Fracture Dislocation C6 to C7: Importance of Adequate Radiographs

<p>[West J Emerg Med. 2011;12(4):577–578.]</p

Rheumatoid nodule mimicking an olecranon bursitis as the primary manifestation of rheumatoid arthritis

Olecranon bursitis is a relatively common condition, being most of the cases idiopathic. Less commonly it is caused by infection, by a systemic inflammatory process or by a crystal-deposition disease such as gout or pseudogout. We present a case that was referred as olecranon bursitis, in which the diagnose of rheumatoid nodule was stablished after histological study of the resected tissue

Minimally invasive bone grafting of simple cyst of the femoral head in femoroacetabular impingement

Femoral head and neck cysts are a common finding among patients with femoroacetabular impingement. However, their exact role in this pathology has not been yet clarified. We report herein the case of a 45-year-old male presenting with femoroacetabular impingement in which the treatment of a femoral simple bone cyst resolved the symptomatology

Long-term functional outcomes of the terrible triad of the elbow

Introduction: The published literature regarding the terrible triad of the elbow has historically shown a high rate of unacceptable outcomes. The objective of the present study was to evaluate the long-term functional outcomes and repercussions in patients who suffered the terrible triad of the elbow. Material and methods: A retrospective analysis of a prospectively-recruited consecutive series of cases registered from August 2005 to August 2009, involving 27 patients from which 16 complied with inclusion criteria for the study. The mean follow-up period was 8.6 years (range: 6.9 to 10.6). Two different final quality of life evaluation questionnaires were performed by telephone: the EuroQol Five Dimensions Questionnaire (EQ-5D) and the patient answered questionnaire portion of the Liverpool Elbow Score (PAQ-LES). Results: Fifteen (93.7%) patients were intervened surgically whereas only 1 case was treated conservatively. EQ-5D-rated outcome averaged 0.87 (range: 0.36 to 1) and the PAQ-LES averaged 33.5 (range: 17 to 36). Five (31.2%) presented pain or discomfort, 4 (25.0%) had some kind of difficulties in their daily activity and 3 (18.7%) founded some limitations with their personal hygiene. Only 6 cases (37.5%) declared to be fully asymptomatic. Conclusion: The terrible triad of the elbow remains a challenging injury that entails the presence of chronic pain and discomfort in almost one third of the cases at a long-term follow-up

La problemática actual de la eutanasia

El problema de la eutanasia vuelve a abrir el debate en nuestro país; esta vez con una propuesta del Parlamento Catalán junto con el PSOE lanzada en mayo de 2018 al Congreso de los Diputados; la cual propone la total despenalización de las prácticas eutanásicas. Las cuestiones relacionadas con la dignidad de la persona en los procesos de muerte han adquirido cada vez mayor importancia en nuestra sociedad como consecuencia de diversos acontecimientos científicos y médicos. Los grandes avances en la medicina han supuesto que la vida pueda tener una prolongación mayor, con el consiguiente envejecimiento de la población actual, pero en contraposición esta prolongación de la esperanza de vida ha supuesto un incremento de las enfermedades crónicas o irreversibles. La autonomía del paciente ha ido evolucionando, siendo así un concepto muy controvertido en el ámbito del derecho médico. El Estado comenzó propiciando una actividad muy paternalista que poco a poco ha ido desembocando en el otorgamiento de una mayor importancia a la autonomía del paciente. No obstante, existen situaciones donde la relación médico paciente queda obstaculizada por el choque entre la todavía normativa paternalista y la voluntad del paciente. Todos estos elementos han ocasionado que en la sociedad haya cada vez más voces que apelan sobre la necesidad de establecer una serie de derechos y garantías que aseguren, o al menos que promuevan, la dignidad de las personas en el proceso de la muerte. La actual tipificación de la eutanasia en el artículo 143 de nuestro Código Penal supone una contradicción a esos derechos y garantías que la sociedad apela y posiblemente pueda suponer un límite, al principio de autonomía personal

Pre-processing techniques for improved detection of vocalization sounds in a neonatal intensive care unit

The sounds occurring in the noisy acoustical environment of a Neonatal Intensive Care Unit (NICU) are thought to affect the growth and neurodevelopment of preterm infants. Automatic sound detection in a NICU is a novel and challenging problem, and it is an essential step in the investigation of how preterm infants react to auditory stimuli of the NICU environment. In this paper, we present our work on an automatic system for detection of vocalization sounds, which are extensively present in NICUs. The proposed system reduces the presence of irrelevant sounds prior to detection. Several pre-processing techniques are compared, which are based on either spectral subtraction or non-negative matrix factorization, or a combination of both. The vocalization sounds are detected from the enhanced audio signal using either generative or discriminative classification models. An audio database acquired in a real-world NICU environment is used to assess the performance of the detection system in terms of frame-level missing and false alarm rates. The inclusion of the enhancement pre-processing step leads to up to 17.54% relative improvement over the baseline.Peer ReviewedPostprint (published version

Can the intra-operative measurement of the diameter of the femoral head help surgeons to choose the best size of the acetabular cup?

