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There is a strong association between vitamin D levels and periodontal disease based on numerous epidemiological studies. We have previously shown that experimental deficiency of serum vitamin D in mice leads to gingival inflammation and alveolar bone loss. Treatment of cultured oral epithelial cells with the active form of vitamin D, 1,25(OH)2 vitamin D3 (1,25(OH)2D3), inhibits the extracellular growth and intracellular invasion of bacteria associated with periodontal disease. Maintenance of periodontal health may be due in part to the anti-inflammatory activities of vitamin D. Furthermore, this hormone can induce the expression of an antimicrobial peptide in cultured oral epithelial cells. We have shown that oral epithelial cells are capable of converting inactive vitamin D to the active form, suggesting that topical treatment of the oral epithelium with inactive vitamin D could prevent the development of periodontitis. We subjected mice to ligature-induced periodontitis (LIP), followed by daily treatment with inactive vitamin D or 1,25(OH)2D3. Treatment with both forms led to a reduction in ligature-induced bone loss and inflammation. Gingival tissues obtained from vitamin D-treated LIP showed production of specialized proresolving mediators (SPM) of inflammation. To examine the mechanism, we demonstrated that apical treatment of 3-dimensional cultures of primary gingival epithelial cells with vitamin D prevented lipopolysaccharide-induced secretion of proinflammatory cytokines and led to a similar production of SPM. Analysis of the oral microbiome of the mice treated with vitamin D showed significant changes in resident bacteria, which reflects a shift toward health-associated species. Together, our results show that topical treatment of oral tissues with inactive vitamin D can lead to the maintenance of periodontal health through the regulation of a healthy microbiome and the stimulation of resolution of inflammation. This strongly supports the development of a safe and effective vitamin D-based topical treatment or preventive agent for periodontal inflammation and disease.
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Gyrate atrophy of the choroid and retina (GACR) is a rare autosomal recessive disease characterised by elevated plasma ornithine levels due to deficiency of the enzyme ornithine aminotransferase (OAT). The accumulation of this amino acid in plasma leads to the development of patches of chorioretinal atrophy in the peripheral retina extending into the macular area. Patients usually present with night blindness followed by constriction of the visual field and, finally, decreased central vision and blindness. The disease is diagnosed by the presence of the characteristic clinical picture, the presence of hyperornithinaemia in plasma and the detection of mutations in the OAT enzyme gene. There is currently no effective gene therapy and the most common therapeutic intervention mainly involves dietary modifications with arginine restriction. This article aims to summarise the pathogenesis, clinical and diagnostic findings and treatment options in patients with GACR.
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Systemic sclerosis is a chronic, autoimmune, multisystem disease characterized by vascular dysfunction, chronic inflammation and widespread fibrosis. Although vascular involvement commonly manifests in the skin, it can also affect other organs, including the eyes. The characteristic vascular alteration is an obliterative fibroproliferative vasculopathy leading to hypoxia and tissue ischemia. We present a case of bilateral macular edema in a patient diagnosed with systemic sclerosis, as a consequence of retinal and choroidal vascular changes.
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Edema Macular , Escleroderma Sistêmico , Humanos , Edema Macular/etiologia , Escleroderma Sistêmico/complicações , Feminino , Pessoa de Meia-Idade , Tomografia de Coerência Óptica , AngiofluoresceinografiaRESUMO
INTRODUCTION: This study examines the relationship between remnant cholesterol, glucose metrics, and chronic complications of type 1 diabetes in users of glucose monitoring systems. MATERIAL AND METHODS: Clinical variables and glucose metrics were collected from individuals using glucose sensors. Statistical models were employed to investigate the association of remnant cholesterol with glucose metrics, diabetic retinopathy, and diabetic nephropathy. RESULTS: A total of 383 individuals, aged 48.3⯱â¯16.2 years, with 54.1% women, and a remnant cholesterol level of 16⯱â¯10â¯mg/dL, were included. The results demonstrated that remnant cholesterol was associated with less time within the target range (pâ¯=â¯0.015) and more time above the target range (pâ¯=â¯0.003). Diabetic nephropathy was the only complication associated with remnant cholesterol levels exceeding 30â¯mg/dL, OR 8.93, 95% CI (2.99-26.62), pâ¯<â¯0.001. CONCLUSION: Remnant cholesterol is independently associated with hyperglycemia and diabetic nephropathy in individuals with type 1 diabetes.
