Factores pronósticos del resultado clínico de las prótesis de cabeza de radio

Introduction. Overlengthening of a radial head implant has been associated with less than optimal clinical outcomes and capitellar erosions. The purpose of this study was to identify which factors, both clinical and radiological, have influenced the clinical results in our series. Material and methods. Analytical study of a sample of 31 patients between 2005 and 2017 with an average follow-up of 5 years.Analysis of qualitative variables of age, sex, type of lesion and type of treatment used and analysis of the lenght of the implant by means of radiological measurements (implant and proximal margin of the lesser sigmoid notch/ lateral ulnohumeral angle) by independent evaluators with the updated results on scales of MEPS and DASH assessment and mobility ranges explored to the patient. Results. No significant differences depending on the type of lesion nor on the type of treatment were found. Implant length was aligned with the proximal margin of the lesser sigmoid notch in 16 cases, was higher in 12 (mean 3 mm, SD 1.5) and inferior in 3 (mean 3.4 mm, SD 1.7). The lateral ulnohumeral joint opening angle was increased an average range of 2,2º and this has shown to have a significant correlation with a reduction in the range of mobility for flexion and supination (p<0,05). Conclusions. An overlengthening or shortening up to 3 mm has not shown to alter the clinical results in our series, while an excessive lateral ulnohumeral joint opening has a negative effect on flexion and supination mobility

Comparación de los requerimientos de sangre y estancia hospitalaria tras la implantación del protocolo fast track en prótesis total de rodilla.

Objectives. To analyse the differences in blood requirements and length of stay in patients undergoing total knee arthroplasty during the period before and after the implementation of the fast track protocol. Material and methods. Retrospective observational follow-up study or cohorts. The variables under study were: initial and minimum haemoglobin, number of patients and units transfused and days of hospital stay. For the comparisons, the chi-square and U-Mann Whitney statistics were calculated. Values of p?0.05 were considered significant. Results. A sample of 189 patients was studied. The pre- and post-implementation values for the variables under study were: minimum haemoglobin 10.2 vs. 11.2 (p = 0.0), percentage of patients who required blood transfusion 20.8 vs. 4.5% (p = 0.001), rate of anaemia 3.4 vs. 2.9 (p = 0.002) and lengths of hospital stay 5.9 vs. 3.8 days (p = 0.017). Conclusions. The fast track protocol significantly improved haemoglobin values and decreased the need for transfusion and length of sta

Desalineación severa de miembros inferiores en paciente con raquitismo hipofosfatémico. Tratamiento secuencial con osteotomías hasta la artroplastia total de rodillas : a propósito de un caso

Total knee arthroplasty is the treatment of choice in patients with osteoarthritis. This intervention not only replaces the damaged joint surfaces, even it can correct misalignments of the axes of the femur and tibia. However, there are situations in which the misalignments are so severe, and also, affect not only the epiphysis, even the entire femur and / or tibia, which require corrective surgeries of such misalignments. We present a case of a patient with hypophosphatemic rickets with realignment osteotomies to achieve a mechanical normo-axis that prevents the failure of the arthroplasty

First three months of anticoagulation for venous thromboembolism in non-cancer patients: LMWH VS. VKAs. Findings from the RIETE registry

