Management of incidental durotomies in an integrated Orthopaedic and Neurosurgical Spinal Unit.

Introduction: Incidental durotomy (ID) is an intraoperative event associated to prolonged bed rest and hospital stay, antibiotic use, higher patient dissatisfaction, and leg pain among other complications of its postoperative course. Several repair techniques and postsurgical care have been proposed for its management. This study was designed to develop an agreed protocol in cases of ID among Orthopaedic Surgeons (OS) and Neurosurgeons (NS) integrated into a Spinal Surgery Unit. Research question: Incidental durotomies management protocol. Materials and methods: From 997 eligible cases operated in Hospital del Mar (Barcelona, Spain) from April 2018 to March 2022, demographic, clinical, surgical and postoperative data was collected for statistical analysis from the morbidity and mortality database, with 79 identified IDs. Redo procedures were significantly associated to OS, and cervical and anterior/lateral approaches to NS, both groups were not comparable. Results: ID occurred in 7.9% of cases, more frequently after the lockdown (p=0.03), in females (p=0.04), during posterior approaches (p=0.003), and less frequently in the cervical spine (p=0.009). IDs were linked to postoperative infections (p< 0.001) and nerve root damage (p< 0.001). Patients without ID evolved more satisfactorily during the postoperative period (p=0.002), and those with CSF leak (20/79) spent on bed rest more than twice the time as those without (p<0.001). Multivariable logistic regression showed strong association between posterior approaches and ID, between complicated postoperative courses and ID. Discussion and conclusions: ID is linked to an adverse postoperative recovery, and it should be primarily repaired under microscope, with early mobilization of patients after surgery.

Desarrollo y maduración normal de la médula ósea, valoración porresonancia magnética / Normal Development and Maturation of Bone Marrow Assessment by Magnetic Resonance Imaging

La maduración ósea ocurre de forma ordenada y predecible. Puede documentarse por medio de resonancia magnética incluso antes de que ocurran cambios histológicos, por lo cual es importante su adecuado conocimiento y caracterización.

Skeletal maturation occurs in an orderly and predictable manner. It can be documented by Magnetic Resonance Imaging even before histological changes occurs, so the importance of adequate knowledge and characterization must be stated.

Tiempo de transito colonico con marcadores radiopacos serie de casos / Colonic transit time with radiopaque markers: case studies

El tiempo de tránsito colónico con marcadores radiopacos (TTCMRO) es un estudio que constituye una manera sencilla y efectiva de evaluar la motilidad del colon. Fue descrito en 1969 y sigue vigente como un método complementario de estudio en pacientes con estreñimiento. Se presentan nueve casos de pacientes en quienes se realizó este estudio como parte del diagnóstico clínico de estreñimiento en 2010; se revisan así mismo la técnica, el aporte diagnóstico y las indicaciones del examen. Aunque en la literatura no hay una estandarización satisfactoria de la técnica de examen, el aporte del estudio para determinar el papel del colon en el estreñimiento de cada paciente ha hecho que se incluya en las guías de trabajo de estreñimiento, lo cual hace aún más relevante la importancia de estandarizar la técnica y la presentación del estúdio.

Diagnóstico por escanografía de bronquiolitis constructiva postinfecciosa(Síndrome de Swyer-James) en un paciente con distribución atípica de edema pulmonar de las alturas / Diagnosis by CT-Scan of Swyer-James syndrome in patient with atypical distribution of high altitud pulmonary edema

Presentamos el caso de un paciente quien ingresa con un edema pulmonar de las alturas, de distribución atípica, en quien se demuestran cambios escanográficos de Síndrome de Swyer-James.

Characterization of dehydrodolichyl diphosphate synthase of Arabidopsis thaliana, a key enzyme in dolichol biosynthesis.

