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BACKGROUND AND OBJECTIVES: Buffy-coat (BC)-derived platelet concentrates (PCs) are the predominant product for platelet transfusion in many countries. Two automated systems, OrbiSac and TACSI, have been introduced in blood centres to prepare these PCs, as an alternative to the manual method. We compared the in vitro quality of PCs prepared by both methods during standard storage. STUDY DESIGN AND METHODS: Twenty primary BC pools were split into two parts, which were processed with OrbiSac and TACSI system to obtain OrbiSac PCs (O-PCs) and TACSI PCs (T-PCs), respectively. On days 1, 5 and 7 of standard storage, samples were taken and the following analysed: cell count, metabolic variables, platelet function and content of activation and proinflammatory substances. RESULTS: Both the OrbiSac and TACSI systems produced PCs that meet the standards for platelet products in terms of platelet and leucocyte content. In vitro evaluation pointed to the similar preservation of platelet metabolism (pH, glucose, bicarbonate and lactate) in O-PCs and T-PCs. Moreover, there were no significant differences between O-PCs and T-PCs as regards the hypotonic shock response or in the platelet aggregation profile. The OrbiSac system caused greater platelet activation, which resulted in higher concentrations of sCD62P, RANTES and sCD40L on the day the PCs were prepared. CONCLUSION: The systems OrbiSac and TACSI can be used to produce buffy-coat-derived PCs whose cell content, platelet function and metabolism are similar during standard storage. However, the preparation with the OrbiSac system induces a transient increase in platelet activation and release of proinflammatory substances.
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Capa Leucocitaria de la Sangre/citología , Plaquetas/citología , Plasma/citología , Plaquetoferesis/instrumentación , Capa Leucocitaria de la Sangre/fisiología , Plaquetas/fisiología , Humanos , Procedimientos de Reducción del Leucocitos , Plasma/química , Activación Plaquetaria , Agregación Plaquetaria , Pruebas de Función Plaquetaria , Transfusión de PlaquetasRESUMEN
The biceps brachii tendon arises directly from the superior glenoid labrum with the remainder usually attached to the supraglenoid tubercle. Although some cases of anomalous origin of this tendon have been described, these anomalies are rarely encountered in daily practice. We report a patient with a capsular origin of the LHBT as a congenital anomaly and present the clinical, magnetic resonance and arthroscopic findings. Recognition of this anatomic variation may be important to explain the patient's clinical data and to aid both diagnosis and surgery.
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Tendones/anomalías , Adulto , Humanos , Imagen por Resonancia Magnética , Masculino , Tendones/anatomía & histología , Tendones/cirugíaRESUMEN
Identification of very long-chain acyl-CoA dehydrogenase deficiency is possible in the expanded newborn screening (NBS) due to the increase in tetradecenoylcarnitine (C14:1) and in the C14:1/C2, C14:1/C16, C14:1/C12:1 ratios detected in dried blood spots. Nevertheless, different confirmatory tests must be performed to confirm the final diagnosis. We have revised the NBS results and the results of the confirmatory tests (plasma acylcarnitine profiles, molecular findings, and lymphocytes VLCAD activity) for 36 cases detected in three Spanish NBS centers during 4 years, correlating these with the clinical outcome and treatment. Our aim was to distinguish unambiguously true cases from disease carriers in order to obtain useful diagnostic information for clinicians that can be applied in the follow-up of neonates identified by NBS.Increases in C14:1 and of the different ratios, the presence of two pathogenic mutations, and deficient enzyme activity in lymphocytes (<12% of the intra-assay control) identified 12 true-positive cases. These cases were given nutritional therapy and all of them are asymptomatic, except one. Seventeen individuals were considered disease carriers based on the mild increase in plasma C14:1, in conjunction with the presence of only one mutation and/or intermediate residual activity (18-57%). In addition, seven cases were classified as false positives, with normal biochemical parameters and no mutations in the exonic region of ACADVL. All these carriers and the false positive cases remained asymptomatic. The combined evaluation of the acylcarnitine profiles, genetic results, and residual enzyme activities have proven useful to definitively classify individuals with suspected VLCAD deficiency into true-positive cases and carriers, and to decide which cases need treatment.
