Easy and Safe Clamping of the Internal Jugular Vein and Internal Carotid Artery for End-to-Side Anastomosis in the Vessel-Depleted Neck.

BACKGROUND: Damage to the vascular system resulting from radiotherapy and previous surgeries in patients with recurrent neck tumors has a negative impact on secondary reconstructions. In this study, we describe a simple method for occlusion of the great vessels of the neck in patients with difficult access to recipient vessels for anastomosis. METHODS: A 1 or 0 gauge silk ligature is placed at a circumference of 540 degrees around the vessel, holding the base of the suture with a fine hemostatic clamp exerting sufficient pressure to stop the blood flow in the vessel (internal carotid artery or internal jugular vein), to prepare the end-to-side anastomosis to the flap. RESULTS: From 90 head a neck reconstructions for oncologic patients using microvascular flaps performed between April 2011 and April 2021, 8 of them (8.8%) were performed in patients with multiple previous surgeries and/or radiotherapy, with lesion of the arterial thyrolyngopharyngofacial trunk and secondary recipient veins, being the internal carotid and internal jugular the only available recipient vessels in the neck. CONCLUSIONS: Occlusion of the great vessels of the neck with a thick silk at 540 degrees held by a hemostatic clamp at its base is a safe and reproducible method for occlusion of these vessels to perform end-to-side anastomosis in patients with difficult vascular access in the neck without increasing the risk of endothelial damage and thrombosis from the anastomosis.

Depression and geriatric assessment in older people admitted for hip fracture.

BACKGROUND: Depression is common among older people with hip fracture. AIM: To assess depression scores and other mental and physical health variables in older people with and without depression, admitted to a traumatology ward for a hip fracture. MATERIAL AND METHODS: Cross sectional study of older patients admitted for surgical treatment of hip fracture. Demographic, clinical and laboratory variables were recorded. Twelve surveys were applied to assess general wellbeing, mental health, fall risk, nutritional status, basic and instrumental activities of daily living, social resources and depression (using Yesavage Depression Scale). RESULTS: We assessed 310 patients aged 78 (72-83) years, 72% women. Overall depression prevalence was 46% and its frequency was significantly higher in women, people over 81 years of age, diabetics and subjects with anxiety. The Yesavage score in patients with and without depression was 6.5 and 3, respectively. The median number of medications used by patients with and without depression was 3 and 2 (p < 0.01). CONCLUSIONS: There is a high frequency of depression in these patients, especially in women and subjects older than 81 years of age. Routine geriatric assessments should be performed in hospitalized older patients with hip fracture.

Síndrome metabólico y otros factores asociados a gonartrosis.

OBJECTIVE: To evaluate whether an association exists between gonarthrosis and metabolic syndrome X (MS) as well as other potential risk factors. METHOD: Comparative cross-sectional study of 310 patients evaluated by pathology of knee grouped in patients with gonarthrosis and without it. Sociodemographic, anthropometric and laboratory data was obtained. Gonarthrosis was defined as a ≥ 2 score in Kellgren-Lawrence radiological scale, and MS was assessed using the International Diabetes Federation criteria. Odds ratio and logistic regression were used for bivariate and multivariate analysis respectively. RESULTS: The prevalence of MS in patients who had gonarthrosis was 79.9%, statistically higher than in patients without gonarthrosis (p = 0.001). Other factors that had a statistically higher frequency in this group included diabetes mellitus (p = 0.02) and hypertension (p = 0.02). Multivariate analysis revealed MS had an association with a higher prevalence of gonarthrosis (p = 0.003), while high density lipoproteins (p = 0.02) was associated with a lower prevalence. CONCLUSIONS: MS and its related alterations are associated to gonarthrosis; their adequate control could prevent patients from developing the disease.

Surgical Site Infection Risk Factors in Hip Arthroplasty for Transcervical Femoral Neck Fractures.

