Luxación congénita de cadera: nuestra experiencia

La luxación congénita de cadera (L.C.C.) representa, aún hoy día, un auténtico problema dentro de la ortopedia infantil por su frecuencia y sobre todo por las secuelas invalidantes que un diagnóstico tardío puede condicionar. Basados en nuestra experiencia y revisión de un total de 334 casos, exponemos y valoramos los resultados obtenidos y propugnamos una íntima colaboración entre tocólogos, pediatras y ortopedas para evitar que la displasia luxante del recién nacido se transforme en una verdadera luxación del niño que ya ha comenzado a caminar. Ante la luxación ya establecida rechazamos cualquier intento de reducción forzada bajo anestesia general e inmovilización en yesos sucesivos de Lorenz, y proponemos una metodología basada en la reducción lenta por tracción continua en abducción progresiva, artrografía, limbectomía si fuese necesaria y posterior osteotomía desrotadora subtrocantérea, a veces con varización. Por encima de los 4 años pueden ser necesarias las acetabuloplastias.Congenital hip dislocation represents, even today, an authenti c problem within the pediatric orthopaedic field due to its frequency, and above all, becaus e of the negative results of a late diagnosis. Based on our experience and review of a total of 334 cases, they must recommend based on those cases an increased colaboration between Tocologists, Pediatricians and Ortopedics to avoid that displasia dislocation in newborns become s a true dislocation in a child that has begun to walk. Unde r established cases of dislocation, they are against the forced reduction unde r general anesthesia and succesive-continued inmovilization with Lorenz Casts. They recommend treatment based on slow reduction by continous captive traction, arthrography, if necessary limbectonomy with posterior. De-Rotational subtrochanteric osteotomy, sometimes Varus-Producing. For children 4 year s or older acetabuloplasty may be necessary

Nucleotomía Percutánea Automatizada: nuestra Experiencia

Ante las diferentes técnicas quirúrgicas en la patología del disco lumbar, los autores presentan su experiencia personal con la nucleotomía percutánea automatizada utilizando el nucleotomo de Surgical Dynamics. Sobre un total de 50 pacientes intervenidos se expone la técnica utilizada, con algunas variantes sobre la inicial de Onik, tal como la posición en sedestación del enfermo. Se puntualizan las indicaciones y contraindicaciones y se analizan los resultados obtenidos tras un mínimo de 6 meses de seguimiento. Se considera como una técnica útil, adecuada, relativamente inócua y que no sustituye sino que complementa a los procedimientos quirúrgicos convencionales.Faced with the different surgical techniques of lumbar disk pathology» the authors convery personal experience with automated percutaneous nucleotomy using the Surgical Dynamics. Based on the intervention of 50 patients, the technique used is explained, with some variations of the Onik procedure, such as the sitting position of the patient. The indications and contraindications are reviewed by the analysis. The results obtained with 6 months of follow up. The technique is considered usefull, proper, and relatively innocuous. It does not substitute but complements conventional surgical procedures

La osteotomía derotadora subtrocanterea en el tratamiento de la Enfermedad de Perthes: experiencia personal

El tratamiento de la enfermedad de Perthes y sus fundamentos patogenéticos están aún sometidos a controversias. Los autores analizan los resultados obtenidos en 43 caderas tratadas y resaltan en la importancia que par a el pronóstico tienen la edad, el sexo, el grado de Catteral, y la subluxación de la cabeza femoral. Proponen como tratamientos su recentraje mediante la osteotomía derotadora subtrocanterea , a veces varizante , para una mejor distribución de cargas, las cuales consideran que son un estímulo par a las fases de reosificación y de remodelación del núcleo en la historia de la enfermedad.Th e treatmen t o f Perthe s diseas e an d its pathogeni c origin s ar e contro - versial . Th e author s hav e analize d th e results obtaine d base d o n thei r casuistr y o f 4 3 Hips, an d emphasiz e th e importanc e fo r th e prognosis o f age , sex , th e degre e o f Catheral, an d th e subluxatio n o f th e femora l head . T h e author s propos e a s treatmen t th e recenterin g usin g subtrochanteri c derota - tiona l osteotomy , sometime s Varus-Producing , fo r bette r loa d distribution , whic h the y conside r a s a stimulatio n for th e fase s o f reosificatio n an d remodelin g o f th e hea d durin g th e cours e o f th e disease

Aloinjertos y autoinjertos de ligamento cruzado anterior de la rodilla: estudio experimental en el perro

