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.

mTOR mutations in Smith-Kingsmore syndrome: Four additional patients and a review.

Smith-Kingsmore syndrome (SKS) OMIM #616638, also known as MINDS syndrome (ORPHA 457485), is a rare autosomal dominant disorder reported so far in 23 patients. SKS is characterized by intellectual disability, macrocephaly/hemi/megalencephaly, and seizures. It is also associated with a pattern of facial dysmorphology and other non-neurological features. Germline or mosaic mutations of the mTOR gene have been detected in all patients. The mTOR gene is a key regulator of cell growth, cell proliferation, protein synthesis and synaptic plasticity, and the mTOR pathway (PI3K-AKT-mTOR) is highly regulated and critical for cell survival and apoptosis. Mutations in different genes in this pathway result in known rare diseases implicated in hemi/megalencephaly with epilepsy, as the tuberous sclerosis complex caused by mutations in TSC1 and TSC2, or the PIK3CA-related overgrowth spectrum (PROS). We here present 4 new cases of SKS, review all clinical and molecular aspects of this disorder, as well as some characteristics of the patients with only brain mTOR somatic mutations.

Factores de riesgo relacionados a la falla de la sutura meniscal en niños y adolescentes / Risk factors related to meniscal suture failure in children and adolescents

Las lesiones meniscales en niños son cada día más frecuentes. La preservación meniscal es una prioridad en este grupo de pacientes, sin embargo, existen pocos artículos que muestran los resultados de suturas meniscales en niños. OBJETIVO: El objetivo de este estudio es identificar factores de riesgo de falla en pacientes sometidos a una sutura meniscal en niños menores de 18 años. MÉTODO: Estudio retrospectivo de 35 pacientes sometidos a una sutura meniscal, con una edad promedio de 16 años (13­18) y un seguimiento de 71 meses de media (16­115). Se evaluaron 6 variables: tipo, localización y tamaño de la lesión, edad, técnica quirúrgica y asociación a rotura de ligamento cruzado anterior (LCA). Los pacientes que presentaron falla de la sutura meniscal fueron identificados y sometidos a una regresión logística usando un modelo Stata V.14.0. RESULTADOS: 9 pacientes (24.3%) presentaron una falla en su cirugía durante el seguimiento. Lesiones iniciales mayores a 16 mm mostraron una tasa de re-rotura de un 73% independiente de la técnica quirúrgica. En lesiones menores a 16 mm, se obtuvo un 78% de reparaciones exitosas. No se encontró relación entre la re-rotura meniscal y lesión de LCA, tipo y localización de la lesión, técnica quirúrgica y edad de los pacientes. CONCLUSIÓN: Este estudio muestra que la reparación meniscal en niños tiene buenos resultados con una tasa de éxito promedio de un 75%. El riesgo de falla de sutura meniscal se correlacionó con el tamaño inicial de la lesión con un 73% de fallo en lesiones mayores a 16 mm independientemente del tipo de cirugía.

Meniscal tears are uncommon in the pediatric population, with an increasing number. Currently meniscal preservation is a priority when treating these injuries. However, only a few studies have reported the clinical outcomes of arthroscopic meniscal repair in children and its risk factors of failure. OBJECTIVE: Identify risk factors related to meniscal suture failure in patients under 18 years who underwent a meniscal repair. METHODS: Retrospective study of 35 patients with an average age of 16 years (13 - 18) who underwent arthroscopic meniscal repair with a mean follow up of 71.1 months (16­115). We evaluate 6 variables: type, location and size of meniscal tear, age, surgical technique and anterior cruciate ligament (ACL) association. Patients with re-rupture were identified and statistical analysis was performed through a logistic regression model using Stata V.14.0. RESULTS: 9 patients (24.3%) presented a suture failure during follow-up. Average time for re-rupture was 16 months (4­60 months). With an initial tear size of 16 mm or bigger, 73% of the meniscal repair will fail despite surgery technique. With an initial tear size smaller than 16 mm, 78% of will heal. No association was found between meniscal re-rupture and ACL rupture, type and location of tear, surgical technique and age. Conclusion: In our study meniscal repairs in pediatric population had good overall results with a global healing rate of 75.7%. The risk of suture failure was related to the initial size of meniscal tear: when meniscal tear is bigger than 16 mm, 73% of them will fail despite surgery.

