Incidence and Epidemiology of Traumatic Tympanic Membrane Rupture: A National Trauma Data Bank Analysis.

The incidence of traumatic tympanic membrane rupture (TTMR) has increased over recent decades. The association of certain external injury causes and bone fracture patterns with TTMR is anecdotal. It has been suggested that a diagnosis of TTMR may be missed during the acute trauma admission. The authors sought to evaluate the incidence of TTMR according to external injury cause and evaluate the association of skull fracture patterns with TTMR using a national trauma database. A cross-sectional analysis of trauma encounters was conducted using the National Trauma Data Bank (NTDB) from 2008 to 2015. Demographic and injury data were abstracted. Poisson regression was used to determine the incidence rate ratios of tympanic membrane rupture by external injury cause and logistic regression was used to estimate odds ratios (OR) of TTMR by skull fracture type. A total of 8214 patients were identified with TTMR during acute admission. The majority were on average 30 years old, 76% male, 71% White, had a mean Injury Severity Score of 14, and 42% were admitted to level I centers. The incidence rate ratio was only higher in lightning related injuries [5.262; 95% confidence interval (CI): 4.194-6.602] when using those caused by explosives as a reference. Basilar skull (OR: 12.95; 95% CI: 12.095-12.866) and cranial vault (OR: 2.938; 95% CI: 2.647-3.260) fractures were most associated with TTMR. The high incidence TTMR in association with certain external causes of injury and types of skull fractures should drive screening in the acute setting in order to increase detection and reduce morbidity from missed injuries.

Chemotaxis in Leishmania (Viannia) braziliensis: Evaluation by the two-chamber capillary assay.

Chemotactic responses play a significant role during Leishmania (V.) braziliensis differentiation through its life cycle and during infection. The aim of this description has been to portray the modified "two-chamber capillary chemotaxis assay" as a technique useful for quantitative in vitro evaluation of Leishmania chemotaxis after reviewing the methods described until now to assess chemotaxis in vitro in Leishmania sp. This valued simple and reproducible method convenient for parasite migration determination, was tested by the use of controlled changes in monosaccharide (D-glucose and D-fructose) concentrations as referent ligands. The validation of the method demonstrates that this technique is useful to evaluate the relationship existing between parasite migration towards the monosaccharides and sugar concentration. This means that within specific ranges, parasites attracted by the monosaccharide migrate towards more concentrated solutions and accumulate (higher number of parasites) at that spot. Interestingly, both the time course of the experiment and the osmolality of the solution influence parasite migration capacity. Our validation suggests that this improved methodology quantitatively evaluates taxis of Leishmania towards/against different substances. On the basis of our herein presented data, we conclude that this technique is a novel, rapid and reliable screening method to evaluate chemotaxis in Leishmania.•The two-chamber capillary chemotaxis assay was standardized for Leishmania.•The technique is useful to quantitatively evaluate in vitro chemotaxis in Leishmania.•Parasite migration was characterized by monosaccharide chemical gradients.•This assay is a novel, rapid and reliable screening method to evaluate chemotaxis. Contain between 1 and 3 bullet points highlighting the customization rather than the steps of the procedure.

Finding the Most Favorable Timing for Cholecystectomy after Percutaneous Cholecystostomy Tube Placement: An Analysis of Institutional and National Data.