Hemos realizado un trabajo de cirugía experimental en perros, en el que comparamos el comportamiento de los autoinjertos frescos de ligamento cruzado anterior de la rodilla (LCA), con lo aloinjertos crioconservados. Con la ayuda de una guía y trefinas, se extrae el LCA con sus inserciones, unido a un taco óseo en cada extremo. Los autoinjertos se reimplantan tras unos minutos en suero fisiológico. Los aloinjertos son sometidos a congelación y, almacenamiento a —80 °C y descongelación rápida, antes de su implantación. Se realiza una fijación de los tacos óseos con tornillos de esponjosa de 6,5 mm, lo que nos permite prescindir de la inmovilización. Los animales se sacrifican a las 3, 6, 12, 24 y 36 semanas, realizando estudio vascular con técnica de transparencia de tejidos de Spalteholz y estudios histológicos. Se demuestra que ambos injertos sufren los mismos procesos biológicos de reparación. Células mesenquimales indiferenciadas y brotes capilares del receptor, invaden los componentes del injerto; se produce una diferenciación polarizada a osteoblastos en el hueso y a fibroblastos en el ligamento, que por mecanismo de sustitución por yuxtaposición, restauran un LCA similar al normal, bien vascularizado. Esta remodelación llega a las zonas profundas, en los autoinjertos a las 12 semanas y en los aloinjertos a las 24 semanas. A las 36 semanas, ambos injertos están maduros. No ha habido rechazo inmunológico. En nuestra opinión el aloinjerto de LCA, con hueso en sus extremos, puede ser el sustituto ideal para las roturas de LCA.Experimental surgery was performed on the dog to compare the behavior of fresh autografts with freeze-stored allografts of the anterior cruciate ligament (ACL). In both cases, drill holes were made at the ACL insertion sites with a cannulated bit and the ligament with a plug of bone attached to each end was extracted with the aid of a guide wire. Prior to implantation, autografts were inmersed in a saline solution for a few minutes. Allografts deeply frozen to -80 °C with liquid nitrogen were quickly thawed before surgery. At implantation, the bone plugs at the ends of the ligament were firmly anchored with 6,5 mm. cancellous bone screws, so inmobilization of the animals was not necessary. Animals were killed at 3, 6, 12, 24 and 36 week after surgery. To study graft vascularity the tissue transparency technique developed by Spalteholz was employed. Both type of grafts underwent the same biological reconstruction process. Indifferentiated mesenchymal cells and capillar buds from the host tissues invaded the implant. Through a mechanism of creeping substitution induced by fibroblastic and osteoblastic differentiation, the grafts gradually took the apparence of normal, well-vascularized ACL. The remodeling process reached the innermost zones of the autografts in 12 weeks and the allografts in 24 weeks. Both type of groups showed a normal mature appearance 36 weeks after surgery. There were no signs of inmunological rejection. In our opinion, the ideal substitution for repair of ACL injurie could be an allograft of the same ligament, removed with bone attached to each end

Profilaxis de los puentes óseos fisarios mediante interposición de injerto autólogo de periostio. Estudio experimental en conejos

Se ha realizado un trabajo experimental sobre la profilaxis de los puentes óseos epifisometafisarios mediante la interposición de injerto autólogo de periostio, planteando los siguientes objetivos: 1) Conseguir una barrera epifisometafisaria que impida la comunicación de los vasos epifisarios y metafisarios y 2) Estudiar la capacidad condrogénica del periostio. Se han utilizado 48 conejos, distribuidos en dos Series de cuatro Grupos cada una, según el momento del sacrificio a la 1a, 2a, 4a y 8a semanas. En la serie Control, se procedió a la extirpación de 1/3 de la fisis distal externa, mientras que en la Experimental se interpuso un injerto Ubre de periostio. Todos los especímenes se estudiaron macroscópica, radiológica e histológicamente. Las conclusiones han sido, que el periostio como injerto Ubre: 1) Actúa como barrera pasiva en las lesiones fisarias en las primeras semanas. 2) Tiene capacidad condrogénica en las primeras semanas. 3) A largo plazo no es un material efectivo en la profilaxis de los puentes óseos epífiso-metafisarios.An experimental work has been carried out on prevention of fiseal bone bridges formation by means of interposing autologus periosteum graft, bringing up the following objetives: 1) To achieve a barrier which can prevent the communication between epiphyseal and metaphyseal vessels, and 2) To study the condrogenic potencial of periosteum. A total of 48 rabbits have been used, arranged in three series of four groups each, acording to the moment of sacrifice in the 1st, 2nd, 4th and 8 t h weeks. They were all operated on the right femur. In the control serie an extirpation of 1/3 of the outer and distal growth plate was carried out, while in the experimental series the created defect was filled up with a free periosteum graft. All the specimens were studied macroscopically, radiologically and histologically. As conclusions, the periosteum used as a free graft: 1) In the first weeks act like a pasive barrier in physeal lesions, 2) It has also condrogenic capacity in the first weeks and, 3) On large follow-up studies, the periosteum do not seems to be a efective material to prevent physeal bone bridges