Delaying Frost Formation by Controlling Surface Chemistry of Carbon Nanotube-Coated Steel Surfaces.

Superhydrophobic surfaces are appealing as anti-icing surfaces, given their excellent water repellent performance. However, when water condenses on the surface due to high humidity, the water becomes pinned, and superhydrophobic surfaces fail to perform. Here we studied how the stability of the superhydrophobicity affected water condensation and frost formation. We created rough surfaces with the same surface structure, but with a variety of surface chemistries, and compared their antifrost properties as a function of intrinsic contact angle. Frost initiation was significantly delayed on surfaces with higher intrinsic contact angles. We coupled these macromeasurements with environmental scanning electron microscopy of water droplet initiation under high humidity conditions. These provide experimental evidence toward previous hypotheses that for a lower intrinsic-angle rough surface, Wenzel state is thermodynamically favorable, whereas the higher intrinsic-angle surface maintains a Cassie-Baxter state. Surfaces with a thermodynamically stable Cassie-Baxter state can then act both as antisteam and antifrost surfaces. This research could answer the persistent question of why superhydrophobic surfaces sometimes are not icephobic; anti-icing performance depends on the surface chemistry, which plays a critical role in the stability of the superhydrophobic surfaces.

The effect of temperature and humidity on adhesion of a gecko-inspired adhesive: implications for the natural system.

The adhesive system of geckos has inspired hundreds of synthetic adhesives. While this system has been used relentlessly as a source of inspiration, less work has been done in reverse, where synthetics are used to test questions and hypotheses about the natural system. Here we take such an approach. We tested shear adhesion of a mushroom-tipped synthetic gecko adhesive under conditions that produced perplexing results in the natural adhesive system. Synthetic samples were tested at two temperatures (12 °C and 32 °C) and four different humidity levels (30%, 55%, 70%, and 80% RH). Surprisingly, adhesive performance of the synthetic samples matched that of living geckos, suggesting that uncontrolled parameters in the natural system, such as surface chemistry and material changes, may not be as influential in whole-animal performance as previously thought. There was one difference, however, when comparing natural and synthetic adhesive performance. At 12 °C and 80% RH, adhesion of the synthetic structures was lower than expected based on the natural system's performance. Our approach highlights a unique opportunity for both biologists and material scientists, where new questions and hypotheses can be fueled by joint comparisons of the natural and synthetic systems, ultimately improving knowledge of both.

A founder EIF2AK4 mutation causes an aggressive form of pulmonary arterial hypertension in Iberian Gypsies.

Pulmonary arterial hypertension (PAH) is a pathological condition characterized by a persistent and progressive elevation of pulmonary vascular resistance with devastating consequences if untreated. In the past recent years, several genes have been related to PAH, however, the molecular defect remains unknown in a significant proportion of patients with familial PAH (∼20%). During the past few years, we have observed that PAH shows a particular behavior in Iberian Gypsies, with more aggressive course and frequently affecting multiple members of the same family. We studied five Gypsy families in whom at least one individual from each family developed a severe form of PAH and in whom no mutation had been identified in the common genes. We applied SNP-array-based homozygosity mapping in three families and obtained, among others, one of which included the gene EIF2AK4, recently reported in patients with PAH from group-1' pulmonary veno-occlusive disease (PVOD) and pulmonary capillary hemangiomatosis (PCH). Subsequently, we sequenced EIF2AK4 and found a homozygous mutation in all five families: c.3344C>T(p.P1115L). The majority of our patients required early lung transplantation. Hence, this mutation appeared with a more severe phenotype than previously reported for other EIF2AK4 mutations. The finding of this novel mutation is important for genetic counseling and calculation of population recurrence risks.

