Autologous haematopoietic stem cell transplantation for multiple sclerosis: a position paper and registry outline.

Background: While substantial progress has been made in the development of disease-modifying medications for multiple sclerosis (MS), a high percentage of treated patients still show progression and persistent inflammatory activity. Autologous haematopoietic stem cell transplantation (AHSCT) aims at eliminating a pathogenic immune repertoire through intense short-term immunosuppression that enables subsequent regeneration of a new and healthy immune system to re-establish immune tolerance for a long period of time. A number of mostly open-label, uncontrolled studies conducted over the past 20 years collected about 4000 cases. They uniformly reported high efficacy of AHSCT in controlling MS inflammatory disease activity, more markedly beneficial in relapsing-remitting MS. Immunological studies provided evidence for qualitative immune resetting following AHSCT. These data and improved safety profiles of transplantation procedures spurred interest in using AHSCT as a treatment option for MS. Objective: To develop expert consensus recommendations on AHSCT in Germany and outline a registry study project. Methods: An open call among MS neurologists as well as among experts in stem cell transplantation in Germany started in December 2021 to join a series of virtual meetings. Results: We provide a consensus-based opinion paper authored by 25 experts on the up-to-date optimal use of AHSCT in managing MS based on the Swiss criteria. Current data indicate that patients who are most likely to benefit from AHSCT have relapsing-remitting MS and are young, ambulatory and have high disease activity. Treatment data with AHSCT will be collected within the German REgistry Cohort of autologous haematopoietic stem CeLl trAnsplantation In MS (RECLAIM). Conclusion: Further clinical trials, including registry-based analyses, are urgently needed to better define the patient characteristics, efficacy and safety profile of AHSCT compared with other high-efficacy therapies and to optimally position it as a treatment option in different MS disease stages.

Autologous haematopoietic stem cell transplantation for multiple sclerosis Substantial progress has been made in the development of disease-modifying medications for multiple sclerosis (MS) during the last 20 years. However, in a relevant percentage of patients, the disease cannot completely be contained. Autologous haematopoietic stem cell transplantation (AHSCT) enables rebuilding of a new and healthy immune system and to potentially stop the autoimmune disease process for a long time. A number of studies documenting 4000 cases cumulatively over the past 20 years reported high efficacy of AHSCT in controlling MS inflammatory disease activity. These data and improved safety profiles of the treatment procedures spurred interest in using AHSCT as a treatment option for MS. An open call among MS neurologists as well as among experts in stem cell transplantation in Germany started in December 2021 to join a series of video calls to develop recommendations and outline a registry study project. We provide a consensus-based opinion paper authored by 25 experts on the up-to-date optimal use of AHSCT in managing MS. Current data indicate that patients are most likely to benefit from AHSCT if they are young, ambulatory, with high disease activity, that is, relapses or new magnetic resonance imaging (MRI) lesions. Treatment data with AHSCT will be collected within the German REgistry Cohort of autoLogous haematopoietic stem cell transplantation MS (RECLAIM). Further clinical trials including registry-based analyses and systematic follow-up are urgently needed to better define the optimal patient characteristics as well as the efficacy and safety profile of AHSCT compared with other high-efficacy therapies. These will help to position AHSCT as a treatment option in different MS disease stages.

Molecular predictors for decitabine efficacy in meningiomas - a pilot study.