Reparación del cartílago articular con injerto libre de pericondrio estudio experimental

Ante la incapacidad de regeneración espontánea de lesiones profundas y amplias del cartílago articular, estudiamos la reparación cartilaginosa con plastias de pericondrio tomadas de la región condro-costal e implantándolas con su cara condrogénica sobre una lesión osteocondral realizada en la superficie articular rotuliana. Macroscópica e histológicamente, a la octava semana, el neocartílago formado tenía igual apariencia que el cartílago hialino normal, no existiendo separación entre el cartílago remanente y el neoformado a partir de la plastia. Estos resultados corroboran el gran potencial condrogénico del pericondrioFaced with the incapacity of spontaneous regeneration of deep and extensive lesions of the articular cartilage we studied the cartilaginous repair with pericondrium grafts taken from the chondro-costal region. Grafts were implanted with their condrogenic face over an osteochondral defect located at the surface of the patella. At the 8th week, the neocartilage formed had macroscopically and histologically, the same appearance as the normal hyaline cartilage, with no separation between the remaining cartilage and the neocartilage induced by the graft. These results corroborate the high chondrogenic potential of the perichondrium

Nucleotomía percutánea automatizada: experiencia en 425 casos

En el presente trabajo exponemos nuestra experiencia en el tratamiento de la hernia discal lumbar mediante Nucleotomía Percutánea Automatizada. El estudio comprende el periodo de Junio de 1988 a Diciembre de 1992. Se incluyen un total de 425 enfermos de edades comprendidas entre los 18 y 58 años. Los pacientes han sido evaluados a las 6 semanas, a los 3 y a los 6 meses tras la intervención. Los resultados han sido satisfactorios en el 71% de los casos. Solamente hubo una complicación de espondilodiscitis. En el 29% de los casos se obtuvieron malos resultados. Un porcentaje importante de los fracasos, se debieron a una mala selección de los pacientes desde el punto de vista de su perfil psicológico.Our experience using automated percutaneous nucleotomy for treatment for herniated disc is presented. A total of 42 5 patientes, aged between 18 and 58 years and operated from June 88 to December 1992, has been included. Patients were clinically assessed at 6 weeks, 3 months and 6 months after surgery. Satisfactory results were found in 71% of cases. As for complications, there was only a case of discitis. In 29% of patients, the outcome was poor. An important group of failures were due to bad selection of patients regadings psychological profile

New insights into the genetic etiology of Alzheimer's disease and related dementias

Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

Multiancestry analysis of the HLA locus in Alzheimer’s and Parkinson’s diseases uncovers a shared adaptive immune response mediated by HLA-DRB1*04 subtypes

Across multiancestry groups, we analyzed Human Leukocyte Antigen (HLA) associations in over 176,000 individuals with Parkinson’s disease (PD) and Alzheimer’s disease (AD) versus controls. We demonstrate that the two diseases share the same protective association at the HLA locus. HLA-specific fine-mapping showed that hierarchical protective effects of HLA-DRB1*04 subtypes best accounted for the association, strongest with HLA-DRB1*04:04 and HLA-DRB1*04:07, and intermediary with HLA-DRB1*04:01 and HLA-DRB1*04:03. The same signal was associated with decreased neurofibrillary tangles in postmortem brains and was associated with reduced tau levels in cerebrospinal fluid and to a lower extent with increased Aβ42. Protective HLA-DRB1*04 subtypes strongly bound the aggregation-prone tau PHF6 sequence, however only when acetylated at a lysine (K311), a common posttranslational modification central to tau aggregation. An HLA-DRB1*04-mediated adaptive immune response decreases PD and AD risks, potentially by acting against tau, offering the possibility of therapeutic avenues

Common variants in Alzheimer’s disease and risk stratification by polygenic risk scores

Genetic discoveries of Alzheimer’s disease are the drivers of our understanding, and together with polygenetic risk stratification can contribute towards planning of feasible and efficient preventive and curative clinical trials. We first perform a large genetic association study by merging all available case-control datasets and by-proxy study results (discovery n = 409,435 and validation size n = 58,190). Here, we add six variants associated with Alzheimer’s disease risk (near APP, CHRNE, PRKD3/NDUFAF7, PLCG2 and two exonic variants in the SHARPIN gene). Assessment of the polygenic risk score and stratifying by APOE reveal a 4 to 5.5 years difference in median age at onset of Alzheimer’s disease patients in APOE ɛ4 carriers. Because of this study, the underlying mechanisms of APP can be studied to refine the amyloid cascade and the polygenic risk score provides a tool to select individuals at high risk of Alzheimer’s disease