Nueva técnica de sutura artroscópica transósea del manguito de los rotadores: estudio anatómico

Se ha realizado un estudio anatómico experimental sobre cadáver que ha fundamentado el desarrollo de una técnica alternativa de reparación artroscópica del manguito rotador, puramente transósea. Se han utilizado 10 hombros de cadáver fresco congelado. Mediante una guía externa diseñada específicamente para esta técnica, se han efectuado perforaciones en el troquíter con diferentes angulaciones. En cada uno de los ángulos se ha medido la distancia al nervio axilar, así como el grosor de la pastilla ósea de troquíter obtenida. El análisis de los datos ha mostrado una distribución normal de los valores, y diferencias estadísticamente significativas entre los resultados obtenidos en cada ángulo de colocación de la guía externa (p<0.001). Conclusiones: La sutura artroscópica transósea del manguito rotador, realizada mediante una guía externa a través del deltoides, es una técnica factible, que puede llevarse a cabo con márgenes de seguridad respecto a una hipotética lesión del nervio axilar.An anatomical study with ten fresh shoulder specimens was carried out in order to establish the safest angle to perform a new arthroscopic technnique for true transosseous rotator cuff repair. With an external guide designed for this study, several osseous tunnels were made through the greater tuberosity using different angles. The minimum distance from the drill to the axillary nerve was measured with each angle, as well as the thickness of the osseous bridge in the greater tuberosity. Statistically significant differences were observed between the measurements obtained with each angle of the external guide (p<0.001). From our data it is concluded that transosseous arthroscopic repair of the rotator cuff with an external guide is a feasible technique and can be performed with minimal risk for the axillary nerve

Fibromatosis palmar infantil: a propósito de un caso

Presentamos como caso clínico, una fibromatosis palmar infantil, complicada con un granuloma piógeno. Ambas entidades, aunque si bien se comportan con una elevada agresividad local, tienen un compor - tamiento benigno, en la mayoría de las ocasiones, siempre que no se trate de la expresión externa de una entidad de mayor gravedad denominada miofibromatosis infantil. Describimos el caso y el seguimiento del paciente, destacando que dentro de un diagnóstico anatomopatológico, de escasa especificidad, es crucial un diagnóstico clínico de mayor envergadura para descartar lesiones de otras localizaciones que pueden poner en peligro la vida del mismo.We present a case of palmar fibromatosis complicated with a pyogenic granuloma in a child. Both entities, even though they are locally aggressive, have a benign behavior in most cases, provided that they are not part of a more serious entity known as infantile myofibromatosis. We report the clinical case and follow up of the patient, highlighting the fact that as we deal with an anatomopathological diagnosis of quite limited specificity, it is crucial to look for an adequate clinical diagnosis in order to discard other lesions in different locations which could endanger our patient's life

Valoración clínica de resultados en artrodesis trapecio-metacarpiana: placa atornillada vs agujas de Kirschner

La rizartrosis es una patología frecuente. Cuando el tratamiento conservador es insuficiente, se indica un tratamiento quirúrgico. Existen diversas técnicas, entre las más ampliamente utilizadas está la artrodesis trapeciometacarpiana. Realizamos un estudio retrospectivo 44 casos (57 intervenciones) comparando dos métodos de artrodesis, agujas de Kirschner y placas atornilladas. Se realizó una valoración radiológica, clínica y funcional de los casos para determinar las posibles ventajas de un método sobre otro. La edad media fue 56,5 5,9 años. Se utilizaron 33 agujas Kirschner, 24 placas atornilladas. Mejoría en los resultados de los cuestionarios EVA (4,8 3,4) y DASH (23,2 23,5). El 44,7% movilidad con escala de Kapandji de 10. Se analizaron estadísticamente los datos, no encontrando diferencias significativas entre los dos métodos en cuanto a la consolidación, estado funcional ni complicaciones. En la mayor parte de los casos la clínica disminuye, se mejora la función con una excelente satisfacción del paciente. No hemos encontrado diferencias en nuestro estudio en las variables observadas.Trapezio-metacarpal arthritis is common. In that cases in which has failed to respond to conservative measures we need to use surgical procedures. One of them is the trapeziometacarpal arthrodesis. Retrospectiv study 44 patients (57 arthrodeses), comparing two surgical arthrodesis procedures, K-wires versus plate and screws, to assess the efficacy of these procedures with respect to patient satisfaction, radiological and clinical outcomes. Average age was 56.5 5.9 years. 33 K-wires, 24 plate and screws. There were an improvement in quetionaires results VAS (4.8 3.4) and DASH (23.2 23.5). The 44.7 % of patients scored a 10 in Kapandji test. We found no statistical differencees between these procedures in non-union rate, functional outcome or complications. For most patients Trapeziometacarpal arthrodesis reduces pain, improves function and results in excellent patient satisfaction. We have found no differences between these procedures in our study