BACKGROUND: Early cholecystectomy (E-CCY; 8 weeks or less) after percutaneous cholecystostomy tube (PCT) placement has been associated with increased postoperative complications, but this finding has not been validated at a national level and PCT-related complications and interventions (PCT-RCIs) were not evaluated. STUDY DESIGN: Adults with PCT for acute cholecystitis subsequently undergoing CCY were identified within the Nationwide Readmission Database (2010-2015) and our institution (2017-2019). Adjusted relative risks (aRRs) of postoperative complications were estimated using Poisson regression comparing E-CCY with delayed cholecystectomy (D-CCY; more than 8 weeks) within the nationwide cohort. Institutional PCT-RCIs, operative data, and postoperative outcomes were compared between E-CCY and D-CCY using chi-square and Kruskal-Wallis tests. RESULTS: Of 6,145 patients from the Nationwide Readmission Database, 32.9% were D-CCY. Risk-adjusted analysis identified no differences between E-CCY and D-CCY in complications (aRR 0.98; 95% CI, 0.89 to 1.07), mortality (aRR 0.88; 95% CI, 0.43 to 1.81), or 30-day readmissions (aRR 1.04; 95% CI, 0.85 to 1.27). Risk-adjusted analyses assessing the association of time to interval cholecystectomy (IC) with morbidity indicated an increased risk of surgical complications in the first month after PCT placement (aRR 1.17; 95% CI, 1.08 to 1.33). In the institutional cohort (E-CCY, n = 23; D-CCY, n = 45), there were no statistically significant differences found in estimated blood loss, length of stay, and postoperative complications. There were increased PCT-RCIs in the D-CCY group (26.9% E-CCY vs 69% D-CCY; p < 0.01) based on our unadjusted analysis. CONCLUSIONS: Increased operative complications when IC is performed within 1 month of PCT placement and increased PCT-RCIs when IC is performed 8 weeks after PCT placement suggest that the most favorable timing for IC is between 4 and 8 weeks after PCT placement.

Evolución clínica y análisis del estado del cartílago articular por mapeo-T2 y segunda vista artroscópica a veinticuatro meses del trasplante de menisco medial / Meniscal transplantation. Clinical evolution of articular cartilage for T2-mapping and second-look arthroscopic at twenty-four months

Introducción: El objetivo de nuestro trabajo es evaluar la evolución clínica, la condroprotección y la reacción inmunológica del trasplante de menisco (TM) con aloinjerto gama irradiado (GI) versus fresco congelado (FC) a veinticuatro meses. Materiales y métodos: veinte TM mediales en veinte pacientes, se evaluaron escalas de rodilla, Mapeo-T2 y segunda vista artroscópica, así como identificación de reacciones inmunológicas con la medición de citocinas inflamatorias por PCR en sangre y líquido sinovial. Trece trasplantes con injerto FC y siete GI, edad promedio de treinta y dos años. Resultados: mejoría significativa en escalas a veinticuatro meses: KOOS (dolor 67.80/79.30; síntomas 60.80/82.10; AVD 8.05/92.40; deportes 37/63.35; CV 28.90/71.30), Lysholm (62.20/85.80), IKDCs (50.17/72.12), EVA (3.35/0.4). El cartílago del compartimento trasplantado se mantuvo dentro de valores normales, sin diferencia a los veinticuatro meses (fémur: 33.43 versus 33.50 ms, p = 0.16) (tibia: 33.57 versus 34.35 ms, p = 0.21). Todos los pacientes mostraron integridad del injerto a los doce meses en la segunda vista artroscópica. Solo se observó aumento en las citoquinas plasmáticas IL-6 e IL-17 en un paciente del grupo GI, sin repercusión clínica. Conclusiones: mejoría clínica, adecuada integración y condroprotección significativa a veinticuatro meses en ambos tipos de injertos

Introduction: Our objective is to evaluate the clinical course, chondroprotection and immunological reaction of meniscus transplantation (TM) with gamma irradiated (GI) versus fresh frozen (FC) allograft at twenty-four months. Materials and methods: twenty medial TMs in twenty patients, knee scales, T2-mapping and second arthroscopic view were evaluated, as well as identification of immunological reactions with the measurement of inflammatory cytokines by PCR in blood and synovial fluid. Thirteen transplants with FC graft and seven GI grafts, average age of thirty-two years. Results: significant improvement on scales at twenty-four months: KOOS (pain 67.80 / 79.30; symptoms 60.80 / 82.10; AVD 8.05 / 92.40; sports 37 / 63.35; CV 28.90 / 71.30), Lysholm (62.20 / 85.80), IKDCs (50.17 / 72.12), EVA (3.35 / 0.4). The cartilage of the transplanted compartment remained within normal values, with no difference at twenty-four months (femur: 33.43 versus 33.50 ms, p = 0.16) (tibia: 33.57 versus 34.35 ms, p = 0.21). Conclusions: all patients showed integrity of the graft at twelve months in the second arthroscopic view. An increase in plasma cytokines IL-6 and IL-17 was only observed in one patient in the GI group, without clinical repercussion. Clinical improvement, adequate integration and significant chondroprotection at twenty-four months in both types of grafts

Free Flap Reconstruction of Complex Oncologic Scalp Defects in the Setting of Mesh Cranioplasty: Risk Factors and Outcomes.

