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BACKGROUND AND OBJECTIVES: The purpose of this study is to analyse the indications, complications, survivorship and clinical/functional outcome of metaphyseal sleeves as a treatment option in revision total knee arthroplasty. MATERIAL AND METHOD: A systematic review was made following the PRISMA recommendations on the use of metaphyseal sleeves for revision total knee arthroplasty. We included prospective and retrospective studies published in the last 10 years looking at implant survivorship, clinical and functional outcome with a minimum follow-up of 2 years. RESULTS: The included studies showed good both functional and clinical outcomes. The overall reoperation rate was 16.2%, with an overall survival rate of 92.2% and aseptic survivorship of 98.2%. CONCLUSIONS: Metaphyseal sleeves are a good treatment option for this surgery, especially in AORI II or III type bone defects, achieving good intraoperative and primary stability of the implant, with good and rapid osseointegration.
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BACKGROUND AND OBJECTIVES: The purpose of this study is to analyze the indications, complications, survivorship and clinical/functional outcome of metaphyseal sleeves as a treatment option in revision total knee arthroplasty. MATERIAL AND METHOD: A systematic review was made following the PRISMA recommendations on the use of metaphyseal sleeves for revision total knee arthroplasty. We included prospective and retrospective studies published in the last 10 years looking at implant survivorship, clinical and functional outcome with a minimum follow-up of 2 years. RESULTS: The included studies showed good both functional and clinical outcomes. The overall reoperation rate was 16.2%, with an overall survival rate of 92.2% and aseptic survivorship of 98.2%. CONCLUSIONS: Metaphyseal sleeves are a good treatment option for this surgery, especially in AORI II or III type bone defects, achieving good intraoperative and primary stability of the implant, with good and rapid osseointegration.
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PURPOSE OF THE STUDY The purpose of this study was to conduct an epidemiological study of hand fractures in adult population. MATERIAL AND METHODS A retrospective observational study in a population of 470,000 habitants was performed. Over the course of three years, all patients over 16 years of age who were diagnosed with fracture or fracture-dislocation at the level of a carpal bone, metacarpal and/or phalange were included. These fractures were classified according to the International Classification of Diseases 10th edition (ICD-10). Incidence rates, along with gender and age distribution were also studied. RESULTS 1,267 patients with a total of 1,341 hand fractures were included. They represented 29.7% of all upper limb fractures and 7.6% of all traumatological emergencies involving a bone fracture during that period. The most frequent ICD-10 group was S62.3, with the fifth metacarpal as the most often affected bone (39.7%). The most frequent location at the level of the phalanges (S62.5) was the proximal third of the proximal phalanx of the fifth radius. The global incidence rate was 99 fractures per 100,000 persons/year. No seasonal variation was observed. Only 10.2% of hand fractures received surgical treatment. DISCUSSION Several epidemiological studies have been published on fractures in the hand, but none have used the ICD-10 classification. Although the distribution of our stratified sample by age and gender was similar to those previously published, the incidence rate in our study was much lower. We may possibly extrapolate our results to the rest of the Spanish population and even to the rest of the population of southern Europe, given the scarcity of epidemiological studies on this matter in these geographical areas. CONCLUSIONS The ICD-10 classification is useful for the description and classification of hand fractures. The most often affected group is that including metacarpals of the long fingers (S62.3), being the distal level of the fifth metacarpal in young male patients the most frequent one. Most fractures are treated conservatively and in case of surgical treatment, the preferred surgical techniques include K-wire fixation, interfragmentary compression screws and plate osteosynthesis. Key words: epidemiology, incidence, fracture, fracture dislocation, carpal bones, metacarpals, finger phalanges.
