Metástasis musculares del adenocarcinoma renal

El carcinoma renal puede producir metástasis, siendo las más frecuentes en pulmón, hígado, esqueleto y encéfalo. Las metástasis aisladas en el músculo esquelético son muy raras, existiendo alrededor de veinte casos publicados en la literatura. Presentamos dos casos de metástasis de carcinoma renal, localizadas en el músculo esquelético. Es importante el diagnóstico diferencial de estas metástasis con los sarcomas de partes blandas, ya que su tratamiento y pronóstico son muy diferentes.The renal cell carcinoma can produce metastatic, the most common are in lung, liver, bones and encephalon. The isolated metastatic in muscle are unusual, there are only twenty cases published, most of them isolated cases. We present two cases of metastatic of renal cell carcinoma isolated in skeletal muscle. It is very important the differential diagnosis of this kind of lesions with soft tissue sarcomas because treatment and prognosis are very different

Complicaciones de los osteocondromas

Los osteocondromas o exostosis cartilaginosas son los tumores óseos más frecuentes, representando el 10-15 % de la totalidad. Parece ser más bien una alteración del desarrollo óseo más que un tumor verdadero. Suele tener una imagen radiográfica patognomónica. Los osteocondromas pueden ser solitarios o múltiples, estos últimos forman parte del síndrome de exostosis múltiples hereditarias, de transmisión autosómica dominante. Las complicaciones que pueden presentar, pueden ser óseas; deformidad del hueso donde asientan o fracturas del mismo, o de los tejidos que lo rodean, pudiendo provocar trastornos neurológicos, vasculares, bursitis, y la peor complicación, que es su malignización. Existen variantes de los osteocondromas como la exostosis subungueal, la displasia epifisaria hemimielica, y las exostosis en torreta y por tracción. Es importante conocer la apariencia radiológica de todos los tipos de exostosis, para diferenciarlas de sus posibles complicaciones.Osteochondroma, also termed osteocartlaginous exostoses represents the most common bone tumors and is a developmental lesion rather than a true neoplasm. It constitutes 10-15 % of all bone tumors. Its radiologic features are often pathognomonic. Osteochondromas may be solitary or multiple, the latter being associated with the autosomal dominant syndrome, hereditary multiple exostoses. Complications associated with osteochondroma include deformity, fracture, vascular compromise, neurologic sequelae, overlying bursa formation, and malignant transformation. Variant of osteochondroma include subungueal exostosis, dysplasia epiphysealis hemimelica, turret and traction exostoses. Recognition of the radiologic spectrum of appearances of osteochondroma and its variants allow prospective diagnosis and differentiation of the numerous potential complications

Consenso SECOT artrosis femorotibial medial.

Se presenta un consenso elaborado por SECOT sobre la actuación en la artrosis del compartimento medial de la rodilla para establecer criterios y recomendaciones clínicas orientadas a unificar criterios en su manejo, abordando los factores implicados en la patogenia de la artrosis femorotibial medial de rodilla, la utilidad de las técnicas diagnósticas por la imagen y la utilidad de la artroscopia. También se analizarán los tratamientos conservadores y el tratamiento quirúrgico. Los expertos consultados muestran consenso (acuerdo o desacuerdo)en el 65,85% de los ítems planteados, dejando 14 ítems donde no se encontró el consenso que se enmarcaron en la etiopatogenia de la artrosis, el valor de la RM en la patología degenerativa,la utilidad de los COX-2 y de los fármacos condroprotectores, así como sobre la técnica idónea de la osteotomía valguizante.© 2013 SECOT. Publicado por Elsevier España, S.L

Osteolisis tibial secundaria a un implante ligamentoso de Leeds-Keio: Presentación de un caso

Hasta hace algunos años, el ligamento artificial de Leeds-Keio, se usó en muchos casos para la reconstrucción de lesiones del ligamento cruzado anterior. Hoy día no se usa para este tipo de lesiones debido a los pobres resultados que se observaron a medio y largo plazo. No obstante, su uso está indicado en otras lesiones, como son la reconstrucción del aparato extensor de la rodilla, y en inestabilidades del hombro y de la columna vertebral. Presentamos un caso de osteolisis masiva del platillo tibial que requirió la retirada del implante seguida de autoinjerto óseo, complicación que no ha sido comunicada anteriormenteSome years ago the Leed-Keio prosthesis was widely used for anterior cruciate ligament repair. Due to the poor middle and long-term results, this technique has been abandoned. However, synthetic implants are used for other lesions such as knee extensor mechanism rupture and shoulder or lumbar spine instabilities. This paper presents a case of massive osteolysis of the tibial plateau requiring removal of the prosthesis and autologous bone graft, a complication not reported before

¿Fue necesaria la creación de la ley 1575 del 2012 para los cuerpos de bomberos oficiales de Bogotá y bomberos de Colombia?

