Tratamiento quirúrgico de las metástasis diafisarias de huesos largos en pacientes oncológicos estadio IV

La incidencia de enfermedad metastásica ósea se ha incrementado debido a la mayor supervivencia de los pacientes con cáncer. El esqueleto es la tercera localización mas frecuente de metástasis procedentes de tumores primarios. Se evalúan las indicaciones quirúrgicas para evitar la aparición de fracturas patológicas y los resultados obtenidos en metástasis diafisarias de huesos largos. Cincuenta lesiones han sido tratadas en 48 pacientes. En todos los casos se estabilizó con un clavo intramedular. La supervivencia media fue de 11 meses (2 días-48 meses). Al final del seguimiento la puntuación media en la escala MSTS fue 25/30 y 27/30 para miembro superior e inferior respectivamente. Debe considerarse la radioterapia postoperatoria para disminuir la progre - sión de la enfermedad. Hay múltiples factores a tener en cuenta en el tratamiento de pacientes con metástasis óseas incluyendo comorbilidades, características histológicas del tumor primario, la expectativa de vida y acti - vidad del paciente y el dolor.The incidence of metastatic bone disease is increasing as patients with cancer living longer. The skeleton is the third most common site for metastasis that originates from primary carcinomas. We evaluated the indications for surgery to prevent pathological fractures and the results obtained in metastases of the diaphyseal long bones. Fifty metastases bone lesion were treated in 48 patients. In all cases an intramedullary nail was in - serted. The chance of surviving was 11 moths average (2 days-48 moths). At follow-up, the MSTS average was 25/30 and 27/30 for superior and inferior limb respectively. To minimize disease progression postoperative ex - ternal-beam irradiation should be considered. There are multiples factors to consider in the treatment of patients with bone metastasic, including comorbidities, the histological characteristics of the primary tumor, the expected life span of the patient, the patient ?s activity level and pain

Prótesis de pirocarbono en fracturas complejas de cabeza de radio.

Presentamos los resultados de un estudio observacional retrospectivo sobre 23 casos de fracturas complejas de cabeza de radio tratadas mediante la implantación de una prótesis cabeza radio de pircocarbono (Mo - Pyc). La distribución por sexos fue 10 hombres y 13 mujeres, y la edad media de 54 años. El seguimiento medio fue de 70 meses (48-93 meses). La principal causa fue una fractura de cabeza de radio no reconstruible con inestabilidad asociada de codo. La evaluación clínica se realizó con la Mayo Elbow Performance Score (MEPS). Radiográficamen - te se valoró la congruencia articular, el tamaño de la prótesis, la radiolucencia periprotésica, la osificación heterotópica y la osteoartritis. Al final del seguimiento la media de la escale MEPS fue 82/100, con 84 % resultados de excelentes y buenos. La flexión media fue de 130º, extensión -30º, pronación 76º y supinación 77º. La estabilidad del codo fue buena en todos los casos y no observamos migración proximal del radio. Observamos radiolucencia alrededor del vástago en 5 pacientes, pero sin aparente repercusión clínica. Las complicaciones fueron una paresia del nervio interóseo posterior con recuperación funcional al cabo de 11 semanas, 2 pacientes presentaron "overstuffing" con subluxación posterior asociada que necesitó realizar exéresis de la cabeza y una osificación heterotópica con repercu - sión sobre el balance articular que necesitó 2 cirugías, todos ellos con resultados clínicos aceptables. Los resultados son alentadores.The authors present the results of a retrospective observational study of 23 cases of a complex radial head fractures treated by pyrocarbon radial head prosthesis (MoPyc). This modular radial head prosthesis is compo - sed of a cementless titanium stem and a 15º angulated neck. The gender distribution was 10 men and 13 women, ave - rage age 54 years. The mean follow-up was 70 months (48-93 months). The main etiology was a radial head fracture with elbow instability. Clinical evaluation was performed using the Mayo Elbow Performance Score (MEPS). Was assessed radiographically joint congruity, the size of the prosthesis, periprosthetic radiolucency, heterotopic ossifica - tion and osteoarthritis. At follow-up, the MEPS average was 82/100, with 84% of good and excellent results. Elbow flexion averaged 130º, extension -30º, pronation 76º and supination 77º. Elbow stability was good in all the cases, and no proximal migration of the radius occurred. Asymptomatic bone lucencies were found in five cases around the stem. Complications included paresis of the posterior interosseous nerve with functional recovery after 11 weeks, 2 patients had "overstuffing" associated with posterior subluxation and they need to perform excision of the head and one heterotopic ossification with articular impact on balance that needs two surgeries, all of them with acceptable clinical results. The preliminary results are encouragin