Background Hip fracture patients often experience surgical site infections (SSIs) as a major infectious complication after undergoing total hip arthroplasty (THA), which can lead to extended hospital stays, increased mortality, and higher healthcare costs. This study aimed to determine the incidence of SSI and identify the risk factors associated with it after THA. Objective This study aimed to explore the correlation between blood transfusion along with other factors and the occurrence of SSIs in postoperative patients who underwent THA for transcervical femoral neck fractures. Methods We conducted a retrospective analysis by reviewing the medical records of patients aged 60-80 years who underwent surgery for hip fractures at the Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia No. 21 in Monterrey, Mexico, between January 2020 and January 2021. We analyzed potential risk factors such as age, sex, transfusion necessity, preoperative hemoglobin levels, history of diabetes mellitus, arterial hypertension, and end-stage chronic disease. Data are presented as numbers and percentages, and statistical analyses were performed using IBM SPSS Statistics for Windows, Version 28.0 (Released 2021; IBM Corp., Armonk, New York, United States). Results The study included 87 patients, of whom 55 (63%) were women with an average age of 73 years. SSIs were identified in 12 (13.8%) patients. Among those with infections, nine (75%) had a history of blood transfusion (p=0.05). Diabetes, hypertension, and chronic kidney disease also increased the risk for infection. There was no association with gender, age, American Society of Anesthesiologists (ASA) risk, and preoperative hemoglobin. Conclusions We found a heightened risk of SSI in patients with a history of blood transfusions, emphasizing the need for careful consideration and monitoring during the perioperative period. Additionally, patients with comorbidities such as diabetes, hypertension, and chronic kidney disease were more susceptible to SSI, underscoring the importance of preoperative assessment and targeted preventive measures. Further research and collaboration are needed to refine strategies for mitigating SSI risk factors and optimizing healthcare resource utilization.

Reproducibility of pop sensation, Thompson sign in achillotomy, and final Pirani score to predict clubfoot relapse: Achillotomy clinical signs and Pirani predictive ability.

Ultrasound (US) can guide and confirm percutaneous release of the achilles tendon in the clubfoot. However, this technique may not always be available; therefore, surgeons' reported feelings of tendon release ("click" or "pop") and the Thompson sign could demonstrate that they are sensitive and reliable for confirming complete tendon release. The purpose of this study was to compare the reproducibility of clinical maneuvers that aim to detect the reported "click" or "pop" sensation by the surgeon and the Thompson sign after surgical release in percutaneous achilles tenotomy compare with US in patients with clubfoot. A cross-sectional reproducibility study of consecutive patients with idiopathic clubfoot was conducted. All the patients were scheduled to undergo tenotomy in the operating room using the standard percutaneous achilles tenotomy technique under sedation. The surgeon's reported surgical sensation ("click" or "pop") and Thompson signs were compared to the US assessment of the cut. The final Pirani score was used to predict recurrence risk and was correlated with the number of plaster casts and age. Forty-five feet were affected in 30 patients. Eighteen (60%) men. Age range: 1 to 60 months. The sensation of "click" or "pop" was recorded in 38 patients, and complete release was confirmed by US in 37 patients, for a sensitivity (Se) of 0.95 and specificity (Sp) of 0.63. Thompson signs were positive in 33 and 36 patients at 2 evaluations, with Se values of 0.87 and 0.92 and Sp values of 0.88 and 0.75, respectively. The Pirani final score, a predictor of recurrence risk, had an area under the curve of 0.80 (95% CI = 0.63-0.97; P = .005), Se = 0.78, and Sp = 0.56, with a cutoff point of 2.75. The feeling of achilles tendon release and Thompson sign had high sensitivity, prevalence, accuracy, and posttest probability. The confirmation of tendon release based on clinical signs could prevent the use of US.

Protective effect of nitroglycerin ointment and dimethyl sulfoxide on necrosis of skin flaps in rats.

