Resultados a largo plazo del tratamiento de las fracturas de rótula mediante hemipatelectomia

Han sido revisadas retrospectivamente 48 fracturas de rótula tratadas mediante hemipatelectomía, con un seguimiento medio de 14,6 años. Para la valoración se han seguido criterios clínicos, radiológicos, subjetivos y de potencia del aparato extensor. El rango de movilidad de la extremidad intervenida es del 89%, la potencia del aparato extensor de 83% y la medición de la circunferencia del muslo del 97%, tomando como referencia la extremidad no intervenida. Encontramos un 45% de resultados excelentes, 39,58% de buenos resultados, 10,41% de resultados regulares y 4,16% de malos resultados. Existe una relación estadísticamente significativa entre el tipo de fractura, la edad de los pacientes, la existencia de patología previa en la rodilla, las lesiones asociadas a la fractura rotuliana por el traumatismo y el resultado final obtenido. A la vista de estos resultados podemos concluir que la hemipatelectomía es una técnica eficaz y segura para el tratamiento de algunos tipos de fracturas de rótula.A retrospective stydy was made of 48 patellar fractures who were threated with a hemipatellectomy. The mean time of follow-up was 14,6 years. The results were assessed with use of clinical, radiological, subjective and isokinetic quadriceps strength-testing criteria. The mean active range of motion was 89%, the strength of quadriceps was 83% and the circumference of the thigh was 97% of these measurements in the contralateral extremity. The over-all results was rated as excellent in 45,83%, dood in 39,58%, fair in 10,41% and poor in 4,16%. There was a significant statistical correlation between the type of fracture, the previous patology in the knee, the associated lesions caused by trauma and the outcome. The results of this study indicate that hemipatellectomy can be an effective and secure treatment for selected patellar fractures

Estudio prospectivo de profilaxis ambulatoria con sulodexida después de una artroplastia total de cadera o rodilla

La falta de continuidad en el tratamiento profiláctico ambulatorio se muestra como una de las causas determinantes en la aparición de complicaciones tromboembólicas en el primer mes tras el alta hospitalaria. La dificultad de administración por parte del paciente de las heparinas de bajo peso molecular y la diferencia de preocupación entre los médicos de Atención Primaria y los Servicios especializados por el problema tromboembólico son algunas de las causas de esta discontinuidad. Se realiza un estudio prospectivo sobre 221 pacientes intervenidos de prótesis total de cadera y rodilla con la finalidad de estudiar los resultados obtenidos con el tratamiento profiláctico mediante Sulodexida, un fármaco que une a sus propiedades antitrombóticas la comodidad de la administración vía oral. Se encontró una respuesta satisfactoria sin aparición de complicaciones tromboembólicas en el 98,8% del grupo que completó el tratamiento (n=164), frente al 21% de complicaciones que presentó el grupo que no completó el estudio.The discontinous thromboprophylaxis is a determinant cause in the presence of thromboembolic complications in the first month after hospital discharge. The difficult administration of the low -molecular- weight heparin by the patient and the different preoccupation for this problem between the Primary Care and the orthopedics specialists are the causes that incite to discontinous thromboprophylaxis. A prospective study was made of 221 patients who undergoing a total hip arthroplasty or a total knee arthroplasty and the objective was to investigate the incidence of venous thrombosis in the patients who were treated with oral sulodexide in the first month after hospital discharge. We analized the efficacy and the secondary effects of sulodexide. There were satisfactory results in 98,8% of patients who were treated with sulodexide (1,2% of venous complications), and 21% of venous complications in the group of patients who did not continue the thromboprophylactic treatment

