El síndrome de nail-patella: presentación de 5 casos

Se presentan 5 casos de síndrome de nail-patella de 2 familias distintas. En todos ellos eran evidentes los rasgos clínicos característicos de la enfermedad. Tres de los pacientes presentaban luxación recidivante de rótula con importante repercusión funcional. Fueron intervenidos quirúrgicamente con unos buenos resultados funcionales. Las alteraciones en los codos no provocaban trastornos funcionales importantes y no precisaron tratamiento quirúrgico.Five cases of nail-patella syndrome of 2 different families are presented. In all of them there were evident the clinical features typical of the disease. Three of the patients presented recurrent dislocation of patella with important functional repercussion. They were managed surgically with a good functional result. The troubles in the elbows did not provoke important functional disorder and they did not need surgical treatmen

¿Qué aporta la artrodesis en la estabilización de las fracturas de la transición toracolumbar?

Se ha realizado un estudio retrospectivo sobre 26 pacientes con fractura estallido tipo II de Denis (23 casos) y fractura luxación tipo IV de Denis (3 casos) de la transición toracolumbar (T11-L2), tratados con fijador vertebral solo (16 casos) o asociando una artrodesis posterolateral (10 casos). El 84,6% de los pacientes hacen vida normal sin dolor o con ligeras molestias que no limitan la actividad diaria. La angulación regional traumática media mejoró desde 19,4º±7,8º hasta 8,7º ±11,8º (p<0,001). Al comparar la angulación regional media final del grupo de pacientes con artrodesis (3,8±6,9º) con el grupo sin artrodesis (7,8º±8,7º), las diferencias no fueron significativas. Los 6 pacientes que presentaron una pérdida marcada de corrección en la evolución con rotura de material en 5 de ellos, pertenecían al grupo sin artrodesis y en 4 se había asociado una laminectomía. La artrodesis posterolateral asociada a la estabilización en fracturas estallido de la transición toracolumbar no mejoró de forma significativa de la deformidad angular cifótica final. Los fracasos de material con pérdida marcada de corrección se relacionaron significativamente con laminectomía sin artrodesis.A retrospective study has been made on 26 patients with type II burst Denis fracture (23 cases) and type IV Denis fracture-dislocation (3 cases) of the thoracolumbar transition (T11-L2). Treatment consisted on a reduction and a stabilisation with a single transpedicular fixation (16 cases) or associated to a posterolateral arthrodesis (10 cases). The 84,6% of the patients carry out a normal life without pain or with slight problems which do not limit daily activity. The segmental traumatic average angle of kyphosis improved from 19,4 ± 7,8º to 8,7 ± 11,8º (p < 0,001). When comparing the final segmental traumatic average angle of kyphosis of the group of patients with arthrodesis (3,8 ± 6,9º) to the group without arthrodesis (7,8 ± 8,7º), the differences were not significant. The 6 patients who presented a marked loss of correction during the post-operative time, with breakage of material in 5 of them, belonged to the group without arthrodesis, and 4 of them had a laminectomy performed. The posterolateral arthrodesis associated to the stabilisation in burst thoracolumbar transition fractures did not improve the final kyphotic deformity significantly. The failures of material which brought on a marked loss of previous correction were related significantly to laminectomy without arthrodesis

The comparative responsiveness of Hospital Universitario Princesa Index and other composite indices for assessing rheumatoid arthritis activity

Objective To evaluate the responsiveness in terms of correlation of the Hospital Universitario La Princesa Index (HUPI) comparatively to the traditional composite indices used to assess disease activity in rheumatoid arthritis (RA), and to compare the performance of HUPI-based response criteria with that of the EULAR response criteria. Methods Secondary data analysis from the following studies: ACT-RAY (clinical trial), PROAR (early RA cohort) and EMECAR (pre-biologic era long term RA cohort). Responsiveness was evaluated by: 1) comparing change from baseline (Delta) of HUPI with Delta in other scores by calculating correlation coefficients; 2) calculating standardised effect sizes. The accuracy of response by HUPI and by EULAR criteria was analyzed using linear regressions in which the dependent variable was change in global assessment by physician (Delta GDA-Phy). Results Delta HUPI correlation with change in all other indices ranged from 0.387 to 0.791); HUPI's standardized effect size was larger than those from the other indices in each database used. In ACT-RAY, depending on visit, between 65 and 80% of patients were equally classified by HUPI and EULAR response criteria. However, HUPI criteria were slightly more stringent, with higher percentage of patients classified as non-responder, especially at early visits. HUPI response criteria showed a slightly higher accuracy than EULAR response criteria when using Delta GDA-Phy as gold standard. Conclusion HUPI shows good responsiveness in terms of correlation in each studied scenario (clinical trial, early RA cohort, and established RA cohort). Response criteria by HUPI seem more stringent than EULAR's