Reconstruction of the medial patellofemoral ligament: Evaluation of the clinical results of autografts versus allografts.

OBJECTIVE: The purpose of the study was to evaluate the functional results after medial patellofemoral ligament (MPFL) reconstruction in patients using auto- and allograft. PATIENTS AND METHODS: A retrospective study was conducted on 28 patients with recurrent patellar dislocation, with 13 patients (13 knees) undergoing MPFL reconstruction with hamstring autograft, and 15 patients (16 knees) with reconstruction surgery with allograft. The total group included 13 males and 15 females, with an age range of 15 to 38 years. The graft-related morbidity was studied and a clinical assessment was performed using the pre- and postoperative Kujala score. Associated complications were reported for each group. All the patients had more than 12 months of follow up. RESULTS: No recurrent dislocations or graft related complications were reported in either group. The post-operative Kujala subjective knee score was 89.2 in the autograft group, and 92.6 in the allograft group (p >.05). One patient in the allograft group received a revision surgery due to poor positioning of anchors. Another patient in the allograft group had non-displaced patella fracture related to the bone tunnels and another patient had flexion deficit and needed mobilization under anesthesia. CONCLUSION: There were no significant differences between both groups, and the results were comparable.

Fracturas múltiples de la columna cervical: Reporte de un caso / Multiple cervical spine fractures: Case report

Introducción: Las fracturas múltiples en la columna cervical son una entidad relativamente infrecuente, acerca de la cual la información disponible a nivel mundial es escasa. Existe una tendencia en los casos reportados a manejar dicha entidad de manera conservadora, con combinación de tracciones esqueléticas y diversas órtesis, con resultados variables. Existen pocos reportes de fracturas múltiples manejadas quirúrgicamente. Objetivo: Reportar un caso clínico de fractura múltiple cervical manejado quirúrgicamente en dos tiempos y su seguimiento, en el Centro de Atención a Lesionados Raquimedulares de la Ciudad de México, en el Hospital General "La Villa" de los SSDF. Material y métodos: Se presenta el caso clínico de un paciente masculino de 46 años de edad quien sufre accidente automovilístico con trauma raquimedular con fracturas de C2 a C6, ASIA C. Se decide su tratamiento quirúrgico a dos tiempos con instrumentación posterior y anterior sucesivamente. Se reporta el seguimiento clínico y radiológico a casi dos años de evolución. Resultados: A 19 meses de seguimiento el paciente se encuentra neurológicamente en ASIA D, con un leve déficit motor en el miembro torácico izquierdo. Reincorporado a su trabajo habitual y con movilidad aceptable en la columna cervical. Conclusiones: La evolución satisfactoria presentada por el paciente, tanto en su recuperación neurológica como en la reincorporación a sus labores cotidianas permite recomendar el manejo quirúrgico de fracturas múltiples, individualizando cada caso e interviniendo de acuerdo con la personalidad de cada fractura, con lo cual se puede esperar la obtención de resultados favorables.

Introduction: Multiple cervical spine fractures are a relatively infrequent entity and thus the available information on them is scarce worldwide. The cases reported are usually managed conservatively, with a combination of skeletal traction and various braces, with variable results. There are only a few reports of multiple fractures treated surgically. Objective: This is a report of a clinical case of a multiple cervical fracture treated surgically in 2 stages at the Mexico City Center for Patients with Spine and Spinal Cord Injury (Centro de Atención a Lesionados Raquimedulares de la Ciudad de México), located at "La Villa" General Hospital, SSDF. Material and methods: We report the clinical case of a male, 46 year-old patient involved in a motor vehicle accident who sustained spine and spinal cord injuries consisting of ASIA C C2-C6 fractures. It was decided to perform two-stage surgery with posterior and anterior instrumentation. We report the 19-month clinical and radiological follow-up. Results: In the 19-month follow-up visit, the patient was found to be ASIA D according to the neurological assessment, with mild motor deficit of the left thoracic limb. The patient had returned to his usual job and had acceptable cervical spine mobility. Conclusions: The patient's appropriate course from the neurological perspective and his return to his daily activities leads to recommending the surgical management of multiple fractures, customizing it in each case according to the fractures' characteristics. Favorable results may be expected from this approach.