INTRODUCTION: Soft-tissue reconstruction of the scalp has traditionally been challenging in oncologic patients. Invasive tumors can compromise the calvarium, necessitating alloplastic cranioplasty. Titanium mesh is the most common alloplastic material, but concerns of compromise of soft-tissue coverage have introduced hesitancy in utilization. The authors aim to identify prognostic factors associated with free-flap failure in the context of underlying titanium mesh in scalp oncology patients. METHODS: A retrospective review (2010-2018) was conducted at a single center examining all patients following oncologic scalp resection who underwent titanium mesh cranioplasty with free-flap reconstruction following surgical excision. Patient demographics, comorbidities, ancillary oncological treatment information were collected. Operative data including flap type, post-operative complications including partial and complete flap failure were collected. RESULTS: A total of 16 patients with 18 concomitant mesh cranioplasty and free-flap reconstructions were identified. The majority of patients were male (68.8%), with an average age of 70.5 years. Free-flap reconstruction included 15 ALT flaps (83.3%), 2 latissimus flaps (11.1%), and one radial forearm flap (5.5%). There were three total flap losses in two patients. Patient demographics and comorbidities were not significant prognostic factors. Additionally, post-operative radiation therapy, ancillary chemotherapy, oncological histology, tumor recurrence, and flap type were not found to be significant. Pre-operative radiotherapy was significantly associated with flap failure (P < 0.05). CONCLUSION: Pre-operative radiotherapy may pose a significant risk for free-flap failure in oncologic patients undergoing scalp reconstruction following mesh cranioplasty. Awareness of associated risk factors ensures better pre-operative counseling and success of these reconstructive modalities and timing of pre-adjuvant treatment.

Radiographic displacement of acute acromioclavicular joint dislocations fixed with AC TightRope.

BACKGROUND: The arthroscopic approach to acromioclavicular (AC) dislocation with methods such as AC TightRope fixation has reported radiographic failure rates between 18% and 50% with functional results graded as good or excellent. Our objective was to review the outcomes after arthroscopic fixation for acute AC joint dislocation using the TightRope device. METHODS: We reviewed the records of 52 patients, with a mean age of 31 years, who underwent arthroscopic fixation with the TightRope device for acute AC joint dislocation. Outcomes were evaluated using the Constant and University of California, Los Angeles scores. The coracoclavicular (CC) distance before and after surgery was compared by radiography. RESULTS: The mean follow-up period was 36.7 months (range, 6-65 months). Postoperatively, the mean Constant score was 97.13 and the mean University of California, Los Angeles score was 33.2. The CC distance was maintained in 73% of the patients, whereas partial loss of reduction occurred in 19.2% and failure of reduction occurred in 7.7%. CONCLUSION: Arthroscopic fixation using the TightRope device for acute AC joint dislocation achieves satisfactory clinical outcomes. However, CC reconstruction appears to result in subluxation in cases with AC dislocation for a period of more than 10 days.

Reparación meniscal con técnica dentro-fuera / Inside-out meniscal repair technique

Sabemos que la meniscectomía lleva al desarrollo temprano de osteoartritis, es por ello que en la actualidad se tiende a reparar más que a resecar meniscos. La reparación meniscal Dentro-Fuera es una técnica que ha probado ser efectiva tanto así que sigue siendo el estándar de oro. Aunque la técnica todo dentro ha sido mejorada, la técnica Dentro-Fuera ofrece ventajas como el poder reparar diferentes tipos de patrones de lesiones así como utilizar diferentes tipos de puntos y suturas. La desventaja es que requiere de una incisión extra y una adecuada disección de los tejidos blandos para evitar complicaciones iatrogénicas y anudar los puntos directamente sobre la cápsula. En el artículo describimos la técnica que utilizamos

It is well known that meniscectomy leads to the early development of knee arthritis, that is the reason that nowadays we favour meniscal repair rather than meniscectomy. The Inside-out meniscal repair technique has proven to be effective, has passed the test of time and has withstanded as the gold standard of meniscal repair techniques. Even when the All-inside technique has improved the inside-out offers advantages like the possibility of repairing all tear patterns and the chance of using several stitch configurations and different kinds of sutures. The main disadvantage is that it requires an extra incision and some deep dissection to tie the knots against the capsule. We describe the technique we currently use

Secondary colonic necrosis. Case report.