Case Report Skin Abscess due to Serratia marcescens in an Immunocompetent Patient after Receiving a Tattoo

The incidence of skin infections caused by Serratia marcescens is extremely low and such infections are typically observed in immunocompromised patients. The clinical manifestations of these infections include cellulitis, abscesses, fluctuant nodules, or granulomatous lesions. Infections caused by S. marcescens are very difficult to treat due to their resistance to many antibiotics, which often leads to specific and prolonged treatment. Infections after receiving a tattoo are very rare and are caused by unhygienic conditions or the inexperience of the tattooist. In this paper we present the case of a 32-year-old male with no comorbidity, who presented an abscess caused by S. marcescens in a area that was tattooed one month earlier. The case was resolved with surgery and antimicrobial therapy that was based on the antibiogram. To our knowledge, this is the first reported case of a S. marcescens skin infection following a tattoo, in the absence of immunosuppression

Vástagos monobloque de recubrimiento completo en cirugía de revisión femoral. Resultados a largo plazo de 80 casos.

Bone stock lost and anatomical changes in the proximal femur make femoral revision surgery a complex procedure where the implant chooses will be essential. With the aim of evaluating the clinical and radiological results of the fully coated monoblock stems, we retrospectively studied 80 consecutive cases of femoral revision surgery operated by our hip team. The mean follow-up was 8.6 years. The average score on the Harris Hip Score was 81,2 points. We achieved better results in patients with less bone defects (Paprosky I, II and IIIA) in contrast to those with Paprosky type IIIB defects (p=0.005), in patients with a single previous surgery (p=0.031), in patients under 65 years (p=0.009) and in those who did not suffer complications (p=0.024). The survival rate was 96.1% at 10 years if we consider as failure the removal of the stem due to aseptic loosening and 89.9% if we consider revision of the stem as a failure due to any cause. After the results obtained, we think that fully coated stems provide a solid and stable fixation in femoral revision surgery. However, worst results obtained in patients with bigger bone defects make other options to be considered

Tratamiento de oligometástasis mediante cirugía oncológica con intención curativa

Oligometastasis is a clinical condition characterized by the presence of one to five metastases in a controlled or potentially controllable neoplasm, which can be treated at a local level through ablative therapy. Material and methods. We report the case of a 49 years old male who is diagnosed of a renal cell carcinoma, and presents metastases in the left humerus and the right radius. Two-stage surgery is carried out with the placement of tumor prosthesis in the humerus and reconstruction by using the fibula and osteosynthesis with a plate in the radius. Results. In the course of two years of monitoring, the patient is now disease free at both a local and systemic levels with a good clinical, functional and radiological condition. Conclusions. The management of patients with metastatic cancer has changed. Patients affected by oligometastasis can be treated with oncology surgery with a curative intention, increasing the chances of survival and even achieving the recovery of the patient

Empirical validity of Leonhard's psychoses: A long-term follow-up study of first-episode psychosis patients

The validation of nosological diagnoses in psychiatry remains a conundrum. Leonhard's (1979) nosology seems to be one of the few acceptable alternative categorical models to current DSM/ICD systems. We aimed to empirically validate Leonhard's four classes of psychoses: systematic schizophrenia (SSch), unsystematic (USch), cycloid psychosis (Cyclo), and manic-depressive illness (MDI) using a comprehensive set of explanatory validators. 243 patients with first-episode psychosis were followed between 10 and 31 years. A wide-ranging assessment was carried out by collecting data on antecedent, illness-related, concurrent, response to treatment, neuromotor abnormalities, and cognitive impairment variables. Compared with USch, Cyclo, and MDI, SSch displayed a pattern of impairments significantly larger across the seven blocks of explanatory variables. There were no significant differences between Cyclo and MDI in explanatory variables. Except for the majority of illness-onset features, USch displayed more substantial abnormalities in the explanatory variables than Cyclo and MDI. SSch and MDI showed higher percentages of correctly classified patients than USch and Cyclo in linear discriminant analyses. Partial validation of Leonhard's classification was found. SSch showed differences in explanatory variables with respect to Cyclo and MDI. USch showed also significant differences in explanatory variables regarding Cyclo and MDI, although with a lower strength than SSch. There was strong empirical evidence of the separation between both Leonhard's schizophrenia subtypes; however, the distinction between the Cyclo and MDI groups was not empirically supported. A mild to moderate discriminative ability between Leonhard's subtypes on the basis of explanatory blocks of variables was observed