Encuesta de percepción de competencias en médicos residentes de Ortopedia y Traumatología en un hospital de Yucatán, México / Competence perception survey among Residents of Orthopedics and Trauma in a hospital of Yucatán México

Antecedentes: El modelo por competencias plantea que lo más importante es poseer elementos para la solución de problemas, ya que una preparación en abstracto no cuenta con suficientes herramientas para solucionarlos. Para ello utiliza competencias centrales y auxiliares que están vinculadas a valores destacando las actitudes. Para explorar estas competencias se hizo el presente estudio. Material y métodos: Estudio transversal, observacional y descriptivo. Se aplicó una encuesta anónima con datos del perfil de médicos residentes de Ortopedia y Traumatología que contenía 14 preguntas que se aplicaron a residentes que cursan diferentes grados académicos. Resultados: En la encuesta participaron 24 residentes de los 35 registrados en el curso. En 100% de ellos aceptó responder la encuesta, 54% cursaban el segundo grado, 29% primer grado y 17% cuarto grado. El 75% manifestó desarrollo de competencias auxiliares, 13% no respondió, 8% desarrollaron competencias centrales y 4% lo ignora. Conclusiones: Se manifestaron tres factores principales que influyen negativamente para mejorar el saber hacer en Ortopedia. El más relevante es que los médicos residentes describen una mala actitud de los médicos adscritos, falta de disponibilidad para enseñar y la mala relación interpersonal entre ellos. Se debe crear conciencia en los especialistas en formación de Ortopedia, que poseer sólo conocimientos y habilidades no es suficiente para abordar integralmente los problemas de salud para cada paciente, ya que se debe motivar el desarrollo de mejores competencias, en especial las centrales.

Background: The competence model states that what is most important is to have the elements to solve problems since abstract training does not provide enough tools to solve them. Therefore, it uses key and auxiliary competences that are linked to values such as attitudes. This study was performed to explore these competences. Material and methods: This is a cross sectional, observational and descriptive trial. An anonymous survey with profile data of Orthopedics and Trauma residents was given, it contained 14 questions for residents of different academic levels. Results: 24 residents participated out of the 35 registered in the course. 100% agreed to answer the survey, 54% was in the second year, 29% in the first year and 17% in the fourth year. 75% expressed auxiliary competences, 13% did not respond, 8% developed key competences and 4% don't know. Conclusions: Three main factors that are a negative influence to improve the knowledge of orthopedics were expressed. The most relevant is that residents describe a bad attitude from attending physicians, lack of willingness to teach and poor interpersonal relationships. Awareness should be raised among orthopedics specialists so they understand that having the knowledge and skills is not enough to approach health issues in a comprehensive manner for each patient and the development of better competences should be fostered, especially key competences.

[Multiple cervical spine fractures. Case report]. / Fracturas múltiples de la columna cervical. Reporte de un caso.

