Widespread Frequent Methane Emissions From the Oil and Gas Industry in the Permian Basin.

Emissions of methane (CH4) in the Permian basin (USA) have been derived for 2019 and 2020 from satellite observations of the Tropospheric Monitoring Instrument (TROPOMI) using the divergence method, in combination with a data driven method to estimate the background column densities. The resulting CH4 emission data, which have been verified using model data with known emissions, have a spatial resolution of approximately 10 km. The CH4 emissions show moderate spatial correlation with the locations of oil and gas production and drilling activities in the Permian basin, as well as with emissions of nitrogen oxides (NOx). Analysis of the emission maps and time series indicates that a significant fraction of methane emissions in the Permian basin is from frequent widespread emissions sources, rather than from a few infrequent very large unplanned releases, which is important considering possible CH4 emission mitigation strategies. In addition to providing spatially resolved emissions, the divergence method also provides the total emissions of the Permian basin and its main sub-basins. The total CH4 emission of the Permian is estimated as 3.0 ± 0.7 Tg yr-1 for 2019, which agrees with other independent estimates based on TROPOMI data. For the Delaware sub-basin, it is estimated as 1.4 ± 0.3 Tg yr-1 for 2019, and for the Midland sub-basin 1.2 ± 0.3 Tg yr-1. In 2020 the emissions are 9% lower compared to 2019 in the entire Permian basin, and respectively 19% and 27% for the Delaware and Midland sub-basins.

Recurrence of primary spontaneous pneumothorax: Associated factors.

INTRODUCTION: Determining the risk of recurrence of primary spontaneous pneumothorax is challenging. The objective of this study was to develop a risk assessment model to predict the probability of recurrence in patients with spontaneous pneumothorax. METHODS: A retrospective study was performed of all episodes of pneumothorax diagnosed in the last 12 years in a hospital, in patients not initially submitted to surgery. Logistic regression was used to estimate the probability of recurrence. Based on a set of variables, a predictive model was built with its corresponding ROC curve to determine its discrimination power and diagnostic precision. RESULTS: Of the 253 patients included, 128 (50.6%) experienced recurrence (37% within the first year). Recurrence was detected within 110 days in 25% of patients. The median of time to recurrence for the whole population was 1120 days. The presence of blebs/bullae was found to be a risk factor of recurrence (OR: 5.34; 95% CI: 2.81-10.23; p=0.000), whereas chest drainage exerted protective effect (OR: 0.19; 95% CI: 0.08-0.40; p=0.000). The variables included in the regression model constructed were hemoglobin and leukocyte count in blood, treatment received, and presence of blebs/bullae, with a fair discriminative power to predict recurrence [AUC=0.778 (95% CI: 0.721-0.835)]. CONCLUSION: The overall recurrence rate was high and was associated with the presence of blebs/bullae, failure to perform an active intervention (chest drainage) and low levels of hemoglobin and leukocytes in blood. Recurrence rarely occurs later than three years after the first episode. Once validated, this precision model could be useful to guide therapeutic decisions.

Luxación tibiofibular proximal diagnóstico y tratamiento / Proximal tibiofibular joint dislocation diagnosis and treatment

Resumen: Introducción: La luxación tibiofibular proximal (LTFP) es una lesión poco frecuente y no diagnosticada. De no ser tratada a tiempo, puede generar una sintomatología crónica de dolor e inestabilidad. La escasa evidencia disponible no entrega un protocolo de enfrentamiento ni consenso respecto a su manejo. Con el objetivo de asistir al enfrentamiento de esta lesión, se presenta una revisión de la literatura de una LTFP con reducción espontánea. Caso clínico: Hombre de 22 años consulta por dolor intenso en su rodilla derecha, posterior a caída en cuatrimoto. Al examen físico con aumento de volumen doloroso en cara lateral de la rodilla y pierna proximal, con movilidad completa y estable. Radiografías son informadas sin alteraciones. Se mantiene la sospecha clínica de LTFP, se continúa estudio con resonancia magnética (RM), la que es sugerente de LTFP. Dentro de las 24 horas de evolución, el paciente indica haber sentido un clank espontáneo en su rodilla afectada con cese completo de sintomatología. Se sigue al paciente por tres meses con RM de control, manteniendo una rodilla asintomática; examen físico y funcionalidad normal. Conclusión: El diagnóstico de las LTFP requiere un adecuado uso de imágenes. Su manejo consiste en una reducción cerrada de urgencia y de no lograrse, una reducción abierta, reparación y fijación interna. El pronóstico de las reducciones espontáneas es incierto, por lo que deben ser seguidas de forma seriada y en caso de recidiva, manejadas quirúrgicamente según el tiempo de evolución.

