Osteomielitis y tumor de Ewing: aspectos clínicos y radiográficos comunes

La osteomielitis aguda y el tumor de Ewing, dos entidades de naturaleza bien distinta, pueden mostrar semejanzas clínicas y radiográficas. Presentamos un caso de tumor de Ewing clásico y dos de osteomielitis que plantearon sendas dudas diagnósticas. Concluimos insistiendo en la importancia de un diagnóstico diferencial definitivo precoz mediante biopsia y cultivo en estas circunstancias.Acute osteomyelitis and Ewing's sarcoma are diseases of quite different natur e which may show similar clinical and radiographic characteristics. The author s present a case of classic Ewing's sarcoma ant two case s of osteomyelitis that suposed diagnosti c doubts in each case . They conclude emphasizing on the importanc e of an early, definitive differential diagnosis in thes e circunstance s by means of a biopsy and bacteriologic culture

La toma de muestras intraoperatorias con hisopo para el diagnóstico precoz de una infección de prótesis total de cadera es una práctica ineficaz

El diagnóstico de infección articular periprotésica es motivo de reuniones y consensos internacionales. Sin embargo, no hay consenso sobre cuál es la prueba más adecuada para identificar de manera profiláctica el o los microorganismos responsables. En este trabajo se realiza un estudio retrospectivo de 1.022 pacientes a los que se les implantaron 1.045 prótesis totales de cadera entre los años 2009-2013, ambos inclusive. Se analizan los resultados del cultivo de muestras tomadas intraoperatoriamente identificándose los microorganismos aislados y su correlación con la clínica de infección. Se calcularon la sensibilidad, especificidad, valores predictivos positivos y negativos de la prueba. Se identificaron los pacientes con complicaciones infecciosas, la clasificación de los mismos según criterios de Tsukayama y el tratamiento realizado. Concluimos que la toma rutinaria de muestras intraoperatorias en la artroplastia primaria de cadera para intentar adelantar el diagnóstico de una infección periprotésica es una práctica ineficaz e ineficiente y, por ello, hay que abandonarla.There are many international meetings and consensus about the diagnosis of periprosthetic joint infection. However, there aren´t consensus about the most appropriate test to identify the prophylactically microorganisms responsible of infection. This paper is a retrospective study of 1.022 patients with 1.045 total hip replacements between 2009-2013. We analyzed the results of intraoperative culture samples, identified the microorganisms and the patients with clinical infection. We calculated the sensitivity, specificity, positive and negative predictive values of the test. The patients with infectious were identified and classified according to criteria Tsukayama and treatment performed. We conclude that intraoperative culture samples in primary hip arthroplasty to try to advance the diagnosis of periprosthetic infection are an ineffective and inefficient practice and we have to stop doing it

La prótesis Bicontact resultados a 11 años de seguimiento

Peer Reviewe

An active tectonic field for CO2 storage management: the Hontomín onshore case study (Spain)

One of the concerns of underground CO2 onshore storage is the triggering of induced seismicity and fault reactivation by the pore pressure increasing. Hence, a comprehensive analysis of the tectonic parameters involved in the storage rock formation is mandatory for safety management operations. Unquestionably, active faults and seal faults depicting the storage bulk are relevant parameters to be considered. However, there is a lack of analysis of the active tectonic strain field affecting these faults during the CO2 storage monitoring. The advantage of reconstructing the tectonic field is the possibility to determine the strain trajectories and describing the fault patterns affecting the reservoir rock. In this work, we adapt a methodology of systematic geostructural analysis to underground CO2 storage, based on the calculation of the strain field from kinematics indicators on the fault planes (ey and ex for the maximum and minimum horizontal shortening, respectively). This methodology is based on a statistical analysis of individual strain tensor solutions obtained from fresh outcrops from the Triassic to the Miocene. Consequently, we have collected 447 fault data in 32 field stations located within a 20 km radius. The understanding of the fault sets’ role for underground fluid circulation can also be established, helping further analysis of CO2 leakage and seepage. We have applied this methodology to Hontomín onshore CO2 storage facilities (central Spain). The geology of the area and the number of high-quality outcrops made this site a good candidate for studying the strain field from kinematics fault analysis. The results indicate a strike-slip tectonic regime with maximum horizontal shortening with a 160 and 50◦ E trend for the local regime, which activates NE–SW strike-slip faults. A regional extensional tectonic field was also recognized with a N–S trend, which activates N–S extensional faults, and NNE–SSW and NNW– SSE strike-slip faults, measured in the Cretaceous limestone on top of the Hontomín facilities. Monitoring these faults within the reservoir is suggested in addition to the possibility of obtaining a focal mechanism solutions for microearthquakes (M < 3)This work has been partially supported by the European Project ENOS: ENabling Onshore CO2 Storage in Europe, H2020 Project ID: 653718 and the Spanish project 3GEO, CGL2017-83931-C3-2-P, MICIU-FEDE

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Blinatumomab and inotuzumab for B cell precursor acute lymphoblastic leukaemia in children: a retrospective study from the Leukemia Working Group of the Spanish Society of Pediatric Hematology and Oncology (SEHOP)

Blinatumomab and inotuzumab ozogamycin represent promising alternatives to conventional chemotherapy in acute lymphoblastic leukaemia (ALL). We analysed data from 29 children with ALL treated under compassionate use with blinatumomab, inotuzumab or both. The complete remission (CR) rate in a heavily pretreated population with overt relapse was 47·6%. At earlier stages (first/second CR), both antibodies represented a useful tool to reduce minimal residual disease, and/or avoid further toxic chemotherapy until stem cell transplantation. Six patients developed grade 3 reversible non‐haematological toxicity. The 12‐month overall survival and event‐free survival rates were 50·8 ± 26·4% and 38·9 ± 25·3% with blinatumomab, 45·8 ± 26% and 27·5 ± 25% with inotuzumab

Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study

Objectives Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis. Setting Prospective, international, multicentre, observational cohort study. Participants Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative). Primary outcome 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality. Results This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787). Conclusions Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups. Trial registration number NCT0432364