OBJECTIVE: To compare the protective effect of nitroglycerin ointment 2% and Dimethylsulfoxide (DMSO) in dorsal flaps of the rat. METHODS: A blind, experimental study was conducted in 24 male Wistar rats, with a mean weight of 320 (286-376) grams. Group 1: Control. Petrolatum jelly (Vaseline), n = 8, Group 2: Nitroglycerin (NTG) ointment 2% (Nitro-Bid, Altana Co.) n = 8, and Group 3: DMSO gel 90% (Neogen corp. Lexington KY, 40611), n = 8. RESULTS: A total of 24 rats were operated on in the 6-month period of this study. Using a non-parametric Mann-Whitney U-test analysis, a statistically significant p was obtained between the control group and 2% NTG ointment, both in the area of necrosis and in the healthy area (p = 0.026). In contrast, the comparison between DMSO [CH3) 2SO] and the control group (p = 0.180) and between both study groups, with a p = 0.18, was not significant. CONCLUSIONS: Our study concluded that there is a protective effect of 2% NTG ointment for flap survival in relation to the control group (petrolatum). DMSO administered topically did not show a protective effect, compared to the control group.

OBJETIVO: Comparar el efecto protector del ungüento de nitroglicerina 2% y el dimetilsulfoxido 90% en colgajos dorsales en ratas. MÉTODOS: Se realizó un estudio experimental ciego en 24 ratas Wistar macho, con un peso medio de 320 gramos. Grupo 1: Control. Petrolato n = 8, Grupo 2: Nitroglicerina unguento al 2 % (Nitro-Bid, Altana Co.), n = 8, Grupo 3. Dimetilsulfóxido al 90% (Neogen corp. Lexington KY.), n = 8. RESULTADOS: Un total de 24 ratas fueron operadas en el período de 6 meses de este estudio. Mediante un análisis no paramétrico de la prueba U de Mann Whitney, se obtuvo una p estadísticamente significativa entre el grupo control y la pomada de nitroglicerina al 2%, tanto en el área de necrosis como en el área sana (p = 0.026). Por el contrario, la comparación entre DMSO y el grupo control (p = 0.180) y entre ambos grupos de estudio, con una p = 0.18, no fue significativa. CONCLUSIONES: Nuestro estudio concluyó que existe un efecto protector de la pomada de nitroglicerina al 2% para la supervivencia del colgajo en relación al grupo control (vaselina). El DMSO administrado por vía tópica no mostró un efecto protector, en comparación con el grupo de control.

Vertebral coccidioidomycosis with mechanical instability treated solely with antifungals: A case report.

Surgical treatment of vertebral coccidioidomycosis presents a challenge, with an unpredictable course and uncertain results. We present a 52-year-old man with disseminated infection due to coccidioidomycosis in the thoracolumbar spine, with vertebral instability, and deferral surgical treatment due to SARS-CoV-2 contingency. Treatment with itraconazole was initiated, followed by liposomal amphotericin B and fluconazole due to a relapse. The patient was discharged long-term with voriconazole. The axial pain improved without neurological deficits. Surgical treatment was not required. 2012 Elsevier Ltd. All rights reserved.

Closed reduction evaluation in dysplastic hip with the Ömeroglu system in children aged 24 to 36 months.