Abstract: Introduction: Proximal tibiofibular joint dislocations (PTFJD) are uncommon and underdiagnosed injuries. Urgent reduction is mandatory to avoid chronic disfunction. The scarcely available literature does not present a unified management guideline. An acute PTFJD case report with spontaneous reduction and a review of the literature is presented, aiming to assist the diagnosis and management of this pathology. Case report: A 22-years old male presented to the emergency department with high intensity right knee pain after falling in a four-wheel motorcycle. The physical exam revealed a prominent painful mass on the lateral aspect of his knee and proximal leg. His range of motion and knee stability were unremarkable. X-rays were informed negative for musculoskeletal injuries. According to a sustained suspicion of PTFJD, the study was continued with a magnetic resonance imaging (MRI), which suggested PTFJD. During the following 24 hours, the patient referred he was entirely asymptomatic after feeling a loud «clank¼. He has been followed for three months with MRI, and remains asymptomatic with full functions. Conclusion: PTFJD diagnosis requires appropriate images. Urgent close reduction is mandatory; if unsuccessful, open reduction, primary repair and internal fixation are indicated. The prognosis of spontaneous reduction remains uncertain and requires a serial clinical evaluation. In the case of recurrence, the appropriate surgical management is indicated according to the elapsed time from the injury.

El ojo: Un rompecabezas diagnóstico: Estudio observacional descriptivo y revisión / The Eye: A Diagnostic Puzzle: Descriptive observational study and review

Se comunica una serie de casos, multicéntricos de la cual participaron cinco instituciones. La muestra fue de 17 pacientes, de los cuales 11 pertenecían al Hospital Dr. J.M. Cullen. Todos consultaron por compromiso orbitario y/o periorbitario. El compromiso en hombres fue de 23.4% y un 76.6% en mujeres. La edad media en años fue de 45.4 (17-69 años). Dentro de los diagnósticos encontrados, cinco casos fueron Enfermedad Relacionada con IgG4 (ER-IgG4), dos casos de Enfermedad de Erdheim Chester (EEC), dos Xantogranuloma, dos xantelasmas, un caso de metástasis de cáncer de mama, un caso de orbitopatía tiroidea, un caso de Amiloidosis con mieloma múltiple, y tres sin diagnóstico. Se revisan los diagnósticos diferenciales encontrados.

A series of multicentric cases is reported, of which five institutions participated. The sample was of 17 patients, of which 11 belonged to our Hospital, the Dr. J.M. Cullen Hospital. All consulted for orbital and/or periorbital commitment. The commitment in men was 23.4% and 76.6% in women. The average age in years was 45.4 (17-69 years). Among the diagnoses found, five cases were IgG4-Related Disease, two cases of Erdheim Chester Disease, two Xantogranuloma, two xanthelasmas, a case of breast cancer metastases, a case of thyroid orbitopathy, a case of Amyloidosis with multiple myeloma, and three without diagnosis. Differential diagnoses found are reviewed.

Viejas enfermedades conocidas que afectan la órbita: Presentación de un caso clínico y revisión / Old known diseases affecting the orbit: Presentation of a clinical case and review

Presentamos el caso de un paciente de 56 años con antecedente de Mieloma Múltiple, que evoluciona con inflamación periorbitaria de ambos parpados, bilateral, de coloración amarillenta-violácea, ulcerada e indolora. Se planteó el diagnóstico diferencial con las enfermedades xantogranulomatosas orbitarias del adulto, en especial con su asociación con Mieloma Múltiple (MM). Al realizar biopsia de la lesión, se observan en la histología fragmentación de haces de colágeno dérmico y alrededor de vasos un material amorfo acelular eosinófilo pálido, rojo congo positivo y coloración verde manzana con luz polarizada, llegando al diagnóstico de Amiloidosis y Xantogranuloma Orbitario del Adulto.