PURPOSE: Effective chemotherapeutical agents for the treatment of meningiomas are still lacking. Previous in-vitro analyses revealed efficacy of decitabine (DCT), a DNA methyltransferase (DNMT) inhibitor established in the treatment of leukemia, in a yet undefined subgroup of meningiomas. METHODS: Effects of DCT on proliferation and viability was analyzed in primary meningioma cells by immunofluorescence and MTT assays, and cases were classified as drug responders and non-responders. Molecular preconditions for efficacy were analyzed using immunofluorescence for Ki67, DNMT1, and five oncogenes (TRIM58, FAM84B, ELOVL2, MAL2, LMO3) previously found to be differentially methylated after DCT exposition, as well as by genome-wide DNA methylation analyses. RESULTS: Efficacy of DCT (10µM) was found in eight (62%) of 13 meningioma cell lines 48 h after drug exposition (p < .05). DCT significantly reduced DNMT1 expression in all but two cell lines, and median ΔDNMT1 reduction 48 h after drug exposition was lower in DCT-resistant (-11.1%) than in DCT-sensitive (-50.5%, p = .030) cells. Rates of cell lines responsive to DCT exposition distinctly decreased to 25% after 72 h. No significant correlation of the patients´ age, sex, histological subtype, location of the paternal tumor, expression of Ki67, DNMT1 or the analyzed oncogenes with treatment response was found (p > .05, each). DCT efficacy was further independent of the methylation class and global DNA methylation of the paternal tumor. CONCLUSION: Early effects of DCT in meningiomas are strongly related with DNMT1 expression, while clinical, histological, and molecular predictors for efficacy are sparse. Kinetics of drug efficacy might indicate necessity of repeated exposition and encourage further analyses.

The Emesis Trial: Depressive Glioma Patients Are More Affected by Chemotherapy-Induced Nausea and Vomiting.

PURPOSE: Glioma patients face a limited life expectancy and at the same time, they suffer from afflicting symptoms and undesired effects of tumor treatment. Apart from bone marrow suppression, standard chemotherapy with temozolomide causes nausea, emesis and loss of appetite. In this pilot study, we investigated how chemotherapy-induced nausea and vomiting (CINV) affects the patients' levels of depression and their quality of life. METHODS: In this prospective observational multicentre study (n = 87), nausea, emesis and loss of appetite were evaluated with an expanded MASCC questionnaire, covering 10 days during the first and the second cycle of chemotherapy. Quality of life was assessed with the EORTC QLQ-C30 and BN 20 questionnaire and levels of depression with the PHQ-9 inventory before and after the first and second cycle of chemotherapy. RESULTS: CINV affected a minor part of patients. If present, it reached its maximum at day 3 and decreased to baseline level not before day 8. Levels of depression increased significantly after the first cycle of chemotherapy, but decreased during the further course of treatment. Patients with higher levels of depression were more severely affected by CINV and showed a lower quality of life through all time-points. CONCLUSION: We conclude that symptoms of depression should be perceived in advance and treated in order to avoid more severe side effects of tumor treatment. Additionally, in affected patients, delayed nausea was most prominent, pointing toward an activation of the NK1 receptor. We conclude that long acting antiemetics are necessary totreat temozolomide-induced nausea.

The applicability of established clinical and histopathological risk factors for tumor recurrence during long-term postoperative care in meningioma patients.

Risk factors to predict late-onset tumor recurrence in meningioma patients are urgently needed to schedule control intervals during long-term follow-up. We therefore analyzed the value of established risk factors for postoperative meningioma recurrence for the prediction of long-term prognosis. Correlations of clinical and histopathological variables with tumor relapse after 3, 5, and 10 years following microsurgery were analyzed in uni- and multivariate analyses, and compared to findings in the entire cohort. In the entire cohort (N = 1218), skull base location (HR: 1.51, 95%CI 1.05-2.16; p = .026), Simpson ≥ IV resections (HR: 2.41, 95%CI 1.52-3.84; p < .001), high-grade histology (HR: 3.70, 95%CI 2.50-5.47; p < .001), and male gender (HR: 1.46, 95%CI 1.01-2.11; p = .042) were independent risk factors for recurrence. Skull base location (HR: 1.92, 95%CI 1.17-3.17; p = .010 and HR: 2.02, 95%CI 1.04-3.95; p = .038) and high-grade histology (HR: 1.87, 95%CI 1.04-3.38; p = .038 and HR: 2.29, 95%CI 1.07-4.01; p = .034) but not subtotal resection (HR: 1.53, 95%CI .68-3.45; p = .303 and HR: 1.75, 95%CI .52-5.96; p = .369) remained correlated with recurrence after a recurrence-free follow-up of ≥ 3 and ≥ 5 years, respectively. Postoperative tumor volume was related with recurrence in general (p < .001) but not beyond a follow-up of ≥ 3 years (p > .05). In 147 patients with a follow-up of ≥ 10 years, ten recurrences occurred and were not correlated with any of the analyzed variables. Skull base tumor location and high-grade histology but not the extent of resection should be considered when scheduling the long-term follow-up after meningioma surgery. Recurrences ≥ 10 years after surgery are rare, and predictors are lacking.