Resección compartimental mediante abordaje quirúrgico modificado en sarcomas de partes blandas del deltoides

Se describe una técnica quirúrgica para la resección radical de sarcomas de partes blandas confinados al compartimento deltoideo en tres pacientes, así como los resultados clínicos y funcionales, además de la evolución oncológica de su patología. Se realiza un abordaje en “Y” que permite la desinserción proximal y distal del deltoides, incluyendo en la pieza tumoral una isla cutánea lateral con la zona de biopsia previa, evitando la necesidad de técnicas de cobertura. No se desarrollaron complicaciones de la herida quirúrgica ni casos de recurrencias locales. Todos los pacientes presentaron un rango de movilidad mínimo de 130º de abducción y una pérdida de fuerza para la abducción y antepulsión. Concluimos que los pacientes con neoplasias malignas confinadas al compartimento deltoideo tratados con la resección radical según la técnica descrita presentan unos resultados funcionales excelentes, en ausencia de lesiones del manguito concomitantes, con un menor riesgo de recidiva local.A surgical technique for radical excision of soft tissue malignant sarcomas is described and functional and oncologic outcomes of this procedure in three patients diagnosed of soft tissue sarcoma are reported. A “Y” approach is used to perform a complete release of deltoid attachments in the scapula, clavicle and proximal humerus. This approach also allows an excision of the biopsy site, avoiding the establishment of large flaps coverage. No local recurrence or surgical wound complications were found. All the patients showed a good range of motion (130º of abduction) but loss of strength in abduction and antepulsion was found. We conclude that patients with malignant soft tissue tumors involving the deltoid muscle which undergo a wide resection of the bump through the previously described technique have an excellent functional outcome with low risk of recurrence, in absence of concomitant rotator cuff injuries

Manejo de la infección protésica de hombro con gran defecto óseo: descripción de un caso complejo

La infección periprotésica de hombro tiene una incidencia de entre el 0.4% al 2.9%; su tratamiento es controvertido y se basa en la experiencia sobre infecciones protésicas de rodilla y cadera. Presentamos el caso de una paciente quien fue tratada mediante recambio en dos tiempos, la cual presentó como complicación añadida un gran defecto óseo metafisodiafisario tratado siguiendo pautas establecidas en la literatura actual, con buen resultado final, valorando aspectos analíticos, radiológicos y clínicosShoulder periprosthetic infection has an incidence of 0.4% to 2.9%; treatment is controversial and is based on the experience of prosthetic hip and knee infections. We report a patient who was treated by two-stage exchange, which added complication presented as a large bone defect treated following guidelines established in the current literature, with good outcome, evaluating blood analysis, radiological and clinical aspects

Tratamiento de fracturas de húmero proximal en hueso osteoporótico mediante fijación con sistema de aumentación