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Diabetes Mellitus Tipo 1 , Nefropatias Diabéticas , Humanos , Feminino , Masculino , Diabetes Mellitus Tipo 1/complicações , Nefropatias Diabéticas/complicações , Automonitorização da Glicemia , Controle Glicêmico , Glicemia , ColesterolRESUMO
We present the case of a 71-year-old woman with severe bilateral primary alveolar proteinosis admitted for bilateral whole lung lavage (WLL) with a double-lumen endotracheal tube. She had a cardiac arrest of respiratory origin during the procedure and recovered after one minute of advanced resuscitation. A second LLP was scheduled under respiratory support with veno-venous extracorporeal membrane oxygenation (VV-ECMO). During this second WLL the patient was completely VV-ECMO-dependent, and the procedure was successfully completed. She was gradually weaned over the next 48â¯h. The patient was finally discharged after clinical improvement and home oxygen therapy was discontinued. WLL is the treatment of choice for severe cases of alveolar proteinosis. In rare cases the intervention may be poorly tolerated due to the degree of lung involvement. This case illustrates how VV-ECMO support is an option that may benefit this subgroup of at-risk patients.
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Lavagem Broncoalveolar , Oxigenação por Membrana Extracorpórea , Proteinose Alveolar Pulmonar , Humanos , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Idoso , Proteinose Alveolar Pulmonar/terapia , Lavagem Broncoalveolar/métodos , Parada Cardíaca/terapia , Parada Cardíaca/etiologiaRESUMO
A 49-year old patient (BMI 29.4kg/m2 and ASA III) with grade III subglottic stenosis (> ventilator in flow controlled ventilation mode, which allowed us to regulate both inspiratory and expiratory flow without compromising gas exchange despite maintaining peak FIO2 at 0.3 due to the risk of ignition. Before proceeding with endoscopic dilation, the 4.5mm laser endotracheal tube was withdrawn and high flow nasal cannula oxygenation was started in order to prolong apnoeic oxygenation. Total apnoea time was 11min, maintaining SpO2>70%) underwent laser resection followed by dilation. During resection he was ventilated by the Evone>ventilator; high flow nasal cannula therapy; apnoeic oxygenation-98% and peak EtCO2 60mmHg throughout the procedure.
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Laringoestenose , Terapia a Laser , Masculino , Humanos , Pessoa de Meia-Idade , Oxigênio , Constrição Patológica , Respiração Artificial , Oxigenoterapia/métodos , Laringoestenose/cirurgiaRESUMO
OBJECTIVE: to determine the direct and indirect costs in the High Specialty Medical Unit Hospital de Traumatology y Orthopedic "Lomas Verdes" of the pathology of complex hand trauma classified as occupational risk. MATERIAL AND METHODS: 50 complete clinical records with a diagnosis of complex hand trauma were analyzed from January 2019 to August 2020. The perspective of the study is to determine the costs of medical care for complex hand trauma in active workers. RESULTS: 50 clinical records of patients with clinical and radiological diagnosis of trauma severe de mano, insured workers with a work risk opinion, were reviewed. CONCLUSION: the presence of these injuries in the active age of our patients speaks to us of the great importance of timely and adequate care for severe hand trauma, which has a significant impact on the country's economy. Hence the great need to establish methods of prevention of such injuries in companies and the need to establish medical care protocols for these injuries and seek to reduce surgical procedures to resolve this pathology.
