Ankle pain in rheumatoid arthritis: comparison of clinical and sonographic findings.

To describe the prevalence and distribution of clinical and ultrasound (US) pathological findings at ankle level and to compare them, in patients with rheumatoid arthritis (RA). This is a descriptive, cross-sectional study assessing patients diagnosed with RA according to the 2010 ACR criteria, who were recruited consecutively and independently of disease status or treatment and of the presence of pain at ankle level. Clinical and US findings were acquired by two independent rheumatologists. US assessments were performed according to the EULAR and OMERACT indications. A total of 224 ankles of 112 RA patients were examined. One hundred (89.3%) patients were women and 12 (10.7%) were men, with a mean age of 51 years. RA mean disease duration was 72 months. Ankle spontaneous pain was found in 56.2% of the patients. In 65.2% of the patients, US found at least one pathologic sign indicative of joint and/or tendon pathology. Using grayscale US, joint involvement was more frequently found than tendon pathology (37.5% vs 22.3%). Conversely, no substantial difference was found between the prevalence of power Doppler signal at joint and tendon level. There was a significant correlation between clinical findings and US findings indicative of tibiotalar joint synovitis and peroneal tenosynovitis. In the present study, pain and US pathologic findings at ankle level were described and compared in a cohort of RA patients. Spontaneous pain was found in more than half of the patients and US found joint involvement more prevalent than tendon pathology.

Estudio comparativo entre placa-injerto, caja-placa y caja de PEEK en artrodesis de la columna cervical con conducto cervical estrecho / Comparative study between plate-graft, cage-plate and peek cage in cervical arthrodesis for cervical stenosis

Introducción: Se han desarrollado una variedad de sistemas para fijar y artrodesar la columna cervical con las ventajas de reducir del riesgo de seudoartrosis, extrusión y colapso del injerto, así como una mayor precisión en la alineación sagital, por tal motivo requerimos comparar resultados de placa-injerto, caja-placa y caja-PEEK, en pacientes con conducto cervical estrecho. Material y métodos: Estudio prospectivo, de intervención y comparativo, formando tres grupos: grupo I, artrodesis con placa-injerto, grupo II, caja-placa, grupo III, caja-PEEK. La evaluación funcional pre- y postoperatoria con escala de discapacidad cervical y escala visual análoga (EVA) de dolor y radiografías columna cervical. Se analizaron los resultados con pruebas no paramétricas de rangos con signo de Wilcoxon y Kruskal Wallis para comparación entre más de dos grupos. Con nivel de significancia de 0.05. Resultados: Muestra de 37 pacientes para el grupo I con n = 12, con 22 niveles; grupo II con: n = 11, con 19 niveles; grupo III con: n = 14 con 25 niveles. La mayoría de pacientes entre la sexta y octava década de la vida. Al año de postoperados el índice de discapacidad cervical y mejoría del dolor con EVA mostraron mejoría con diferencia estadística en los tres grupos (p = 0.001). Sin embargo, las mediciones radiográficas al año de seguimiento mostraron una mejoría significativa de la lordosis segmentaria (p = 0.02) sólo en pacientes operados con placa-injerto. Conclusiones: El uso de la placa injerto ofrece mejores resultados clínicos y radiográficos en comparación con la caja-placa y caja-PEEK al año de seguimiento.

Introduction: A variety of systems have been developed to fix and perform arthrodesis of the cervical spine, with the advantages of reducing the risk of pseudoarthrosis, extrusion and graft collapse and achieving a more precise sagittal alignment. We therefore need to compare the results of the following approaches to patients with cervical stenosis: plate-graft, cage-plate and PEEK cage. Material and methods: Prospective, interventional, comparative trial involving three groups: group I, arthrodesis with plate-graft; group II, cage-plate, and group III, PEEK cage. The pre- and postoperative assessments included the cervical disability scale, the pain visual analog scale (VAS), and cervical spine X-rays. The results were analyzed with non-parametric tests such as the Wilcoxon sign test and the Kruskal-Wallis test for the comparison of more than two groups. Significance level was 0.05. Results: The sample included a total of 37 patients: n = 12 in group I, with 22 levels; n = 11 in group II, with 19 levels, and n = 14 in group III, with 25 levels. Patient age ranged between 60 and 80. One year after surgery there was an improvement in cervical disability and the pain VAS score, with a statistically significant difference among the three groups (p = 0.001). However, radiographic measurements at that time showed a significant improvement in segmental lordosis (p = 0.02) only in plate-graft patients. Conclusions: The plate-graft approach provides better clinical and radiographic results compared to the cage-plate and PEEK cage techniques, at the one-year follow-up.

[Comparative study between plate-graft, cage-plate and peek cage in cervical arthrodesis for cervical stenosis]. / Estudio comparativo entre placa-injerto, caja-placa y caja de PEEK en artrodesis de la columna cervical con conducto cervical estrecho.