Introducción. Para el tratamiento de fracturas de húmero proximal en pacientes osteoporóticos, se han desarrollado fijaciones con aumentación que mejoran la estabilidad del implante. El objetivo de este estudio es analizar los resultados obtenidos con la técnica empleada. Material y métodos. Estudio descriptivo retrospectivo de 7 pacientes con fracturas en 3-4 fragmentos intervenidos mediante placa Philos (Synthes)® de aumentación. Seguimiento medio de 12 meses. Resultados. La puntuación media en la Escala Visual Analógica de dolor fue de 4,4. En la escala Quick Dash de 47,47. En la Escala Constant-Murley de 36,36. La abducción activa media fue de 95º; la flexión anterior media de 105º; la rotación externa media de 44,14º; la rotación interna alcanzó en tres pacientes S1, en dos L5, en uno L2 y en otro T10. En los controles radiográficos se mantuvo la reducción. Nos encontramos con un caso de consolidación parcial. Conclusión. Las técnicas de aumentación disminuyen el riesgo de fallos de fijación manteniendo la reducción.. Introduction. To treat proximal humerus fractures in patients with osteoporosis, the last few years, systems to improve implant stability by augmentation techniques have been developed. The aim of this study is to analyze the results obtained with the surgical technique employed. Materials and methods. Retrospective descriptive study. We selected 7 patients with 3 or 4- part fractures treated operatively with Philos Augmentation plate (Synthes)® fixation technique. Average follow-up was 12 months. Results. Pain measured with a Visual Analogical Scale (VAS) got a average value of 4,4. The mean Quick Dash Score was 47,47. The mean Constat-Murley modified was 36,36. The active articular balances showed a mean abduction of 91º; mean anterior flexion of 105º; mean external rotation of 44,14º; and finally the internal rotation achieved in three patients got to S1, in two patients to L5, in one patient to L2 and in other patient to T10. In X- Ray post-operative controls we can appreciate the reduction maintenance. In one case we observe a partial consolidation of the fracture. Conclusion. Surgical techniques that imply implant augmentation reduces the risk of implant failure and maintains the fracture reduction

Recidivas tras tratamiento con colagenasa : estudio histológico

recurrences following CCH treatment of Dupuytren?s disease are controversial and sometimes normal pathological anatomy is distorted. Our study aims to evaluate the presence of possible alterations of the disease at pathological level on samples of recurrence of Dupuytren?s disease (CCH vs fasciectomy). Methods: prospective, blind study for pathological and statistical analysis of patients who underwent fasciectomy due to recurrence of Dupuytren?s disease after previous treatment with collagenase or previous fasciectomy. Pathological study with H / E and immunohistochemistry. Results: a total of 8 patients were included (4 with previous treatment with CCH and 4 with fasciectomy). There were no significant differences in anatomopathological or inmonuhistochemical analysis. Conclusions: histologically, recurrences of Dupuytren Disease after fasciectomy or collagenase treatment are indistinguishable. The presentation of macroscopic forms other than those seen in fasciectomy is possible

Utilidad de la procalcitonina sérica para la discriminación temprana entre fascitis necrosante y celulitis de las extremidades : serie de casos y revisión de la literatura

Objective: to assess the usefulness of a risk scale based on serum procalcitoninwhen compared with the LRINEC score in the early discrimination between necrotizing fasciitis (NF) and extremities cellulite.Material and method: retrospective study, between 2009 and 2017, of all patients with the confirmed diagnosis of NF in one limb (N = 10). The findings of these patients were compared with those of 23 patients who were admitted for severe cellulitis of limbs in the same period. The variables related to each group were analyzed. Using the area under the curve (AUC), the discriminationcapacity for NF diagnosis of two scales was compared, one based on procalcitonin levels and another based on the LRINEC score.Results: the area under the curve was greater for the risk categorized by procalcitonin levels. When analyzing the LRINEC score and procalcitonin levels as continuous variables, the latter also presented a larger area under the curve. The cut-off point with the greatest area under the curve was that corresponding to> 0.87 ng / ml of procalcitonin (sensitivity of 100% and specificity of 82.6%) and score 5 on the LRINEC score (sensitivity of 80% and specificity of 82.6%).Conclusion: in our sample the level of procalcitoninand the scale based on this level has been shown as a more sensitive and at least as specific tool as the LRINEC scale for early discrimination between NF and a cellulite of the extremities