BACKGROUND: Colonic vascular lesion secondary to verapamil overdose is mediated by free radicals, forming vascular microtrombos and endotoxin generation, being a difficult diagnosis. CLINICAL CASE: A 27-year-old female is admitted with an acute abdomen of 4 days after an event referred for a suicidal attempt due to an overdose of verapamil, operating surgically where there is a right transmural colon necrosis, performing a right hemicolectomy with terminal ileostomy. CONCLUSIONS: Recognize and properly treat an acute abdomen, not always reach an adequate diagnosis, so a thorough history could conclude.

ANTECEDENTES: La lesión vascular colónica secundaria a la sobredosis de verapamilo, es mediada por radicales libres, formando microtrombos vasculares y generación de endotoxinas, siendo un diagnostico difícil. CASO CLÍNICO: Femenino de 27 años, ingresa con abdomen agudo de 4 días posteriores a un evento remitido de intento suicida por sobredosis de verapamilo, interviniéndose quirúrgicamente donde se halla necrosis colónica transmural derecha, realizando hemicolectomía derecha con ileostomía terminal. CONCLUSIONES: Reconocer y tratar de forma adecuada un abdomen agudo, no siempre se suele llegar a un adecuado diagnostico, por lo cual una minuciosa anamnesis lograría concluirlo.

Healthcare-Associated Pneumonia: Don't Forget About Respiratory Viruses!

Introduction: Healthcare-associated infections are an important cause of morbidity and mortality, are among the most common adverse events in healthcare, and of them, pneumonia is the most commonly reported. Our objective was to evaluate the incidence and clinical outcome of respiratory viruses in hospital-acquired pneumonia (HAP). Methods: This was a prospective cohort study, include patients aged between 0 and 18 who fulfilled Centers for Diseases Control and Prevention (CDC) criteria for HAP. Demographic and clinical data were obtained, and a nasopharyngeal swab specimen was taken for the detection of respiratory viruses. All included patients were monitored until discharge to collect data on the need for mechanical ventilation, intensive care unit (ICU) admission, and mortality. All-cause 30-day mortality was also ascertained. Results: Four thousand three hundred twenty-seven patients were followed for 42,658 patient-days and 5,150 ventilator-days. Eighty-eight patients (2.03%) met the CDC criteria for HAP, 63 patients were included, and clinical and epidemiological characteristics showed no statistically significant differences between patients with virus associated healthcare-associated pneumonia (VAHAP) and those with non-viral healthcare-associated pneumonia (NVHAP). At least one respiratory virus was detected in 65% [95% CI (53-77)] of episodes of HAP, with a single viral pathogen observed in 53.9% and coinfection with 2 viruses in 11.1% of cases. The outcome in terms of ICU admission, mechanical ventilation and the 30-day mortality did not show a significant difference between groups. Conclusions: In two-thirds of the patients a respiratory virus was identified. There was no difference in mortality or the rest of the clinical outcome variables. About half of the patients required mechanical ventilation and 10% died, which emphasizes the importance of considering these pathogens in nosocomial infections, since their identification can influence the decrease in hospital costs and be taken into account in infection control policies.

Seroprevalencia de Bordetella pertussis en el personal de enfermería y médicos residentes del Hospital Infantil de México Federico Gómez / Seroprevalence of Bordetella pertussis in pediatric healthcare workers at the Hospital Infantil de México Federico Gómez

