Scaling theory of absorption in the frozen mode regime.

A stationary inflection point (SIP) of the Bloch dispersion relation of a periodic system is a prominent example of an exceptional point degeneracy (EPD) where three Bloch eigenmodes coalesce. The scattering problem for a bounded photonic structure supporting a SIP features the frozen mode regime (FMR), where the incident wave is converted into the "frozen mode" with vanishing group velocity and diverging amplitude. We analyze the effect of losses and disorder on the FMR and develop a scaling formalism for the absorbance in the FMR that takes into consideration losses, disorder, and system size. The signatures of the EPD appear as an abrupt growth of absorbance for system sizes greater than a characteristic length that follows a parallel resistance law involving the absorption length and the Anderson localization length.

Polymorphism E23K (rs5219) in the KCNJ11 gene in Euro-Brazilian subjects with type 1 and 2 diabetes.

Insulin secretion is regulated by ATP-sensitive potassium channels (KATP). The potassium inwardly-rectifying channel, subfamily J, member 11 (KCNJ11) gene, located on chromosome 11p15.1, encodes the subunit Kir6.2 that forms the pore region of KATP channels in pancreatic ß-cells. Among the single nucleotide polymorphisms (SNPs) associated with KCNJ11, the E23K polymorphism (rs5219) promotes a substitution (G > A) of a glutamic acid residue for lysine at position 23. The E23K SNP has been associated with diabetes in several populations, although with controversial results. The aim of this study was to evaluate the association of the E23K SNP with type 1 and 2 diabetes in a case-control study approved by the Ethics Committee. We genotyped 458 Euro-Brazilian individuals, classified as healthy (control group, CTRL, N = 217), patients with type 1 diabetes mellitus (T1D, N = 102), and patients with type 2 diabetes mellitus (T2D, N = 139). Genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) using BanII restriction digestion. The restriction fragments were separated by polyacrylamide gel electrophoresis and visualized by ethidium bromide staining. The genotype (EE/EK/KK) frequencies (%) for the CTRL group (38.2/50.2/11.6), T1D (34.3/52.0/13.7), and T2D (38.2/48.9/12.9) were in Hardy-Weinberg equilibrium and there were no significant differences (CRTL vs T1D, P = 0.771; CRTL vs T2D, P = 0.937; T1D vs T2D, P = 0.831). The minor allele frequencies (MAF; K) for CTRL (37.0%), T1D (39.7%), and T2D (37.4%) were not different among the groups (P > 0.05). The MAF value for healthy subjects was similar to other Caucasian populations (34.5-37.5%). In summary, the E23K polymorphism (rs5219) was not associated with type 1 or 2 diabetes mellitus in the studied population.

Comparative study of the Weil osteotomy with and without fixation.

BACKGROUND: Weil osteotomy is a technique widely used in patients with metatarsalgia which shortens the metatarsal and reduces the load under the metatarsal head. METHODS: The aim of this paper is to compare the results of the Weil osteotomy with and without any fixation system. We present a retrospective study of 92 patients (97 feet) who underwent treatment for metatarsalgia between 1999 and 2005. One hundred and six osteotomies were vixed using a screw amd no fixation was used in 92. The mean follow-up was 51.2 and 46.6 months respectively. RESULTS: All the patients were evaluated following the AOFAS LMIS scale, obtaining a mean score of 69.8 points (ranged 15-100) and 75.3 points (from 47 to 100) in each group (P=0.11). CONCLUSIONS: The results of fixed and unfixed Weil osteotomies were not significantly different. Our study could not find a significant relationship between metatarsal shortening and main complications (recurrent metatarsalgia, transfer metatarsalgia and stiffness of the metatarsophalangeal joint).

[Acquired flat foot of the adult by posterior tibial dysfunction. Options for surgical treatment]. / Pie plano adquirido del adulto por disfunción del tibial posterior. Opciones para el tratamiento quirúrgico.