Closed reduction (CR) as an initial treatment for developmental hip dysplasia of the hip (DDH) in children aged 24 to 36 months is debatable; however, it could have better results than open reduction (OR) or osteotomies, because it is minimally invasive. The purpose of this study was to evaluate the radiological results in children (24-36 months) with DDH initially treated with CR. Initial, subsequent, final anteroposterior pelvic radiological records were retrospectively analyzed. The International Hip Dysplasia Institute was used to classify the initial dislocations. To evaluate the final radiological results after CR (initial treatment) or additional treatment (CR failed), the Ömeroglu system was used (6 points excellent, 5 good, 4 fair-plus, 3 fair-minus, and ≤2 poor). The degree of acetabular dysplasia was estimated using the initial acetabular index and the final acetabular index, Buchholz-Ogden classification was used to measure avascular necrosis (AVN). A total of 98 radiological records were eligible, including 53 patients (65 hips). Fifteen hips (23.1%) were redislocated, OR with femoral osteotomy and pelvic osteotomy was the preferred surgical treatment 9 (13.8%). The initial acetabular index versus final acetabular index in total population was (38.9º ± 6.8º) and (31.9º ± 6.8º), respectively (t = 6.5, P < .001). The prevalence of AVN was 40%. Overall AVN in OR, femoral osteotomy and pelvic osteotomy were 73.3% versus CR 30%, P = .003. Unsatisfactory results ≤ 4 points on the Ömeroglu system were observed in hips that required OR with femoral and pelvic osteotomy. Hips with DDH treated with CR initially might had better radiological results than those treated with OR and femoral and pelvic osteotomies. Regular, good, and excellent results, ≥4 points on the Ömeroglu system, could be estimated in 57% of the cases, in whom CR was successful. AVN is frequently observed in hips with failed CR.

Postaxial hypoplasia of the lower extremity associated with congenital dislocation of the patella: A case report.

RATIONALE: Evaluation of clinical and radiologic abnormalities in patients with postaxial hypoplasia of the lower extremity (PHLE) for treatment decisions represents a major challenge, which is more complicated when PHLE is associated with congenital dislocation of the patella. PATIENT CONCERNS: : Herein, we present the case of an 8-year-old female patient with evident length inequality in her left lower extremity and inability to walk. DIAGNOSES: Radiological evaluation revealed PHLE with fibular hemimelia, proximal femoral focal deficiency, tarsal coalition, and congenital patellar dislocation of the patella. The right lower extremity was also affected by fibular hemimelia. INTERVENTIONS AND OUTCOMES: Surgical management included the Roux-Goldthwait technique for patellofemoral joint realignment, a medial knee stapled with Blount technique, and femur enlargement using the Wagner technique. The results from surgical intervention included a left femoral elongation of 6.7 cm featuring callus with angulation, displacement, and a discrepancy of 5 cm between femurs with a flexor contraction in the knee of -15° and a centralized knee. LESSON: PHLE accompanied by congenital dislocation of the patella has not been extensively described in the literature; therefore, there is no established management. Starting reconstruction at an early age, together with an adequate classification of the deformity, are essential factors when opting for limb reconstruction.

Survival at 30 days in elderly patients with hip fracture surgery who were exposed to hypothermia: Survival study.

ABSTRACT: The effect of hypothermia as a mortality risk factor at 30 days in the elderly who had hip fracture (HF) surgery is still controversial because it may be due to a set of poorly identified factors. In this study, we aim to determine if exposure to intra and immediate postoperative hypothermia increases the incidence of mortality at 30 days in elderly patients who had HF surgery.Survival study in the elderly who had HF surgery with and without exposure to hypothermia. Sociodemographic, anesthetic and surgical factors were collected. The temperature of the rectum was measured at the end of the surgery and in the recovery room. The effect of hypothermia was analyzed by the incidence of mortality at 30 days. Other results were considered, such as, surgical site infection (SSI), blood transfusions, and influence of implants used in the 30-day mortality.Three hundred eighty five subjects were eligible, to include 300. Inadvertent hypothermia was 12%, the 30-day overall mortality was 9% and in subjects with hypothermia it was 25% (P = .002). Subjects with hypothermia had a higher risk of SSI (relative risk 4.2, 95% confidence interval 1.3-13.6, P = .03) and receive more transfusions (relative risk 3.6, 95% confidence interval 2.0-6.5, P < .001).Elderly subjects with HF exposed to hypothermia who undergo hip hemiarthroplasty and who receive 2 or more blood transfusions during their treatment, are at greater risk of dying after 30 days of the surgery. Hypothermia, as a possible causative factor of mortality, should continue to be studied.

Obesity, depression and factors associated to the quality of life in total knee arthroplasty.