Background: The use of low-molecular-weight heparin (LMWH) for long-term therapy of venous thromboembolism (VTE) in patients without cancer has not been consistently evaluated. Methods: We used the data in the RIETE registry to compare the 3-month outcomes (VTE recurrences, major bleeding or death) in non-cancer patients with VTE, according to long-term therapy with LMWH or vitamin K antagonists (VKAs). Results: As of March 2018, 14,582 non-cancer patients with VTE had received initial therapy with LMWH and then switched to VKAs, while 9151 were prescribed LMWH for initial and long-term therapy. Overall, 11,494 had initially presented with pulmonary embolism (PE) and 12,239 with isolated deep vein thrombosis (DVT). Among 11,494 patients initially presenting with PE, 84 had VTE recurrences, 204 major bleeding and 406 died. Among 12,239 patients with isolated DVT, 133 developed VTE recurrences, 137 bled and 289 died. On propensity score analysis, PE patients on long-term LMWH therapy were at increased risk for PE recurrences (OR: 3.30; 95%CI: 1.67–6.48), major bleeding (OR: 1.68; 95%CI: 1.21–2.32) or death (OR: 3.16; 95%CI: 2.43–4.09) compared with those receiving VKAs. In patients with DVT, those on long-term LMWH also were at increased risk for PE recurrences (OR: 2.31; 95%CI: 1.13–4.73), major bleeding (OR 2.28; 95%CI: 1.51–3.44) or death (OR: 2.32; 95%CI: 1.54–3.51). Conclusions: In the RIETE non-cancer patients with VTE, long-term therapy with VKAs was associated with a lower risk for recurrences, major bleeding or death

Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study)

BACKGROUND: Treatment with angiotensin-converting-enzyme (ACE) inhibitors reduces the rate of cardiovascular events among patients with left-ventricular dysfunction and those at high risk of such events. We assessed whether the ACE inhibitor perindopril reduced cardiovascular risk in a low-risk population with stable coronary heart disease and no apparent heart failure. METHODS: We recruited patients from October, 1997, to June, 2000. 13655 patients were registered with previous myocardial infarction (64%), angiographic evidence of coronary artery disease (61%), coronary revascularisation (55%), or a positive stress test only (5%). After a run-in period of 4 weeks, in which all patients received perindopril, 12218 patients were randomly assigned perindopril 8 mg once daily (n=6110), or matching placebo (n=6108). The mean follow-up was 4.2 years, and the primary endpoint was cardiovascular death, myocardial infarction, or cardiac arrest. Analysis was by intention to treat. FINDINGS: Mean age of patients was 60 years (SD 9), 85% were male, 92% were taking platelet inhibitors, 62% beta blockers, and 58% lipid-lowering therapy. 603 (10%) placebo and 488 (8%) perindopril patients experienced the primary endpoint, which yields a 20% relative risk reduction (95% CI 9-29, p=0.0003) with perindopril. These benefits were consistent in all predefined subgroups and secondary endpoints. Perindopril was well tolerated. INTERPRETATION: Among patients with stable coronary heart disease without apparent heart failure, perindopril can significantly improve outcome. About 50 patients need to be treated for a period of 4 years to prevent one major cardiovascular event. Treatment with perindopril, on top of other preventive medications, should be considered in all patients with coronary heart disease

Implementing stakeholder engagement to explore alternative models of consent: An example from the PREP-IT trials

Introduction: Cluster randomized crossover trials are often faced with a dilemma when selecting an optimal model of consent, as the traditional model of obtaining informed consent from participant's before initiating any trial related activities may not be suitable. We describe our experience of engaging patient advisors to identify an optimal model of consent for the PREP-IT trials. This paper also examines surrogate measures of success for the selected model of consent. Methods: The PREP-IT program consists of two multi-center cluster randomized crossover trials that engaged patient advisors to determine an optimal model of consent. Patient advisors and stakeholders met regularly and reached consensus on decisions related to the trial design including the model for consent. Patient advisors provided valuable insight on how key decisions on trial design and conduct would be received by participants and the impact these decisions will have. Results: Patient advisors, together with stakeholders, reviewed the pros and cons and the requirements for the traditional model of consent, deferred consent, and waiver of consent. Collectively, they agreed upon a deferred consent model, in which patients may be approached for consent after their fracture surgery and prior to data collection. The consent rate in PREP-IT is 80.7%, and 0.67% of participants have withdrawn consent for participation. Discussion: Involvement of patient advisors in the development of an optimal model of consent has been successful. Engagement of patient advisors is recommended for other large trials where the traditional model of consent may not be optimal