We present the case of a 56-year-old patient with a history of Multiple Myeloma, who evolves with periorbital inflammation of both eyelids, bilateral, yellowish-violet, ulcerated and painless. The differential diagnosis with the adult orbital xanthogranulomatous diseases was raised, especially XN due to its association with MM. When performing a biopsy of the lesion, fragmentation of dermal collagen bundles and around vessels a pale eosinophilic acellular material, positive congo red and apple-green color with polarized light are observed in the histology, reaching the diagnosis of Amyloidosis and Orbital Xantogranuloma of the Adult.

Lesión osteocondral extensa de cóndilo femoral; tratamiento en un tiempo con matriz colágena y concentrado de médula ósea: reporte de un caso / Big osteochondral lesion; treatment with collagen scaffold and bone marrow concentrate: case report

El tratamiento de las lesiones osteocondrales de gran tamaño y profundidad resultan un desafío debido a que las técnicas habituales (microfractura o transplante osteocondral autólogo), son insuficientes para cubrir el defecto; eso es particularmente importante en pacientes jóvenes, pues se debe intentar técnicas que generen la menor comorbilidad posible. Presentamos un caso de un paciente de 18 años con una lesión osteocondral de 6 cm2 por 14 mm de profundidad, tratado mediante autoinjerto óseo, concentrado de médula ósea y matriz colágena, con resultados satisfactorios tanto en lo funcional como en lo imagenológico. Esa técnica presenta la ventaja de realizarse en un tiempo y con una fuente de células troncales mesenquimáticas (Médula ósea), validada en la literatura y altamente reproducible.

The treatment of large osteochondral defects represent a challenge, because the common techniques used (micro fracture or osteochondral autologous transplantation) are insufficient to cover the defect; this is particularly important in young patients where we expect the least comorbidity. We report a case of an 18-year-old patient with an ostechondral injury of 6 cm2 and 14 mm deep, treated with bone autograft, bone marrow concentrate and a matrix of collagen with satisfactory functional and images results. This technique has the advantage to be performed in one single time and with a source of mesenchymal stem cells (bone marrow) validated in the literature.

Revascularisation pattern of ruptured flexor tendon grafts in anterior cruciate ligament reconstruction: A histological study. / Patrón de revascularización de injertos de tendones flexores rotos en reconstrucción de ligamento cruzado anterior: un estudio histológico.

INTRODUCTION: For successful anterior cruciate ligament (ACL) reconstruction, revascularisation and histological maturation are necessary, as their failure can cause graft rupture. PURPOSE: The purpose of this study was to describe differences in the histological maturation of early failed plasty (less than 12 months after surgery) and late failed plasty (more than 12 months after surgery) in patients with re-rupture after ACL reconstruction with hamstring tendons. MATERIAL AND METHODS: A descriptive observational study was conducted on a consecutive series of 20 patients whose ACL reconstruction had failed. Graft biopsy samples were obtained during the revision surgery from the proximal, medial, and distal graft remnants. The samples were evaluated by light microscopy, and the vascularity and maturation of the samples were established by histological scoring. RESULTS: The most common aetiology of reconstruction failure (86.6%) was a specific event with non-contact mechanism. The patients with re-rupture of their ACL plasty less than 12 months after surgery had substance vessels that were less deep. The distal segment of the graft in those patients showed a delay in histological maturation with fewer collagen fibres. CONCLUSION: In patients whose ACL grafts failed less than 12 months after surgery, a lower distribution of blood vessels and collagen fibres was found that were less ordered in the distal graft. These results indicate a delay in maturation, which leads to a higher risk of graft failure.

Predicción del diámetro de autoinjerto semitendinoso-gracilis en pacientes con esqueleto inmaduro sometidos a reconstrucción del ligamento cruzado anterior (LCA): utilidad de las medidas antropométricas / Prediction of semitendinosus-gracilis autograft diameter in skeletally immature patients undergoing ACL reconstruction: usefulness of anthropometric measurements

