A series of patients with refractory myasthenia gravis.

INTRODUCTION: Advances in the treatment of myasthenia gravis (MG) have improved quality of life and prognosis for the majority of patients. However, 10%-20% of patients present refractory MG, with frequent relapses and significant functional limitations. PATIENTS AND METHODS: Patients with refractory MG were selected from a cohort of patients diagnosed with MG between January 2008 and June 2019. Refractory MG was defined as lack of response to treatment with prednisone and at least 2 immunosuppressants, inability to withdraw treatment without relapse in the last 12 months, or intolerance to treatment with severe adverse reactions. RESULTS: We identified 84 patients with MG, 11 of whom (13%) met criteria for refractory MG. Mean (standard deviation) age was 47 (18) years; 64% of patients with refractory MG had early-onset generalised myasthenia (as compared to 22% in the group of patients with MG; P < .01), with a higher proportion of women in this group (P < .01). Disease severity at diagnosis and at the time of data analysis was higher among patients with refractory MG, who presented more relapses during follow-up. Logistic regression analysis revealed an independent association between refractory MG and the number of severe relapses. CONCLUSIONS: The percentage of patients with refractory MG in our series (13%) is similar to those reported in previous studies; these patients were often women and presented early onset, severe forms of onset, and repeated relapses requiring hospital admission during follow-up.

Benefits of analgesic blocks, PENG block (PEricapsular Nerve Group), in fast recovery after hip surgery. / Beneficios de los bloqueos analgésicos, PENG (PEricapsular Nerve Group), en la recuperación precoz tras la cirugía de cadera.

INTRODUCTION: Hip fracture is a frequent orthopedic emergency which associates high morbidity and mortality and intense pain. Locoregional analgo-anesthetic techniques, both central and peripheral, occupy a preferential place in the multimodal therapeutic arsenal. Recently, a new regional blockade has emerged, the pericapsular block or PENG block (PEricapsular Nerve Group). The objective is to evaluate in patients with hip fracture, the antinociceptive efficacy of the preoperative PENG block, residual motor block and time for postoperative functional recovery. METHOD AND MATERIALS: Prospective descriptive observational study with patients going to have total hip arthroplasty. PENG block was performed before surgery. Pain was assessed with the Visual Numerical Scale (VNS) before the blockade, 30min later, in the immediate postoperative period and 24h after the intervention. Motor block according to the Bromage scale and time needed for assisted walking were also evaluated. RESULTS: PENG block provided effective analgesia in all patients, with a decrease in at least 3 points on the VNS at every step in which it was evaluated. The average difference between pain before and after the block was 7.5 points on the VNS. It allowed the transfer and placement of the patient without hemodynamic alteration, exacerbation of pain or other complications. CONCLUSIONS: PENG block is an effective and safe regional analgesic technique for patients with hip fracture. It allows mobilization and placement before surgery without pain exacerbation, promoting early mobility and rehabilitation.

[Translated article] Benefits of analgesic blocks, PENG block (PEricapsular Nerve Group), in fast recovery after hip surgery.

INTRODUCTION: Hip fracture is a frequent orthopaedic emergency which associates high morbidity and mortality and intense pain. Locoregional analgo-anaesthetic techniques, both central and peripheral, occupy a preferential place in the multimodal therapeutic arsenal. Recently, a new regional blockade has emerged, the pericapsular block or PENG block (PEricapsular Nerve Group). The objective is to evaluate in patients with hip fracture, the antinociceptive efficacy of the preoperative PENG block, residual motor block and time for postoperative functional recovery. METHOD AND MATERIALS: Prospective descriptive observational study with patients going to have total hip arthroplasty. PENG block was performed before surgery. Pain was assessed with the Visual Numerical Scale (VNS) before the blockade, 30min later, in the immediate postoperative period and 24h after the intervention. Motor block according to the Bromage scale and time needed for assisted walking were also evaluated. RESULTS: PENG block provided effective analgesia in all patients, with a decrease in at least 3 points on the VNS at every step in which it was evaluated. The average difference between pain before and after the block was 7.5 points on the VNS. It allowed the transfer and placement of the patient without haemodynamic alteration, exacerbation of pain or other complications. CONCLUSIONS: PENG block is an effective and safe regional analgesic technique for patients with hip fracture. It allows mobilisation and placement before surgery without pain exacerbation, promoting early mobility and rehabilitation.