Lesión traumática expuesta, compleja y grave de tibia, tratada con fijador externo Álvarez Cambras / Exposed, complex and severe traumatic injury of the tibia treated with Alvarez Cambra external fixation

RESUMEN Con el paulatino incremento de accidentes automovilísticos, de trabajo, y la violencia urbana, las fracturas expuestas y complejas constituyen traumatismos de creciente incidencia y de difícil solución, con largos períodos de convalecencia que ponen en peligro la vida o la conservación del miembro lesionado. Un gran número de ellas dejan secuelas invalidantes. Existen varios tratamientos, entre ellos la fijación externa, utilizando el sistema creado por el profesor Rodrigo Álvarez Cambras, con varias ventajas que proporcionan una mejor evolución. Se realizó este trabajo con el objetivo de mostrar la evolución y los resultados de un paciente ingresado y operado con el diagnóstico de lesión expuesta, compleja y grave de la extremidad inferior, específicamente de tibia. Este presentó varias complicaciones, por lo que se le colocó un aparato de osteosíntesis de fijación externa Álvarez Cambras en el Hospital Provincial Clínico Quirúrgico Docente José Ramón López Tabrane, de Matanzas (AU).

ABSTRACT With the gradual increase of automobile and work accidents as well as urban violence, exposed and complex fractures are traumas of increasing incidence and difficult solution, with long periods of convalescence that endanger the life or the conservation of the injured member. A large number of them leave invalidating sequels. There are several treatments, including external fixation using the system created by Professor Rodrigo Alvarez Cambra, with several advantages that provide a better evolution. The current work was carried out with the objective of showing the evolution and results of a patient who entered the Teaching Provincial Clinical-surgical Hospital Jose Ramon Lopez Tabrane, of Matanzas, and underwent a surgery with the diagnosis of exposed, complex and serious lesion in the lower limb, specifically of tibia. The patient had several complications and so he was put an Alvarez Cambra external fixation osteosynthesis devise (AU).

Imaging temozolomide-induced changes in the myeloid glioma microenvironment.

Rationale: The heterogeneous nature of gliomas makes the development and application of novel treatments challenging. In particular, infiltrating myeloid cells play a role in tumor progression and therapy resistance. Hence, a detailed understanding of the dynamic interplay of tumor cells and immune cells in vivo is necessary. To investigate the complex interaction between tumor progression and therapy-induced changes in the myeloid immune component of the tumor microenvironment, we used a combination of [18F]FET (amino acid metabolism) and [18F]DPA-714 (TSPO, GAMMs, tumor cells, astrocytes, endothelial cells) PET/MRI together with immune-phenotyping. The aim of the study was to monitor temozolomide (TMZ) treatment response and therapy-induced changes in the inflammatory tumor microenvironment (TME). Methods: Eighteen NMRInu/nu mice orthotopically implanted with Gli36dEGFR cells underwent MRI and PET/CT scans before and after treatment with TMZ or DMSO (vehicle). Tumor-to-background (striatum) uptake ratios were calculated and areas of unique tracer uptake (FET vs. DPA) were determined using an atlas-based volumetric approach. Results: TMZ therapy significantly modified the spatial distribution and uptake of both tracers. [18F]FET uptake was significantly reduced after therapy (-53 ± 84%) accompanied by a significant decrease of tumor volume (-17 ± 6%). In contrast, a significant increase (61 ± 33%) of [18F]DPA-714 uptake was detected by TSPO imaging in specific areas of the tumor. Immunohistochemistry (IHC) validated the reduction in tumor volumes and further revealed the presence of reactive TSPO-expressing glioma-associated microglia/macrophages (GAMMs) in the TME. Conclusion: We confirm the efficiency of [18F]FET-PET for monitoring TMZ-treatment response and demonstrate that in vivo TSPO-PET performed with [18F]DPA-714 can be used to identify specific reactive areas of myeloid cell infiltration in the TME.