El objetivo de este estudio fue evaluar si las medidas antropométricas y demográficas de pacientes con esqueleto inmaduro pueden ser utilizadas para predecir el diámetro del autoinjerto semitendinoso-gracilis (ST-G) en la cirugía de reconstrucción del ligamento cruzado anterior (LCA). Métodos: Serie retrospectiva de 169 pacientes con esqueleto inmaduro (112 hombres, 57 mujeres, edad media 15,8 años) que se sometieron a cirugía de reconstrucción del LCA con autoinjerto ST-G. Se registraron las medidas antropométricas (peso, talla e índice de masa corporal [IMC]), datos demográficos (edad y sexo) y diámetro del autoinjerto ST-G utilizados. Se utilizaron coeficientes de correlación, regresión lineal y t de Student para determinar la relación entre variables antropométricas-demográficas y el diámetro del injerto. Los valores de p < 0,05 fueron considerados estadísticamente significativos. Resultados: El análisis estadístico mostró una correlación positiva significativa tanto para la talla y el peso con el diámetro del injerto (r = 0,483, p < 0,0001; r = 0,248, p = 0,001, respectivamente). Sin embargo, la edad y el IMC no se correlacionaron con el diámetro del injerto (r = 0,098 y p = 0,203, r = 0,009 y p = 0,905, respectivamente). La media del diámetro del injerto en los hombres fue de 8,2mm (rango 6-10) y 7,5mm en las mujeres (rango 6-9), diferencia que fue estadísticamente significativa (p < 0,001). Conclusiones: La predicción del diámetro del injerto ST-G según la talla del paciente es un método fácil y fiable en pacientes con esqueleto inmaduro. Estos datos pueden proporcionar información preoperatoria relevante sobre la necesidad de una técnica para aumentar el injerto ante un eventual diámetro insuficiente de este...

The aim of this study was to evaluate whether the anthropometric and demographic measures of patients under 18 years old can be used to predict the diameter of semitendinosus-gracilis (ST-G) autografts in anterior cruciate ligament (ACL) reconstruction surgery. Methods: A study was conducted on retrospective series of 169 patients under 18 years (112 men, 57 women, average age 15.8 years) who underwent to ACL reconstruction surgery with ST-G autograft. The anthropometric measurements were recorded (weight, height and body mass index), demographics (age and gender) and the diameter of the ST-G used. Correlation coefficients, linear regression and unpaired t-test were used to determine the relationship between anthropometric/demographic variables and the diameter of the graft. P values <.05 were considered statistically significant. Results:Correlation analysis showed a significant positive relationship between height and graft diameter (r=0.483, P<.0001), as well as between weight and graft diameter (r=0.248, P=.001). However, age and body mass index (BMI) did not correlate with graft thickness (r=0.098 and P=.203, r=0.009 and P=.905, respectively). The mean graft diameter in men was 8.2 (range 6-10) and 7.5 in women (range 6-9), a difference that was statistically significant (P<.001). Conclusions:Prediction of the ST-G graft diameter according the height of the patient is an easy and reliable method in children and adolescents. These data can provide relevant preoperative information on the need for an alternative graft source for an eventual insufficient diameter of the latter...

Reconstrucción anatómica de ligamento cruzado anterior con banda simple a través del uso de un portal medial accesorio: resultados clínicos e imagenológicos en seguimiento a mediano plazo / Anatomic anterior cruciate ligament reconstruction with single band through an accessory medial portal

Objetivo: Evaluar los resultados clínicos de la reconstrucción anatómica de Ligamento Cruzado Anterior (LCA) con una banda a través de un portal medial accesorio. Material y método: serie prospectiva, 52 pacientes con reconstrucción anatómica de LCA a través de un portal medial accesorio. Edad promedio: 26,4 años (15-39), 68 por ciento hombres, 32 por ciento mujeres. Seguimiento promedio: 39 meses (36-53). Evaluación de estabilidad anteroposterior mediante la prueba artrométrica KT-1000 y estabilidad rotacional con test de Pivot-shift. Resultados clínicos evaluados con scores de Lysholm e International Knee Documentation Committee Score (IKDC). Se solicitó resonancia magnética (RM) 6 meses post-reconstrucción para evaluar la madurez e incorporación del injerto. También se registraron las complicaciones. Resultados: diferencia promedio de KT-1000 entre ambas rodillas: 2,09 mm, 92,4 por ciento de los pacientes entre 1-3 mm, 3,8 por ciento entre 3-5 mm, y 3,8 por ciento con más de 5 mm. Pivot Shift negativo en 86,5 por ciento y presente en 13,5 por ciento de los pacientes. IKDC promedio: 89,2 puntos, Lysholm promedio: 93,8 puntos. Integración del injerto en RM: 100 por ciento de los pacientes. 3 pacientes (5,8 por ciento) presentaron una re-rotura del injerto (20 meses promedio) y 1 paciente (1,9 por ciento) presentó una lesión condral femoral sintomática (12 meses). Discusión y Conclusiones: nuestro estudio muestra buenos y excelentes resultados para la reconstrucción anatómica de LCA con banda simple con respecto a estabilidad anterior y rotacional, scores clínicos e integración del injerto. Nuestra tasa de re-roturas es similar a las tasas descritas en la literatura para reconstrucciones transtibiales, lo que podría explicarse por otros factores involucrados en este proceso independientes de la posición del injerto. Nivel de evidencia: III. Tipo de estudio: Estudio de cohorte prospectivo