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INTRODUCTION: Diagnosis of Gilbert's disease often involves unnecessary testing and patient anxiety. Rifampin test can support the diagnosis; it has been described in short series and lacks standardization in dose, collection times, result presentation and interpretation. Our objective was to compare the response to oral rifampin in a series of patients with Gilbert's disease, 2 and 4 h after drug administration. PATIENTS AND METHODS: Eighty-nine patients with Gilbert's disease (elevated total bilirubin with no hepatopathy or hemolysis) were recruited. After a basal blood collection, 900 mg rifampin were administered per os and new samples were drawn 2 and 4 h later. Total and esterified bilirubin were measured in every sample. Haptoglobin concentration was also analyzed. RESULTS: When expressed as relative increase with respect to basal values, variations observed 2 h after rifampin intake were all above 15%. A significant correlation (r = 0.902; p = 0.000) was found between relative increases 2 and 4 h after drug administration. No significant variations were found in haptoglobin concentrations. CONCLUSION: Rifampin test is useful in diagnosing Gilbert's disease, but variations in total bilirubin concentrations (basal and post-rifampin) make that no absolute cut-off value can be used. Correlation between 2- and 4-h relative increases suggests that a shortened version could simplify the test.
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Inhibidores Enzimáticos , Enfermedad de Gilbert/diagnóstico , Rifampin , Adulto , Bilirrubina/sangre , Humanos , Persona de Mediana EdadRESUMEN
PURPOSE: The purpose of this study is to analyze if there is any difference between the arthroscopic reparation of full-thickness supraspinatus tears with simple row technique versus suture bridge technique. MATERIAL AND METHODS: We accomplished a retrospective study of 123 patients with full-thickness supraspinatus tears between January 2009 and January 2013 in our hospital. There were 60 simple row reparations, and 63 suture bridge ones. RESULTS: The mean age in the simple row group was 62.9, and in the suture bridge group was 63.3 years old. There were more women than men in both groups (67%). All patients were studied using the Constant test. The mean Constant test in the suture bridge group was 76.7, and in the simple row group was 72.4. We have also accomplished a statistical analysis of each Constant item. Strength was higher in the suture bridge group, with a significant statistical difference (p 0.04). The range of movement was also greater in the suture bridge group, but was not statistically significant. CONCLUSIONS: Suture bridge technique has better clinical results than single row reparations, but the difference is not statistically significant (p = 0.298).
OBJETIVO: Analizar si existen diferencias clínicas entre las técnicas «hilera simple¼; versus «. MATERIAL Y MÉTODOS: suture bridge¼; en la reparación artroscópica de roturas de espesor completo del supraespinoso. Estudio retrospectivo de 123 pacientes con rotura de espesor completo del supraespinoso, intervenidos entre Enero de 2009 y Enero de 2013 (60 hilera simple y 63. RESULTADOS: suture bridge). La edad media en el grupo suture bridge fue 63.3 años y en el grupo hilera simple, 62.9. Predominio de mujeres (67%) en ambos grupos. En todos los casos, se reparó la hilera medial con anclajes Bio-Corkscrew y la hilera lateral con implantes Bio-PushLock (Arthrex, Naples, FL). El valor del test de Constant medio en individuos intervenidos mediante. CONCLUSIONES: suture bridge fue 76.7 (ponderado 96.5). En hilera simple, fue 72.4 (ponderado 92.8). Se realizó también un análisis estadístico comparativo de cada ítem del test de Constant por separado. La fuerza es el único parámetro del test de Constant estadísticamente significativo y es mayor en el grupo suture bridge. La reparación de las roturas de espesor completo del supraespinoso mediante.