We present the possible etiopatogenic causes of posterior tibial dysfunction or painful flat foot of the adult and the cause-and-effect relationship that may exist. We also expose the gradation of the lesion and the different therapeutic options for the surgical treatment of the deformity. Since 1939, multiple articles have been published, which have been endorsed by clinical, experimental, electromyographic and biomechanical studies; publications that have been consulted and evaluated for the development of this review. In our opinion: the dysfunction of the posterior tibial is caused in principle by a failure of the plantar navicular calcaneus ligament (spring ligament), the main passive stabilizer of the internal plantar arch. This failure would, in time, mean an increase in work of the posterior tibial tendon, in itself "insufficient", which would go into fatigue, until it reached a partial or total rupture. Published work on soft-part procedures acting on the posterior tibial tendon in stage II has not had the expected result in the natural history of deformity. Arthrodesis, on the other hand, has been effective in other stages, but is associated with a loss of movement dynamics in the back foot and increased pressure on adjacent joints.

Presentamos la posible causa etiopatogénica de la disfunción del tibial posterior o pie plano doloroso del adulto y la relación causa-efecto que puede existir. También exponemos la clasificación de la lesión y las diferentes opciones para el tratamiento quirúrgico de la deformidad. Desde 1939, múltiples artículos han sido publicados, avalados por la clínica, así como por estudios experimentales, electromiográficos y biomecánicos; publicaciones consultadas y evaluadas para el desarrollo de esta revisión, según nuestro criterio: el primum movens de la disfunción del tibial posterior es ocasionado por un fallo del ligamento en hamaca o calcáneo navicular plantar (spring ligament), principal estabilizador pasivo del arco plantar interno. Este fallo supondría en el tiempo un aumento de trabajo del tendón tibial posterior, de por sí "insuficiente", que entraría en fatiga hasta llegar a la rotura parcial o total. Los trabajos publicados en relación con los procedimientos de partes blandas que actúan sobre el tendón tibial posterior en el estadio II no han tenido el resultado esperado en la historia natural de la deformidad. La artrodesis por el contrario, ha sido efectiva en otros estadios, pero está asociada a una pérdida de la dinámica del movimiento en el retropié y a un aumento de la presión en las articulaciones adyacentes.

[Forestier-Rotes-Querol's disease. Ossification of the anterior cervical longitudinal ligament as a cause of dysphagia]. / Enfermedad de Forestier-Rotes-Querol. Osificación del ligamento longitudinal cervical anterior como causa de disfagia.

Forestier's disease or diffuse idiophatic skeletal hyperostosis is a systemic reumathological abnormality of unknown etiology. It produces calcificationossification of the anterior longitudinal ligament. The low dorsal region is the most affected in the raquis. These patients are tipically asymptomatic or with few symptoms (minimal joint pain, spinal pain, stiffness). Dysphagia is the most common symptom when the disease affects the cervical spine; less frequent is dyspnea, both secondary to extrinsic compression of the esophagus and trachea. Neurological complaints are quite rare. In the 1970s Resnick described specific radiological criteria for the diagnosis of Forestier's disease that are still used today. It affects men more frequently than women (2:1); the peak occurrence is in patients in their 60s. We present two cases diagnosed by severe difficulty with deglution, a 84 years-old woman and a 54 years-old man; we operated on them for surgical decompression of the esophagus with resection of osteophytes C3-C4 and C5-C6 respectively through a conventional anterolateral neck approach. Relief of difficulty in swallowing was immediately ensued.

Delayed intracerebral hemorrhage after ventriculoperitoneal shunt insertion. Case report and literature review.

We present another case of delayed intracerebral hemorrhage after a ventriculoperitoneal (VP) shunting procedure. In this case, a right occipital intraparenchymal hematoma and associated intraventricular hemorrhage occurred six days after the operation for hydrocephalus secondary to subarachnoid hemorrhage in a 64 year old woman. It is a rare complication of VP shunting, with few cases reported previously in the literature. The presumed mechanism is the erosion of a cerebral blood vessel secondary to a close contact with the ventricular catheter; bleeding disorder, vascular malformation, head trauma or brain tumor were excluded in this patient.