INTRODUCTION: A variety of systems have been developed to fix and perform arthrodesis of the cervical spine, with the advantages of reducing the risk of pseudoarthrosis, extrusion and graft collapse and achieving a more precise sagittal alignment. We therefore need to compare the results of the following approaches to patients with cervical stenosis: plate-graft, cage-plate and PEEK cage. MATERIAL AND METHODS: Prospective, interventional, comparative trial involving three groups: group I, arthrodesis with plate-graft; group II, cage-plate, and group III, PEEK cage. The pre- and postoperative assessments included the cervical disability scale, the pain visual analog scale (VAS), and cervical spine X-rays. The results were analyzed with non-parametric tests such as the Wilcoxon sign test and the Kruskal-Wallis test for the comparison of more than two groups. Significance level was 0.05. RESULTS: The sample included a total of 37 patients: n = 12 in group I, with 22 levels; n = 11 in group II, with 19 levels, and n = 14 in group III, with 25 levels. Patient age ranged between 60 and 80. One year after surgery there was an improvement in cervical disability and the pain VAS score, with a statistically significant difference among the three groups (p = 0.001). However, radiographic measurements at that time showed a significant improvement in segmental lordosis (p = 0.02) only in plate-graft patients. CONCLUSIONS: The plate-graft approach provides better clinical and radiographic results compared to the cage-plate and PEEK cage techniques, at the one-year follow- up.

[Functional results of surgery for cervical stenosis]. / Resultados funcionales de la cirugía del conducto cervical estrecho.

INTRODUCTION: Cervical stenosis refers to the narrowing of the spinal canal or the intervertebral foramina at different anatomic levels, secondary to pathologic processes of the vertebral elements. Surgical management is used when conservative management fails. The anterior and posterior approaches are the most frequently used ones, and the surgical options resulting from these approaches are: anterior cervical diskectomy plus fusion, anterior corporectomy plus fusion, laminoplasty, laminectomy and arthroplasty. MATERIAL AND METHOD: This is an ambispective study conducted in 195 patients with a diagnosis of cervical stenosis who required surgical treatment at our hospital from January 1995 to January 2007. The neck disability index questionnaire was applied, as well as the Nurick scale. Descriptive statistics was used with frequency and percentage measures. RESULTS: The review of the National Rehabilitation Institute electronic records from January 1st 1995 to December 31st 2007 showed that 195 patients underwent surgery for cervical stenosis. Females were predominant. The most affected age group was 46-55 years. The most frequently affected level was C5-C6. A significant improvement was seen in the neck disability index due to pain and the Nurick scale. CONCLUSION: According to world literature, mean age of patients with cervical stenosis is 57.2 years, and the most compromised levels were C4-C5 and C5-C6. Improvement was evident according to the neck disability index and the Nurick scale.

[Clinical safety and effectiveness evaluation of the PDN-HydraFlex device]. / Evaluación clínica de la seguridad y efectividad del dispositivo PDN-HydraFlex.

INTRODUCTION: Nucleus arthroplasty is a motion preservation technology in which the degenerated nucleus pulposus is replaced during a surgical intervention. MATERIAL AND METHODS: Ten patients with degenerative disc disease (DDD) were selected based on a sampling of patients who met the inclusion criteria of the Spine Service, National Rehabilitation Institute, from August 2006 to January 2007. The PDN-Hydraflex device was applied to them using a retroperitoneal anterolateral approach. At the 2-year follow-up visit a clinical assessment (VAS, Oswestry, SF-12, and physical exam), X-ray studies and MRI were performed. An MRI was taken at two years to document degenerative changes by comparing it with the postoperative MRI. Degenerative changes were assessed using the Modic scale. RESULTS: Five males and 5 females were included; mean age was 35.1 years (22-51 years). There was no subsidence at the 2-year postoperative follow-up (p = 0.79), with clinical improvement in the Oswestry scale (p = 0.005) and the quality of life according to the SF-12 questionnaire (p = 0.005). There was significant decrease in lumbar pain (p = 0.007) and in right pelvic limb pain (p = 0.036). Ninety percent of patients had Modic changes. CONCLUSIONS: The use of the PDN-HydraFlex partial nucleus replacement system resulted in improvement of the patients' clinical conditions at the 2-year follow-up, without migration or device-related adverse reactions. Disc height and mobility were maintained at 2 years.

[Dynamic interspinous stabilization versus transpedicular fixation and arthrodesis in the treatment of lumbar stenosis in patients 45-65 years of age]. / Estabilización dinámica interespinosa versus fijación transpedicular y artrodesis en el tratamiento del conducto lumbar estrecho en pacientes de 45 a 65 años de edad.

