Tratamiento no quirúrgico de la enfermedad de Dupuytren con aponeurotomía percutánea con aguja: 10 años de experiencia / Non-surgical treatment of Dupuytren's disease by using percutaneous needle aponeurotomy: a 10-year experience

INTRODUCCIÓN: La enfermedad de Dupuytren es un trastorno fibroproliferativo de la aponeurosis palmar que conduce a contracturas de flexión digital. Esta afección incapacitante se puede tratar con un procedimiento mínimamente invasivo, llamado aponeurotomía percutánea con aguja (APA). OBJETIVO: Presentar los resultados de 10 años de experiencia en el tratamiento de la contractura de Dupuytren por APA en la Consulta de Mano Reumatológica de nuestro departamento. MÉTODOS: Se ha realizado un estudio retrospectivo con la descripción del método de ejecución de la APA junto con el análisis de los resultados posteriores al procedimiento. RESULTADOS: Se han observado un total de 197 pacientes con enfermedad de Dupuytren. Noventa y ocho pacientes (49,7%) fueron tratados con APA, lo que equivale a 117 dedos tratados. Hubo un 84% de buenos resultados inmediatos, con mejores resultados para las etapas menos avanzadas. Se observaron recurrencias en un 12% de los pacientes. Se registró una tasa de complicación del 1,7%. CONCLUSIÓN: Nuestros resultados confirman el valor de esta técnica especialmente en las primeras etapas de la enfermedad de Dupuytren, con resultados satisfactorios inmediatos asociados a una baja tasa de complicaciones

INTRODUCTION: Dupuytren's disease is a fibroproliferative disorder of the palmar aponeurosis that leads to digital flexion contractures. This disabling condition can be treated with a minimally invasive procedure, called percutaneous needle aponeurotomy (PNA). OBJECTIVE: To report the results of 10 years of experience treating Dupuytren's contracture by PNA in the rheumatology hand unit of our department. METHODS: We conducted a retrospective study with a description of method to perform PNA and analysis of post-procedure results. RESULTS: There were 197 patients with Dupuytren's disease. Ninety-eight patients (49.7%) underwent PNA, corresponding to 117 treated fingers. Good immediate results were achieved in 84% of the patients, with results being better in those with less advanced stages. Recurrences occurred in 12% of the patients. The complication rate was 1.7%. CONCLUSION: Our results confirm the value of this technique especially in the early stages of Dupuytren's disease, with immediate satisfactory results and a low rate of complications

The architecture of the 6-month-old gastrocnemius: a 3D volumetric study

Gastrocnemius is essential in normal gait, contributing to the control of ankle plantar flexion and knee flexion. However, there is a paucity of literature on the architecture of the infant gastrocnemius muscle prior to the onset of weight-bearing and gait. This study investigates the three-dimensional (3D) musculoaponeurotic architecture of the gastrocnemius in a six-month-old infant. One six-month-old cadaver was used in this study (The University of Toronto Health Sciences Research Ethics Board, #32679, and The University of Auckland Human Participants Ethics Committee, #016164). Medial (MG) and lateral (LG) heads of the gastrocnemius were serially dissected and a Microscribe G2X(TM) digitizer used to digitize fiber bundles, aponeuroses and tendons. Data were then exported to Autodesk(R) Maya(R) to create 3D models. Custom software quantified architectural parameters, including fiber bundle length, pennation angle, physiological cross-sectional area, and muscle volume. The intramuscular architecture was assessed to determine whether musculoapo-neurotic partitions were present. Muscle volume was <1cm3 for both MG and LG. Three architectural partitions, proximal, middle, and distal, were identified for both MG and LG. Notably, the proximal partitions of both MG and LG had mean fiber bundle length at 2.21 ± 0.41 cm and 2.22 ± 0.27 cm, significantly greater (p < 0.05) than the middle and the distal partitions. The results of this study suggest that both MG and LG have architectural partitions before the commencement of gait. Further longitudinal studies with larger sample sizes are needed to confirm the presence of these architectural partitions, as well as to investigate their growth across the developmental spectrum

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Case report on the cadaveric discovery of a unilaterally absent medial head of the gastrocnemius

We report on a unique instance of anatomical variation in the gastrocnemius muscle. A 91-year-old Caucasian male cadaver was found to have a missing medial head of his left gastrocnemius. A layer of fibrous, fatty infiltration occupied the anatomical location of the missing musculature. Dis-section revealed no evidence of atrophy as a result of damage to nervous tissue, blood supply or muscle tissue death. There was no evidence of sarcopenia. No hypertrophy of the left-side-lateral head was documented when compared to the contralateral lower leg. There were no reports of a known defect in the musculature in the patient’s medical history. Upon superficial inspection, the extensive amount of body fat on the cadaver hid any signs of an external deformity on the leg prior to dissection. We suspect that the missing medial head was compensated for via reliance on more motor unit recruitment from the underlying soleus, as well as potential behavioural adjustments of the patient

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Evaluación ecográfica de un eumicetoma subcutáneo ciliar en una paciente inmunodeprimida / Ultrasound Assessment of a Subcutaneous Eumycetoma of the Eyebrow in an Immunocompromised Patient

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Respuesta al comentario del Dr. Arquero / No disponible

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Nódulo pétreo subcutáneo / Stony-hard Subcutaneous Nodule

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