INTRODUCTION: Multiple cervical spine fractures are a relatively infrequent entity and thus the available information on them is scarce worldwide. The cases reported are usually managed conservatively, with a combination of skeletal traction and various braces, with variable results. There are only a few reports of multiple fractures treated surgically. Objective: This is a report of a clinical case of a multiple cervical fracture treated surgically in 2 stages at the Mexico City Center for Patients with Spine and Spinal Cord Injury (Centro de Atenci6n a Lesionados Raquimedulares de la Ciudad de Mexico), located at "La Villa" General Hospital, SSDF. MATERIAL AND METHODS: We report the clinical case of a male, 46 year-old patient involved in a motor vehicle accident who sustained spine and spinal cord injuries consisting of ASIA C C2-C6 fractures. It was decided to perform two-stage surgery with posterior and anterior instrumentation. We report the 19-month clinical and radiological follow-up. RESULTS: In the 19-month follow-up visit, the patient was found to be ASIA D according to the neurological assessment, with mild motor deficit of the left thoracic limb. The patient had returned to his usual job and had acceptable cervical spine mobility. CONCLUSIONS: The patient's appropriate course from the neurological perspective and his return to his daily activities leads to recommending the surgical management of multiple fractures, customizing it in each case according to the fractures' characteristics. Favorable results may be expected from this approach.

[Effect of early versus late rehabilitation in patients with Achilles tendon tenorrhaphy]. / Efecto de la rehabilitación temprana versus tardía, en pacientes con tenorrafia del tendón de Aquiles.

BACKGROUND: Achilles tendon tear is a prevalent condition in our setting. There is no consensus in the literature regarding the ideal treatment modality or the right immobilization period before starting physiatrics. The harmful effect of prolonged immobilization is widely known, so the functional results of early versus late physical therapy are compared in patients subjected to surgery for Achilles tendon tear. MATERIAL AND METHODS: Ambispective, longitudinal, comparative study in patients over 16 years of age with Achilles tendon rupture treated surgically and referred to rehabilitation; they followed the management protocol established at the service. Retrospective record review was performed for discharged patients and patients admitted after the study initiation date were followed-up prospectively. The evaluation continued by means of a phone interview; results were recorded according to the Achilles Tendon Rupture Score. RESULTS: A total of 115 patients were included; they were classified into two groups according to the time elapsed between the surgery and the onset of physical therapy, as follows: 31 patients in group A, with onset between postoperative days 0 and 21; and 84 patients in group B, with onset after postoperative day 21. Two infectious complications were reported and no re-ruptures. Functional results were 6.52 for group A and 8.18 for group B. CONCLUSIONS: The duration of rehabilitation was similar in all patients, regardless of the protocol. The time elapsed between surgery and discharge was shortest in patients who underwent early physical therapy. The functional score is independent from the onset of physical therapy. Surgery followed by early mobilization is a safe practice that does not increase complications and shortens the total time the patients need to resume their daily activities.

[Effect of a short antimicrobial prophylaxis regimen on the prevalence of postoperative infection in elective orthopedics and traumatology surgery]. / Efecto de un esquema corto de profilaxis antimicrobiana sobre la prevalencia de infecciones postoperatorias en cirugía electiva de traumatología y ortopedia.

OBJECTIVE: To assess the efficacy of two antimicrobial prophylaxis regimens, a short cycle and the standard one, on the prevalence of acute postoperative infection in orthopedic surgery for acute and chronic disease of a thoracic and a pelvic limb. MATERIAL AND METHODS: Prospective, observational, experimental randomized, double-blind trial in patients undergoing orthopedic surgery due to acute or chronic disease, between April and September 2009. The sample size was determined using the formula to calculate the finite population. Two groups were formed: one was given cefalotin for 24 hours plus ten additional days of dicloxacillin, the standard regimen and a second one that received cefalotin for 24 hours and placebo for ten days. The wound was assessed during hospitalization and it was checked on days 5, 8, 14 and 30. A statistical software was used for the statistical analysis, which included Student's t-test and chi2, and descriptive statistics for percentages, frequencies, means and standard deviations. The protocol was approved by the local health research committee. RESULTS: One hundred and thirty-one patients were included. Group I included 62 patients with cefalotin/dicloxacillin and Group II 69 patients with cafalotin/placebo for 10 days. In Group I one patient had infection and in Group II there were 3 cases, with p = 0.50 when chi2 was applied. CONCLUSIONS: Antimicrobial prophylaxis with 24 hour-cefalotin has the same effect on the prevalence of postoperative infection than a prolonged cycle of cefalotin plus dicloxacillin, according to the chi2 test. It is clear that there is no considerable benefit in giving antibiotics indiscriminately and for long periods of time compared with protection from infection in clean wounds.

