin gel and hyaluronic acid in articular chondrocytes and stem cells infrapatellar adipose tissue (Hoffa-Kastert syndrome) differentiated to chondrocyte phenotype and deduce a biological replacement for the structure of cartilage

Subcutaneous anti-COVID-19 hyperimmune immunoglobulin for prevention of disease in asymptomatic individuals with SARS-CoV-2 infection: a double-blind, placebo-controlled, randomised clinical trialResearch in context

Summary: Background: Anti-COVID-19 hyperimmune immunoglobulin (hIG) can provide standardized and controlled antibody content. Data from controlled clinical trials using hIG for the prevention or treatment of COVID-19 outpatients have not been reported. We assessed the safety and efficacy of subcutaneous anti-COVID-19 hyperimmune immunoglobulin 20% (C19-IG20%) compared to placebo in preventing development of symptomatic COVID-19 in asymptomatic individuals with SARS-CoV-2 infection. Methods: We did a multicentre, randomized, double-blind, placebo-controlled trial, in asymptomatic unvaccinated adults (≥18 years of age) with confirmed SARS-CoV-2 infection within 5 days between April 28 and December 27, 2021. Participants were randomly assigned (1:1:1) to receive a blinded subcutaneous infusion of 10 mL with 1 g or 2 g of C19-IG20%, or an equivalent volume of saline as placebo. The primary endpoint was the proportion of participants who remained asymptomatic through day 14 after infusion. Secondary endpoints included the proportion of individuals who required oxygen supplementation, any medically attended visit, hospitalisation, or ICU, and viral load reduction and viral clearance in nasopharyngeal swabs. Safety was assessed as the proportion of patients with adverse events. The trial was terminated early due to a lack of potential benefit in the target population in a planned interim analysis conducted in December 2021. ClinicalTrials.gov registry: NCT04847141. Findings: 461 individuals (mean age 39.6 years [SD 12.8]) were randomized and received the intervention within a mean of 3.1 (SD 1.27) days from a positive SARS-CoV-2 test. In the prespecified modified intention-to-treat analysis that included only participants who received a subcutaneous infusion, the primary outcome occurred in 59.9% (91/152) of participants receiving 1 g C19-IG20%, 64.7% (99/153) receiving 2 g, and 63.5% (99/156) receiving placebo (difference in proportions 1 g C19-IG20% vs. placebo, −3.6%; 95% CI -14.6% to 7.3%, p = 0.53; 2 g C19-IG20% vs placebo, 1.1%; −9.6% to 11.9%, p = 0.85). None of the secondary clinical efficacy endpoints or virological endpoints were significantly different between study groups. Adverse event rate was similar between groups, and no severe or life-threatening adverse events related to investigational product infusion were reported. Interpretation: Our findings suggested that administration of subcutaneous human hyperimmune immunoglobulin C19-IG20% to asymptomatic individuals with SARS-CoV-2 infection was safe but did not prevent development of symptomatic COVID-19. Funding: Grifols