OBJETIVO: determinar los costos directos e indirectos en la Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia "Lomas Verdes" de la patología del trauma complejo de mano calificado como riesgo de trabajo. MATERIAL Y MÉTODOS: se analizaron 50 expedientes clínicos completos con diagnóstico de trauma complejo de mano de Enero de 2019 a Agosto de 2020. La perspectiva del estudio es determinar los costos de la atención médica del trauma complejo de mano en trabajadores activos. RESULTADOS: se revisaron 50 expedientes clínicos de pacientes con diagnóstico clínico y radiológico de trauma severo de mano, trabajadores asegurados con dictamen de riesgo de trabajo. CONCLUSIÓN: la presencia de estas lesiones en la edad activa de nuestros pacientes nos habla de la gran importancia que conlleva una atención oportuna y adecuada del trauma severo de mano, que impacta de manera importante en la economía del país. De ahí de la gran necesidad de establecer métodos de prevención de dichas lesiones en las empresas y la necesidad de establecer protocolos de atención médica para estas lesiones y buscar disminuir los procedimientos quirúrgicos para resolver esta patología.
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Traumatismos da Mão , Ortopedia , Traumatologia , Humanos , Traumatismos da Mão/terapia , HospitaisRESUMO
OBJECTIVE: One genetic variant (rs1121980) of FTO gene has been related with body mass index and visceral adiposity. The objective of our study was to investigate the role of rs1121980 genetic variant of FTO gene on weight loss and metabolic changes secondary to a partial meal replacement (pMR) hypocaloric diet. PATIENTS AND METHODS: We conducted an interventional study on 219 obese Caucasian subjects with body mass index (BMI) > 30 kg/m2. The subjects received two intakes per day of a normocaloric hyperproteic formula for 12 weeks. Adiposity and biochemical parameters (lipid profile, insulin, homeostasis model assessment (HOMA-IR) and glucose) were determined. RESULTS: After the pMR diet, body weight, BMI, fat mass, waist circumference, blood pressure, total-cholesterol, LDL-cholesterol, triglyceride, fasting insulin levels and HOMA-IR decreased in both genotype groups. The improvements in adiposity parameters and some biochemical parameters (insulin, HOMA-IR, triglyceride levels) were bigger in non-T allele carriers than in T allele carriers. The percentage of patients who achieved 7.5% weight loss was higher in the non-T carriers (76.7% vs. 48.4%), also with a different average of weight loss (-12.3±0.3 kg vs. -5.9±0.5 kg: p=0.01). The odds ratio to achieve 7.5% of weight loss was (OR= 2.22, 95% CI=1.24-4.01; p=0.02). CONCLUSIONS: Non-T allele carriers of rs1121980 show a higher magnitude of weight loss and improvement in adiposity parameters, insulin, HOMA-IR and triglyceride levels resulting from a pMR diet than T allele carriers.
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Resistência à Insulina , Obesidade , Humanos , Obesidade/metabolismo , Dieta Redutora/métodos , Resistência à Insulina/genética , Polimorfismo de Nucleotídeo Único , Redução de Peso/genética , Insulina , Genótipo , Triglicerídeos , Dioxigenase FTO Dependente de alfa-Cetoglutarato/genéticaRESUMO
INTRODUCTION: The biomechanical characterization of grip involves the determination of the different kinematic and dynamic variables that affect its different phases: transport, grip formation and manipulation, as well as its relationship with the anthropometric characteristics of the subject and those of the object. The contact force in the fingers during the making of bidigital or multi-digital grips but involving only the use of distal phalanges (grip type clamp) and cylindrical power grip are among the most used for daily activities. Hand grip force measurement is an essential element for follow-up during growth, injury, rehabilitation and therapeutic trials. MATERIAL AND METHODS: Descriptive, prospective, cross-sectional study with 61 patients without upper extremity pathology, 30 male, 31 female, with age range of 20 to 59 years, anthropometric measurements and Force test (kg/strength) were performed. The variables were statistically analyzed with Pearson's "r" and Mann-Whitney's U. RESULTS: The hand grip and clamp 1 Force of the dominant hand as non-dominant is correlated with weight, size, body fat percentage and wrist circumference, HGF and clamp 1 in both the dominant and non-dominant hand is higher in men than in women, with p < 0.05. CONCLUSIONS: The average HGF of the dominant hand is higher than in the non-dominant for men and women. This is related to weight, size, body fat percentage and wrist circumference.