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The clinical usefulness of quantitative plasma polymorphonuclear elastase (PMN-elastase) determinations as prognostic markers of adult respiratory distress syndrome (ARDS) in polytraumatized patients was analyzed. PMN-elastase and C-reactive protein (CRP) levels were determined in 55 polytraumatized patients admitted into the Intensive Care Unit. Eight patients developed ARDS and 47 patients did not. These parameters were also analyzed in a control group (n = 34). PMN-elastase levels in ARDS cases reached significantly higher values than in patients who did not develop this syndrome (P < 0.01). We conclude that the increase in plasma PMN-elastase levels can be useful in predicting the development of ARDS in polytraumatized patients, in instituting prophylactic actions and monitoring the course of the disease in these high risk patients. This test is easily adaptable to the routine of any hospital laboratory.
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Neutrófilos/enzimología , Elastasa Pancreática/sangre , Síndrome de Dificultad Respiratoria/enzimología , Adolescente , Adulto , Proteína C-Reactiva/análisis , Femenino , Humanos , Elastasa de Leucocito , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Síndrome de Dificultad Respiratoria/sangre , Síndrome de Dificultad Respiratoria/etiología , Sensibilidad y Especificidad , Heridas y Lesiones/sangre , Heridas y Lesiones/complicaciones , Heridas y Lesiones/enzimologíaRESUMEN
The objective was to measure the gender-specific differences for syphilis and for the sexual transmission of human immunodeficiency virus (HIV) in a cross-sectional analysis of injecting drug users (IDUs) admitted to detoxification between February 1987 and January 1990. HIV was determined by enzyme-linked immunosorbent assay (ELISA) and confirmed with Western blot. For syphilis reactive samples to a rapid plasma reagent (RPR) were confirmed with treponemal tests (FTA-ABS or MHA-TP). Of the 386 heterosexual IDUs, 68% were HIV-positive and 4.7% had serologic syphilis (RPR and FTA-ABS or MHA-TP positive). Syphilis was higher in women (12%) than in men (3%), and women reported a significantly (P < 0.001) higher number of sex partners. Men had an IDU as a sex partner more often than women did (P = 0.001). Serologic syphilis in women was associated with having had more than one sexual partner in the previous year (P = 0.028) but this association was not present in men. HIV infection was not associated with syphilis in male IDUs. However, HIV was present in all women with syphilis that reported more than one partner.
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Infecciones por VIH/complicaciones , Infecciones por VIH/transmisión , Factores Sexuales , Sífilis/complicaciones , Sífilis/diagnóstico , Adolescente , Adulto , Estudios Transversales , Transmisión de Enfermedad Infecciosa , Femenino , Infecciones por VIH/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Asunción de Riesgos , Conducta Sexual , Parejas Sexuales , Abuso de Sustancias por Vía Intravenosa , Sífilis/epidemiologíaRESUMEN
BACKGROUND: The evolution of the prevalence of HIV infection in intravenous drug addicts who initiate hospital detoxication was analyzed. METHODS: Six hundred fifty intravenous drug addicts (535 males, 115 females) were analyzed for HIV and surveyed in regard to demographic variables and the use of drugs over a period of 7 years (1987-1993): age, sex, year of initiation of intravenous drug addiction, length of the habit and year of admission. RESULTS: Most of the subjects were men (82%) with a mean age of 19.7 years at the time of initiation to the use of i.v. drugs and an age of 25.9 years on admission to the unit. The mean time of i.v. drug addiction at admission was 74 months. The characteristics of the patients according to the year of admission were homogeneous in regard to age, length of drug addiction and male/female ratio. More than 50% of the subjects had initiated the use of i.v. drugs during the first half of the last decade. The global prevalence of HIV infection was of 66.3% with no differences being observed between sexes. The frequency of infection was shown to have globally decreased from 1987 to 1993 (p = 0.06) although the rates of HIV infection in women did not significantly modify (p = 0.08) in contrast to that of men (p = 0.05). CONCLUSIONS: The epidemia of HIV infection in intravenous drug addicts may have entered into remission following a decade characterized by a spread in the use of heroin and great diffusion of the disease.