Resumen Introducción Bordetella pertussis es el agente causal de la tosferina, una enfermedad de alta letalidad, especialmente en menores de 6 meses, pero prevenible mediante la vacunación. Los reportes en hospitales de brotes de tosferina muestran que el caso índice suelen ser personas adultas. En adultos, la enfermedad se manifiesta principalmente con tos persistente. El propósito de este estudio fue conocer la seroprevalencia de B. pertussis en el personal de salud de un hospital pediátrico en un país donde aún no se considera la vacunación obligatoria para los empleados. Métodos Participaron personal de enfermería y médicos residentes en trato directo con pacientes hospitalizados. A cada participante se le realizó detección de anticuerpos inmunoglobulina G, antitoxina de pertussis (anti-TP) y se le aplicó un cuestionario para datos clínicos y demográficos. Resultados Se incluyeron 93 individuos, el 85% de personal de enfermería con mediana de edad de 35 años (rango intercuartil: 29-42.5). El 21.5% de los participantes laboraban en el Servicio de Urgencias, el 8.6%, en la Unidad de Terapia Intensiva Pediátrica, el 6.5%, en la Unidad de Cuidados Intensivos Neonatales. Se encontraron títulos detectables de anticuerpos anti-TP en el 18.3%, de los cuales, el 53% presentaron títulos de infección reciente y solamente el 23.5%, historia de tos de más de dos semanas de evolución. Conclusiones El personal de salud está en riesgo de sufrir la enfermedad y de transmitirla a los lactantes, quienes pueden fallecer por esta causa. Este estudio sugiere que las políticas actuales de vacunación en personal de salud se deben de modificar para determinar obligatoriedad de la vacuna, especialmente en quienes atienden a la población pediátrica.

Abstract Background Bordetella pertussis is the causative agent of pertussis, a disease that is preventable by vaccination but has a high mortality, particularly in children < 6 months. Reports of pertussis outbreaks in hospitals show that the index case is usually an adult. In adults, the disease manifests mainly with persistent cough. The purpose of this study was to determine the seroprevalence of B. pertussis in the health personnel of a pediatric hospital in a country where vaccination of this staff is not considered mandatory. Methods Nursing staff and resident doctors who were involved in direct treatment with hospitalized patients participated in the study. Each participant was screened for immunoglobulin G anti-pertussis toxin antibodies (anti-PT), and a questionnaire was applied for clinical and demographic data. Results Ninety-three individuals were included, of which 85% were nurses, median age 35 years (interquartile range: 29-42.5). The participants worked in the emergency department (21.5%), in the Pediatric Intensive Care Unit (8.6%), and in the Neonatal Intensive Care Unit (6.5%). Detectable titers of anti-TP antibodies were found in 18.3%, of which 53% presented titles suggestive of recent infection and only 23.5% cough > 2 weeks of duration. Conclusions Health personnel are at risk of suffering from the disease and be potential transmitters to infants, who may die from this cause. This study suggests that the current vaccination policies in health personnel should be modified to determine the compulsory nature of the vaccination, especially in those individuals in charge of the care of the pediatric population.

Seroprevalence of Bordetella pertussis in pediatric healthcare workers at the Hospital Infantil de México Federico Gómez.

Background: Bordetella pertussis is the causative agent of pertussis, a disease that is preventable by vaccination but has a high mortality, particularly in children < 6 months. Reports of pertussis outbreaks in hospitals show that the index case is usually an adult. In adults, the disease manifests mainly with persistent cough. The purpose of this study was to determine the seroprevalence of B. pertussis in the health personnel of a pediatric hospital in a country where vaccination of this staff is not considered mandatory. Methods: Nursing staff and resident doctors who were involved in direct treatment with hospitalized patients participated in the study. Each participant was screened for immunoglobulin G anti-pertussis toxin antibodies (anti-PT), and a questionnaire was applied for clinical and demographic data. Results: Ninety-three individuals were included, of which 85% were nurses, median age 35 years (interquartile range: 29-42.5). The participants worked in the emergency department (21.5%), in the Pediatric Intensive Care Unit (8.6%), and in the Neonatal Intensive Care Unit (6.5%). Detectable titers of anti-TP antibodies were found in 18.3%, of which 53% presented titles suggestive of recent infection and only 23.5% cough > 2 weeks of duration. Conclusions: Health personnel are at risk of suffering from the disease and be potential transmitters to infants, who may die from this cause. This study suggests that the current vaccination policies in health personnel should be modified to determine the compulsory nature of the vaccination, especially in those individuals in charge of the care of the pediatric population.