INTRODUCCIÓN: La caracterización biomecánica de agarre supone la determinación de las diferentes variables cinemáticas y dinámicas que afectan sus distintas fases: transporte, formación del agarre y manipulación; su relación con las características antropométricas del sujeto y las propias del objeto. La fuerza de contacto en los dedos durante la realización de agarres bidigitales o multidigitales pero que involucran únicamente uso de las falanges distales (agarre tipo pinza) y el agarre de potencia cilíndrico son de los más empleados para las actividades diarias. La medición de la fuerza de presión (FPM) es un elemento esencial para seguimiento durante el crecimiento, lesiones, rehabilitación y ensayos terapéuticos. MATERIAL Y MÉTODOS: Estudio descriptivo, prospectivo, transversal con 61 pacientes sin patología de miembro torácico, 30 hombres y 31 mujeres, con rango de edad de 20 a 59 años, se realizaron mediciones antropométricas y prueba de fuerza (kg/fuerza). Se analizaron las variables estadísticamente con "r" de Pearson y U de Mann-Whitney. RESULTADOS: La fuerza de prensión de la mano y la pinza 1 de la mano dominante como la no dominante está correlacionada con el peso, talla, porcentaje de grasa corporal y circunferencia de la muñeca, la FPM y la pinza 1 tanto en la mano dominante como en la no dominante es mayor en los hombres que en las mujeres, con p < 0.05. CONCLUSIONES: La FPM promedio de la mano dominante es mayor que en la no dominante para hombres y mujeres, relacionado con el peso, talla, porcentaje de grasa corporal y circunferencia de la muñeca.
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Força da Mão , Mãos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Articulação do Punho , Adulto JovemRESUMO
OBJECTIVE: We evaluated the effect of the genetic variant rs10767664 of BDNF gene on anthropometric and biochemical changes after weight loss secondary to a high-fat hypocaloric diet with a Mediterranean dietary pattern. PATIENTS AND METHODS: A sample of 277 obese subjects was recruited. After subjects met the inclusion criteria, they received a nutritional intervention with a high-fat hypocaloric diet [36% of carbohydrates, 40% of fats (60.0% of monounsaturated fats, 25.0% of saturated fats and 15.0% of polyunsaturated fats) and 24% of proteins]. Biochemical and anthropometric parameters were measured at basal and 3 months. RESULTS: One hundred and seventy-nine subjects (64.6%) had the genotype AA (wild group) and 98 (35.4%) subjects had the next genotypes; AT (81 patients, 29.2%) or TT (17 patients, 6.2%) (Mutant group). The improvement of BMI, weight, fat mass, waist circumference, systolic blood pressure, leptin, total cholesterol and LDL cholesterol was similar in both genotypes after dietary intervention. Secondary to weight loss and only in non-T allele, insulin levels (AA vs. At+TT) (-5.2+0.2 UI/L vs. -2.9+0.3 UI/L: p=0.02) and HOMA-IR (-2.1+0.2 units vs. -1.1+0.1 units: p=0.02) decreased significantly. CONCLUSIONS: T allele carriers of the BDNF variant rs10767664 may be an independent predictor of the lack of improvement induced by weight loss on insulin levels and insulin resistance after a high-fat hypocaloric diet with a Mediterranean dietary pattern.