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Infecciones por VIH/epidemiología , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adulto , Femenino , Infecciones por VIH/etiología , Humanos , Masculino , Prevalencia , Distribución por Sexo , España/epidemiología , Abuso de Sustancias por Vía Intravenosa/complicacionesRESUMEN
BACKGROUND: The differences in the rates of HIV infection in intravenous drug addicts according to the age of onset of drug consumption, sex and length of intake were evaluated. METHODS: The study sample was made up of 650 intravenous drug addicts (535 males and 115 females) admitted to a Hospital Detoxication Unit over 7 years (1987-1993). Of all these patients HIV serology and a questionnaire related to sociodemographic variables and drug consumption (age, sex, year of onset of intravenous drug intake, length of addiction and year of admission) were obtained. RESULTS: The rate of HIV infection for any length of addiction was higher in females than in males with this difference being significant for a length of addiction of less than 24 months (p = 0.03). The greater the age of onset in the use of intravenous drugs the lower the rate of HIV infection (p < 0.0001). In addiction times of less than 24 months the subjects who began drug consumption at an earlier age than the mean (19 years) presented significantly higher HIV infection rates (p = 0.04). CONCLUSIONS: Among the intravenous drug consumers in the area of Barcelona, Spain subgroups may be found: those who enter the consumption of intravenous drugs early and women, demonstrating high rates of HIV seroprevalence from the onset of their addiction.
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Infecciones por VIH/epidemiología , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , Distribución por Edad , Femenino , Infecciones por VIH/etiología , Humanos , Masculino , Distribución por Sexo , España/epidemiología , Factores de TiempoRESUMEN
BACKGROUND: The HIV/AIDS epidemics has contributed to an excess of morbidity and mortality in injecting drug users. The main goal of this study is to estimate incidence and factors associated with mortality from different causes among intravenous drug users. SUBJECTS AND METHODS: Prospective study of patients admitted to a detoxification unit between 1987 and 1990. At baseline they underwent interviews (drug injecting patterns) and venipuncture for HIV and other parameters including T-cell subsets. Viral status was determined for those who returned at least once. Cumulative incidence, overall and cause-specific mortality rates were calculated according to gender, HIV at admission and length of injecting drugs. RESULTS: 420 patients (334 men, 86 women), 69.6% HIV+, were admitted to treatment; the mean age of participants was 26 years and the mean duration of injecting drugs was 73 months. Three hundred and eighty seven patients were followed-up (92% of the initial cohort) for 2,029 persons-years and 101 deaths occurred. The overall mortality rate was 50/1000 persons-year (52/1000 for men and 40/1000 for women). The relative risk (RR) for death among women compared with men was 1.3 (95% CI = 0.8-2.2). The mortality rates for HIV+ was 60/1000 persons-year and 29/1000 persons-year for the seronegatives (RR: 2.1; 95% CI = 1.2-3.4). The HIV+ patients with CD4/microliter < or = 500 showed a threefold increase in mortality rates compared to HIV+ patients without immunosuppression (CI = 1.7-5.3). The cause-specific mortality rates were 27/1000 persons-year for HIV/AIDS, 15/1000 persons-year for drug overdose, 3/1000 persons-year for violence/trauma and 1/1000 persons-year for non-AIDS conditions. CONCLUSIONS: In this hospital cohort, HIV/AIDS and overdose have had a marked effect on mortality among intravenous drug users. Detoxification units may provide clinical services and extensive use of antiretroviral treatment for HIV infected drug users as a strategy to reduce the risk of death from AIDS.