Zoonotic Potential and Antibiotic Resistance of Escherichia coli in Neonatal Calves in Uruguay.

Escherichia coli is one of the main etiological agents of neonatal calf diarrhea (NCD). The objective of this study was to assess the presence of virulence genes, genetic diversity, and antibiotic resistance mechanisms in E. coli associated with NCD in Uruguay. PCR was used to assess the presence of intimin, Shiga-like toxin, and stable and labile enterotoxin genes. Resistance to fluoroquinolones and oxyimino-cephalosporins was estimated on Müller-Hinton agar plates. Further antibiotic disc-diffusion tests were performed to assess bacterial multi-resistance. The presence of PMQR, ESBL, MCR-1, and integron genes was evaluated. Isolates were typed using ERIC-PCR, and 20 were selected for MLST, adhesion to Hep-2 cells, in vitro biofilm formation, and eukaryotic cytotoxicity. The prevalence of ETEC genes was lower than 3% in each case (estA and elt). Six isolates were EPEC (eae+) and 2 were EHEC/STEC (eae+/stx1+). The results of a diversity analysis showed high genetic heterogenicity among isolates. Additionally, different sequence types, including ST10, ST21, and ST69, were assigned to selected isolates. Thirty-six percent (96/264) of the isolates were fluoroquinolone-resistant, with 61/96 (63.5%) being multidrug-resistant. Additionally, 6 were oxyimino-cephalosporin-resistant. The qnrB, qnrS1, and blaCTX-M-14 genes were detected, whereas no isolates carried the mcr-1 gene. Isolates had the ability to adhere to Hep-2 cells and form biofilms. Only 1 isolate expressed toxins in vitro. E. coli from NCD cases in Uruguay are very diverse, potentially virulent, and may interact with eukaryotic cells. Zoonotic potential, together with resistance traits and the presence of horizontal transfer mechanisms, may play a significant role in infections caused by these microorganisms.

Cirugía mínima invasiva en el tratamiento de la fractura extracapsular de cadera / Chirurgie mini-invasive dans le traitement de la fracture extracapsulaire de la hanche / Minimally invasive surgery in the treatment of extracapsular hip fractures

Introducción: el clavo trocantérico GT-estándar del sistema de enclavado intramedular ha sido diseñado y fabricado para tratar de manera lógica cómoda y efectiva las fracturas del tercio proximal del fémur por cirugía minimamente invasiva. Objetivo: aplicar este tratamiento en pacientes ingresados y valorar su evolución. Métodos: estudio prospectivo y transversal. El universo de estudio lo constituyeron 280 pacientes ingresados con fractura de cadera entre el 1ro. de enero de 2009 y el 31 de diciembre de 2010, en el Hospital Provincial Docente Clínico Quirúrgico José R. López Tabrane, en Matanzas. La muestra estuvo constituida por 53 pacientes que cumplieron con los criterios de inclusión. Resultados: se realizó este tipo de intervención en 53 (29 por ciento) pacientes con fracturas extracapsulares; predominó el sexo masculino (64 por ciento) en el grupo de edades de 80 a 89 años (43 porciento). En el 64 % de estos pacientes el tiempo quirúrgico estuvo entre una y dos h. Solamente cinco pacientes se complicaron (9 por ciento dos hematomas de la herida, dos pérdida de la fijación y una migración de los tornillos del cuello femoral. Solo cuatro pacientes (8 por ciento) necesitaron transfundirse durante el trans- y el posoperatorio. El 100 por ciento fue dado de alta del hospital vivo, y de ellos el 75 por ciento antes de las 48 horas. En el seguimiento de estos pacientes encontramos que al 56 por ciento se les indicó el apoyo antes de los 15 días. Conclusiones: la evolución de los pacientes con este tipo de tratamiento fue muy buena(AU)