Introduction: The aim of this study was to evaluate the clinical results of anatomic single bundle anterior cruciate ligament (ACL) reconstruction through an accessory medial portal. Methods: prospective case series. Fifty-two patients undergoing arthroscopic hamstring ACL reconstruction through an accessory medial portal were prospectively studied. Mean age: 26,4 years (15-39) Men: 68% Female: 32%. Average follow-up: 39 months. (36-53) Anteroposterior stability was assessed by using KT-1000 arthrometer. Rotational stability was determined by Lateral Pivot-Shift test. Clinical results were asses by International Knee Documentation Committee (IKDC) and Lysholm scores. Magnetic Resonance Imaging (MRI) was taken at 6 months post-operatively to evaluate graft maturation and incorporation. Results: the average KT-1000 side-to-side difference was 2,09 mm with 92,4% between 1-3 mm, 3,8% between 3-5 mm and 3,8% more than 5 mm. Pivot-Shift test was negative in 86,5% and positive in 13,5% of the patients. IKDC mean score: 89,2; Lysholm mean score: 93,8. Graft integration at MRI: 100% of the patients. 3 patients (5,8%) had an ACL re-rupture (mean 20 months) and 1 patient (1,9%) presented a symptomatic femoral chondral lesion (12 months). Discussion and conclusion: our study shows good and excellent results in anterior and rotational stability as well as IKDC, and Lysholm scores and Graft integration measured by MRI for the anatomic single bundle ACL reconstruction. Re-rupture rate is similar to series with transtibial non-anatomic technique; this is probably due to other factors that do not include the position of the graft. Level of evidence: III. Type of study: Prospective cohort study

Reconstrucción anatómica de ligamento cruzado anterior utilizando técnica de retroconstrucción con FlipCutter / Anatomic reconstruction of anterior cruciate ligament with FlipCutter retroconstruction technique

El posicionamiento anatómico de los túneles en cirugía de ligamento cruzado anterior, ha sido sugerido como una estrategia para reducir la inestabilidad rotacional y por tanto la artrosis futura. Las técnicas más comunes utilizadas para posicionar el túnel femoral son: la técnica transtibial y la técnica de portal anteromedial. Ha sido reportado que un posicionamiento anatómico del túnel femoral es imposible mediante la técnica transtibial, incluso con modificaciones. Por otra parte, la técnica de portal anteromedial si bien logra un posicionamiento más anatómico del túnel femoral, puede resultar en un túnel más corto, además de la posibilidad de causar daño al cartílago articular del cóndilo femoral medial durante el proceso de realización de este; y por último, existe el riesgo de dañar las estructuras neurovasculares al pasar las guías y brocas de medial a lateral. En un esfuerzo por ir mejorando las técnicas quirúrgicas disponibles, se ha desarrollado la técnica de túnel femoral retrogrado o retroconstrucción, la cual lograría posicionar un túnel femoral anatómico evitando las complicaciones de la técnica de portal anteromedial. En este artículo, presentaremos la técnica de Retroconstrucción de LCA con autoinjerto semitendinoso-gracillis, utilizando el instrumental FlipCutterTM (Arthrex Inc, Naples) con método de fijación femoral suspensorio Tight RopeTM (Arthrex Inc, Naples) y fijación tibial con tornillo interferencial BiocompositeTM (Arthrex Inc, Naples).

