Resultados funcionales e imagenológicos de la reparación artroscópica de lesiones parciales bursales del manguito rotador sin acromioplastia. Seguimiento a mediano plazo / Midterm functional outcomes and tendon integrity after in situ repair of partial bursal supraspinatus tears without acromioplasty

Antecedentes y objetivoAnalizar la cicatrización mediante ecografía y el seguimiento funcional a mediano plazo de pacientes con roturas parciales bursales del manguito rotador (RPBMR) con reparación in situ sin acromioplastia.Materiales y métodosSe evaluaron 62 pacientes. Se realizó la medición del rango de movimiento y la puntuación en el score American Shoulder and Elbow Surgeons (ASES). El dolor se registró usando una escala visual análoga (EVA). Se valoró ecográficamente la reparación con un mínimo de seguimiento de 5 años.ResultadosLa edad promedio fue de 57,2 años (rango de 44 a 77 años) y el seguimiento promedio, de 7 años (rango de 5 a 9 años). Todos los parámetros del rango de movimiento activo mejoraron significativamente (p<0,0001). El puntaje de ASES mejoró de 46,5 a 90,2 y los puntajes EVA mejoraron de 6,5 a 1,73 (p<0,0001). Un total de 56 pacientes (90%) realizaron control ecográfico al final del seguimiento; 51 presentaron integridad del tendón (91%) en la ecografía. Cinco pacientes presentaron re-roturas (9%); 3 tuvieron una re-rotura completa del tendón (5%) y 2 una re-rotura parcial (4%). No hubieron diferencias funcionales o del rango de movilidad significativas entre aquellos pacientes con el tendón intacto y los que presentaron re- roturas.ConclusionesA mediano plazo, la reparación in situ artroscópica de RPBMR demostró excelentes resultados funcionales en la mayoría de los pacientes con baja tasa de complicaciones. Estos mantienen un alto índice de cicatrización en el tiempo.(AU)

Background and purposeThe purpose of this study was to analyze midterm functional outcomes and tendon integrity in patients treated with in situ arthroscopic repair of Partial Bursal Rotator Cuff Tears (PBRCTs) without acromioplasty.Materials and methodsSixty two patients were included. Clinical assessment consisted of glenohumeral range of motion measurement and the American Shoulder and Elbow Surgeons (ASES) score. Pain was rated by using a visual analog scale (VAS). A postoperative ultrasound image control was performed at a minimum 5 years follow up to assess tendon integrity.ResultsMean age was 57.2 years (range, 44–77 years) and mean follow up was 7 years (range of 5–9 years). Significant improvements in range of motion, functional outcomes and pain were observed postoperatively (P<.0001). The ASES score improved from 46.5 to 90.2; and the VAS improved from 6.5 to 1.73 (P<.0001). Fifty six patients (90%) performed ultrasound evaluation at the end of follow up. Fifty-one patients (91%) presented tendon integrity on ultrasound. Five patients presented re-tears (9%). Three patients (5%) had a complete tendon re-tear and two patients (4%) had a partial re-tear. No difference in range of motion or functional outcomes were found between patients with intact tendon and those who had re-tears.ConclusionsIn the midterm follow up, arthroscopic in situ repair PBRCTs without acromioplasty showed excellent functional outcomes and high healing rates in most patients with low complication rates.(AU)

Midterm functional outcomes and tendon integrity after in situ repair of partial bursal supraspinatus tears without acromioplasty / Resultados funcionales e imagenológicos de la reparación artroscópica de lesiones parciales bursales del manguito rotador sin acromioplastia. Seguimiento a mediano plazo