Introduction: the trochanteric GT-estandard nail of the intramedullary nailing system has been designed and manufactured to treat proximal femoral fractures by minimally invasive surgery in a rational, comfortable and effective manner. Objective: apply this treatment in patients hospitalized and assess their evolution. Methods: prospective cross-sectional study. The study universe was composed of 280 patients with this hip fracture, hospitalized between 1 January 2009 and 31 December 2010 at José R. López Tabrane Provincial Clinical Surgical University Hospital in Matanzas. The sample consisted of 53 patients meeting the inclusion criteria. Results: the intervention was performed on 53 patients with extracapsular fractures (29 percent). There was a predominance of the male sex (64 percent) and the 80-89 age group (43 percent). In 64 percent of these patients surgical time ranged between one and two hours. Only five patients (9 percent) had complications: two wound hematomas, two loss of fixation and one migration of femoral neck screws. Only four patients (8 percent) had to be transfused during the operative and postoperative stages. All patients were discharged alive, 75 percent of them within 48 hours. Follow-up revealed that 56 percent of patients were indicated to rest their foot on the floor within 15 days. Conclusions: patients undergoing the treatment had a very good evolution(AU)

Introduction: la tige trochantérienne GT-standard du système de tiges intramédullaires a été dessinée et fabriquée pour traiter de façon logique, aisée et effective les fractures du tiers proximal du fémur par chirurgie mini-invasive. Objectif: le but de cette étude est d'appliquer ce traitement aux patients atteints de ce type de fracture de hanche, et d'évaluer leur évolution. Méthodes: on a effectué une étude prospective et transversale. L'étude a compris 280 patients hospitalisés entre le 1e janvier 2009 et le 31 décembre 2010 à l'hôpital universitaire José R. López Tabrane de la province de Matanzas. L'échantillon a été composée de 53 patients en respectant les critères d'inclusion. Résultats: cinquante-trois patients (29 pourcent) atteints de fractures extracapsulaires ont été opérés par ce type de procédé ; les patients du sexe masculin (64 pourcent) et âgés de 80-89 ans (43 pourcent) ont été les plus souvent touchés. Dans 64 pourcent des patients le temps chirurgical a été entre 12 heures. Seuls cinq patients (9 pourcent) ont eu des complications -deux hématomes de la blessure, deux pertes de fixation et une migration de la tige du cou fémoral. Quatre patients (8 pourcent) seulement ont eu besoin de transfusion au cours de l'opération et dans le postopératoire. Cent pour cent des patients, dont 75 pourcent avant les 48 heures, sont sortis de l'hôpital tout à fait récupérés. Au suivi, on a trouvé que 56 pourcent des patients ont été conseillés de faire l'appui avant les 15 jours. Conclusions: la récupération des patients a été très bonne dû spécialement à ce type de traitement(AU)

CD4(+) T cells predominate in cerebrospinal fluid and leptomeningeal and parenchymal infiltrates in cerebral amyloid ß-related angiitis.

BACKGROUND: In amyloid (Aß)-related angiitis (ABRA)of the central nervous system (CNS), cerebral amyloid angiopathy occurs in association with primary vasculitis of small- and medium-sized leptomeningeal and cortical arteries. It has been suggested that ABRA is triggered by vascular deposition of A followed by an Aß-directed (auto)immune response. OBJECTIVE: To provide a detailed description of the cellular composition of the inflammatory infiltrates in the cerebrospinal fluid (CSF) and CNS and their response to immunotherapy in a typical case of ABRA. DESIGN: Report of a single case. SETTING: Neurologic referral center. PATIENT: 67-year-old white woman. MAIN OUTCOME MEASURES: Neurologic examination,magnetic resonance imaging, lumbar puncture, flow cytometry,leptomeningeal biopsy, and histopathologic analysis. RESULTS: In a typical case of ABRA, we demonstrate for the first time the presence of a vast majority of partially activated CD4(+) T cells in CSF and leptomeningeal and parenchymal (peri)vascular infiltrates, which were frequently found in close proximity to major histocompatibility complex (MHC) class II-expressing microglia, epithelioid macrophages, and multinucleated giant cells containing intracellular deposits of Aß. CONCLUSION: Our findings support the notion of adaptive Aß-directed autoimmunity as the underlying pathogenic mechanism in ABRA.