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Infecciones por VIH/mortalidad , Abuso de Sustancias por Vía Intravenosa/mortalidad , Síndrome de Inmunodeficiencia Adquirida/mortalidad , Adulto , Causas de Muerte , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Distribución por Sexo , España/epidemiologíaRESUMEN
OBJECTIVE: We reviewed the first cases that underwent arthroscopic surgery at our center due to relapsing glenohumeral stability of the shoulder. The objective of this paper is to analyze the influence of the learning curve on the results obtained. MATERIAL AND METHODS: We analyzed 137 patients who underwent surgery at Hospital 12 de Octubre in Madrid, Spain between.February 1999 and March 2010. A total of 101 patients met the inclusion criteria, and these patients were divided into two groups using a chronological order, the first 50 patients and the second 50 patients. There were no statistically significant differences in sex, age and laterality between both groups (p = 0.51, p = 0.15 and p = 0.23, respectively), so the groups were comparable. We compared the following between both groups: clinical outcomes, number of dislocations, reoperations and complications, i.e., implant migration, arthrosis and axillary nerve neuropathy. We also compared the functional results, which were measured using the Constant and Rowe scales. RESULTS: Four episodes of redislocation occurred in group 1 and 6 in group 2. Three reoperations were performed in group 1 and 6 in group 2. No statistically significant differences were found in the number of redislocations and reoperations (p = 50 and p = 0.48, respectively).
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Artroscopía , Curva de Aprendizaje , Luxación del Hombro/cirugía , Adulto , Femenino , Humanos , Masculino , RecurrenciaRESUMEN
BACKGROUND AND AIM: The aim of our study is to analyze the different techniques used in arthroscopic treatment of talus osteochondral lesions. MATERIAL AND METHOD: We retrospectively analyzed 73 patients who underwent surgery between 2000 and 2011. Patients were divided in two groups: group A (51 patients), those treated with osteochondral stimulation techniques, and group B (32 patients), that were treated by repair techniques. The mean age was 32.58 (19-73) years in group A and 36.50 (19-58) in group B. It is identified male predominance and medial lesions in both groups. RESULTS: Were evaluated according to the AOFAS ankle scoring scale, it is observed a statistically significant clinical improvement (P<.001). Preoperative values were 48.77 (31-67) in group A and 58.08 (41-75) in group B. After surgery scores amounted to 85.19 (60-100) in group A and 93.60 (80-100) in group B. CONCLUSIONS: Ankle arthroscopy is an excellent technique for the accurate staging of osteochondral lesions, and diagnosis and treatment of associated injuries. The arthroscopic treatment of lesions grade i, ii and sometimes iii, by stimulation techniques and chondral lesions grade iii and iv by replacement techniques, gives good results with few complications.
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Artroscopía , Cartílago Articular/lesiones , Cartílago Articular/cirugía , Astrágalo/lesiones , Astrágalo/cirugía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Heridas y Lesiones/terapia , Adulto JovenRESUMEN
OBJECTIVES: Arthroscopic repair of Bankart lesion has become the treatment of choice of anterior shoulder instability. Our objective is to analyze the medium-term results of arthroscopic Bankart repair. MATERIAL AND METHODS: Between January 1999 and November 2007, 86 shoulders of 85 patients with diagnosis of relapsing shoulder dislocation were treated arthroscopically. After a mean 62-month follow-up (minimum 24 months) the results obtained were retrospectively assessed according the Rowe and Constant functional scales. A statistical analysis was done of the relation between functional results and age, sex, the side operated, capsulorrhaphy, rehabilitation and postoperative immobilization in our series. Moreover, the validity of MRI for diagnosing Bankart lesion was assessed. RESULTS: Eighty-five percent of patients had good or excellent results according to the Rowe scale. The mean Constant scale score was 90.6. There-dislocation rate in our series was 9%. The statistical analysis showed that female sex and immobilization time were related with worse results according to the Constant scale. CONCLUSIONS: In our hands, arthroscopic Bankart repair provides results similar to those in other published series. MRI is a useful diagnostic test in our setting, albeit its important implications for the diagnosis of Bankart lesion. Female sex and prolonged immobilization were related with worse functional results.