The enzyme dehydrodolichyl diphosphate (dedol-PP) synthase is a cis-prenyltransferase that catalyzes the synthesis of dedol-PP, the long-chain polyprenyl diphosphate used as a precursor for the synthesis of dolichyl phosphate. Here we report the cloning and characterization of a cDNA from Arabidopsis thaliana encoding dedol-PP synthase. The identity of the cloned enzyme was confirmed by functional complementation of a yeast mutant strain defective in dedol-PP synthase activity together with the detection of high levels of dedol-PP synthase activity in the transformed yeast mutant. The A. thaliana dedol-PP synthase mRNA was detected at high levels in roots but was hardly detected in flowers, leaves, stems and in A. thaliana suspension-cultured cells.

Complicaciones sépticas de pared abdominal en cirugía limpia contaminada / Septic complications of contaminated abdominal wall surgery

Aún hoy en dia es contraversial el uso profiláctico en cirugía limpia contaminada (vesícula y vías biliares). Por tal motivo el objeto del presente trabajo es determinar el germén etiológico mas frecuente, semiología clínica y frecuencia de presentación, efectos de procedimientos quirúrgicos agregados y tiempo operatorio. A través de un estudio retrospectivo clínico controlado simple se estudio a los pacientes en el Hospital Clínico Viedma, por tatología de vesículas y de vías biliares, que resibieron profilaxis antibiótica. De 95 pacientes estudiados 7 presentaron infección de la herida operatoria, con un 7.3 por ciento de frecuencia. Se puede concluir que el uso profiláctico de antibióticos no disminuye en frecuencia la infección de pared. El germen habitual de vesícula y vías biliares es encontrado en el cultivo de secreción de pared abdominal y los procedimientos agregados a cirugía de vesícula y vía biliar son factores que aumentan el riesgo de infecciónb.

[Hereditary hemorrhagic telangiectasia as a cause of iron-deficiency anemia]. / Telangiectasia hemorrágica hereditaria como causa de anemia ferropénica.

We reviewed cases with Rendu-Osler disease or hereditary hemorrhagic telangiectasia (HHT) between 1976 and 1989 in our area of internal medicine. Of the ten reported cases, six presented severe iron deficiency anemia-three as a result of repeated and intense epistaxis and the rest as a result of digestive losses. The most frequent clinical manifestations were: epistaxis (80%) and the presence of characteristic mucocutaneous lesions easily explored by sight (80%). We emphasize the role of this disease as a cause of iron deficiency anemia and the importance of clinical exploration.

Pseudocyst of the ear. Report of three cases.

Pseudocyst of the ear is a rare entity with controversial pathogenesis. Usually it is presented as a solitary, unilateral, fluctuant and non-inflammatory tumour of the ear with overlying normal skin. It occurs most often in young adult males. Incission reveals a serous liquid, with the consistency of olive oil, contained in the cyst-like lesion. Histopathology shows an intracartilaginous cavity with signs of degeneration and necrosis of the limiting cartilage. We present three new cases of this entity. Continuous minor trauma appears to be the causative factor in one of the patients, who also presented bilateral lesions.

Correlative detection of human immunodeficiency virus (HIV) antigen p24 and Epstein-Barr virus DNA in vitro: clinical influence on HIV infection.

The existence of molecular transactivations between EBV and HIV-1, as well as reactivations of EBV latent infections in AIDS patients, have been recently documented. In order to shed more light on the putative association between EBV and HIV, and its role in the evolution to AIDS, we have determined simultaneously p24 protein and EBV DNA in culture supernatants of peripheral blood mononuclear cells from 47 individuals suspected of having HIV infection. The results of the in vitro assays were correlated with the clinical stage of the individuals and their serologic status to EBV. Statistical analysis showed a concordance between HIV infection and in vitro detection of EBV DNA (P < 0.002); particularly, a strong correlation between the presence of EBV DNA and p24 in culture was observed (P < 0.001). These results are consistent with the occurrence of viral interactions, manifested in vitro. However, in our series, the appearance of EBV DNA in culture was not concomitant with an elevation of anti-VCA IgG titers, anti-EA titers or the development of symptomatology, suggestive of a reactivation of a latent EBV infection or a progression of HIV infection. Therefore we conclude that, although interaction between both viruses may take place at the molecular level, there is no clear evidence of the repercussion that this event may have on the clinical course of HIV infection.