Residual tumor after laser ablation of human non-small-cell lung cancer demonstrated by ex vivo staining: correlation with invasive temperature measurements.

OBJECT: Histology is the gold standard for confirming thermally induced necrosis. Generally, however, no specimen is obtained from thermal ablation therapy for pathological examination. The aim of this study was to provide evidence for the relationship between temperatures reached and resulting tissue coagulation during laser ablation in a near-physiological ex vivo lung tumor model by combining viability staining and direct temperature measurement. MATERIALS AND METHODS: In all, 17 human lung specimens with primary non-small-cell lung cancer (NSCLC) were examined in this study. Organs were resected with curative intent from patients of either gender (5 female, 12 male) with an average age of 65 years (51-78). Here, 11/17 specimens were subjected to interstitial laser thermal ablation in an ex vivo lung perfusion and ventilation model after surgery. A control group of 6/17 specimens was tested for viability without laser ablation. Tissue temperature was measured invasively in real-time during the ablation process using thermocouples. Afterwards, representative slices of all 17 specimens were tested for viability with triphenyltetrazolium chloride (TTC). Maximum tissue temperature Tmax[°C] measured at a distance of 10 and 20 mm from the laser tip and time of temperature exposure were correlated with the diameter of the induced coagulation as ascertained with viability staining. CH evaluated the results. RESULTS: Mean maximum temperature was 75.9°C ± 14.4°C at a distance of 10 mm from the laser tip and 50.3°C ± 14.6°C at a distance of 20 mm, respectively. The mean distance between the coagulation margin and the laser tip was 17.8 mm ± 7.3 mm. CONCLUSION: We found that coagulation size correlated positively with temperature. There was a clear trend towards the correlation of time over 44°C and ablation depth. Maximum temperatures did not significantly correlate with coagulation size. Laser ablation of lung tumors using the IHLP (isolated human lung perfusion) model represents a possible method for evaluating ex vivo the interrelationships of temperature, time of temperature exposure, and resulting coagulation.

Evaluating the 'next generation' of cell salvage--will it make a difference?

INTRODUCTION: Donor blood supplies are diminishing, becoming more costly and these transfusions lead to higher mortality in cardiac patients. The transfusion risks and the literature highlight the need for an alternative similar to cell salvage to be routinely considered. The Xtra is the first cell saver to be launched since 2001 and will undoubtedly initiate evolution towards the 'next generation' of cell savers. It is also the first to be launched in a new era where the demand for electronic perfusion data management (EPDM) has grown. RESULTS: The user interface (UI) was easy to use. The increased data entry options improved the quality of the recordable data. The integrated data management system (DMS) was comprehensive. Data was easy to manage and enabled central data compilation, which reduces repeated data, the risk of inconsistent data inventory and provides the potential for research and analyses. The haematocrit of the processed blood is a key quality indicator for cell salvage. The comparison of the manufacturer's integrated protocol, Popt, to our team's own protocol showed that Popt delivered a higher haematocrit on its '1st bowl' (59.1% compared to 57.3%) and its 'total process' end product haematocrit was 0.68% higher. The Popt cycle took an average of 330s, whereas our own settings completed in just over 300s. CONCLUSION: The Xtra is a device which will lead the evolution of 'next generation' cell saver technology. The user interface and data management system provide export options and the ability to record the level of data required for good EPDM. This is essential to 'future proof' cell salvage technology. The manufacturer's integrated protocol achieved a higher end product haematocrit than our perfusion team's best practice. The design of the Xtra is contemporary, but the DMS equips this cell saver for the new era that faces both Perfusion and Cardiac Surgery.

Aortic surgery using total miniaturized cardiopulmonary bypass.