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Fator Neurotrófico Derivado do Encéfalo/genética , Dieta Hiperlipídica/efeitos adversos , Dieta Mediterrânea/efeitos adversos , Polimorfismo de Nucleotídeo Único/genética , Adulto , Idoso , Índice de Massa Corporal , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Genótipo , Humanos , Pessoa de Meia-Idade , Redução de Peso , Adulto JovemRESUMO
BACKGROUND: Neisseria gonorrhoeae (NG) isolates with high-level azithromycin resistance (HL-AziR) have emerged worldwide in recent decades, threatening the sustainability of current dual-antimicrobial therapy. OBJECTIVES: This study aimed to characterize the first 16 NG isolates with HL-AziR in Barcelona between 2016 and 2018. METHODS: WGS was used to identify the mechanisms of antimicrobial resistance, to establish the MLST ST, NG multiantigen sequence typing (NG-MAST) ST and NG sequence typing for antimicrobial resistance (NG-STAR) ST and to identify the clonal relatedness of the isolates with other closely related NG previously described in other countries based on a whole-genome SNP analysis approach. The sociodemographic characteristics of the patients included in the study were collected by comprehensive review of their medical records. RESULTS: Twelve out of 16 HL-AziR isolates belonged to the MLST ST7823/NG-MAST ST5309 genotype and 4 to MLST ST9363/NG-MAST ST3935. All presented the A2059G mutation in all four alleles of the 23S rRNA gene. MLST ST7823/NG-MAST ST5309 isolates were only identified in men who have sex with women and MLST ST9363/NG-MAST ST3935 were found in MSM. Phylogenomic analysis revealed the presence of three transmission clusters of three different NG strains independently associated with sexual behaviour. CONCLUSIONS: Our findings support the first appearance of three mild outbreaks of NG with HL-AziR in Spain. These results highlight the continuous capacity of NG to develop antimicrobial resistance and spread among sexual networks. The enhanced resolution of WGS provides valuable information for outbreak investigation, complementing the implementation of public health measures focused on the prevention and dissemination of MDR NG.
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Gonorreia , Minorias Sexuais e de Gênero , Antibacterianos/farmacologia , Azitromicina/farmacologia , Surtos de Doenças , Farmacorresistência Bacteriana , Feminino , Gonorreia/epidemiologia , Homossexualidade Masculina , Humanos , Masculino , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Neisseria gonorrhoeae/genética , Espanha/epidemiologiaRESUMO
The increase in urban runoff brought about by a rise in impermeable surfaces has triggered the alteration and pollution of many aquatic systems. The overall goal of this research was to design a 'Sustainable Urban Drainage System' (SUDS) for the retention of heavy metals from a car park consisting of mixing autochthonous soil (70%) with sand (30%) to improve the hydrological conductivity and adsorption capacity. To quantify the retention of metals we characterize the adsorption kinetics and isotherms of the soil mixture and perform dynamic experiments. The proposed methodology allowed us to work out the amount of heavy metal retention by the adsorbent and the retention mechanisms. The retention capacity of the adsorbent mixture was as follows: Cr3+â¯≈â¯Cu2+â¯â«â¯Zn2+â¯>â¯Ni2+â¯>â¯Cd2+. Chromium and copper ions were mainly retained by precipitation, whereas zinc, nickel and cadmium were retained by ionic exchange with calcium ions that saturate the soil colloids. The soil mixture buffered pH was found to change when fed with an acid solution of metallic ions.
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PURPOSE: To investigate the seasonal influence on the incidence of uveitis attacks. METHODS: An ecological study was designed including 731 uveitis attacks in 594 patients diagnosed at the eye emergency of a hospital in Madrid between 2014 and 2017. The incidence of uveitis attacks, B27+, and presumed herpetic attacks were calculated, and their correlations with seasonal and environmental variables in the same timeframe were analyzed. The analyzed variables were precipitation, barometric pressure, temperature, humidity, wind speed, global solar radiation, ultraviolet radiation, air pollution components (particulate matter and polluting gases), and the incidence of influenza. RESULTS: The incidence of attacks was significantly higher in the winter than in the autumn (p = .025). It showed a significant correlation to the number of rainy days per month (r = 0.612;p = .04), and the average wind speed (r = 0.469;p = .02) after Bonferroni correction. CONCLUSION: Uveitis episodes happened more frequently under rainy and windy conditions. Most factors were not significantly correlated to attacks.