Seguimiento y características clínicas de los pacientes con nódulos tiroideos en nuestra práctica clínica antes de 2015 / Follow-up and clinical characteristics of patients with thyroid nodules in our clinical practice before 2015

INTRODUCCIÓN: Los nódulos tiroideos son una consulta muy prevalente en Endocrinología. Las guías de la Asociación Americana de Tiroides (2015) animaban a realizar estudios a largo plazo. El objetivo de este estudio fue revisar las características, el seguimiento y la evolución de los nódulos de tiroides seguidos en nuestras consultas hasta 2015. MATERIAL Y MÉTODOS: Estudio retrospectivo de pacientes con al menos dos ecografías o cirugía. Los datos clínicos, ecográficos y de punción, así como la evolución y los resultados histológicos de aquellos operados, se analizaron con métodos descriptivos, bivariados y de regresión. RESULTADOS: 1.420 pacientes seguidos en Endocrinología a largo plazo fueron incluidos. 20 se excluyeron por tener una sola ecografía. El 71,2% presentaban normofunción, 9,6% hipertiroidismo subclínico, 9,5% hipotiroidismo subclínico, 5,7% hipotiroidismo clínico y 4% hipertiroidismo clínico. Del total de nódulos seguidos (n= 1400), 64,1%, 15,6% y 20,3% permanecieron estables, aumentaron y disminuyeron respectivamente. Los que crecieron no tuvieron más características sospechosas en las ecografías. De los intervenidos (457 casos (32,6% del total), 207 fueron malignos (45,2%). 57% de ellos fueron diagnosticados e intervenidos durante el primer año, en la primera evaluación. La aparición de nódulos malignos en el resto de pacientes fue de 89 casos (6,3% de todos los nódulos seguidos, 38,3% de ellos, incidentalomas). La ecografía y la citología empleadas antes de la homogenización de los criterios diagnósticos tuvieron una baja sensibilidad y especificidad en nuestro medio. CONCLUSIONES: Más de la mitad de los cánceres de tiroides fueron diagnosticados en la evaluación inicial del nódulo tiroideo. Más de la mitad de los nódulos no operados en el primer año mantienen el mismo tamaño a largo plazo. No encontramos predictores clínicos del aumento de tamaño. El valor diagnóstico de la ecografía y PAAF sin unos criterios estandarizados homogéneos es bajo.

INTRODUCTION: Thyroid nodules are a very prevalent consultation in endocrinology. Guidelines from the American Thyroid Association (2015) encouraged to conduct follow-up studies in the long term. This study object was to review the clinical characteristics, follow-up and evolution of thyroid nodules visited in our consultations till 2015. MATERIAL AND METHODS: Retrospective study of patients that had at least two thyroid ultrasounds or had been operated. Clinical, ultrasound and FNA (fine needle aspiration) data as well as the evolution and histology results of those operated, were analyzed with descriptive, bivariated and regression analyses. RESULTS: 1.420 patients followed in Endocrinology in the long term were included. 20 were excluded for having only one ecography. 71,2% had normal function, 9,6% subclinical hyperthyroidism, 9,5% subclinical hypothyroidism, 5,7% clinical hypothyroidism and 4% clinical hyperthyroidism. Of all the nodules followed (n=1400), 64,1%, 15,6% and 20,3% remained the same size, grew and decreased respectively. Nodules that grew didn´t have more suspicious sonographic characteristics. Of the operated nodules (457 cases (32,6% of all), 207 were cáncer (45,2%). 57% of them were diagnosed and intervened during the first year, in the first evaluation. Malignant nodules were detected in the rest of patients in 89 cases (6,3% of all the followed nodules, 38,3% of them were incidental cases). The ultrasound and citology diagnoses used before the homogenization of diagnoses criteria had a low senitivity and specificity in our clinical environment. CONCLUSIONS: More than half of the thyroid cancers were diagnosed in the initial evaluation of the thyroid nodule. More than half of nodules non operated in the first year remained the same size long term. We could not find clinical predictors of growth. The diagnostic value of the ultrasound and FNA is low without standardized and homogenous criteria.