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Fracturas Óseas , Traumatismos de la Mano , Huesos del Metacarpo , Adulto , Fijación Interna de Fracturas/métodos , Fracturas Óseas/epidemiología , Fracturas Óseas/cirugía , Traumatismos de la Mano/epidemiología , Traumatismos de la Mano/cirugía , Humanos , Clasificación Internacional de Enfermedades , Masculino , Huesos del Metacarpo/lesiones , Extremidad SuperiorRESUMEN
BACKGROUND: Among the various methods available, the administration of prostaglandins is the most effective for inducing labour in women with an unfavourable cervix. Recent studies have compared treatment with various titrated doses of oral misoprostol with vaginal misoprostol or dinoprostone, indicating that the use of an escalating dose of an oral misoprostol solution is associated with a lower rate of caesarean sections and a better safety profile. The objective of this study is to assess which of these three therapeutic options (oral or vaginal misoprostol or vaginal dinoprostone) achieves the highest rate of vaginal delivery within the first 24 h of drug administration. METHODS: An open-label randomised controlled trial will be conducted in Araba University Hospital (Spain). Women at ≥41 weeks of pregnancy requiring elective induction of labour who meet the selection criteria will be randomly allocated to one of three groups: 1) vaginal dinoprostone (delivered via a controlled-release vaginal insert containing 10 mg of dinoprostone, for up to 24 h); 2) vaginal misoprostol (25 µg of vaginal misoprostol every 4 h up to a maximum of 24 h); and 3) oral misoprostol (titrated doses of 20 to 60 µg of misoprostol following a 3 h on + 1 h off regimen up to a maximum of 24 h). Both intention-to-treat analysis and per-protocol analysis will be performed. DISCUSSION: The proposed study seeks to gather evidence on which of these three therapeutic options achieves the highest rate of vaginal delivery with the best safety profile, to enable obstetricians to use the most effective and safe option for their patients. TRIAL REGISTRATION: NCT02902653 Available at: https://clinicaltrials.gov/show/NCT02902653 (7th September 2016).
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Maduración Cervical/efectos de los fármacos , Dinoprostona/administración & dosificación , Trabajo de Parto Inducido/métodos , Misoprostol/administración & dosificación , Oxitócicos/administración & dosificación , Ensayos Clínicos Controlados Aleatorios como Asunto , Administración Intravaginal , Administración Oral , Adolescente , Adulto , Quimioterapia Combinada , Femenino , Humanos , Embarazo , Resultado del Tratamiento , Adulto JovenRESUMEN
There is increasing interest in the influence of place on health, and the need to distinguish between environmental and individual level factors. For environmental-level factors, current evidence tends to show associations through cross-sectional and uncontrolled longitudinal analyses rather than through more robust study designs that can provide stronger causal evidence. We restricted this systematic review to randomised (or cluster) randomised controlled trials and controlled before-and-after studies of changes to the built environment. Date of search was December 2016. We identified 14 studies. No evidence was found of an effect on mental health from 'urban regeneration' and 'improving green infrastructure' studies. Beneficial effects on quality-of-life outcomes from 'improving green infrastructure' were found in two studies. One 'improving green infrastructure' study reported an improvement in social isolation. Risk-of-bias assessment indicated robust data from only four studies. Overall, evidence for the impact of built environment interventions on mental health and quality-of-life is weak. Future research requires more robust study designs and interdisciplinary research involving public health, planning and urban design experts.
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Entorno Construido , Planificación Ambiental , Salud Mental , Adulto , Humanos , Calidad de Vida , Población UrbanaRESUMEN
We propose that the injection of electric currents can be used to independently manipulate the position and chirality of vortex-like domain walls in metallic ferromagnetic nanotubes. We support this proposal upon theoretical and numerical assessment of the magnetization dynamics driven by such currents. We show that proper interplay between the tube geometry, magnitude of the electric current and the duration of a current pulse, can be used to manipulate the position, velocity and chirality of a vortex domain wall. Our calculations suggest that domain wall velocities greater than 1 km s(-1) can be achieved for tube diameters of the order of 30 nm and increasing with it. We also find that the transition from steady to precessional domain wall motion occurs for very high electric current densities, of the order of 10(13) A m(-2). Furthermore, the great stability displayed by such chiral magnetic configurations, and the reduced Ohmic loses provided by the current pulses, lead to highly reproducible and efficient domain wall reversal mechanisms.