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Meio Ambiente , Estações do Ano , Uveíte Anterior/epidemiologia , Adulto , Idoso , Pressão Atmosférica , Feminino , Humanos , Umidade , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologia , Temperatura , VentoRESUMO
INTRODUCTION: The management of postoperative pain in joint replacement surgery represents a challenge. Therefore, the advent of new strategies in the management of pain such as local infiltration analgesia (LIA) and the adductor canal block, allowed an adequate postoperative pain control and early rehabilitation of the patient in total knee arthroplasty. MATERIALS AND METHODS: A descriptive, observational and longitudinal study of a prospective cohort of patients operated by the group of joint replacements between September 29, 2017 and November 30, 2017 was conducted. They were evaluated with the analog pain scale for postoperative pain at 5 different times (1:Upon leaving recovery; 2:On the first postoperative day; 3:Before initiating in-hospital physical therapy; 4:At the end of physical therapy, and 5:Upon departure from the clinic). RESULTS: Of the 141 patients operated on, 70.9% of the patients were managed with LIA and 29.1% with adductor canal block. There were no differences between groups in postoperative pain assessment during the 5 different times (P≥.45). DISCUSSION: Our results indicate that LIA and the adductor canal blockade demonstrated the same efficacy for the control of postoperative pain and rehabilitation.
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Anestesia Local , Artroplastia do Joelho , Bloqueio Nervoso , Manejo da Dor/métodos , Dor Pós-Operatória/terapia , Recuperação de Função Fisiológica , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de TempoRESUMO
Ca2+ channels play an important role in the development of different types of cancer, and considerable progress has been made to understand the pathophysiological mechanisms underlying the role of Ca2+ influx in the development of different cancer hallmarks. Orai1 is among the most ubiquitous and multifunctional Ca2+ channels. Orai1 mediates the highly Ca2+-selective Ca2+ release-activated current (ICRAC) and participates in the less Ca2+-selective store-operated current (ISOC), along with STIM1 or STIM1 and TRPC1, respectively. Furthermore, Orai1 contributes to a variety of store-independent Ca2+ influx mechanisms, including the arachidonate-regulated Ca2+ current, together with Orai3 and the plasma membrane resident pool of STIM1, as well as the constitutive Ca2+ influx processes activated by the secretory pathway Ca2+-ATPase-2 (SPCA2) or supported by physical and functional interaction with the small conductance Ca2+-activated K+ channel 3 (SK3) or the voltage-dependent Kv10.1 channel. This review summarizes the current knowledge concerning the store-independent mechanisms of Ca2+ influx activation through Orai1 channels and their role in the development of different cancer features.
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Canais de Cálcio/metabolismo , Cálcio/metabolismo , Proteínas de Neoplasias/metabolismo , Neoplasias/metabolismo , Proteína ORAI1/metabolismo , Molécula 1 de Interação Estromal/metabolismo , Animais , Sinalização do Cálcio , ATPases Transportadoras de Cálcio/metabolismo , Carcinogênese , HumanosRESUMO
Triple negative breast cancer is an aggressive type of cancer that does not respond to hormonal therapy and current therapeutic strategies are accompanied by side effects due to cytotoxic actions on normal tissues. Therefore, there is a need for the identification of anti-cancer compounds with negligible effects on non-tumoral cells. Here we show that (-)oleocanthal (OLCT), a phenolic compound isolated from olive oil, selectively impairs MDA-MB-231 cell proliferation and viability without affecting the ability of non-tumoral MCF10A cells to proliferate or their viability. Similarly, OLCT selectively impairs the ability of MDA-MB-231 cells to migrate while the ability of MCF10A to migrate was unaffected. The effect of OLCT was not exclusive for triple negative breast cancer cells as we found that OLCT also attenuate cell viability and proliferation of MCF7 cells. Our results indicate that OLCT is unable to induce Ca2+ mobilization in non-tumoral cells. By contrast, OLCT induces Ca2+ entry in MCF7 and MDA-MB-231 cells, which is impaired by TRPC6 expression silencing. We have found that MDA-MB-231 and MCF7 cells overexpress the channel TRPC6 as compared to non-tumoral MCF10A and treatment with OLCT for 24-72â¯h downregulates TRPC6 expression in MDA-MB-231 cells. These findings indicate that OLCT impairs the ability of breast cancer cells to proliferate and migrate via downregulation of TRPC6 channel expression while having no effect on the biology of non-tumoral breast cells.