[Adult medulloblastomas: our experience]. / Meduloblastomas del adulto: serie quirúrgica de 11 casos.

INTRODUCTION: Medulloblastomas are malignant, invasive and highly cellular tumours from the cerebellum, rarely seen in adults. We describe the experience in the treatment of this entity in our institution. MATERIALS AND METHODS: A retrospective study was made including 11 adult patients with medulloblastomas confined to the craniospinal axis treated between 1984-2010. Clinical, radiological and therapeutic data were assessed during the evolution of this entity. RESULTS: Mean age of patients was 30.2 years (9 women/2 men). Over 80% of the patients presented intracranial hypertension, while 54.5% presented cerebellum syndrome. Gross total surgical resection was achieved in 8 patients (72.7%) and subtotal resection in the other 3 (27.3%). All patients received craniospinal radiotherapy. After primary surgical resection, 6 patients received chemotherapy with cisplatin (CDDP) and etoposide (VP-16). During the follow up period and after a median time of 35.2 months, 4 patients (36.4%) presented with relapse, mainly in the posterior cranial fossa, managed in the majority of cases with surgical resection plus additional chemotherapy. Mean survival time was 100.3 months with a 5- and 8- year overall survival rate of 84 and 56% respectively. CONCLUSIONS: In the treatment of this malignancy, gross surgical resection has a crucial role, followed as soon as possible by oncological therapy, specially radiotherapy if needed.

[Linear accelerator radiosurgery for the treatment of vestibular schwannoma]. / Radiocirugia con acelerador lineal en el tratamiento del schwannoma vestibular.

INTRODUCTION AND AIM: Radiosurgery is among the treatment options for patients with vestibular schwannoma. We present the experience in our institution in the treatment of this disease with this technique. PATIENTS AND METHODS: A retrospective study was made including 20 patients (11 women and 9 men; median age: 55.15 years-old) with vestibular schwannoma who received linear accelerator radiosurgery treatment since April 2005 until December 2008. Follow-up period was between 12 and 42 months, considering clinical examination of cranial nerves VII (House-Brackmann scale) and VIII (Gardner-Robertson scale) as well as radiological findings (considering tumor volume). For statistical analysis, the Fisher's exact test and logistic regression test were used. RESULTS: Certain worsening of hearing function was present in 25% of the patients. Five patients had large tumors at the moment of the treatment (equal or larger than 3.5 cm3), from which four deteriorated from headache, unsteady gait, dizziness/vertigo, facial numbness and tinnitus, with statistical significance (p < 0.05). From the first year of treatment on, there was a tumor volume decrease tendency, with no tumor growth in the medium/long term follow-up, achieving a local control rate of 100%. CONCLUSIONS: Radiosurgery has become an alternative in the treatment of patients with vestibular schwannoma of appropriate size, with high safety level, using low radiation doses, low rate of complications and good tumor control rate in the medium term follow-up.

[Development of a program of nutritional education and valuation of the change of healthful nourishing habits in a population of students of Obligatory Secondary Education]. / Desarrollo de un programa de educación nutricional y valoración del cambio de hábitos alimentarios saludables en una población de estudiantes de Enseñanza Secundaria Obligatoria.