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OBJECTIVE: To analyze maternal and perinatal risk factors related to the onset and severity of hypospadias. MATERIAL AND METHODS: Data of 614 boys operated on hypospadias in our county during 25 years (1972-1998) has been studied. The patients were divided into 3 groups according the malformation severity: proximal, middle, and distal hypospadias. We use two periods, before and after 1980 to analyze the differences in risk factors along the time. RESULTS: There were 9% of proximal hypospadias, 13.6% middle hypospadias, and 77.5% distal hypospadias. We found statistical significance in several risk factors related to severe hypospadias: low birth weight, intrauterine growth restriction, preterm births, and associated malformations (p < 0.001). We did not find statistical significance with maternal age, toxic exposure, associated diseases, and x-ray exposure during pregnancy. After 1980, there were more severe hypospadias and less gestational age. CONCLUSIONS: Several events during pregnancy can contribute to the development of hypospadias in the fetus. In our experience, since 1980 there is a rise in the number and severity of hypospadias.
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Hipospadias , Preescolar , Femenino , Humanos , Hipospadias/epidemiología , Hipospadias/etiología , Recién Nacido , Masculino , Madres , Embarazo , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de TiempoRESUMEN
INTRODUCTION: Spinal dural arteriovenous fistulas (AVFs) frequently cause progressive myelopathy. Although endovascular approaches to spinal cord vascular malformations become an important adjunct or primary treatment of theses disorders, surgery can be safely performing in some categories. CASE REPORTS: Two males patients presented with progressively myelopathy two months and three years before, were diagnosed by typical MRI findings and spinal selective arteriograms of dorsal AVFs with single feeder of Spetzler's modified classification of spinal cord vascular lesions. After an attempt of embolization following diagnostic angiography in first case, surgical approach for clipping the afferent single feeder was done for both. CONCLUSIONS: Early recognition by selective diagnostic spinal angiography in patients with slowly progressive and fluctuating myelopathy, allow us surgery as recommended treatment in AVFs, so can effect a better outcome and often reverse presenting neurologic deficits.
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Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/cirugía , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico , Malformaciones Vasculares del Sistema Nervioso Central/cirugía , Angiografía , Fístula Arteriovenosa/congénito , Fístula Arteriovenosa/patología , Malformaciones Vasculares del Sistema Nervioso Central/patología , Duramadre/irrigación sanguínea , Duramadre/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE: To establish a technique for transurethral resection of the prostate (TURP), combining the use of local anaesthesia with an Amplatz suprapubic tube, in patients at high surgical risk. MATERIALS AND METHOD: A study was carried out in 32 patients who underwent TURP with a 30 F Amplatz suprapubic tube following local anaesthesia. This technique was indicated where surgery presented a general risk, in elderly patients, and for patients refusing to undergo spinal intradural or general anaesthesia. The mean age of the patients was 70 years (61-82 years). The risk of surgery was assessed according to the ASA classification. RESULTS: According to the ASA classification, 7 patients were ASA III (21.9%), and 25 patients were ASA IV (78.1%). In 31 of the 32 patients the operation was completed in one session. When questioned about the pain they felt, 11 patients reported no pain, 12 slight discomfort and 3 occasional pain. In the latter three patients, intravenous sedation was enhanced with 0.1 mg etomidate per kg body weight. The volume of the resected fragments ranged from 18 to 120 ml, with a mean of 47 ml, except in one patient with 205 ml who required two treatment sessions. CONCLUSIONS: Large prostate resection in patients at high surgical risk was performed comfortably using a combination of local anaesthesia and an Amplatz suprapubic tube. This procedure is one possible option to be considered as an alternative to other treatments.
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Anestesia Local , Cistostomía , Hiperplasia Prostática/cirugía , Resección Transuretral de la Próstata/métodos , Adenocarcinoma/cirugía , Anciano , Anciano de 80 o más Años , Anestesia Local/instrumentación , Anestésicos Locales/administración & dosificación , Bupivacaína/administración & dosificación , Humanos , Lidocaína/administración & dosificación , Masculino , Mepivacaína/administración & dosificación , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio , Hiperplasia Prostática/complicaciones , Neoplasias de la Próstata/cirugía , Resección Transuretral de la Próstata/instrumentación , Resultado del Tratamiento , Cálculos de la Vejiga Urinaria/complicaciones , Cálculos de la Vejiga Urinaria/cirugía , Cateterismo UrinarioRESUMEN
BACKGROUND: Discomfort in the lumbar region is a frequent complaint of helicopter pilots. Two factors that helicopter crewmembers relate to back pain are exposure to vibration and poor posture during flight, because during flight the seat and controls force the pilot to adopt an asymmetric posture. Repeated exposure to these adverse flight conditions could cause pathological changes in the spine. The purpose of this study was to compare right and left sided lumbar muscular activity in helicopter pilots under real flight conditions, using surface electromyography (SEMG) to demonstrate the effects of asymmetrical posture on the musculoskeletal system. An attempt was also made to correlate lumbar muscular activity with environmental factors and such variables as type of flight, type of helicopter, duration of flight, age, physical fitness, and height. METHODS: Right- and left-sided lumbar electrical activity were measured using two-channel SEMG during 35 flights in 2 types of helicopter and a cockpit mock-up. RESULTS: There was a statistically significant increase in right-sided lumbar activity when related to the duration of flight. CONCLUSIONS: The data showed that when the pilot used the manual controls during flight, he did not maintain a symmetrical posture and contracted one side more than the other. We think the relationship between the greatest right-sided contraction and flight duration is due to maintaining an asymmetric posture over a long period. We also noted a tendency towards greater right lumbar musculature activity in older pilots.