Babelomics 5.0: functional interpretation for new generations of genomic data

This article has been accepted for publication in Nucleic Acids Research Published by Oxford University Press.Babelomics has been running for more than one decade offering a user-friendly interface for the functional analysis of gene expression and genomic data. Here we present its fifth release, which includes support for Next Generation Sequencing data including gene expression (RNA-seq), exome or genome resequencing. Babelomics has simplified its interface, being now more intuitive. Improved visualization options, such as a genome viewer as well as an interactive network viewer, have been implemented. New technical enhancements at both, client and server sides, makes the user experience faster and more dynamic. Babelomics offers user-friendly access to a full range of methods that cover: (i) primary data analysis, (ii) a variety of tests for different experimental designs and (iii) different enrichment and network analysis algorithms for the interpretation of the results of such tests in the proper functional context. In addition to the public server, local copies of Babelomics can be downloaded and installed. Babelomics is freely available at: http://www.babelomics.org.Spanish Ministry of Economy and Competitiveness [BIO2011-27069], Conselleria d'Educacio of the Valencian Community [PROMETEOII/2014/025]; EU FP7-PEOPLE Project MLPM [316861]; Fundació la Marató TV3 [151/C/2013]. Funding for open access charge: Spanish Ministry of Economy and Competitiveness [BIO2011-27069]

Multi-ancestry GWAS reveals excitotoxicity associated with outcome after ischaemic stroke

During the first hours after stroke onset, neurological deficits can be highly unstable: some patients rapidly improve, while others deteriorate. This early neurological instability has a major impact on long-term outcome. Here, we aimed to determine the genetic architecture of early neurological instability measured by the difference between the National Institutes of Health Stroke Scale (NIHSS) within 6 h of stroke onset and NIHSS at 24 h. A total of 5876 individuals from seven countries (Spain, Finland, Poland, USA, Costa Rica, Mexico and Korea) were studied using a multi-ancestry meta-analyses. We found that 8.7% of NIHSS at 24 h of variance was explained by common genetic variations, and also that early neurological instability has a different genetic architecture from that of stroke risk. Eight loci (1p21.1, 1q42.2, 2p25.1, 2q31.2, 2q33.3, 5q33.2, 7p21.2 and 13q31.1) were genome-wide significant and explained 1.8% of the variability suggesting that additional variants influence early change in neurological deficits. We used functional genomics and bioinformatic annotation to identify the genes driving the association from each locus. Expression quantitative trait loci mapping and summary data-based Mendelian randomization indicate that ADAM23 (log Bayes factor = 5.41) was driving the association for 2q33.3. Gene-based analyses suggested that GRIA1 (log Bayes factor = 5.19), which is predominantly expressed in the brain, is the gene driving the association for the 5q33.2 locus. These analyses also nominated GNPAT (log Bayes factor = 7.64) ABCB5 (log Bayes factor = 5.97) for the 1p21.1 and 7p21.1 loci. Human brain single-nuclei RNA-sequencing indicates that the gene expression of ADAM23 and GRIA1 is enriched in neurons. ADAM23, a presynaptic protein and GRIA1, a protein subunit of the AMPA receptor, are part of a synaptic protein complex that modulates neuronal excitability. These data provide the first genetic evidence in humans that excitotoxicity may contribute to early neurological instability after acute ischaemic stroke. Ibanez et al. perform a multi-ancestry meta-analysis to investigate the genetic architecture of early stroke outcomes. Two of the eight genome-wide significant loci identified-ADAM23 and GRIA1-are involved in synaptic excitability, suggesting that excitotoxicity contributes to neurological instability after ischaemic stroke.Peer reviewe