Purpose: We hypothesized that the intra-operative measurement of the femoral head may increase the accuracy of the acetabular cup size optimal selection in total hip arthroplasty (THA). The purpose of this clinical research was to analyze the correlation between the estimated cup size from intra-operative measurement of the femoral head and the pre-operative templated cup size. Methods: A prospective observational single-center study was conducted from June 2019 to January 2020 including primary THA (n = 100). All cases were pre-operatively templated. The measurement of the anterior-posterior diameter of the femoral head was routinely intra-operatively performed. Any definitive implanted cup was considered as 'oversized' when the size was > 4 mm than the diameter of the native head. Results: The median (interquartile range) size of the implanted cup, pre-operative planned cup size, and diameter of the femoral head were measured 52 (50-54) mm, 50 (48-54) mm and 49 (45-51) mm, respectively. Pre-operative planned size cup accurately predicted the implanted cup or differed in only one size (2 mm) in 77 (78%) cases. Otherwise, intra-operative femoral head measurement method accurately predicted the implanted or differed in only one size (2 mm) in 51 (87%) cases (p = 0.097). Conclusion: The intra-operative femoral head measurement is a simple and reliable tool to help the surgeons choose the best size of the acetabular cup and is as reliable as the pre-operative templating in order to avoid cup oversizing in THA. Utmost caution is warranted whenever the cup reamer is > 4 mm than the anterior-posterior diameter of the native head

Intraoperative Transfusion of Red Blood Cell Units Stored >14 Days is Associated with an Increased Risk of Prosthetic Joint Infection.

Background: The aim of the present study was to evaluate the association between prosthetic joint infection (PJI) after joint arthroplasty and the length of red blood cell (RBC) storage, timing of RBC transfusion, and the number of RBC units transfused. Study design and Methods: All patients who underwent a primary or revision joint artrhoplasty between January 2000 and December 2012 were retrospectively reviewed. For this study, only patients who received RBC transfusions during the day of the surgery (early transfusion group) or within the first 4 days after surgery (late transfusion group) were included. Results: A total of 9906 patients were reviewed. In the early transfusion group (n=1153, 11.6%), patients receiving 1 or 2 RBC units (3.5% vs 6.3%, P=0.041), 3 or 4 RBC (1.3% vs 13.3%, P=0.004) or ≥5 RBC units (5.0% vs 37.5%, P=0.026) had a higher PJI rate only when >50% of RBC units transfused had been stored >14 days. In the late transfusion group (n=920, 9.3%) these differences were not significant. Early transfusion of RBCs stored >14 days was an independent variable associated with an increased risk of PJI (OR:2.50, 95%CI:1.44-4.33) Conclusion: Transfusion of RBC within the first 6h after joint arthroplasty was an independent variable associated with PJI risk when RBC units are stored >14 days. The rate of PJI increased with the number of old RBC units transfused within this critical period

Efectividad de la acupuntura en la hipogalactia y en la inflamación mamaria. Revisión bibliográfica

Objetivo: Determinar la efectividad de la acupuntura en el tratamiento de la hipogalactia y de la inflamación mamaria; mapear los puntos de aplicación y las técnicas utilizadas. Metodología: Revisión bibliográfica efectuada en las bases de datos PubMed, Cinahl, Cuiden, Scielo, Lilacs, Dialnet, Latindex, Cuidatge, WorldCat y Google Académico. Resultados: Se incluyeron 10 estudios; 7 observaron una mayor producción láctea o una prolongación en el tiempo de la lactancia; 2 evaluaron la efectividad de la acupuntura en la inflamación mamaria, y constataron un rápido alivio sintomático y un menor uso de antibióticos. No se ha encontrado unanimidad en la selección de la técnica y de los puntos para los diferentes tratamientos con acupuntura. Conclusión: La acupuntura parece ser efectiva para aumentar la producción láctea y mejorar los síntomas mamarios. Dada la falta de consenso en la selección de puntos y en las técnicas empleadas para los diferentes tratamientos con acupuntura, se requieren más estudios para poder generalizar estos tratamientos en la práctica clínica

Functional Discharge Criteria In Total Hip Arthroplasty. What Makes The Difference For Overnight Hospital Stay In Our Center?

Overnight total hip arthroplasty is becoming common in our center. Despite all the patients are under the same protocol, which includes a funcional discharge criteria, not all the patients leave the hospital the day after the surgical procedure. We conducted a study evaluating a group of patients who stayed one night, compared to a matched pair regarding age, body mass index and sex. Group 1 mean age was 61.4 years-old (SD 9.3), Group 2 was 60.8 years-old (SD 9.6); 10 women and 20 men each group, BMI was 28.1 (SD 3.7) and 27.8 (SD 3.6) for Groups 1 and 2 respectively. Patients who stayed only 1 night after THA were found to have higher levels of preoperative hemoglobin, had uncommonly 2 or more major comorbidities, and the operation was predominantly performed by anterior approach