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Aeronaves , Electromiografía/métodos , Dolor de la Región Lumbar/etiología , Músculo Esquelético/fisiología , Adulto , Medicina Aeroespacial , Ergonomía , Humanos , Dolor de la Región Lumbar/fisiopatología , Región Lumbosacra , Masculino , Personal Militar , Movimiento , PosturaRESUMEN
PURPOSE: Percutaneous nephroscopy is usually performed with the patient prone, which is uncomfortable for the patient and does not prevent damage to the colon. We assess the possibility of performing percutaneous nephroscopy using local anesthesia with the patient supine, and evaluate the advantages and complications. MATERIALS AND METHODS: A total of 557 consecutive percutaneous nephroscopies were attempted in 221 men and 242 women in the supine position. Patient age ranged from 8 to 87 years (mean 55.1). Patients are supine with a 3 l. serum bag below the ipsilateral flank. We catheterize the affected uretheral meatus with a 5F catheter through a flexible cystoscope. The tract is infiltrated with local anesthesia. The skin is punctured in the posterior axillary line which corresponds to approximately 1 cm. above the bag. We use an Alken set to dilate the tract to 30F, which is the size of the Amplatz sheath we commonly use. RESULTS: Nephroscopy was performed in 519 cases (93.1%). Mean operation time was 85 minutes (range 15 to 240). Serious bleeding occurred in 3 cases. The colon was never damaged in patients treated in the supine position. CONCLUSIONS: Percutaneous nephroscopy using local anesthesia with the patient supine is safe and easy. According to our experience the advantages in comfort to the patient and feasibility to the surgeon justify its use.
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Endoscopía/efectos adversos , Endoscopía/métodos , Posición Supina , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVES: The present study reviewed the records of patients with Wilms' tumor treated at the University Hospital of Zaragoza from January, 1980 to January, 1995. METHODS: A retrospective study was conducted in 12 patients (5 boys and 7 girls) with Wilms' tumor, aged 9 months to 9.5 years, with special reference to the clinical symptoms and signs. RESULTS: In 9 of the 12 cases, the tumor was localized to the left kidney and 3 cases had right-sided involvement. No patient showed an unfavorable histological finding, intraoperative rupture or the associated phenotypic manifestations that are frequently described in cases with this tumor type. CONCLUSION: The mortality and survival rates are comparable with those reported by other authors in our country.
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Neoplasias Renales , Tumor de Wilms , Niño , Preescolar , Femenino , Humanos , Lactante , Neoplasias Renales/diagnóstico , Neoplasias Renales/patología , Masculino , Estudios Retrospectivos , España , Tumor de Wilms/diagnóstico , Tumor de Wilms/patologíaRESUMEN
OBJECTIVES: Considerations on a case of prenatal torsion of the spermatic cord. METHODS: Review of cases reported in the literature. RESULTS: Testicular torsion rarely occurs in the perinatal period. Nearly a hundred cases with surgical confirmation have been reported. CONCLUSIONS: Prenatal torsion is almost exclusively extravaginal, while postnatal extravaginal torsion is extremely rare. The possibility of finding a viable testis is extremely remote. The treatment should be directed at minimizing any potential perioperative complications by scheduling an elective operation after the neonate is medically stable.