INTRODUCTION: Adolescence is a critical period for the acquisition and configuration of healthy dietary habits and lifestyle for the young future, which will likely persist throughout the adulthood. Paediatric and juvenile obesity is a public health problem which control necessarily implies prevention and nutritional education. OBJECTIVES: To evaluate the nutritional status of the adolescents and determine the proportion with overweight or obesity, and to establish a Nutritional Intervention Programme and analyse the improvement in the pattern of dietary habits among the adolescents. METHODS: The study has been carried out in a population of 372 Obligatory Secondary Education (OSE) students from the Institute of Secondary Education of Gandía (Valencia). RESULTS: 37.8% of the adolescents have improved the level of their diet quality. Those consuming a high quality diet have increased from 30.0% to 58.6%. Also significant is the number of students that have taken up having breakfast and those having discontinued taking industrial bakery with this meal. The decrease in the number of adolescents going to fast food places and of those that have discontinued eating candies regularly is statistically significant. The data from the KIDMED index show that 47.4% (p < 0.001) of de the students have improved the quality of their diet and in none of them it has worsened. DISCUSSION: Before starting the programme, 30% of the students followed a high quality diet comparable to the traditional Mediterranean Diet, and after the education programme, this percentage increased to 58.6%. Forty-seven point four percent of overweighed or obese students receiving the Nutritional Education and Intervention have improved their diet quality and the percentage of those following a high quality diet varied from 28.9% to 71.0%.

[Lumboperitoneal shunt in an outpatient setting for the treatment of chronic hydrocephalus in adults. A study and follow-up of 30 cases]. / Derivación lumboperitoneal en régimen ambulatorio en el tratamiento de la hidrocefalia crónica del adulto. Estudio y seguimiento de 30 casos.

INTRODUCTION AND AIMS: One of the therapeutic options for chronic adult hydrocephalus that has become widely used in our service is the lumboperitoneal shunt with low-pressure Spetzler catheter and in an outpatient regimen. We report on the first 30 patients treated in this way with a follow-up of between one and five years. PATIENTS AND METHODS: Diagnosis was reached after studying the patient history and a clinical examination; Hakim and Adams' triad was found to be a primary and highly predictive factor, together with flow magnetic resonance imaging and the use of the ambulatory tap test. Patients who responded to the latter were submitted to placement of a shunt in a short operation performed with local anaesthetic and sedation. An evaluation of the three symptoms was carried out before and after the intervention according to a mixed scale (Rankin-Stein and Langfitt-Vall d'Hebron) and graphic tests based on the minimental test. RESULTS: At three months, 21 patients (70%) had improved and 14 of them (65%) maintained this improvement at three years; eight of these have been monitored for four and five years. Five patients died due to intercurrent illnesses. CONCLUSIONS: After comparing the complications that occurred with other case mixes involving both lumboperitoneal and ventriculoperitoneal shunts, we discuss the usefulness of this method (which is preferred by patients and relatives) in comparison to ventriculoperitoneal shunts, where the complications are more severe because they invade the brain and due to the need for general anaesthesia and longer hospitalisation. In addition, the method is more economical than the alternatives.

[Tension pneumocephalus in a patient with a scalp wound and ventriculo-peritoneal shunt: case report and literature review]. / Neumoencefalo a tensión tras herida en cuero cabelludo en portadora de válvula de derivación ventrículo-peritoneal: caso clínico y revisión de la literatura.

Skull defects and even meningeal defects are responsible for the majority of pneumocephalus cases. Sometimes, several factors can produce intracranial gas under pressure (tension pneumocephalus) with severe neurological impairment. We present a case of a 66 year old woman with a double ventriculo-peritoneal shunt that was admitted to the emergency service with an intracranial hypertension syndrome. A scalp wound was found on the physical examination and a brain CT showed a tension pneumocephalus. The scalp wound was just located on the border of a cranioplasty made after surgical removal of a parasagital meningioma eight years ago. Evacuation of pneumocephalus, reparation of cranial and meningeal defects and modification of factors contributing to the tension pneumocephalus (ventricular-peritoneal shunts programmed to low pressure) were performed. When we found a patient with a tension pneumocephalus we must think not only about a skull or meningeal defect but also look for other elements that produce gas inside skull under pressure (shunts, cerebrospinal fluid leak between others). Therefore, therapeutic approach has three parts: pneumocephalus drainage, to find and repair entrance of gas and to modify factors that turn pneumocephalus in a tension pneumocephalus.