The anatomical positioning of tunnels in Anterior Cruciate Ligament (ACL) surgery has been suggested as a strategy to reduce rotational instability and osteoarthritis. Usual techniques used to make the femoral tunnel are the transtibial technique and the anteromedial portal technique. It has been reported that it is impossible to make an anatomical femoral tunnel using the transtibial technique, even with variations. Furthemore, the anteromedial portal technique can locate a more anatomical tunnel but has complications like short tunnel, damage to the medial femoral condyle and risks for the lateral neurovascular bundle. In an effort to improve our capacity of positioning an anatomical femoral tunnel with less complications, the retroconstruction technique has been developed. In this article we present the ACL retroconstruction technique using autologous semitendinous-gracillis graft with FlipCutterTM (Arthrex Inc, Naples).

Uso del plasma rico en plaquetas en cirugía ligamentosa de rodilla / Use of platelet rich plasma in knee ligament surgery

Platelet Rich Plasma (PRP) is used in musculoskeletal lesion surgery, including muscle, bone, tendons and ligaments. PRP might accelerate the healing process and the integration of the graft, allowing an earlier return to sports activities of patients. PRP is obtained from autologous blood, which is centrifuged, obtaining platelet and supposedly growth factor concentrations three to five times higher than those of regular blood. The clinical results of studies performed in Chile and elsewhere on PRP use in knee anterior cruciate ligament (ACL) reconstruction have been variable. Therefore, there is not enough evidence to support or deny the usefulness of PRP in ACL reconstructions.

[Clinical factors and findings in knee arthroscopy of patients with knee arthrosis candidates for conversion to total replacement]. / Factores clínicos y hallazgos en la artroscopia de pacientes con artrosis de rodilla que favorecen la conversión a artroplastia total.

OBJECTIVES: To identify those clinical characteristic and arthroscopic findings in patients with knee arthrosis that are associated with worsening of the disease and subsequent total knee arthroplasty (TKA). METHOD: A retrospective, descriptive study was conducted on 78 consecutive patients (88 knees) who underwent knee arthroscopy for arthrosis. The study included 44 women and 34 men, with a mean age of 58.9 years (range: 37-78 years). After a mean follow-up of 50.4 months (range: 12-96 months), those patients who progressed towards TKA were identified. A logistic regression model was applied to recognise the factors associated with deterioration of the arthrosis, with consequent progression towards a TKA. RESULTS: Twenty-four out of the 88 knees progressed towards a TKA (27.3%) within a mean time of 13.5 months after arthroscopy (range: 13-29 months). The clinical characteristics that showed a significant association with poor progression of the arthrosis were: female gender (0.02) and Ahlbäck 2 (P=.04). Arthroscopic finding that proved significant correlation with worsening of the arthrosis towards TKA were: meniscal tears of the posterior horn (P=.02), meniscectomies above 60% (P=.03), and 2nd degree chondral lesions in loading areas of the medial femoral condyle (P=.02). CONCLUSION: The variables associated with a greater chance of progressing towards a TKA after a knee arthroscopy due to arthrosis in this study were, female gender, grade 2 radiographic arthrosis, posterior horn meniscal lesions, meniscectomies over 60%, and chondral lesions in loading area of the medial femoral condyle.

[Use of platelet rich plasma in knee ligament surgery]. / Uso del plasma rico en plaquetas en cirugía ligamentosa de rodilla.

Platelet Rich Plasma (PRP) is used in musculoskeletal lesion surgery, including muscle, bone, tendons and ligaments. PRP might accelerate the healing process and the integration of the graft, allowing an earlier return to sports activities of patients. PRP is obtained from autologous blood, which is centrifuged, obtaining platelet and supposedly growth factor concentrations three to five times higher than those of regular blood. The clinical results of studies performed in Chile and elsewhere on PRP use in knee anterior cruciate ligament (ACL) reconstruction have been variable. Therefore, there is not enough evidence to support or deny the usefulness of PRP in ACL reconstructions.

[Laparoscopic apendicectomy vs open approach for the treatment of acute appendicitis]. / Apendicectomía laparoscópica frente al abordaje abierto para el tratamiento de la apendicitis aguda.