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Aldeídos/farmacologia , Cálcio/metabolismo , Fenóis/farmacologia , Canal de Cátion TRPC6/metabolismo , Neoplasias de Mama Triplo Negativas/tratamento farmacológico , Neoplasias de Mama Triplo Negativas/metabolismo , Aldeídos/isolamento & purificação , Linhagem Celular Tumoral , Movimento Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Monoterpenos Ciclopentânicos , Feminino , Humanos , Células MCF-7 , Azeite de Oliva/química , Fenóis/isolamento & purificação , Neoplasias de Mama Triplo Negativas/patologiaRESUMO
Advanced scafosemilunar collapse (SLAC) and advanced scaphoid pseudoarthrosis (SNAC) collapse are the result of trauma causing scaphoid fracture and the consequent pseudoarthrosis resulting in abnormal kinematics of the wrist and a scapholunate ligament injury, respectively. Current surgical options for SLAC/SNAC treatment include partial arthrodesis, carpal proximal row resection. MATERIAL AND METHODS: Retrospective, cross-cutting and descriptive study was carried out in the period from January 2010 to December 2015. 52 patients operated on with 4-cornered arthrodesis and 19 patients with carpectomy were studied. RESULTS: 71 patients, 62 male patients and 9 female patients were analysed. For the carpectomy procedure were 5 female patients, for patients with four-corner arthrodesis 48 male patient and 4 female patient were included. 48 patients with SNAC and 23 patients with SLAC were identified. 19 carpectomies and 52 arthrodesis of four corners of the total patients 65 of them were carried without any complications, 3 patients with delay of consolidation two with residual pain, and one with superficial infectious process. DISCUSSION: The four-corner arthrodesis technique involves longer surgery and costs in relation to carpectomy, however arthrodesis has a faster return to pain-improvement work with respect to carpectomy; the final decision will depend on the case, the patients activity.
Las lesiones por el colapso escafosemilunar avanzado y el colapso avanzado por seudoartrosis del escafoides son consecuencia de un traumatismo que origina la fractura de escafoides y la consecuente seudoartrosis, resultando en una cinemática anormal de la muñeca y en una lesión de ligamento escafosemilunar, respectivamente. Las opciones quirúrgicas actuales para el tratamiento incluyen artrodesis parcial y carpectomía de la línea proximal del carpo. Material y métodos: Estudio retrospectivo, transversal y descriptivo en el período comprendido de Enero de 2010 a Diciembre de 2015. Se estudiaron 52 pacientes operados con artrodesis de cuatro esquinas y 19 pacientes manejados con carpectomía. Resultados: Del total de 71 pacientes, 62 fueron masculinos y nueve femeninos. Para el procedimiento de carpectomías, fueron 14 varones y cinco mujeres, para los pacientes con artrodesis de cuatro esquinas se incluyeron 48 masculinos y cuatro femeninos. Se identificaron 48 pacientes con colapso avanzado por seudoartrosis del escafoides y 23 pacientes con colapso escafosemilunar avanzado. Se realizaron 19 carpectomías y 52 artrodesis de cuatro esquinas del total de pacientes, 65 de ellos cursaron sin ninguna complicación, tres pacientes con retardo de la consolidación, dos con dolor residual, y uno con proceso infeccioso superficial. Discusión: La técnica de artrodesis de cuatro esquinas implica mayor tiempo de cirugía y de costos en relación con la carpectomía; sin embargo, la artrodesis tiene una reincorporación más rápida al trabajo con mejoría del dolor con respecto a la carpectomía; la decisión final en nuestra institución dependerá del caso y de la actividad del paciente.