PURPOSE: Few centers have attempted aortic surgery using miniaturized cardiopulmonary bypass (MCPB) systems due to concerns of air handling. The extra corporeal circuit optimized (ECCO) total MCPB system uses a venous air removal device and a parallel soft-shell reservoir that allows for venting of the heart. At our institution, total MCPB is used for all coronary artery bypass graft patients. Our objective was to assess the suitability of the ECCO total MCPB system during aortic surgery. DESCRIPTION: Fifty consecutive and unselected aortic procedures using the ECCO system were undertaken. Surgical feasibility, air removal ability, and blood transfusion requirements were audited to determine the efficacy of this technique. EVALUATION: The bypass time was 81.6 +/- 28.0 minutes and the ischemic time was 56.7 +/- 18.9 minutes. Total MCPB handled 1,910 +/- 404 mL of vented blood with 96 venous air removal device activations noted. The blood product transfusion rate was 12%, which was below the surgical transfusion rate for our unit. There were no complications. CONCLUSIONS: Aortic surgery can be undertaken safely and effectively using the ECCO total MCPB system.

Morbimortalidad de la fractura de cadera / Morbimortality of the hip fracture

Las lesiones traumáticas de la cadera ocupan uno de los aspectos más importantes de la cirugía traumatológica por ocurrir con extraordinaria frecuencia, y por ser características del sujeto de avanzada edad constituyen el grupo nosológico de mayor morbimortalidad. Basándonos en esto se realizó un estudio epidemiológico observacional, descriptivo, de tipo longitudinal en pacientes que ingresaron con fractura de cadera en los hospitales “José R. López Tabrane”, de Matanzas, e “Iluminado Rodríguez”, de Jagüey Grande, en el período comprendido entre noviembre del 2001 y marzo del 2006. Nuestro universo estuvo constituido por 129 pacientes en quienes se realizó el tratamiento quirúrgico

Traumatic lesions of the hip are one of the most important aspects of the traumatic surgery, because they are very frequently, and because they take place in advanced-aged subjects: the higher morbimortality nosologic group. On that base, we carried out a longitudinal, descriptive, observacional, epidemiologic study in patients entering the hospitals “José R. López Tabrane”, of Matanzas, and “Iluminado Rodríguez”, of Jagüey Grande with hip fractures during the period November 2001 and march 2006. Our universe was constituted of 129 patients, receiving surgical treatment.

Parálisis del nervio interóseo anterior: síndrome de Nevin-Kiloh, presentación de un caso / Paralysis of the anterior inter-bone nerve: Nevin-Kiloh syndrome, presentation of a case

Se presenta un caso de un paciente blanco, masculino, con antecedentes de salud, que trabaja como fregador en una base de ómnibus, acude a consulta, ya que hace 3 meses presenta impotencia funcional a la flexión de la articulación interfalángica del pulgar y de la interfalángica distal del segundo dedo de la mano izquierda, sin otra sintomatología, lo que le imposibilitaba realizar trabajos manuales que antes realizaba. Se efectúa examen físico y complementarios y se diagnostica una parálisis del nervio interóseo anterior (Síndrome de Nevin-Kiloh). Después de tres meses de tratamiento conservador se decide someter al paciente a tratamiento quirúrgico, realizándose una transposición tendinosa. Después de 2 meses de operado ya se han recuperado las funciones perdidas. La evolución fue satisfactoria. Se revisa la literatura...

We present the case of a white, male patient, with healthy antecedents, working as a car washer in a bus parking lot. He comes to our consult referring a flexional functional impotence of the thumb interphalanx joint and of the distal interphalanx of the left hand second finger already for three months, without any other symptom, making him impossible to do some works he did before. We made a physical and complementary examination, and diagnosed the paralysis of the anterior inter-bone nerve ( Nevin- Kiloh syndrome). After three months of conservative treatment, we decided the surgical intervention of the patient, performing a tendon transposition. Two months after surgery, the lost functions have been recovered. The evolution was satisfactory. We reviewed the literature.

Síndrome del Túnel Carpiano Familiar: a propósito de una familia cubana / Familiar carpal tunnel syndrome: on the purpose of a Cuban family

Se presenta una serie familiar de casos que presentaron síntomas y signos clásicos de síndrome del túnel carpiano. Todos presentaron dolor en el territorio inervado por el mediano y parestesias. Sus ocupaciones eran variadas. En total fueron 5 mujeres las afectadas, su edad osciló entre los 33 y los 57 años, en dos de ellas la presentación fue bilateral. No se recogieron antecedentes de otra entidad concomitante. Se realizó exámenes complementarios donde se corroboró el diagnóstico, se intervinieron quirúrgicamente, se indicó fisioterapia post operatoria y hasta la fecha después de 14 meses de haber sido operados no hay recidivas...