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Artroscopía , Inestabilidad de la Articulación/cirugía , Articulación del Hombro/cirugía , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Factores de Tiempo , Adulto JovenAsunto(s)
Terapia Antirretroviral Altamente Activa/estadística & datos numéricos , Infecciones por VIH/tratamiento farmacológico , Dependencia de Heroína/complicaciones , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , Recuento de Linfocito CD4 , Estudios Transversales , Femenino , Infecciones por VIH/complicaciones , Humanos , Masculino , Aceptación de la Atención de Salud , España , Insuficiencia del Tratamiento , Carga ViralRESUMEN
We analyse the elapsed time between intravenous (IV) drug initiation and HIV infection in a cohort of 972 injecting drug users attending a hospital detoxification unit. We use the time of seroconversion instead of the time of HIV infection because the date of HIV infection is rarely known and the gap between these two times is negligible (around one to three months). Although seroconversion time cannot be determined exactly, it can be inferred at least to within an interval. This seroconversion interval is determined from the dates of HIV antibody tests, if available. The data is consequently interval-censored. We estimate the distribution function of the elapsed time from IV drug initiation to seroconversion as well as the risk of seroconversion by means of a non-parametric Bayesian approach. The analysis is conducted according to the following four calendar periods: before or at 1980; between 1981 and 1985; between 1986 and 1991; after or at 1992 where the IV drug use was initiated. The methodology used is based on an alternating conditional sampling algorithm. The Bayesian approach allows not only the incorporation of prior beliefs about the distribution function, but also the analysis of the risk of seroconversion without assuming restrictive parametric models. Furthermore, the estimator for the distribution function is smooth and thus differences between groups can be easily interpreted.
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Teorema de Bayes , Infecciones por VIH/etiología , Riesgo , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adolescente , Adulto , Factores de Edad , Niño , Estudios de Cohortes , Femenino , Seropositividad para VIH , Seroprevalencia de VIH , Humanos , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
The prevalence of anti-retroviral therapy (ART) use over time and the incidence of AIDS in a cohort of HIV-seroconverting injecting drug users (IDUs) were assessed by means of a hospital-based study of IDUs with a well documented date of HIV infection. Use of ART and clinical endpoints were assessed by hospital records. Three calendar periods (before 1992, 1992-6 and 1997-2000) were defined as corresponding to modalities of ART available. Prevalence of ART usage in each calendar period, changes in medication and, hazard of AIDS in patients reaching the same duration of HIV infection at different calendar periods were analysed. In total, 132 IDUs with a median age of 23 years at seroconversion were followed up for 6.8 years (median) (range 0.2-15.7). At the end of the study, 58 patients (44%) had developed AIDS. Before the introduction of highly active anti-retroviral therapy (HAART) 12% of patients were on ART. Starting in 1997, an increasing proportion were receiving HAART with a prevalence of 39.5% by January 2000. Taking 1992-6 as the reference category the relative hazard of AIDS during 1997-2000 was 0.42 (95% CI, 0.1-1.1) (P = 0.09). A 40% penetration of HAART in a cohort of IDUs with known dates of seroconversion resulted in a 58 % reduction of the hazard of AIDS.