Severa complicación neurológica tras vertebroplastia percutánea

La vertebroplastia percutánea como tratamiento de las fracturas acuñamientos vertebrales osteoporóticos tras fracaso del tratamiento sintomático y ortopédico así como para el tratamiento de lesiones tumorales del caquis ha tomado un auge importante debido a los buenos resultados publicados y la baja tasa de complicaciones. Este hecho ha llevado a las casas comerciales a desarrollar productos específicos para esta técnica que simplifican su utilización y disminuyen en lo posible las dificultades técnicas del procedimiento así como sus complicaciones. A pesar de ello, en nuestra opinión es una técnica que requiere una alta demanda de entrenamiento y que puede dar lugar a graves complicaciones a pesar de que no existan prácticamente en la literatura complicaciones severas con la utilización de esta técnica. Presentamos un caso ocurrido en nuestra serie de una paraplejia completa no resuelta tras una vertebroplastia percutanea torácica para una fractura osteoporótica.The technique of percutaneous vertebroplasty for osteoporotic fractures and spine tumors was develop an important increase because there were a lot of publications with good results and low rate of complications. This fact was done a fast developing of instruments and new PMMA cements to simplify this technique and decreased the rate of complications. In our opinion the percutaneous vertebroplasty is a high demand technique and have a high potential of major neurological complications if it is not performed with use of appropriate safeguards, but the purpose of this article is not to condemn the technique because we have had a good results using it in this pathologies and the majority of publications have shown a high rate of excellent results

Estudio a corto plazo en artroplastia total de cadera no cementada con par de fricción cerámica-cerámica

Se revisan 38 prótesis con par de fricción cerámica-cerámica en 31 pacientes intervenidos durante los años 2000 a 2003. La edad media era de 47,3 años. La valoración clínica con la escala de Harris pasó de 53 puntos de media en el preoperatorio a 97 en el postoperatorio lo que permitió establecer un 76,3% de resultados excelentes y un 23,7 de buenos. No hemos podido constatar ninguna complicación asociada al par cerámica-cerámica. Los resultados iniciales con el par cerámica-cerámica son superponibles a otras pares de fricción, su utilización en implantes que han demostrado su eficacia con otros pares de fricción, la mejoría en la fabricación y la estricta observación de la técnica quirúrgica permite obviar el riesgo de fractura. Merced a su baja incidencia de desgaste y buen comportamiento biológico representa una alternativa real para su implantación en pacientes jóvenes o con una actividad elevada.From 2000 to 2003, 38 patients underwent ceramic on ceramic bearing total hip artrhoplasty. Mean age was 47.3 years. Clinical evaluation with the harris hip score increased from 53 points preoperatively to 97 postoperatively. There were no complications associated with ceramic on ceramic bearing.Initial results are similar to those found with others bearing surfaces. The use of ceramics in implants that have shown their effectiviness with others bearing surfaces, improvement in manufactured of the ceramics and a carefull surgery decreased the risk os fracture. Low incidence of wear debris and biological caracteristics makes ceramics a real alternative in young or high activity patients

Resultados en recambios de cotilo mediante la técnica de Sloof: nuestra experiencia

Objetivos: osteolisis es un importante problema para el cirujano en los recambios de cotilo. Hoy en día existen múltiples técnicas para intentar subsanar este defecto. Una de ellas es la Técnica de Sloof. Hemos querido mostrar nuestros resultados con esta técnica. Material y métodos: Se revisaron 20 pacientes entre 1999 y octubre 2003 clasificados con la escala de Paprosky intervenidos con esta técnica. Se valoraron resultados en cuanto a mejoría del dolor, funcionalidad, actividad y consolidación radiológica, usando para ello las escalas de Harris. Resultados: La mayoría de los pacientes obtuvieron una mejoría significativa del dolor y una función suficiente como para realizar su vida de forma independiente, consiguiéndose la incorporación del injerto en todos los casos.Aim: The osteolysis of the pelvis is an important problem for the surgeon associated with acetabular revision. Nowadays there are many techniques which try to solve such a defect. One of them is the Sloof’s technique. We have shown our results using this technique. Materials and Methods: Study of 20 patients from 1999 to October 2003 who were treated with this technique. Results related to pain-free, functionality, activity and radiology consolidation, have been valued using Harris scale. Results: Most of patients got a significant pain diminution and a function enough to achieve their lives in a self- sufficiency way. We have obtained the graft incorporation in all the cases

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570