Preoperative prediction of autologous hamstring graft diameter in anterior cruciate ligament reconstruction. / Predicción preoperatoria del diámetro de la plastia autóloga de isquiotibiales en reconstrucción de ligamento cruzado anterior.

BACKGROUND AND OBJECTIVE: Currently, there is no stablished pre-operative model that helps the orthopaedic surgeon predict the final graft diameter in anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to determine whether there is a correlation between semitendinosus (ST) and gracilis (GT) cross-sectional area (CSA) evaluated pre-operatively in mm2 using magnetic resonance imaging (MRI) and the final intra-operative ST-GT autograft diameter in mm2. METHODS: A retrospective study was designed, 89 patients undergoing ACLR with hamstring autograft participated. We analysed ST-CSA (mm2) and GT-CSA (mm2) using pre-operative MRI, intra-operative autograft diameter, age, sex, side of the injury, weight, height and body mass index (BMI). RESULTS: A moderate-strong correlation was identified between final autograft diameter and ST-GT CSA in MRI (Pearson correlation coefficient .6911 P<.001). We observed that, if the combination of ST-CSA and GT-STA is at least 19mm2, the probability of obtaining an autograft with a diameter greater than or equal to 8mm is 91.8% or more. The ROC curve analysis demonstrated, in this model, that this predictive method on MRI correctly discriminates in over 95.6% of cases between achieving or otherwise an autograft greater than or equal to 8mm during surgery. Intra and interobserver concordance of the MRI measurements were excellent, as shown in the intraobserver intraclass correlation coefficient (CCI) of .79 and the interobserver CCI of .84 and .77 for the ST and GT respectively. CONCLUSIONS: Preoperative determinations of ST-CSA and GT-CSA (mm2) using MRI correlate with the final autograft diameter. This method represents a reliable and reproducible model to predict the hamstring autograft diameter in ACLR. LEVEL OF EVIDENCE: Retrospective cohort study, level IV. CLINICAL RELEVANCE: A review of the available literature reveals a higher risk of ACL failure or re-rupture if the graft is smaller than 8mm in diameter. Despite being an important factor there is no established pre-operative model that predicts the final graft diameter. Knowing beforehand the possibilities of obtaining a hamstring autograft with a diameter greater than or equal to 8mm would help the orthopaedic surgeon to better plan the surgery and to anticipate the need for other graft options (such as bone-patellar-tendon-bone autograft or allografts, amongst other alternatives).

Analysis of the diet in a Spanish prison and the level of perception in a sample of prisoners.

INTRODUCCIÓN: An analysis is carried out of the diet provided at the Quatre Camins prison (Barcelona), where meals were modified in the first quarter of 2017 to provide a healthier diet. OBJECTIVES: The new meals are described in relation to the most prevalent chronic and metabolic pathologies in the prison population and it is checked if they correspond to a healthy diet. The food offered at the prison shops and the perception of prisoners regarding prison food are also analysed. MATERIALS AND METHODS: A mixed methodology study was carried out: a) a descriptive analysis of the new food offered by the kitchen service; and b) an analysis of the meals using the Spanish Healthy Eating Index (IASE) as a reference; as well as a description of the most prevalent pathologies in the prison. To determine the prisoners' perceptions, an ad hoc self-completed questionnaire was designed that consisted of four closed Likert questions and four open questions about the perception of prison food. The prisoners who responded to the questionnaire did so voluntarily, anonymously and under informed consent. RESULTS: A sample of 22 prisoners was used. The score according to the IASE is 60.5 points. The assessments of the sample of 22 prisoners regarding quality, quantity and perception of diet as healthy does not reach pass. DISCUSSION: Access to safe water and food meets the requirements for healthiness, quality and quantity regulated by the current Prison Regulation. The results obtained suggest that the diet in the prison "needs changes" according to the IASE.

Clinical and radiological short-term complications after single-stage bilateral uncemented total hip arthroplasty.