Background and purposeThe purpose of this study was to analyze midterm functional outcomes and tendon integrity in patients treated with in situ arthroscopic repair of Partial Bursal Rotator Cuff Tears (PBRCTs) without acromioplasty.Materials and methodsSixty two patients were included. Clinical assessment consisted of glenohumeral range of motion measurement and the American Shoulder and Elbow Surgeons (ASES) score. Pain was rated by using a visual analog scale (VAS). A postoperative ultrasound image control was performed at a minimum 5 years follow up to assess tendon integrity.ResultsMean age was 57.2 years (range, 44–77 years) and mean follow up was 7 years (range of 5–9 years). Significant improvements in range of motion, functional outcomes and pain were observed postoperatively (P<.0001). The ASES score improved from 46.5 to 90.2; and the VAS improved from 6.5 to 1.73 (P<.0001). Fifty six patients (90%) performed ultrasound evaluation at the end of follow up. Fifty-one patients (91%) presented tendon integrity on ultrasound. Five patients presented re-tears (9%). Three patients (5%) had a complete tendon re-tear and two patients (4%) had a partial re-tear. No difference in range of motion or functional outcomes were found between patients with intact tendon and those who had re-tears.ConclusionsIn the midterm follow up, arthroscopic in situ repair PBRCTs without acromioplasty showed excellent functional outcomes and high healing rates in most patients with low complication rates.(AU)

Antecedentes y objetivoAnalizar la cicatrización mediante ecografía y el seguimiento funcional a mediano plazo de pacientes con roturas parciales bursales del manguito rotador (RPBMR) con reparación in situ sin acromioplastia.Materiales y métodosSe evaluaron 62 pacientes. Se realizó la medición del rango de movimiento y la puntuación en el score American Shoulder and Elbow Surgeons (ASES). El dolor se registró usando una escala visual análoga (EVA). Se valoró ecográficamente la reparación con un mínimo de seguimiento de 5 años.ResultadosLa edad promedio fue de 57,2 años (rango de 44 a 77 años) y el seguimiento promedio, de 7 años (rango de 5 a 9 años). Todos los parámetros del rango de movimiento activo mejoraron significativamente (p<0,0001). El puntaje de ASES mejoró de 46,5 a 90,2 y los puntajes EVA mejoraron de 6,5 a 1,73 (p<0,0001). Un total de 56 pacientes (90%) realizaron control ecográfico al final del seguimiento; 51 presentaron integridad del tendón (91%) en la ecografía. Cinco pacientes presentaron re-roturas (9%); 3 tuvieron una re-rotura completa del tendón (5%) y 2 una re-rotura parcial (4%). No hubieron diferencias funcionales o del rango de movilidad significativas entre aquellos pacientes con el tendón intacto y los que presentaron re- roturas.ConclusionesA mediano plazo, la reparación in situ artroscópica de RPBMR demostró excelentes resultados funcionales en la mayoría de los pacientes con baja tasa de complicaciones. Estos mantienen un alto índice de cicatrización en el tiempo.(AU)

Midterm functional outcomes and tendon integrity after in situ repair of partial bursal supraspinatus tears without acromioplasty. / Resultados funcionales e imagenológicos de la reparación artroscópica de lesiones parciales bursales del manguito rotador sin acromioplastia. Seguimiento a mediano plazo.

BACKGROUND AND PURPOSE: The purpose of this study was to analyze midterm functional outcomes and tendon integrity in patients treated with in situ arthroscopic repair of Partial Bursal Rotator Cuff Tears (PBRCTs) without acromioplasty. MATERIALS AND METHODS: Sixty two patients were included. Clinical assessment consisted of glenohumeral range of motion measurement and the American Shoulder and Elbow Surgeons (ASES) score. Pain was rated by using a visual analog scale (VAS). A postoperative ultrasound image control was performed at a minimum 5 years follow up to assess tendon integrity. RESULTS: Mean age was 57.2 years (range, 44-77 years) and mean follow up was 7 years (range of 5-9 years). Significant improvements in range of motion, functional outcomes and pain were observed postoperatively (P<.0001). The ASES score improved from 46.5 to 90.2; and the VAS improved from 6.5 to 1.73 (P<.0001). Fifty six patients (90%) performed ultrasound evaluation at the end of follow up. Fifty-one patients (91%) presented tendon integrity on ultrasound. Five patients presented re-tears (9%). Three patients (5%) had a complete tendon re-tear and two patients (4%) had a partial re-tear. No difference in range of motion or functional outcomes were found between patients with intact tendon and those who had re-tears. CONCLUSIONS: In the midterm follow up, arthroscopic in situ repair PBRCTs without acromioplasty showed excellent functional outcomes and high healing rates in most patients with low complication rates.