Recovery of ovarian function after childbirth, lactation and sexual activity with relation to age of women.

The time for recovery of ovulation, lactation and initiation of sexual intercourse after childbirth was studied in 90 women, who were divided into three groups: 1) adolescents less than 19 years old (n = 30); 2) younger mothers 19 to 32 years old (n = 30); and 3) older women more than 32 years old (n = 30). No differences were found in the duration of breast-feeding or in the initiation of sexual intercourse among the three groups. The postpartum amenorrhea in lactating women was significantly longer than in nonlactating mothers. The amenorrhea was significantly less in younger women than in older mothers and tended to be lower than in adolescents. The time between delivery and detection of ovulation was significantly longer in women who breast-fed than in those who did not. Furthermore, this time was significantly shorter in younger women than in older mothers. The present work suggests that younger women had a quicker recovery of ovarian function than adolescents and older women.

[Leiomyosarcoma of the paranasal sinuses with intracranial involvement: report of a clinical case and review of the literature]. / Leiomiosarcoma de senos paranasales con extensión intracraneal: presentación de un caso clínico y revisión de la literatura.

We describe a 53 year old man with a two months history of frontal headache and right visual loss, with complete right blindness at the moment of diagnosis. Neither nasal obstruction nor endocrine symptoms were found. Computerized Tomography showed a neoplasm involving both paranasal sinuses and sellar region, with bilateral orbital extension. The patient underwent a bifrontal craniotomy with apparent complete excision. Histopathologic examination proved smooth muscle cells sarcoma (leiomyosarcoma). Clinical evolution was unfavorable, with rapid local recurrence. The patient died of cerebellar metastasis 4 months after the initial diagnosis and treatment. Leiomyosarcoma of the sinonasal tract is an unusual tumor, and we have found only 63 cases previously reported. The most frequent clinical presentation is nasal obstruction. Surgery is the treatment of choice, as far as radiotherapy or chemotherapy do not appear to slow disease progression. No relationship has been found between the aggressiveness of leiomyosarcoma of the sinonasal tract and morphologic parameters; instead, prognosis is dependent on the distribution of disease at clinical onset. Leiomyosarcoma of the sinonasal tract may be regarded as a locally aggressive neoplasm with only limited metastatic potential.

[Peroneal tendoscopy: our experience]. / Tendoscopia de los peroneos: nuestra experiencia.

BACKGROUND: The peroneal tendon pathology is a common cause of posterolateral ankle pain. Recently, the incidence and awareness of this disease and its treatment are booming thanks to the development of tendoscopic procedures. OBJECTIVE: To describe and assess the current role and indications of tendoscopy for peroneal tendon pathology. MATERIAL AND METHODS: From June 2010 to July 2011, twenty three patients with retrofibular pain were treated with peroneal tendoscopy. We founded twelve peroneal brevis tendon tears, six peroneal longus tendon tears, three cases of tenosynovitis and two cases of luxation, one patient with an intrasheath subluxation and another one of extrasheath. Of the 23 patients, 12 had another injury associated: 4 talar osteochondral lesions, 3 instabilities and 7 cases of soft tissue impingement. DISCUSSION: The three main indications include tendon tears, tenosynovitis and subluxation or luxation. It is a technically demanding procedure that requires extensive experience in arthroscopic management of small joints and can be particularly complex in cases of wide tenosynovitis, broad tendon tears or anatomical defects but very useful for the evaluation of the lesions and for the treatment of peroneal tendon disorders. CONCLUSIONS: Tendoscopy is a useful procedure with low morbidity and excellent functional results to treat the pathology of the peroneal tendons.