PURPOSE: Economic crisis time gives to efficient procedures an important role in healthy system. Total hip replacement is a common bilateral orthopedic procedure, but there exists an important controversy to perform it in single or two stages. Our aim is to report our clinical and radiological short-term complications of bilateral uncemented total hip arthroplasty in a single time. MATERIALS AND METHODS: We have retrospectively reviewed the patients treated between 2000 and 2011 in our center by bilateral uncemented total hip replacement in a single time. We have reviewed the medical history and analyzed by age, diagnosis and ASA parameters related to the procedure, hospital stay, transfusion requirements and clinical complications. Radiological evaluation was made with anteroposterior hip radiograph evaluation (acetabular radiolucencies and stem migration). Functional assessment was carried out by the Merle D'Aubigné score. RESULTS: Seventeen patients with mean age of 47.4 (18-68) years were reviewed with a mean follow-up of 44.3 (6-172) months. ASA distribution: 29.4 % grade I; 52.9 % grade II and 17.6 % grade III. Merlé D'Aubigné score improved from 11.01 to 16.45. Hospital stay was 6 days. Transfusion requirements were two hematic concentrates for each patient. Two external popliteal sciatic nerve neurapraxias fully recovered at follow-up. Radiological results showed one case of axial migration. CONCLUSIONS: With proper patient selection and multidisciplinary team, the bilateral uncemented total hip arthroplasty in a single time has low complication rates. Our results could be used in the development of future randomized controlled trials or prospective cohort studies. LEVEL OF EVIDENCE: IV.

Experimental in situ exposure of the seagrass Posidonia oceanica (L.) Delile to 15 trace elements.

The Mediterranean seagrass Posidonia oceanica (L.) Delile has been used for trace element (TE) biomonitoring since decades ago. However, present informations for this bioindicator are limited mainly to plant TE levels, while virtually nothing is known about their fluxes through P. oceanica meadows. We therefore contaminated seagrass bed portions in situ at two experimental TE levels with a mix of 15 TEs (Al, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Mo, Ag, Cd, Pb and Bi) to study their uptake and loss kinetics in P. oceanica. Shoots immediately accumulated pollutants from the beginning of exposures. Once contaminations ended, TE concentrations came back to their original levels within two weeks, or at least showed a clear decrease. P. oceanica leaves exhibited different uptake kinetics depending on elements and leaf age: the younger growing leaves forming new tissues incorporated TEs more rapidly than the older senescent leaves. Leaf epiphytes also exhibited a net uptake of most TEs, partly similar to that of P. oceanica shoots. The principal route of TE uptake was through the water column, as no contamination of superficial sediments was observed. However, rhizomes indirectly accumulated many TEs during the overall experiments through leaf to rhizome translocation processes. This study thus experimentally confirmed that P. oceanica shoots are undoubtedly an excellent short-term bioindicator and that long-term accumulations could be recorded in P. oceanica rhizomes.

Modification of the number and phenotype of striatal dopaminergic cells by carotid body graft.

In non-human primates, striatal tyrosine hydroxylase-immunoreactive (TH-ir) cells are increased in number after dopamine depletion and in response to trophic factor delivery. As carotid body cells contain the dopaminotrophic glial cell line-derived neurotrophic factor (GDNF), we evaluated the number, morphology and neurochemistry of these TH-ir cells, in the anterior and posterior striatum of five monkeys treated with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) which received a graft of carotid body cell aggregates (CBCA) (n = 3) or sham surgery (n = 2), and six MPTP-monkeys that were sacrificed 6 months and 3 years after the last MPTP dose [MPTP I (n = 3) and MPTP II (n = 3), respectively]. Three intact monkeys served as controls. A disability rating scale was used for the assessment of parkinsonism in all lesioned animals, both before and after surgery. For the neurochemical examination, tissue sections were double-labelled with antibodies to TH, dopamine transporter, dopa decarboxylase-67, vesicular monoamine transporter 2, glutamic acid decarboxylase -67, calbindin, parvalbumin, calretinin, neuronal nitric oxide synthase and GDNF. Only animals receiving CBCA graft showed a moderate but significant recovery of parkinsonism that persisted 12 months after the graft. The grafted striatum contained the greatest TH-ir cell density (120.4 +/- 10.3 cells/100 mm2), while the control striatum displayed the lowest (15.4 +/- 6.8 cells/100 mm2), and MPTP I, MPTP II and sham-operated monkeys showed a similar intermediate value (66.1 +/- 6.2, 58.3 +/- 17.2 and 57.7 +/- 7.0 cells/100 mm2, respectively). In addition, in the post-commissural striatum, only CBCA graft induced a significant increase in the TH-ir cell density compared to control animals (47.9 +/- 15.9 and 7.9 +/- 3.2, respectively). Phenotypically, TH-ir cells were striatal dopaminergic interneurons. However, in the grafted animals, the phenotype was different from that in control, MPTP and sham-operated monkeys, with the appearance of TH/GDNF-ir cells and the emergence of two TH-ir subpopulations of different size as the two main differentiating features. Our data confirm and extend previous studies demonstrating that striatal CBCA grafts produce a long-lasting motor recovery of MPTP-monkeys along with an increase in the number and phenotype changes of the striatal TH-ir interneurons, probably by the action of the trophic factors contained in carotid body cells. The increased number of striatal TH-ir cells observed in the grafted striatum may contribute to the improvement of parkinsonism observed after the graft.