La presente investigación se desarrolló con el fin de establecer si fue necesaria la creación de la Ley 1575 e identificar cuales ventajas establece para el diseño de un sistema específico de carrera para los cuerpos oficiales de bomberos de Bogotá y Colombia. Para adquirir el objetivo de la investigación, se procedió a realizar una reseña histórica de las primeras actuaciones bomberiles, estableciendo los cambios que se han dado a través del tiempo hasta el día de hoy, adquiriendo una transformación que conlleva a la implementación de un sistema específico de carrera, fundamentando el desarrollo integral de sus empleados, mediante la igualdad de oportunidades, a través de la regulación de acceso, la capacitación, los ascensos, y la clasificación del personal, bajo metodologías objetivas; permitiendo el reconocimiento de la formación académica de los bomberos con el fin de alcanzar la eficiencia y la eficacia en la prestación de un servicio esencial para la comunidad.The present investigation was created in order to establish whether it was necessary to create Law 1575, which allows the design of a specific career system for the official fire brigades of Bogotá and Colombia. To acquire the objective of the investigation, we proceeded to make a historical review of the first fireworks performances, establishing the changes that have given over time to the present, acquiring a transformation that leads to the implementation of a specific system of Based on the integral development of its employees, through the equality of opportunities, through the regulation of access, training, promotions, and classification of personnel, under objective methodologies; Allowing the recognition of the academic training of firefighters in order to achieve efficiency and effectiveness in the provision of an essential service for the community. Key words: creation, firemen, efficiency, efficiency, specific system, transformation

Andalusia in the spanish territorial division of labour. An approach in the light of its socio- economic metabolism