We present a familiar series of cases presenting symptoms and classic signs of carpal tunnel syndrome. They all presented pain in the territory enervated by the medial and the paresthesia. They had different occupations. In all, there were 5 women affected, their ages ranged from 57 to 33 years old, and in two of the, the presentation was bilateral. There were not found antecedents of any other concomitant entity. Complementary studies corroborated the diagnosis. They were operated and post surgery physiotherapy was indicated and after 14 months of surgery there are not recidivisms.

Manejo de la sacrolumbalgia en el Área de Salud / Low back pain management in a Health Area

Los dolores bajos de la espalda constituyen un motivo frecuente por el que personas de diferentes edades concurren a la consulta médica, unas veces en manos del médico general, otras del clínico, del urólogo, del internista y siempre en uno u otro momento en las del ortopédico que es a quien finalmente se le impone emitir un diagnóstico al expectante paciente, sin que éste pueda en todos los casos ofrecerle una respuesta satisfactoria y, lo que es peor, una solución definitiva. Debido a esto se realizó un estudio epidemiológico observacional en 117 pacientes que acudieron a consulta por presentar sacrolumbalgia en el período comprendido entre noviembre del 2005 y abril del 2006 en el área de salud de Jagüey Grande...

Low back pains are a frequent motive of the assistance of different age's persons to the doctor's office. Sometimes they visit the physician, sometimes the clinician, the urologist, the internist, but finally the orthopaedic is the one who diagnoses the expectant patient, not always offering a satisfactory answer, and worse, a definitive solution. Because of that we did an observational, epidemiologic study in 117 patients coming to our office suffering low back pain in the period between November 2005 and April 2006 in the Health Area of Jagüey Grande.

Enfermedad de Forestier: a propósito de un caso / Forestier 's disease: a case report

La Hiperostosis Esquelética Difusa Idiomática (HEDI) o enfermedad de Forestier es una entidad que interesa al aparato locomotor en la cual se produce una osificación exuberante de los ligamentos del cuerpo, pero más característicamente del ligamento longitudinal anterior de la médula espinal con predilección por la columna cervical. La hiperostosis de los cuerpos vertebrales a dicho nivel y los osteofitos que genera, produce afectación medular que se manifiesta con disfagia y más raramente con disfonía. Presentamos el caso de un paciente de 66 años de edad con disfagia progresiva de larga evolución. Su diagnóstico se basó fundamentalmente en el estudio radiológico a través de radiología simple y un esofagograma con contraste baritado. Describimos con este caso clínico las manifestaciones otorrinolaringológicas de la enfermedad...

The Diffuse Idiopathic Skeletal Hyperostosis (DISH) or Forestier's disease is an entity affecting the locomotive apparatus, characterized by extensive spinal osteophytic formation and endo-chondral ossification of paravertebral ligaments and muscles that can affect the neck. Dysphagia and rarely hoarseness are caused, as a consequence of the hyperostosis involvement of the cervical spine. We report the case of a 66 year old man who had progressive dysphagia. The diagnosis was achieved by a radiological study consisting of a simple radiography and a barium swallowing aesophagogram. The case is described and the head and neck manifestations of this disease are discussed.

Fibroma condromixoide diafisario de tibia / Chondromyxoid diaphyseal fibroma of the tibia

Se presenta el caso de una paciente de 21 años de edad con antecedentes de salud, atendida en el Hospital José R López Tabrane de Matanzas; que presentaba aproximadamente durante 6 meses, dolor y aumento de volumen de la cara antero interna de la tibia izquierda, sin estar asociado a otra sintomatología, ni antecedentes traumáticos. Se realizaron estudios radiológicos, humorales y anatomopatológicos, y se diagnosticó un fibroma condromixoide diafisario de tibia. Fue intervenida quirúrgicamente, se realizó curetaje de la lesión y se rellenó con injerto óseo esponjoso y corticoesponjoso