A phase II study of pegylated-camptothecin (pegamotecan) in the treatment of locally advanced and metastatic gastric and gastro-oesophageal junction adenocarcinoma.

PURPOSE: Combination chemotherapy results in a significant survival advantage in patients with advanced gastric cancer compared to best supportive care. Nevertheless, the prognosis remains poor with a median survival of 8-10 months. Topoisomerase-I inhibitors such as irinotecan have activity in advanced gastric cancer. Pegamotecan may offer significant advantages over other topoisomerase-I inhibitors due to its prolonged circulating half-life, tolerability and passive tumour accumulation. PATIENTS AND METHODS: This was a non-randomised, multi-centre, two-step Fleming design phase II study. Eligible patients with locally advanced (inoperable) or metastatic gastric or gastro-oesophageal adenocarcinoma, with measurable disease, ECOG performance status < or =2, with adequate haematological, renal and hepatic function, who had received < or =1 prior chemotherapy regimen for advanced disease, were treated with 7,000 mg/m(2) of pegamotecan as a 1-h infusion every 21 days until disease progression or unacceptable toxicity. The primary efficacy measure was the objective response rate. RESULTS: Five of the 35 patients recruited into this study had a partial response (14.3%), with a median time to progression of 11.9 weeks (95% CI: 6.6, 13.1), and median overall survival of 38.1 weeks (95% CI: 29.0, 47.3). Grade 3/4 toxicities included neutropenia in 6 (17.1%) patients, thrombocytopenia in 4 (11.4%), fatigue in 8 (22.9%), nausea in 6 (17%), vomiting in 6 (17%) and anorexia in 4 (11.4%) patients. There were no episodes of febrile neutropenia and no toxic deaths. CONCLUSIONS: Pegamotecan has activity in this patient population and was generally well-tolerated. The favourable rate of haematological toxicities and diarrhoea compared with irinotecan in similar studies suggests that pegamotecan could be combined with other active agents in further studies in this disease.

Mycotic aneurysm: a rare complication of vertebral osteomyelitis

We report the case of a 49-year-old man that presented with persistent low back pain after being treated for vertebral osteomyelitis. An abdominopelvic CT scan with intravenous contrast showed a mycotic aneurysm of the abdominal aorta. The patient was taken to the operating room where a bypass reconstruction surgery was successfully performed. The history, pathophysiology, most common organisms, risk factors, and clinical presentation of mycotic aneurysms are discussed. The importance of a high index of suspicion for prompt and proper diagnosis and treatment, is emphasized to create awareness about this dreadful complication of vertebral osteomyelitis.

Mucolipidosis tipo II: comunicación de un caso / Mucolipidoses type II: case report

We report a female newborn with type II mucolipidoses. This condition is characterized clinically by Hurler like features, progressive psychomotor retardation and death during the first or second year of life. Most cases present during the first year of life, with poor weight gain and coarse facies features. The cause of this rare autosomal recessive hereditary disease is the deficiency of the enzyme N-acetylglucosamine-1-phosphotransferase, required for the synthesis of mannose-6-phosphate, the ligand that allows the transport of acid hydrolases into lysosomes. The patient had clinical features commonly found in mucolipidosis II, including disproportionate dwarfism, retarded psychomotor development, coarse facies features, gibbous and restricted joint mobility. The diagnosis was proved by an extremely elevated activity of lysosomal enzymes in the serum, secondary to non-regulated secretion and subsequent intracellular depletion of these proteins. The child suffered recurrent pneumonia and died at 22 months of age