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Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Terapia Antirretroviral Altamente Activa/estadística & datos numéricos , Seropositividad para VIH/epidemiología , Evaluación de Resultado en la Atención de Salud , Cooperación del Paciente/estadística & datos numéricos , Abuso de Sustancias por Vía Intravenosa/complicaciones , Síndrome de Inmunodeficiencia Adquirida/sangre , Síndrome de Inmunodeficiencia Adquirida/etiología , Adulto , Recuento de Linfocito CD4 , Estudios de Cohortes , Femenino , Seropositividad para VIH/sangre , Seropositividad para VIH/mortalidad , Hospitales con más de 500 Camas , Humanos , Estudios Longitudinales , Masculino , Registros Médicos , Prevalencia , Estudios Retrospectivos , España/epidemiología , Encuestas y Cuestionarios , Análisis de Supervivencia , Factores de TiempoRESUMEN
OBJECTIVE: To determine the incidence of mortality of injecting drug users as a function of the duration of injecting drugs and HIV status, and to assess how these effects vary according to age at initiation and calendar period (before and after 1992). METHODS AND DESIGN: Cohort of 376 intravenous heroin users admitted to detoxification between February 1987 and January 1990. SETTING: Patients referred from outpatient clinics of metropolitan Barcelona. Duration and characteristics of drug use were determined by interviews. Blood samples were collected during admission and analyzed for HIV, CD4+ cell count and different biologic parameters. Assessment of vital status and causes of death were obtained by hospital charts, death certificates, and autopsies. RESULTS: The study population consisted of 299 men and 77 women, whose mean age at entry was 26 years, mean duration of injecting drug use before admission 6.1 years; HIV seroprevalence at entry 70.2%. By the end of the follow-up (median 5.6 years), 21.8% of individuals had died (26.6% in HIV-positive, and 10.7% in HIV-negative injecting users). Based on Kaplan-Meier estimates, 10%, 20%, and 30% of HIV negative patients died by 8.7, 11.3 and 14.3 years, respectively, after initiating injecting drugs. The corresponding survival times for the seropositives were substantially lower: 6.6, 8.5, and 11.6 years, respectively. Overall, the survival time was significantly (p < .05) decreased by 22% in HIV-positive injecting drug users. Older age at initiation of injecting drug use was significantly (p < .05) associated with mortality in HIV-positive heroin users but it showed the opposite direction among HIV-negative people. Death rates in HIV-positive patients of the same duration of drug use were similar in periods before and after 1992 (relative hazard (RH) = 0.97; 95% confidence interval: 0.58-1.61). Although not statistically significant, the hazard of death in HIV-negative injecting drug users was substantially lower after 1992 (RH = 0.59). CONCLUSIONS: Before introduction of potent antiretroviral therapies, HIV infection further increased rates of mortality that had already been heightened by injecting drug use. Furthermore, HIV infection modifies the effect of age at initiation and eliminates the seemingly downward trend of mortality in HIV-negative people.
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Infecciones por VIH/complicaciones , Dependencia de Heroína/complicaciones , Dependencia de Heroína/mortalidad , Abuso de Sustancias por Vía Intravenosa/complicaciones , Abuso de Sustancias por Vía Intravenosa/mortalidad , Adolescente , Adulto , Femenino , Infecciones por VIH/mortalidad , Seronegatividad para VIH , Humanos , Masculino , Factores de Riesgo , Análisis de Supervivencia , Factores de TiempoRESUMEN
Introducción y objetivo. El objetivo de nuestro estudio es analizar las distintas técnicas artroscópicas empleadas en el tratamiento de las lesiones osteocondrales de astrágalo. Material y método. Realizamos un estudio retrospectivo de 73 casos, intervenidos entre los años 2000 y 2011. Los pacientes se dividieron en 2 grupos: grupo A (51 pacientes), aquellos tratados mediante técnicas de estimulación osteocondral; grupo B (32 pacientes), tratados mediante técnicas de reparación. La edad media fue de 32,58 años (19-73) en el grupo A, y 36,50 años (19-58) en el grupo B. Se identifica predominio del sexo masculino y de lesiones mediales en ambos grupos. Resultados. Se evaluaron los resultados siguiendo la escala de la AOFAS de retropié, observando una mejoría clínica estadísticamente significativa (p < 0,001). Los valores preoperatorios fueron 48,77 (31-67) en el grupo A, y 58,08 (41-75) en el grupo B. Después de la intervención quirúrgica las puntuaciones ascendieron a 85,19 (60-100) en el grupo A, y 93,60 (80-100) en el grupo B. Conclusiones. La cirugía artroscópica es la técnica de elección en el tratamiento de las lesiones osteocondrales de tobillo, permite una correcta estadificación y tratamiento de las lesiones asociadas. El tratamiento artroscópico de las lesiones grado i , ii y, en ocasiones iii mediante técnicas de estimulación condral, y de lesiones grado iii y iv mediante técnicas de reparación ofrece buenos resultados con escasas complicaciones (11%) (AU)