[The induction of a septal infarct as a therapeutic alternative in hypertrophic obstructive cardiomyopathy: new observations apropos a case]. / Inducción de infarto septal como alternativa terapéutica en la miocardiopatía hipertrófica obstructiva: nuevas observaciones a propósito de un caso.

The hypertrophic cardiomyopathy may be associated with a variable degree of left ventricular outflow tract obstruction. There are several available therapeutic strategies for treatment: pharmacological, dual-chamber pacing, surgery and induced septal infarction. This last one is a novel technique with less experience in practice. We present the clinical case of a patient which showed persistent and severe obstruction in spite of the medications and dual-chamber pacing, and who underwent this novel technique. The results were optimal but new observations arise from this particular case.

[Symptomatic ischemia in a patient with a single right coronary artery without lesions]. / Isquemia sintomática en un paciente con coronaria derecha única sin lesiones.

Coronary artery anomalies are not a frequent finding, and a single right coronary artery is extremely rare. This anomaly has been included among the potentially serious ones because its association with infarction and sudden death has been reported. We present the case of a female patient who complained of chest pain, showed a positive exercise treadmill test and had a single right coronary artery in the angiography with no stenotic lesions. The pathophysiology and the clinical implications are discussed.

[Active infective endocarditis complicated by paravalvular abscess. Review of 40 cases]. / Endocarditis infecciosa activa complicada con absceso paravalvular. Revisión de 40 casos.

We have performed a retrospective analysis of the clinical, echocardiographic, surgical and necropsy data in 40 patients affected by infective endocarditis complicated by paravalvular abscess. The abscess developed on prosthetic valve in 13 cases, and on native valve in 27. Aortic valve was the most affected (85%). The clinical course was considered to be acute in 52% of the patients. Fever persisted despite of adequate antibiotic therapy in 57%. In 90%, overt heart failure were present. Staphylococcus were the most frequent causative microorganism (S. aureus, 22.5%; S. epidermidis, 20%). Bundle branch or atrioventricular block were detected in 18 patients (sensibility, 45%; specificity, 88%). Bidimensional echocardiography, along with Doppler techniques when necessary, detected an abscess in 81% of patients (sensibility, 80%; specificity, 84%). Thirty patients were operated. Eight of them (26%) died, two intraoperatively. Ten patients were not operated and nine died (90%). The difference was significant (p less than 0.001). Only age and surgical treatment were related to early survival. Over the follow-up of the operated patients, five presented prosthetic dehiscence, but only two required a new operation 3 months after the first intervention, and none died. In conclusion, the detection of a paravalvular abscess complicating an infective endocarditis is an indication for surgical treatment. Both surgical mortality and postoperative prosthetic dehiscence are acceptable. Bidimensional echocardiography is the most reliable tool for the diagnosis of this complication.

[Ileosigmoid volvulus. A case report]. / Vólvulo íleosigmoideo. Informe de un caso.

This is a case report of an ileosigmoid volvulus in a 68 year old man. The patient had emergency surgery for an acute abdominal condition. Intraoperative diagnosis of an ileosigmoid knot was made and it was necessary to resect the necrotic portion of the ilium, with ilioiliostomy, and to resect the gangrenous section of the sigmoid colon, end colostomy, and Hartmann pouch. Eleven weeks later, a colosigmoidostomy was realized. The evolution of the patient was satisfactory. The literature about ileosigmoid volvulus is reviewed.