BACKGROUND: Knee osteoarthritis can be accompanied by depression and obesity, which could affect the quality of life (QOL) and function after a total knee arthroplasty (TKA). OBJECTIVE: To compare the QOL in subjects with depression and obesity 5 years after TKA. METHODS: Cross-sectional study of prospectively collected data, with two and three groups based on depression and obesity status. Sociodemographic variables, QOL and pain were compared. Depression was evaluated with a screening geriatric depression questionnaire used in the Mexican Health and Age Study (CENASEM). QOL was evaluated with the health survey SF-36. RESULTS: 378 participants were reviewed, 266 were included. Depression was detected in 24.1%, female (p < 0.001), with comorbidity (p = 0.04) and anxiety (p < 0.001), and the QOL score in subjects with depression was lower (p < 0.001). Obese subjects had greater pain (analogous visual scale 3 vs. 2; p = 0.002) and affection of the vitality domain in the QOL (75 vs. 80; p = 0.02). CONCLUSIONS: Evaluating depression and QOL with questionnaires such as CENASEM and SF-36 in elderly subjects who undergo ATR should be indispensable, since detecting and treating depression could increase QOL and function. Obese elderly with TKA may present greater pain.

ANTECEDENTES: La gonartrosis puede acompañarse de depresión y obesidad, afectando la calidad de vida (CV) y la funcionalidad después de una artroplastia total de rodilla (ATR). OBJETIVO: Comparar la CV en sujetos con depresión y obesidad 5 años después de una ATR. MÉTODO: Estudio transversal prolectivo, con dos y tres grupos basados en el estatus de depresión y la obesidad. Se obtuvieron variables sociodemográficas, clinimétricas, antropométricas y de CV. La depresión se evaluó con el cuestionario de tamizaje del Estudio Nacional sobre Salud y Envejecimiento de México (CENASEM). La CV se evaluó con la encuesta de salud SF-36. RESULTADOS: Se revisaron 378 participantes, para incluir 266. Se detectó depresión en el 24.1%, mujeres (p < 0.001), con comorbilidad (p = 0.04) y ansiedad (p < 0.001). El puntaje en la CV en sujetos con depresión fue menor (p < 0.001). Las personas obesas tuvieron mayor dolor (escala visual análoga 3 vs. 2; p = 0.002) y afección del dominio de vitalidad en la CV (75 vs. 80; p = 0.02). CONCLUSIONES: Es indispensable evaluar la depresión y la CV con cuestionarios como el CENASEM y el SF-36 en ancianos que se sometan a ATR, ya que detectar y tratar la depresión podría aumentar la CV y la función. Las personas ancianas obesas con ATR pueden presentar mayor dolor.

Work, sport activities and factors associated with medial meniscal tears in nonathletic subjects.

BACKGROUND: It is known that late surgical reconstruction of the anterior cruciate ligament (ACL) is associated with a medial meniscal (MM) tears. However, the association between factors relating to sports and work activities and joint instability, has not been examined in non-athletic subjects. OBJECTIVE: To compare sports and work activities and other factors associated with MM tears, in subjects with ACL rupture. METHOD: A case-control design study, of patients with ACL injury, 140 cases and 140 controls with and without a rupture of MM respectively, were included. Sociodemographic factors, sports and work activities were compared. RESULTS: The independent factors associated with MM ruptures were continuing sports activities after injury (odds ratio [OR]: 3.6; 95% confidence interval [95% CI]: 1.7-7.9), joint instability (OR: 2.2; 95% CI: 1.8-2.6), time between injury and surgical intervention (time of evolution) (OR: 1.003; 95% CI: 1.0-1.01) and age (OR: 1.1; 95% CI: 1.03-1.1). CONCLUSIONS: Intense activities of daily life such as continuing sports activities, after an ACL injury in non-athletic factory workers subjects, without previous training, as well as, age, joint instability and surgical delay are risk factors for rupture of MM.