[Myasthenia gravis induced by atezolizumab]. / Miastenia gravis inducida por atezolizumab.

TITLE: Miastenia gravis inducida por atezolizumab.

A series of patients with refractory myasthenia gravis. / Descripción de una serie de pacientes con miastenia gravis refractaria.

INTRODUCTION: Advances in the treatment of myasthenia gravis (MG) have improved quality of life and prognosis for the majority of patients. However, 10%-20% of patients present refractory MG, with frequent relapses and significant functional limitations. PATIENTS AND METHODS: Patients with refractory MG were selected from a cohort of patients diagnosed with MG between January 2008 and June 2019. Refractory MG was defined as lack of response to treatment with prednisone and at least 2 immunosuppressants, inability to withdraw treatment without relapse in the last 12 months, or intolerance to treatment with severe adverse reactions. RESULTS: We identified 84 patients with MG, 11 of whom (13%) met criteria for refractory MG. Mean (standard deviation) age was 47 (18) years; 64% of patients with refractory MG had early-onset generalised myasthenia (as compared to 22% in the group of patients with MG; P<.01), with a higher proportion of women in this group (P<.01). Disease severity at diagnosis and at the time of data analysis was higher among patients with refractory MG, who presented more relapses during follow-up. Logistic regression analysis revealed an independent association between refractory MG and the number of severe relapses. CONCLUSIONS: The percentage of patients with refractory MG in our series (13%) is similar to those reported in previous studies; these patients were often women and presented early onset, severe forms of onset, and repeated relapses requiring hospital admission during follow-up.

[Recurrent stroke, acrocyanosis and livedo racemosa: is it always Sneddon's syndrome?] / Ictus recidivante, acrocianosis y livedo racemosa: ¿siempre síndrome de Sneddon?

TITLE: Ictus recidivante, acrocianosis y livedo racemosa: ¿siempre síndrome de Sneddon?

Ten-year follow-up of an anatomical hydroxyapatite-coated total hip prosthesis.

We report our results after ten year follow-up of 107 consecutive ABG-I hip prostheses implanted between June 1990 and December 1992: Only 84 prostheses were still in the study after ten years, but only six patients had undergone surgical revision. We can consider our clinical outcomes as excellent, with a whole-implant survival rate greater than 96%, a mean Merle D'Aubigne and Postel score increasing from 7.97 before operation to 16.17 at ten year follow-up, and a personal subjective assessment as excellent or good in 82.14% of patients. However, radiographic outcomes are more worrying: around 90% of patients show a stress-shielding phenomenon and granulomatous lesions in the proximal femur, and more than 82% suffer polyethylene wear greater than one millimetre (mean 1.68 mm). We think that zirconia stem heads and hooded antiluxation PE inserts are determining factors in the process of PE wear and, secondarily, in cancellous bone resorption and bone osteolysis.

[Simple bone cysts in childhood. Retrospective study of 15 cases and review of literature]. / El quiste óseo esencial en la infancia. Estudio retrospectivo de 15 casos y revisión de la literatura.

We present a review of 15 cases of simple bone cyst treated by curettage and bone grafting or intralesional steroids injection. We analysed the localisation, cyst activity, the number of cavities and the occupied area, valuing the results according to the Neer and Chigira classification. We have noticed a higher rate' of cure with curettage and bone grafting than with steroids injection (p: 0.01). The activity of the cyst, the uni-multilocutarity and the area related to a greater index of recurrence and failure in the cases treated by steroids injection, although this is statistically non significant.

[Giant cell reparative granuloma: report of a case and review of the literature]. / Granuloma reparativo de células gigantes: presentación de un caso y revisión de la literatura.

We report a case of giant cell reparative granuloma involving proximal phalanx of the index finger. Differential diagnosis with other lytic lesions of the phalanges is analysed and surgical treatment performed is explained. After 24 months follow-up there is no recurrence and finger function is normal.

Use of the suture anchor in modified open Bankart reconstruction.

This study describes the 2-year follow-up of Bankart reconstruction in 44 patients with posttraumatic recurrent anterior instability of the shoulder, using suture anchors and reinforcing the repair with a subscapularis overlap. Forty-three of 44 patients (98%) regained normal stability. One recurrent dislocation occurred. The mean loss of external rotation was 15 degrees. The functional results according to the Rowe scoring system were excellent in 30 cases, good in 13 cases, and poor in 1 case. The suture anchors were found to simplify the procedure.