Introducción: Bordetella pertussis es el agente causal de la tosferina, una enfermedad de alta letalidad, especialmente en menores de 6 meses, pero prevenible mediante la vacunación. Los reportes en hospitales de brotes de tosferina muestran que el caso índice suelen ser personas adultas. En adultos, la enfermedad se manifiesta principalmente con tos persistente. El propósito de este estudio fue conocer la seroprevalencia de B. pertussis en el personal de salud de un hospital pediátrico en un país donde aún no se considera la vacunación obligatoria para los empleados. Métodos: Participaron personal de enfermería y médicos residentes en trato directo con pacientes hospitalizados. A cada participante se le realizó detección de anticuerpos inmunoglobulina G, antitoxina de pertussis (anti-TP) y se le aplicó un cuestionario para datos clínicos y demográficos. Resultados: Se incluyeron 93 individuos, el 85% de personal de enfermería con mediana de edad de 35 años (rango intercuartil: 29-42.5). El 21.5% de los participantes laboraban en el Servicio de Urgencias, el 8.6%, en la Unidad de Terapia Intensiva Pediátrica, el 6.5%, en la Unidad de Cuidados Intensivos Neonatales. Se encontraron títulos detectables de anticuerpos anti-TP en el 18.3%, de los cuales, el 53% presentaron títulos de infección reciente y solamente el 23.5%, historia de tos de más de dos semanas de evolución. Conclusiones: El personal de salud está en riesgo de sufrir la enfermedad y de transmitirla a los lactantes, quienes pueden fallecer por esta causa. Este estudio sugiere que las políticas actuales de vacunación en personal de salud se deben de modificar para determinar obligatoriedad de la vacuna, especialmente en quienes atienden a la población pediátrica.

Understanding nationwide readmissions after thyroid surgery.

BACKGROUND: The 30-day readmission rate is increasingly utilized as a metric of quality that impacts reimbursement. To date, there are no nationally representative data on readmission rates after thyroid surgery. We aimed to determine national readmission rates after inpatient thyroidectomy operations and whether select clinical factors were associated with increased odds of postthyroidectomy readmission. METHODS: Using the 2014 Nationwide Readmissions Database, we identified patients undergoing inpatient thyroid surgery as defined by the International Classification of Diseases, Ninth Revision, procedure codes for thyroid lobectomy, partial thyroidectomy, complete thyroidectomy, and substernal thyroidectomy. Descriptive statistics were used to report readmission rates, most common diagnosis and causes of readmission, and timing of presentation after discharge. Multivariable logistic regression models controlling for potential confounders were used to determine whether select factors were associated with 30-day readmission. RESULTS: A total of 22,654 patients underwent inpatient thyroid surgery during the study period, 990 of whom (4.4%) were readmitted within 30 days. Among these, the most common diagnoses during readmission were disorders of mineral metabolism and hypocalcemia, accounting for 36.0% and 26.6% of readmissions, respectively. This held true regardless of the apparent indication for thyroid surgery (goiter, cancer, or thyroid function disorder) or timing of readmission after discharge. Calcium-related abnormalities were the top diagnoses at readmissions (22.1%). Most readmissions (54.6%) occurred within 7 days of discharge, with 24.6% within the first 2 days Factors associated with an increased odds of readmission included having Medicare (adjusted odds ratio [AOR] 1.47 and 95% confidence interval [CI] 1.03-2.11) or Medicaid insurance (AOR 1.44 [CI 1.04-1.99]), being discharged to inpatient post acute care (AOR 2.31 [CI 1.48-3.62]) or to home health care (AOR 1.78 [CI 1.21-2.63]), having an Elixhauser comorbidity score ≥ 4 (AOR 2.04 [CI 1.27-3.26]), and a duration of stay ≥2 days after the thyroid surgery (AOR 2.7 [CI 1.9-3.82]). The only complication during index admission associated with increased odds of readmission was hypocalcemia (AOR 1.5 [CI 1.1-2.06]. Indications for thyroid surgery were not associated with increased odds of readmission. CONCLUSION: Readmissions after thyroid surgery are relatively low and occur early after surgery. The most common diagnoses identified on readmission were calcium and mineral metabolism disorders, which also were the most common cause of readmission. Socioeconomic factors, comorbidities, and complications during the index admissions were found to be associated with nonelective, postthyroidectomy readmissions. Recognition of these risk factors may guide the development of interventions and protocols to decrease readmissions.