En las páginas que siguen trataremos de aproximarnos al lugar que ocupa Andalucía dentro de la división territorial del trabajo en España utilizando la metodología de la Contabilidad de Flujos Materiales (CFM), con la que se trata de ir más allá de los valores monetarios, haciendo un seguimiento de los flujos físicos involucrados en los procesos económicos en términos de metabolismo social. Para ello utilizamos en la primera parte los datos regionales sobre extracción de materiales y energía, para seguir, en una segunda parte, con la consideración de los flujos físicos comerciales;finalmente, (tercera parte), se atiende a la localización regional de las diferentes ramas de actividad dentro de la economía española para así presentar un dibujo más completo del reparto espacial de funciones y su alcance social y ecológico.Reduced to the isolated universe of monetary value, the conventional economic approach circumscribes the economic dynamics affecting territories, such as the relationships between them, to a set of flows solely expressed in monetary terms. This one-dimensional view disconnects the economic system from the social, physical and territorial world in such a way that the social and economic costs essential for the maintenance and enrichment of life in those territories are ignored. This way of viewing economics generates a conflict between the economy and the territory and this conflict is at the root of ecological degradation which reaches different degrees and has different implications depending on the economic activities occurring in those territories and depending on the role they play within the system and the relationships between them. The territorial division of work, which has been intensified by globalization, has accentuated the polarization between territories devoted to activities located in the later stages of the manufacture and marketing of goods and services, to be found at the apex of the hierarchy of tasks within the division of work (central territories) and territories which supply primary products and which perform the first stages of extraction and processing of natural resources (peripheral territories). Behind the veil of the monetary worldview held by the conventional economy, therefore, lie hidden the relationships of power and the spatial division of work as mechanisms for domination and for the appropriation of the wealth of some territories by others. This paper studies the place occupied by Andalusia in the territorial division of work in Spain using Material Flow Accounting (MFA) methodology. The aim is to look beyond monetary value, monitoring the physical flows involved in the economic processes in terms of social metabolism. To do so, in a step-by-step approach, the first section uses regional data on the extraction of materials and energy, followed in the second section by an examination of physical commercial flows. Finally, in section three, the regional localization of different branches of activity within the Spanish economy is considered. Section 1 compares the capacity for the appropriation of monetary value (GDP) of each Autonomous Community with the endogenous resources generated by each one, represented by the domestic extraction of materials. This reveals a regional grouping in which we can clearly distinguish a set of regions which, with relatively low domestic extraction of resources, appropriate a significant proportion of the monetary value generated by the Spanish economy. Among them, the territories which have traditionally been central to the Spanish economy (Madrid, Catalonia and the Basque Country), (9.3% of the territory), enjoyed 42.6% of the added value in the Spanish economy, which is more than double the figure for their domestic extraction (20.2% of the Spanish total). They are, basically, the regions which use the rest of the territory to supply their production and consumption patterns. On the other hand, there are the majority of the Spanish regions, where 67.9% of the domestic extraction of resources takes place and where 41.3% of added value is enjoyed. In this case, more than half of the extraction (50.2%) is located in five regions: Murcia, Galicia, Castilla La Mancha, Castilla León and Andalusia. The latter is the region with the greatest difference between the GDP obtained and the use of endogenous natural resources. The study of external trade flows offers a clearer profile of Andalusia’s specialization within the Spanish economy as it allows us more clearly to determine what is demanded of the Andalusian economy from outside and, at the same time, makes it possible to incorporate the manufacturing process of products and to calibrate the weighting of different sectors of production within the complex of interregional relationships.With respect to exports, there is considerable concentration in two sectors: Energy products and Food products. These two sectors represented well over half (58.2%) of the products exported from Andalusia to the other Autonomous Communities over the 15 years studied. The first item, Energy products, is related to the relocation to Andalusia in the 1960s of certain industrial activities (oil refining, basic chemical industry, paper mills, initial processing and production of metals) which covers the first stages of production processes whose later, more complex phases, where greater added value is generated, take place outside Andalusia. The ecological degradation associated with this relocation of industrial activities has caused environmental damage in Andalusia which is proportionally much greater than that seen in the industrialized regions. The second item of Andalusian exports, food products, represented 26.0% of total Andalusian exports for the period 1996-2010. Most are agricultural products or the results of the initial processing of foodstuffs, which is simply a prolongation of agricultural activity (fruit, vegetables and oil). In this regard, it is interesting to note that these exports represent a growing proportion of the biomass extracted in Andalusia, and so it can be said that the natural heritage of Andalusia is, increasingly, being used to satisfy the food requirements of other territories which receive primary products from Andalusia with a very low level of processing, and which are distanced from the more dynamic nucleus of the agri-food system. In contrast, it should be noted that the high volume of food products exported to the rest of Spain is accompanied by a similar tonnage of imports from those other regions. These are mainly processed products. Here, a growing gap is to be found between domestic extraction and the internal demand for foodstuffs, which accentuates the food dependency of Andalusia and, at the same time, translates into a sharp disconnection between food production and consumption. The third section looks in greater detail at specialization in the tasks performed in the different territories by looking at the regional localization of economic activities. This gives us a more complete picture of the spatial distribution of those tasks as it uses a more detailed breakdown of the different processing activities and includes services. Here, again, it can be observed that, as it has traditionally been, Andalusia is still an extractive economy, a supplier of primary products. With a system of intensive agriculture on a model in which extraction is forced through the introduction into the system of increasing volumes of materials and energy and the intensity of extraction is increased through the progressive use of intermediate inputs, which are mainly non-renewable, and which, in turn, involve extractive processes in the same and/or other spaces, with the consequent deterioration and progressive degradation of the environment in which this agriculture is practiced, and to which is added to the import of sustainability from other territories. The devotion to extractive industry in the Andalusian economy differentiates and distances it from the “central” economies, as can be seen in a comparison with Catalonia, deepening an unequal exchange between Andalusia and other territories which is masked by the conventional conception of the economy and is related to the fact that, in monetary terms, the contribution of nature has no cost, and to the role of Power relationships within the system. In this paper, Andalusia is seen to be a territory specializing in activities which generate social and ecological damage which remains hidden by the focus of the conventional economy. An area for the appropriation of wealth at low cost by the central territories, from where not only their own spheres of activity are controlled and managed, but also, to a large extent, those of outside and “peripheral” territories such as Andalusia, for which economic growth means the exacerbation of their situation of dependency and marginalization. This domination is not only material. It is also an ideological domination which results in the very situation of domination being interpreted in terms of models and instruments operating in favor of the dominant interests. For Andalusia, this is a path of divergence, not convergence, a path which leads to the loss of control over the management of its resources and the separation of the Andalusian economy from what should be its priority objective: the maintenance and enrichment (sustainability) of social and natural life