[Sauvé-Kapandji procedure in distal radioulnar joint disorders]. / Procedimiento de Sauvé-Kapandji en los trastornos de la articulación radiocubital distal.

OBJECTIVE: To evaluate the functional and subjective results of the Sauvé-Kapandji procedure as a treatment for distal radioulnar joint disorders. MATERIAL AND METHOD: A retrospective study was conducted on 27 patients treated using the Sauvé-Kapandji technique from January 2001 to March 2012. The aetiología, age, sex, laterality, articular movement, radiographical signs of joint degeneration, and cubitus varus, were analysed. The Mayo Clinic wrist assessment scale and the DASH questionnaire were used for the postoperative evaluation. The mean follow-up was 24 months (6-48 months). The mean age was 47.2 years, with 66.7% females, and 55% the dominant side. RESULTS: At one year after surgery, 16 cases had mild or no pain (59.2%), 8 cases with moderate (29.6%) and 3 cases with severe pain (11.1%). The pronation-supination went from a pre-operative average of 96.8° to 136.4° postoperative, operatorios, which was a significant statistical difference (Wilcoxon test). The radioulnar ratio went from an pre-operative average of +2.6mm to -0.39 mm postoperative. Full functional recovery was observed in 48%. A grip strength of 50.6%, compared to the contralateral wrist was achieved. CONCLUSIONS: The Sauvé-Kapandji technique could avoid the complications common in other procedures, such as cubital-carpal migration. Our study agrees with that in the literature with good results as regards the range of joint movement, with an acceptable improvement in pain compared to the previous stage, but it also demonstrates the frequent loss of grip strength and instability of the proximal radio-ulnar joint.

[Disruption of anterointernal weight bearing: sequelae of surgical treatment of hallux valgus]. / Alteración del apoyo anterointerno como secuela del tratamiento quirúrgico del hallux valgus.

Sequelae of forefoot surgery range between 30 and 40%; the most frequent ones are transfer metatarsalgia and deformity relapse. Forefoot surgery complications disrupt biomechanics. Anterointernal weight bearing alteration is most frequent, due to involvement of the metatarsal, the phalanx or both. Metatarsophalangeal arthrodesis normalizes the length of the first ray and pressure transmission. The use of this technique has made it possible to confirm pain relief, as well as improved function and a better cosmetic result, which allows the patient to wear ormal footwear.

Aceclofenac is as safe and effective as tenoxicam in the treatment of ankylosing spondylitis: a 3 month multicenter comparative trial. Spanish Study Group on Aceclofenac in Ankylosing Spondylitis.

OBJECTIVE: To compare in a 3 month, multicenter, double blind, parallel study the efficacy and safety of a nonsteroidal antiinflammatory drug, aceclofenac, 100 mg bid orally, with that of tenoxicam, 20 mg orally at bedtime, in the treatment of adult patients with active ankylosing spondylitis (AS). METHODS: A total of 273 patients (135 in the aceclofenac group and 138 in the tenoxicam group) entered the study. Eight efficacy variables were assessed: morning stiffness, visual analog pain scale, control of additional paracetamol, modified Schöber's test, C7 line-iliac crest distance, lateral flexion of the spine, thoracic expansion, and occiput-wall distance. RESULTS: Seven of the 8 variables improved significantly in both groups, with no differences between the 2 groups in any variable at the end of the study. Six percent of patients taking aceclofenac and 5% of patients taking tenoxicam withdrew because of unsatisfactory therapeutic action. Forty-two adverse events possibly or probably related to treatment were observed in the aceclofenac group and 37 in the tenoxicam group. However, only 2.2% of patients in the aceclofenac group and 1.4% in the tenoxicam group withdrew for this reason. CONCLUSION: Aceclofenac and tenoxicam are similar in terms of safety and effectiveness; and aceclofenac, 100 mg orally twice daily, is a safe, effective, and convenient treatment for active AS.