Estudio comparativo de la osteointegración de dos tornillos biocompuestos en el tunel tibial mediante tomografía axial computada en pacientes operados de reconstrucción del ligamento cruzado anterior / Osseointegration process of bioabsorbable screws with CT scan in ACL reconstruction

Introducción: La reconstrucción del LCA es uno de los procedimientos ortopédicos más comunes. Los tornillos por interferencia biocompuestos están integrados por un polímero y algún material osteoconductor, cuya función es promover el crecimiento óseo en el sitio del implante al mismo tiempo que éste se reabsorbe. Material y método: se incluyeron un total de 28 pacientes, operados de reconstrucción artroscópica de LCA fijados con tornillo Milagro y tornillo bio-intrafix. Todos los pacientes fueron valorados con TAC, se realizaron mediciones del diámetro del túnel tibial en el segmento proximal, medio y distal, con trazo libre utilizando por lo menos 10 puntos de referencia para cada trazo. Así como una valoración subjetiva en relación a la presencia o ausencia de esclerosis adyacente al tornillo. Resultados: del total de la muestra, 12 pacientes no presentaron datos de osteointegración y 16 pacientes sí, encontrándose una asociación significativa entre osteointegración y el tornillo Milagro (p=0.006). En cuanto a degradación, no se observó ningún paciente sin datos de degradación. 53 por ciento se catalogaron como degradación parcial y 47 por ciento como total, de éstos el 76.9 por ciento pertenecían al grupo con tornillo Milagro encontrándose así una asociación entre el tornillo Milagro y degradación (p=0.006). Discusión y conclusiones: el tornillo Milagro fue el que se asoció con osteointegración. El área total en el túnel tibial incrementó, siendo éste porcentaje mayor para el tornillo bio-intrafix. Sin embargo, no se encontró una relación lineal entre el tiempo transcurrido desde la cirugía y el cambio en el área del túnel tibial; sugerente de que existen otros factores que influyen en este proceso. A pesar de los resultados clínicos satisfactorios, la adición de una cerámica osteoconductora no resultó en osteointegración completa de ninguno de los tornillos. Nivel de evidencia: III. Tipo de estudio: Cuasiexperimental, transversal, ambilectivo.

Introduction: The ACL reconstruction is one of the most common procedures in orthopedics. The bio-interference screws are made of a polymer plus an osteoconductive ceramic which function is to promote bone formation at the site of the implant while it reabsorbs. Methods: 28 patient were included, all were submitted to an arthroscopic ACL reconstruction procedure. CT scans were made in all of them, the diameter of the tibial tunnel was measured at the proximal, medial, and distal segments by a 10 point reference free hand line. Also a subjective evaluation was made in relation to the presence of adjacent sclerosis at the screw. Results: from the total sample, 12 patients did not show signs of osseointegration, 16 did, finding a significant association between osseointegration and the Milagro screw (p=0.006). None of the patients had absence of degradation. 53% were classified as partial degradation and 47% as total, from these the 76.9% belong to the Milagro screw group resulting in an association between the Milagro screw and total degradation (p=0.006). Discussion and conclusions: the Milagro screw was associated with osseointegration. The total area of the tibial tunnel increased, being this percentage major for the bio-intrafix screw. Hence, a linear relation was not found between the time from intervention and the change at the area of the tibial tunnel though, suggesting there are other factors that influence this process. Beside the satisfactory clinical results, the addition of an osseoconductive ceramic did not result in a complete osseointegration of neither screw. Level of evidence: III. Type of study: Cuasi experimental, transversal, ambilective.

Estudio comparativo de la osteointegración de dos tornillos biocompuestos en el tunel tibial mediante tomografía axial computada en pacientes operados de reconstrucción del ligamento cruzado anterior / Osseointegration process of bioabsorbable screws with CT scan in ACL reconstruction