INTRODUCTION: Ligamentoplasty is a posterior dynamic stabilization method. The purpose of this study is to compare the incidence of adjacent segment disease in patients undergoing decompression and ligamentoplasty versus patients with standard 360 degrees arthrodesis. MATERIAL AND METHODS: Two groups were studied, each with 15 patients. The first group underwent recalibration with fixation (Group A) and the second group recalibration with ligamentoplasty (Group L). The occurrence of adjacent segment degeneration was assessed, together with the presence of adjacent segment disease in both groups. The statistical analysis was performed with the SPSS 17.0 software. RESULTS: Both techniques showed a statistically significant clinical improvement at the six-month postoperative follow-up (p = 0.001). Radiographic findings showed a higher translational instability index at the one-year follow-up in the arthrodesis group. No statistical difference was found in the clinical course or in the rest of the radiographic variables at the 3-year comparison between both groups. The rate of adjacent segment degeneration in Group A was 33.3%, compared with 20% in Group L at the one-year follow-up. Until now, there have been two cases of radiculopathy, one in Group L and one in Group A, both with adjacent segment disease. CONCLUSION: At the 3-year follow-up it is not possible to say that ligamentoplasty, unlike 360 degrees arthrodesis, decreases the rate of adjacent segment disease. However, this technique has promising results.

[Comparison between arthrodesis and non-arthrodesis in thoracic and lumbar spine fractures: two-year follow-up]. / Comparación entre artrodesis y no artrodesis en fracturas de vértebras torácicas y lumbares: Seguimiento de dos años.

INTRODUCTION: The currently accepted treatment of thoracolumbar fractures is reduction, decompression, fixation and arthrodesis. However, it is not the perfect solution due to the medium- and long-term consequences of arthrodesis, which include the wear of the adjacent segments above and below. Some previous studies have proposed the treatment with fixation without arthrodesis. However, there are no reports on the medium- and long-term clinical and radiographic follow-up. MATERIAL AND METHODS: Two 20-patient groups treated with transpedicular fixation and decompression, one with and one without posterolateral arthrodesis, were compared. CONTROL GROUP: The mean hospital stay was 5 days. The postoperative visual analog scale pain score was 2-3 in 4 patients; the rest were asymptomatic. The functional Oswestry disability index was 8.3%. The functional economic rehabilitation scale was 4.55. Case group: The mean hospital stay was 5 days. The postoperative visual analog scale pain score was 1-2 in 2 patients; the rest were asymptomatic. The functional Oswestry disability index was 6.3%. The functional economic rehabilitation scale was 6.4. CONCLUSIONS: Both groups had very similar results. The group without arthrodesis had better results in the Oswestry functional disability scale and the functional economic rehabilitation scale.

Follicle-stimulating hormone treatment reverses the effect of hypophysectomy on cell proliferation in the chicken embryo ovary.

The present study evaluated the effect of FSH treatment on ovarian cell proliferation in the hypophysectomized chicken embryo. Hypophysectomy (Hx) was performed by the partial decapitation technique. Two series of experiments were performed: (a) Hx embryos were treated at 8 days of development with recombinant human FSH (rhFSH) and evaluated at 9 days by measuring BrdU incorporation; (b) Hx embryos were injected with rhFSH and rhCG at 9 days of development and the proliferation rate was measured at 13 days. The presence of mRNA for FSHR and LHR in the ovary of control and Hx embryos was demonstrated by RT-PCR analysis. There was a decrease in the percentage of BrdU labeled cells in the absence of hypophysis at 9 and 13 days of incubation. The decrease was reversed with rhFSH treatment. This effect was observed in the ovarian surface epithelium and the somatic cells of the cortex and the medulla in the 9-day-old embryo. Moreover, the number of somatic, steroidogenic, and germ cells was reduced at 13 days of incubation in the Hx embryo; when treated with rhFSH the number of cells increased to the level of controls. In another experiment, ovaries of 9-day-old chicken embryos were organ cultured for 48 h in a serum-free medium with rhFSH and rhCG separately. The proliferation index was incremented by rhFSH compared to control and rhCG-treated embryos. Therefore, FSH stimulates somatic cell proliferation in the chicken embryo ovary as early as 9 days of development.

The P450 aromatase (P450 arom) gene is asymmetrically expressed in a critical period for gonadal sexual differentiation in the chick.

Steroid hormones appear to play an important role in gonadal sex differentiation of birds. Here we studied the steady-state level of the P450 arom mRNA by reverse transcriptase polymerase chain reaction (RT-PCR) in the left and the right presumptive ovary and testis of developing chicken embryos. The gonads were evaluated every hour during the undifferentiated period, at 144-156 h of incubation (h/i), and every 24 h after sexual differentiation at 168 and 192 h/i. Activity of P450 arom was determined by estrone production from [3H]androstenedione at 144-192 h/i. Moreover, morphological development of the gonad was also examined by light microscopy. Results show that onset of P450 arom mRNA and its protein activity were simultaneously detected in the left and the right ovaries at 147 h/i. Asymmetric function of P450 arom gene expression was observed at 156 h/i when morphological gonadal differentiation is first recognized. Biotransformation of [3H]androstenedione to estrone was also asymmetrically detected between the left and right gonad at 156 h/i and asymmetry was maintained throughout the analyzed stages. It is proposed that there is a gene in birds that is asymmetrically expressed in the undifferentiated stage of the female and the male gonad. In the female this gene could promote P450 arom gene expression, increasing estrogen production, which in turn could induce ovarian cortex proliferation and expression of other structural estrogen-regulated genes involved in ovarian sexual determination.