Lipomas profundos

Se han revisado retrospectivamente 10 lipomas profundos localizados en los miembros. Todos los pacientes fueron intervenidos quirúrgicamente y el diagnóstico de certeza fue histopatológico. Siete de los casos eran lipomas intra o intermusculares y los restantes angiolipoma, hibernoma y fibrolipoma intraneural, respectivamente. El seguimiento medio postoperatorio fue de 48 meses (mínimo: 14, y máximo: 84). No ha habido recidiva en ningún caso.This article is a retrospective review of 10 deep lipomata localized in the limbs. In all the cases the treatment required surgery, and the diagnosis was made by histopathological analysis. Seven cases were intra or intermuscular lipomata, and the other three were angiolipoma, hibernoma and endoneural fibrolipoma. The average postoperative follow-up time was 48 months (14 min-84 max). None showed recurrence at review

Sinovitis villonodular pigmentada difusa: Revisión de 13 casos

Se hace un estudio retrospectivo de trece pacientes con Sinovitis Villonodular pigmentada, seis localizadas en la rodilla, dos en la muñeca y pie, y uno en tobillo, cadera y codo respectivamente. En cinco de los casos existía una afectación del hueso. Se hace una revisión bibliográfica sobre la etiopatogenia, radiología, métodos diagnósticos y tratamientoA retrospective study of thirteen patients with pigmented villonodular synovitis was made. Six cases were localized in the knee, two in the wrist and feet, and one in ankle, hip and elbow. Five case showed bone invasion, the pathogenesis, radiographical appearance, diagnosis and treatment are discussed

Hallazgos electromiográficos y electroneurográficos en el pie cavo esencial

La etiología del pie cavo cuando ésta es conocida, suele ser debida a un trastorno de tipo neurológico o miopático, aunque en determinados casos nos encontramos con pacientes que padecen esta deformidad en el pie, en los cuales no podemos descubrir ningún antecedente de este tipo, por lo que lo calificamos de pie cavo «esencial». A un grupo de estos pacientes con pie cavo «esencial», en los que no hemos encontrado ningún tipo de antecedente neurológico, lo hemos sometido a una exploración electroneurográfica, encontrando que la mitad de ellos padecían algún trastorno neuropático/miopático, que no había sido detectado en la exploración clínica inicial.Neurological or myopathic diseases are frequently involved in the etiology of flat foot. In some cases, no antecedents of disease can be found and therefore these flat foots are classified as «essential». We have undertaken an electrophysiologic study in a series of patients with «essential» flat food in order to explore unsuspected neurological disorders. In half of the patients, neuropathic and myopathic electroneurographic patterns of different severity were detected

Afectación tumoral del sistema nervioso periférico

Se han estudiado 18 pacientes con afectación del S.N.P. por lesiones tumorales tratados en nuestra unidad en un período de 8 años. La mayoría de estos tumores tenían una localización intraneural (14 casos), eran de naturaleza benigna (13 casos) y afectaban al miembro superior. La prueba diagnóstica más exacta fue la R.M.N. Destacamos la existencia en nuestra seria de algunos tumores de rara presentación en la clínica, como un caso de fibrolipoma, condroma intraneural y neurosarcoma de la variedad "Tritón", respectivamente.Eighteen patients who had tumours of peripheral nerves have been studied retrospectively. They were treated in our department for eight years. Most of these tumours were placed intraneuraly (14 cases), were benignant (13 cases), and located in the upper limb. The most precise test for diagnosis was the MRI. We want to emphasize the existence in our series of some tumours which rarely appears in clinic, for example a Fibrolipoma, a intraneural chondroma and a malignant triton tumour