Introducción: La reconstrucción del LCA es uno de los procedimientos ortopédicos más comunes. Los tornillos por interferencia biocompuestos están integrados por un polímero y algún material osteoconductor, cuya función es promover el crecimiento óseo en el sitio del implante al mismo tiempo que éste se reabsorbe. Material y método: se incluyeron un total de 28 pacientes, operados de reconstrucción artroscópica de LCA fijados con tornillo Milagro y tornillo bio-intrafix. Todos los pacientes fueron valorados con TAC, se realizaron mediciones del diámetro del túnel tibial en el segmento proximal, medio y distal, con trazo libre utilizando por lo menos 10 puntos de referencia para cada trazo. Así como una valoración subjetiva en relación a la presencia o ausencia de esclerosis adyacente al tornillo. Resultados: del total de la muestra, 12 pacientes no presentaron datos de osteointegración y 16 pacientes sí, encontrándose una asociación significativa entre osteointegración y el tornillo Milagro (p=0.006). En cuanto a degradación, no se observó ningún paciente sin datos de degradación. 53 por ciento se catalogaron como degradación parcial y 47 por ciento como total, de éstos el 76.9 por ciento pertenecían al grupo con tornillo Milagro encontrándose así una asociación entre el tornillo Milagro y degradación (p=0.006). Discusión y conclusiones: el tornillo Milagro fue el que se asoció con osteointegración. El área total en el túnel tibial incrementó, siendo éste porcentaje mayor para el tornillo bio-intrafix. Sin embargo, no se encontró una relación lineal entre el tiempo transcurrido desde la cirugía y el cambio en el área del túnel tibial; sugerente de que existen otros factores que influyen en este proceso. A pesar de los resultados clínicos satisfactorios, la adición de una cerámica osteoconductora no resultó en osteointegración completa de ninguno de los tornillos. Nivel de evidencia: III. Tipo de estudio: Cuasiexperimental, transversal, ambilectivo.(AU)

Introduction: The ACL reconstruction is one of the most common procedures in orthopedics. The bio-interference screws are made of a polymer plus an osteoconductive ceramic which function is to promote bone formation at the site of the implant while it reabsorbs. Methods: 28 patient were included, all were submitted to an arthroscopic ACL reconstruction procedure. CT scans were made in all of them, the diameter of the tibial tunnel was measured at the proximal, medial, and distal segments by a 10 point reference free hand line. Also a subjective evaluation was made in relation to the presence of adjacent sclerosis at the screw. Results: from the total sample, 12 patients did not show signs of osseointegration, 16 did, finding a significant association between osseointegration and the Milagro screw (p=0.006). None of the patients had absence of degradation. 53% were classified as partial degradation and 47% as total, from these the 76.9% belong to the Milagro screw group resulting in an association between the Milagro screw and total degradation (p=0.006). Discussion and conclusions: the Milagro screw was associated with osseointegration. The total area of the tibial tunnel increased, being this percentage major for the bio-intrafix screw. Hence, a linear relation was not found between the time from intervention and the change at the area of the tibial tunnel though, suggesting there are other factors that influence this process. Beside the satisfactory clinical results, the addition of an osseoconductive ceramic did not result in a complete osseointegration of neither screw. Level of evidence: III. Type of study: Cuasi experimental, transversal, ambilective.(AU)

Prevention of intestinal adhesions as a result of intraperitoneal mesh with the addition of hyaluronic acid/carboxymethylcellulose gel. Experimental model in rats.

BACKGROUND: Intraperitoneal meshes produce adhesions and intestinal fistula. Composite materials with an antiadherent barrier prevent that complication. There are no studies using gel products in intraperitoneal meshes to keep in contact with viscera. METHODS: Two groups of 20 rats each were used. Polypropylene mesh was placed intraperitoneally in both groups adding hyaluronic acid/carboxymethylcellulose gel to the mesh in the study group. At 28 days, rats were sacrificed and evaluated using the Diamond adhesions scale. RESULTS: There were 20 rats in the study group and 19 rats in the control group (one postoperative death). Control group all had adhesions: six (32%) >50% of the mesh surface. In the study group one rat (5%) showed no adhesions, and in 14 (70%) <25% of the mesh surface. Severity showed strong and cohesive adhesions in 11 (58%) control group rats and thin, avascular adhesions in 11 (55%) study group rats. For density, in the study group there were two rats (10%) where adhesions were released spontaneously by separating the flap. There was mild to moderate traction in 16 (80%) study group rats and six (32%) control group rats. Adhesiolysis with scissors was used in the study group (5%) and in 13 (68%) control group rats (p <0.05). CONCLUSIONS: Hyaluronic acid/carboxymethylcellulose gel appears to be effective in reducing the percentage of adhesions to segments of intraperitoneal mesh implants.