BACKGROUND: There is no international consensus on the approach of choice for performing appendectomy. AIMS: To analyze and compare open and laparoscopic approaches in the surgical treatment of acute appendicitis. MATERIAL AND METHODS: A retrospective study was carried out on patients over 14-years-old operated on for suspected acute appendicitis between January 2007 and December 2009. Variables were: age, sex, body mass index, specialized surgeon or resident in training, progression duration, conversion rate, use of drains, abdominal cavity irrigation, macroscopic appearance of the appendix, onset time of anesthesia, ASA classification, postoperative hospital stay, resumption of intake of liquids, and complications. The patients were divided into two groups: laparoscopic approach (LA) and open approach (OA). RESULTS: A total of 533 patients were enrolled (290 LA and 243 OA). Onset time of anesthesia was 75 min (30-190 min) in LA vs 55 min (20-160 min) in OA (p<0,0001). COMPLICATIONS: intraabdominal abscesses in 17 LA cases vs 13 OA cases (p=0,79); surgical wound alterations in 16 LA cases vs 47 OA cases (p=0,0001); incisional hernias in 2 LA cases (1%) vs 10 OA cases (p=0,008). There were no statistically significant differences in postoperative hospital stay (3 days), resumption of intake of liquids (1 day) or readmission rate (8%). CONCLUSIONS: There are fewer surgical wound alterations and incisional hernias with the laparoscopic approach, but there is higher cost, lengthier surgery duration, and a longer learning curve. Our results cannot provide a clear indication for one approach or the other, and therefore each case must be evaluated on an individual basis.

Hartmann's operation: how often is it reversed and at what cost? A multicentre study.

AIM: The study evaluated the rate of reversal of Hartmann's operation after the initial surgery and its morbidity. METHOD: A multicentre retrospective study was carried out in seven hospitals in the Valencia area of patients who underwent Hartmann's operation from 2004 to 2008. The incidence of reversal was determined. RESULTS: Four hundred and fifty-two patients of mean age 67.5 ± 15.4 years were included, of whom 78.8% had an emergency operation. The most common diagnosis was cancer (58.6%), although diverticulitis predominated in the emergency setting. At a median follow up of 44 months, 159 (35.2%) patients had undergone reversal, including 16.6% after elective surgery and 40.4% after an emergency Hartmann's procedure (P < 0.001). The most frequent reason why reversal was not done was death (74 [25%] patients). Patients undergoing reversal were younger and had a low ASA risk. Trauma was associated with a higher rate of reversal, followed by diverticular disease. Surgery was performed at a median of 10 months. An open approach with stapled anastomosis was used in most cases. The mortality was 3.5%. Complications occurred in 45.2%, with a 6.2% rate of anastomotic leakage. Complications were associated with age, diabetes mellitus, arteriosclerosis, obesity, smoking, chemotherapy and COPD. CONCLUSION: Hartmann's reversal was performed in a small percentage of patients, mostly including those with benign disease. It had a significant morbidity.

[Clinical-imaging-arthroscopic correlation in the diagnosis of meniscal lesions]. / Correlación clínica - imagenológica - artroscópica en el diagnóstico de las lesiones meniscales.

OBJECTIVE: To assess the relation between location and intensity of pain in the articular interline as reported by the patient and proven objectively with the physical exam, and the type and location of the meniscal lesion found in the knee imaging study and arthroscopy. METHOD: Prospective, observational, longitudinal study including 34 consecutive patients with a clinical and arthroscopic diagnosis of symptomatic meniscal tears. Pain location was reported, an MRI was taken and finally all patients were assessed with knee arthroscopy. RESULTS: We found an excellent correlation between the clinical manifestation of pain and the arthroscopic findings (p < 0.001), as well as between the clinical findings and the MRI (p < 0.001). CONCLUSION: Correlating the clinical expression of meniscal pathology with the anatomical lesion could be useful at the time of deciding to perform surgery, as the clinical identification of certain types of meniscal tears could potentially determine what the best time to perform surgery is. Our study shows that there is no significant relation neither between the magnitude of pain and the laterality of the lesion, nor between the magnitude of pain and the type of lesion diagnosed arthroscopically. This shows that patients cannot be selected considering the anatomy of the lesion based only on the physical exam.