ANTECEDENTES: Se sabe que la reconstrucción tardía del ligamento cruzado anterior (LCA) se asocia a rotura del menisco medial (MM). Sin embargo, la asociación entre factores referentes a las actividades deportivas, laborales e inestabilidad articular no se ha examinado en sujetos no deportistas. OBJETIVO: Comparar las actividades laborales, deportivas y otros factores asociados a rotura del MM en sujetos con rotura del LCA. MÉTODO: Diseño de casos y controles, de sujetos con rotura del LCA; 140 casos y 140 controles con y sin rotura de MM, respectivamente. Se compararon factores sociodemográficos, actividades deportivas y laborales. RESULTADOS: Los factores independientes asociados a roturas del MM fueron el continuar con actividades deportivas después de la lesión (razón de momios [RM]: 3.6; intervalo de confianza del 95% [IC 95%]: 1.7-7.9), la inestabilidad articular (RM: 2.2; IC 95%: 1.8-2.6), el tiempo de evolución entre la lesión y la reconstrucción (RM: 1.003; IC 95%: 1.0-1.01) y la edad (RM: 1.1; IC 95%: 1.03-1.1). CONCLUSIONES: Actividades intensas de la vida diaria, como continuar con deportes, después de una lesión del LCA en sujetos obreros, no deportistas, sin entrenamiento previo, así como la edad, el retraso en la reconstrucción y la inestabilidad articular, son factores de riesgo para rotura del MM.

Depression and geriatric assessment in older people admitted for hip fracture / Depresión y evaluación geriátrica en adultos mayores ingresados por fractura de cadera

ABSTRACT Background: Depression is common among older people with hip fracture. Aim: To assess depression scores and other mental and physical health variables in older people with and without depression, admitted to a traumatology ward for a hip fracture. Material and Methods: Cross sectional study of older patients admitted for surgical treatment of hip fracture. Demographic, clinical and laboratory variables were recorded. Twelve surveys were applied to assess general wellbeing, mental health, fall risk, nutritional status, basic and instrumental activities of daily living, social resources and depression (using Yesavage Depression Scale). Results: We assessed 310 patients aged 78 (72-83) years, 72% women. Overall depression prevalence was 46% and its frequency was significantly higher in women, people over 81 years of age, diabetics and subjects with anxiety. The Yesavage score in patients with and without depression was 6.5 and 3, respectively. The median number of medications used by patients with and without depression was 3 and 2 (p < 0.01). Conclusions: There is a high frequency of depression in these patients, especially in women and subjects older than 81 years of age. Routine geriatric assessments should be performed in hospitalized older patients with hip fracture.

Antecedentes: La alta prevalencia de depresión en la población anciana con fractura de cadera rara vez se reconoce. Objetivo: Estimar la prevalencia de depresión y comparar la salud física, mental, y otras variables geriátricas, en ancianos hospitalizados por fractura de cadera con y sin depresión. Material y Métodos: Estudio transversal con muestreo probabilístico con reemplazo, de pacientes que ingresaron para su atención quirúrgica. Se recolectaron variables sociodemográficas, antropométricas, clínicas y de laboratorio. Se aplicaron 12 encuestas para evaluar el estado de salud general, mental, riesgo de caídas, estado nutricional, actividades básicas e instrumentadas de la vida diaria, recursos sociales y depresión, entre otras. Para detectar depresión se usó la escala de tamizaje de Depresión Geriátrica Yesavage (EDG-15). Resultados: Se revisaron 310 pacientes (grupos con y sin depresión). La prevalencia de depresión fue de 46%, significativamente mayor en mujeres, sujetos mayores de 81 años, diabéticos y aquellos con ansiedad. La mediana de la puntuación EDG-15 fue de 6,5 y 3 para sujetos con y sin depresión (n = 142), (n = 168), respectivamente. La mediana del número de fármacos fue de 3 y 2 en estos grupos (p < 0,01). Conclusiones: La evaluación geriátrica sistemática en la atención del adulto mayor con fractura de cadera es indispensable, lo que podría aumentar las tasas de detección de depresión y de otros padecimientos e impactar positivamente en la calidad de vida y restauración de la función.