Background and aim. The aim of our study is to analyze the different techniques used in arthroscopic treatment of talus osteochondral lesions. Material and method. We retrospectively analyzed 73 patients who underwent surgery between 2000 and 2011. Patients were divided in two groups: group A (51 patients), those treated with osteochondral stimulation techniques, and group B (32 patients), that were treated by repair techniques. The mean age was 32.58 (19-73) years in group A and 36.50 (19-58) in group B. It is identified male predominance and medial lesions in both groups. Results. Were evaluated according to the AOFAS ankle scoring scale, it is observed a statistically significant clinical improvement (P<.001). Preoperative values were 48.77 (31-67) in group A and 58.08 (41-75) in group B. After surgery scores amounted to 85.19 (60-100) in group A and 93.60 (80-100) in group B. Conclusions. Ankle arthroscopy is an excellent technique for the accurate staging of osteochondral lesions, and diagnosis and treatment of associated injuries. The arthroscopic treatment of lesions grade i , ii and sometimes iii , by stimulation techniques and chondral lesions grade iii and iv by replacement techniques, gives good results with few complications (AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto Joven , Adulto , Persona de Mediana Edad , Artroscopía/instrumentación , Artroscopía , Astrágalo/lesiones , Astrágalo/cirugía , Astrágalo , Factores de Riesgo , Estudios Retrospectivos , Traumatismos del Tobillo/rehabilitación , Traumatismos del Tobillo/cirugía , Traumatismos del Tobillo , Hidroterapia/métodos , Estudios de Cohortes , Indicadores de MorbimortalidadRESUMEN
Introducción. La artroplastia total de codo es una opción disponible para el tratamiento de diversas patologías del codo. Además de la indicación clásica en la artritis reumatoide, han surgido nuevas indicaciones en fracturas y pseudoartrosis de húmero distal. Sin embargo, no es una técnica exenta de complicaciones. La rotura del aparato extensor es una de ellas. Caso clínico. Mujer de 61 años con fractura conminuta no consolidada supraintercondílea de húmero distal, en un codo con afectación severa por artritis reumatoide, es tratada mediante artroplastia total semiconstreñida de codo tipo Coonrad Morrey. Al mes postoperatorio desarrolló una osificación en el tríceps distal que se extirpó. Varios meses después presenta una lesión del aparato extensor que fue tratada mediante sutura directa. Conclusión. Para casos seleccionados, el empleo de prótesis totales de codo ofrece resultados alentadores. Una correcta indicación y una buena técnica quirúrgica son indispensables para obtener resultados satisfactorios y minimizar la aparición de complicaciones (AU)
Introduction. Total elbow arthroplasty is an available option for the treatment of many pathologies of the elbow. Apart from the classic indication in rheumatoid arthritis, new indications have arisen in fractures and non-unions of the distal part of the humerus. Many complications have been described with the use of this technique. Extensor mechanism rupture is one of them. Case report. We present the case of a 61-year-old woman with a nonunited comminuted distal humerus fracture in a severely affected rheumatoid elbow who was treated with a Coonrad-Morrey semiconstrained total elbow arthroplasty. One month after the operation she developed a palpable ossification in distal triceps which was extirpated. Some months later she presented an extensor mechanism rupture which was surgically treated using a direct suture. Conclusion. In selected cases, the use of total elbow prosthesis is related to good results. A correct indication and a meticulous surgical technique are essential in order to obtain satisfactory results and to minimise the risk of complications (AU)