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Torsión del Cordón Espermático/congénito , Humanos , Recién Nacido , Masculino , Torsión del Cordón Espermático/diagnósticoRESUMEN
Based on the fact that the results obtained with extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy are uncertain in cases of complex lithiasis in horseshoe kidney, and counting on a wide laparoscopic experience as the most suitable solution in these cases, the authors present their initial experience in two cases of double lithiasis in right hemikidney. Approach was done through transperitoneal laparoscopy, after placement of a stent catheter and under the support of a radiological C-arc. After removal of the stones, the renal pelvis was closed with loose 4 zero reabsorbable suture with kots done intracorporeally. The post-operative had no complications with the exception of a transient leak of urine (5 days) that cause no further complications or subsequent sequelae. Monitoring at 6 months showed absence of residual lithiasis and good morphology and renal function of the sides operated.
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Cálculos Renales/cirugía , Riñón/anomalías , Riñón/cirugía , Laparoscopía/métodos , Anciano , Humanos , Cálculos Renales/complicaciones , Masculino , Persona de Mediana EdadRESUMEN
We report a case of subclinical retroperitoneal tumor in a young patient. Although different diagnostic techniques were utilized (US, urography, CT, etc.), the tumor type could not be determined preoperatively. A malignant tumor was suspected, therefore surgical excision was warranted. The pathological analysis disclosed an angiomyolipoma in the psoas muscle, a benign tumor in an uncommon site. The foregoing finding prompted us to report the present case.
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Angiomiolipoma/diagnóstico , Músculos Psoas , Neoplasias Retroperitoneales/diagnóstico , Adulto , Femenino , HumanosRESUMEN
With the purpose of evaluating the long-term results of percutaneous endoscopic urethrocervicopexy performed in our unit since 1987, using a modified Stamey's technique, in the treatment of stress urinary incontinence in women, 51 patients who had undergone surgery up to June 92 were retrospectively studied. Mean time since surgery was 35 months, and satisfactory results during this time were accomplished in 60.5%, bearing in mind that the patients are totally "dry" and do not require sanitary towels. Comparison of our results and those contributed by other authors in the literature, indicating the decrease over time in the number of good results, and that between three to four years after intervention, the stress urinary incontinence reappears in one third of the women. Finally, we try to provide an statistical correlation of the cases in which continence was not achieved, including the patient's personal features or their medical-surgical background.
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Cuello del Útero/cirugía , Uretra/cirugía , Endoscopía/métodos , Endoscopía/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Recurrencia , España/epidemiología , Factores de Tiempo , Incontinencia Urinaria de Esfuerzo/epidemiología , Incontinencia Urinaria de Esfuerzo/cirugíaRESUMEN
We report on two adolescent girls with imperforate hymen that had presented clinically as urinary retention. In the second case described herein, hydrocolpos could have resulted from the imperforate hymen and might have caused the congenital hydronephrosis incorrectly diagnosed during the neonatal period and childhood as such.
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Hematocolpos/complicaciones , Himen/anomalías , Retención Urinaria/etiología , Adolescente , Femenino , Humanos , Hidronefrosis/congénito , Hidronefrosis/etiología , Himen/cirugía , Uréter/anomalías , Reflujo Vesicoureteral/etiologíaRESUMEN
Presentation of one case of renal mycosis by Aspergillus as a primary complication in one patient diagnosed with acquired immunodeficiency syndrome. The importance of conservative treatment at all costs through percutaneous drainage is underlined, specially if we considered the short life expectancy of patients who have developed AIDS.
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Absceso/microbiología , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Enfermedades Renales/microbiología , Absceso/diagnóstico por imagen , Absceso/etiología , Absceso/terapia , Adulto , Aspergillus fumigatus , Drenaje , Humanos , Enfermedades Renales/diagnóstico por imagen , Enfermedades Renales/etiología , Enfermedades Renales/terapia , Masculino , Infecciones Oportunistas/diagnóstico por imagen , Infecciones Oportunistas/terapia , Cintigrafía , Tomografía Computarizada por Rayos XRESUMEN
A minimally invasive surgical technique is proposed which considerably simplifies the Stamey technique, shortens the surgical time and fives a weighted success rate of over 80%, which makes it worthy of consideration in treating female urinary incontinence.