Total knee arthroplasty for treatment of osteoarthritis associated with extra-articular deformity.

OBJECTIVE: Our purpose was to review senior author results of TKA in patients with extra-articular angular deformities (correction of mechanical axis was performed without an additional procedure for osteotomy). METHODS: Results of TKA in nine knees with osteoarthritis and associated extra-articular angular deformity of femur were reviewed retrospectively. This group was compare with a with a control group of 20 patients diagnosed with osteoarthritis that underwent TKA without extra-articular deformity. Angulation of deformity in patients was 19° in coronal plane (range 15°-25°) and 12° in sagittal plane (range 8°-5°). Knee Score (KS) and Functional Score (FS) were measured pre and post-surgery, likewise arc flexion was reported. Results in KS and FS were correlationed with extra-articular angulation. RESULTS: Duration of follow-up averaged 55 months (range, 48-63 months). KS Average and FS increased from 50.5 and 38.4 points, preoperatively, to 96.5 and 84.4 points, respectively, at time of following-up. No statistically significant differences in any postoperative parameters were found between the postoperative group of extra-articular deformities and the control group were found. Positive correlation was obtained between deformity degrees and KS. Arc of motion averaged 86° preoperatively and 118° at time of following-up. No total knee arthroplasty was revised. CONCLUSION: In our opinion, best management for extra-articular deformities associated to osteoarthritis is to carry out a knee replacement without corrective osteotomy on condition that planification allow to us avoid ligaments insertions, using an extensive soft-tissue balancing in conjunction with a minimally constrained TKA.

Management of severe valgus knee by total unconstrained arthroplasty: A comparative study with long-term follow-up. / Tratamiento de valgos severos de rodilla mediante artroplastia total no constreñida: estudio comparativo con seguimiento a largo plazo.

OBJECTIVE: To evaluate the use of unconstrained implants in the correction of large valgus deformities using total knee arthroplasty (TKA). MATERIAL AND METHOD: A total of 817 primary TKA operated between 1998 and 2006 were retrospectively assessed. 50 TKA were selected (group A) in 49 patients, with a minimum deformity of 15° of valgus, 41 cases were included. Another 50 ATR were selected (group B), with a maximum deformity of 15° of varus, finally including 44 cases in 42 patients. The same surgeon performed every operation. The minimum follow-up time was 10 years. The Knee Society Score (KS and FS), the Oxford Knee Score (OKS) and the Range of Mobility (ROM), both preoperative and postoperative at 1,.5 and 10 years, as well as radiographic evolution and complications were evaluated. RESULTS: Preoperative values of KS, FS and OKS were lower in group A (P<.0001, P<.01 and P<.05, respectively), but not ROM. Postoperatively, KS, FS, OKS and ROM were not different between the groups, neither year, nor 5, nor 10 years. There were also no radiological or complications between the two groups. DISCUSSION: The use of non-constricted implants in severe valgus was not inferior to the mild varus, implying, in addition, a saving in economic terms, with excellent postoperative results. CONCLUSIONS: Correction of severe valgus deformities can be performed with non-constrained primary implants, without obtaining worse results than those obtained in mild deformities.

[Brain SPECT with 201-thallium in AIDS patients]. / SPECT cerebral con 201Tl en pacientes con SIDA.

UNLABELLED: Brain lymphoma is a late complication in AIDS. Lymphoma incidence is increasing in AIDS patients due to the introduction of HAART and prolongation of these patients' life expectancy. This work aims to evaluate the usefulness of brain SPECT with 201Tl in patients with AIDS who present focal brain lesions in computed tomography (CT). METHODS: Seventeen patients with neurologic symptoms and focal neurologic lesions in the CNS (central nervous system) were studied. The images were interpreted as positive when the intensity of the focal deposit of the tracer was greater than that of the adjacent tissue. The SPECT results were compared with serologic data, clinical evolution and/or radiologic follow-up and cerebral biopsy. RESULTS: SPECT images showed focal uptake of radiotracer in 3 patients. All three died shortly after the SPECT was performed. All of them had negative serology for toxoplasmosis. Four patients were diagnosed of progressive multifocal leukoencephalopathy and the ten remaining cases had a good clinical and/or radiologic response. CONCLUSIONS: Brain SPECT with 201Tl is a very useful non-invasive technique for the differential diagnosis of cerebral focal lesions in AIDS patients.

SPECT cerebral con 201Tl en pacientes con SIDA / Brain spect with 20 tallium in aids patients

El linfoma cerebral es una complicación tardía en la evolución del SIDA. La incidencia de linfoma cerebral en estos pacientes está aumentando debido a que el uso de la terapia antiretroviral de alta actividad prolonga la vida de los pacientes con SIDA. El propósito del presente trabajo es valorar la utilidad del SPECT cerebral con 201 Tl en los pacientes con SIDA que presentan lesiones neurológicas focales en la tomografía axial computarizada (TAC). Métodos: Se ha estudiado a 17 pacientes que presentaban sintomatología neurológica y lesiones focales en el SNC (sistema nervioso central). Se ha interpretado que las exploraciones eran positivas cuando existían depósitos focales del trazador de intensidad superior a la del tejido adyacente. Los resultados del SPECT cerebral se han comparado con datos serológicos, evolutivos clínicos y radiológicos, y biopsia cerebral. Resultados: Los 3 pacientes en los que el SPECT cerebral fue positivo fallecieron al poco tiempo de la exploración. Todos ellos tenían serología negativa para toxoplasma. Cuatro pacientes fueron diagnosticados de leucoencefalopatía multifocal progresiva y los otros 10 experimentaron mejoría clínica y/o radiológica. Conclusiones: El SPECT cerebral con 201Talio es una técnica no invasiva de gran utilidad en el diagnóstico diferencial de las lesiones focales del SNC en los pacientes con SIDA (AU)

Identification of AIDS-related tuberculosis with concordant gallium-67 and three-hour delayed thallium-201 scintigraphy.

Concordant gallium-67 and thallium-201 uptake has been described in malignant lesions. More recently, 201Tl accumulation has been described in some benign conditions. The authors report three HIV-positive patients who underwent 67Ga and 201Tl scintigraphy. These studies revealed concordant 67Ga and 201Tl uptake and tumour was erroneously diagnosed. All three patients were finally diagnosed as having tuberculosis.

[Subtotal hemilaryngectomy]. / Hemilaringuectomía subtotal.

The technique of subtotal hemilaryngectomy developed by the author is described. It consists of: 1. Performing a lymph node excision as wide and extensive as necessary. 2. Removal of half (in a sagittal sense) of the thyroid and arytenoid, if necessary, from the side of the lesion. 3. Complete preservation of the cricoid cartilage. 4. Immediate closure of the larynx defect with pre-laryngeal musculature.

[Treatment of sphenopalatine ganglion neuralgia]. / Tratamiento de la neuralgia del ganglio esfenopalatino.

The Sphenopalatine neuralgia of the ganglion is characterized for a throbbing pain mostly unilateral encircling the orbit and occasionally extended to the neighborhood. A vegetative component hydrorrhea, sneezing crisis and abnormal lacrimation is associated. The ideal therapy, giving excellent results, is the iontophoresis of the ganglion, which technic was published years ago by F. Barceló.

Treatment of acromioclavicular disruptions: trial of a simple surgical approach.

Following the Allman and the Zlotsky and Ballard classifications, 85 cases of acromioclavicular disruptions (ACD) have been treated. Types I and II have been conservatively managed, while type III was treated by a special surgical technique described in the text. Types I and II were reviewed by a questionnaire form and type III was assessed clinically and radiologically, with good results according to a score rating made for the review.