Rol de la cirugía artroscópica en pacientes mayores de 50 años con artrosis de rodilla / Treatment of knee osteoarthritis in patients older than 50 years old: role of arthroscopic surgery

Objective: To describe the functional outcomes in patients with knee osteoarthritis older than 50 years, treated with arthroscopic surgery. Methods: Retrospective study in 100 patients with knee osteoarthritis who underwent knee arthroscopy. Inclusion criteria: 50 years or more, knee osteoarthritis and Ahlbãck classification I-III. Exclusion criteria: Ahlbãck IV, deformities, joint inflammatory disease. There were 50 males and 50 females with an average age of 60.1 years (50-83). Lysholm and IKDC (International Knee Documentation Committee) postoperative scores were performed in all the cases. Associated lesions and procedures were also registered. Statistical analysis was performed by using a T Test for independent samples. Results: Average follow up 35.9 +/- 15.2 months. Postoperative average scores were: Lysholm 86.9 +/- 15.5 and IKDC 79.4 +/- 24.7 points. Associated lesions: chondral injuries: 48 percent condrales and meniscal tears:36 percent. Patients with meniscal lesions had 70 percent of good and excellent Lysholm results versus 84.6 percent of patients with chondral lesions (p = 0.035). Conclusion: Patients with knee arthroscopic surgery for mild to moderate knee osteoarthritis and associated lesions show good and excellent functional results in a mediumto long term follow up.

Objetivo: Describir resultados clínicos en pacientes mayores de 50 años con artrosis de rodilla tratados con artroscopía, evaluando lesiones asociadas y tratamiento. Métodos: Estudio retrospectivo de una serie consecutiva de 100 pacientes sometidos a una artroscopía de rodilla por diagnóstico de artrosis. Los criterios de inclusión fueron: pacientes > 50 años, diagnóstico clínico e imagenológico de artrosis y clasificación Ahlbãck I-III. Los criterios de exclusión fueron: Ahlbãck IV, mal alineamiento de extremidades inferiores y enfermedades inflamatorias articulares. Fueron 50 hombres y 50 mujeres, con edad promedio 60,1 años (50-83). Evaluamos con puntajes Lysholm e International Knee Documentation Committee (IKDC) postoperatorios. Documentamos lesiones asociadas encontradas y procedimientos realizados. Se utilizó T Test para muestras independientes. Resultados: Seguimiento promedio de 35,9 +/- 15,2 meses. Puntajes postoperatorios promedio: Lysholm 86,9 +/- 15,5 e IKDC 79,4 +/- 24,7 puntos. Las lesiones asociadas más frecuentes fueron: condrales (48 por ciento) y meniscales (36 por ciento) inestables. El 70 por ciento de los casos con lesiones meniscales refirieron buenos y excelentes resultados según Lysholm versus 84,6 por ciento de casos con lesiones condrales inestables (p = 0,035). Conclusión: Pacientes con artrosis asociada a lesiones condrales o meniscales refirieron buenos y excelentes resultados al seguimiento clínico a mediano-largo plazo luego de ser sometidos a un aseo artroscópico y estabilización de lesiones tanto meniscales como condrales.

Estudio clinico comparativo de la condroplastia termica versus mecanica en el tratamiento de lesiones condrales de espesor parcial en rodillas de pacientes mayores de 50 años / Comparative clinical study of the thermal vs. mechanical chondroplasty in the treatment of partial thickness chondral injuries in knees of patients over 50 years

Comparar los resultados clínicos en pacientes mayores de 50 años con lesiones condrales de rodilla, tratados con radiofrecuencia bipolar o condroplastía mecánica. Métodos: Estudio retrospectivo, descriptivo de una serie consecutiva de 41 pacientes sometidos a una artroscopía de rodilla por diagnóstico clínico e imagenológico de lesión condral. Veintiún hombres y veinte mujeres con un promedio de edad de 60,1 años (50-83) ingresaron al estudio. Evaluamos con puntajes Lysholm e Intemational Knee Documentation Committee (IKDC) postoperatorios. Documentamos lesiones asociadas encontradas y procedimientos realizados. Para el análisis estadístico se utilizó el Test de Wilcoxon y Test T para muestras independientes. Resultados: Seguimiento promedio de 35,9± 15,2 meses. Diecinueve pacientes fueron tratados con radiofrecuencia bipolar y veintidos con condroplastía mecánica. Puntajes postoperatorios promedio: radiofrecuencia bipolar: Lysholm 86,3 e IKDC 83,2, condroplastía mecánica: Lysholm 88,8 e IKDC 79,6. No se encontró diferencia estadísticamente significativa entre los grupos (p>0,05). Conclusión: El tratamiento con radiofrecuencia bipolar y condroplastía mecánica ofrece buenos resultados en pacientes con lesiones condrales de espesor parcial...