Surgical fixation of displaced midshaft clavicular fractures with precontoured plates in adolescents. / Tratamiento de fracturas mediodiafisarias de clavícula con placas precontorneadas en adolescentes.

BACKGROUND: The use of plate fixation to treat displaced midshaft clavicular fractures in adults reduces complications and residual shoulder disability. New features of the precontoured locking plates have been shown to reduce the need for hardware removal in adults. There is a lack of studies evaluating surgical fixation of displaced clavicular fractures with precontoured plates in adolescents. We evaluate outcomes and complications of adolescents with displaced midshaft clavicular fractures treated with precontoured locking plates. MATERIALS AND METHODS: 40 adolescents with displaced midshaft clavicular fractures were surgically treated from January 2010 to May 2017. Outcomes were evaluated using the Constant score, the 11- item version of the Disabilities of Arm, Shoulder and Hand (QuickDASH) questionnaires, and radiographs, and a visual analog scale. Return-to-sport rate, level achieved, and complications were recorded. RESULTS: Mean follow-up was 50 months (18 - 108 months). Constant, Quick-DASH, and visual analog scale scores were 95.6, 2.8 and 0.5 points, respectively. 100% of adolescents returned to sports at the same level they had before injury. Mean time to return was 69 days and 95% of patients were able to return before 12 weeks. Complication rate was 12.5%, 3 patients (7.5%) required hardware removal. CONCLUSIONS: Adolescents with displaced midshaft clavicular fractures treated with precontoured locking plates exhibited satisfactory outcomes and low complication rate. Compared to other reports, this study had lower rates, anatomic plates might reduce hardware-related complications.

Resultados de la artroplastia parcial de superficie para el tratamiento de pacientes con necrosis ósea avascular del húmero proximal / Results of partial resurfacing of humeral head in patients with avascular necrosis

Objetivo: El objetivo de este trabajo es reportar los resultados a corto plazo y las complicaciones de la artroplastia de superficie del húmero proximal (HemiCup(R)) en pacientes tratados por necrosis ósea avascular. Material y métodos: Entre 2010 y 2014 fueron evaluados 9 pacientes a los que se les realizó una artroplastia de superficie del húmero proximal. Todos los pacientes fueron tratados por necrosis ósea avascular. El seguimiento promedio fue de 44 meses (mínimo 24 meses). La edad promedio fue de 47 años (rango 32-57 años). Los pacientes fueron evaluados cínica y radiológicamente. Se reportaron las complicaciones. Resultados: Los pacientes presentaron una mejoría significativa en los scores funcionales y la movilidad entre el preoperatorio y el último control en el seguimiento. El score de Constant mejoró de 35 a 79 puntos (p<0,001), el score de ASES mejoró de 31 a 76 puntos (p<0,001), la flexión anterior y la rotación externa mejoraron de 101 a 150° (p<0,001) y de 24 a 45° (p<0,001), respectivamente. Un paciente presentó desgaste sintomático en la glena durante el seguimiento, requiriendo una cirugía de revisión. Conclusión: En nuestra serie, la artroplastia parcial de superficie del húmero proximal (HemiCup(R)) demostró una mejoría significativa en los scores funcionales y la movilidad en pacientes tratados por necrosis ósea avascular, con un seguimiento promedio de 44 meses

Objective: The aim of this study was to report the short-term results and complications of partial humeral head resurfacing (HemiCup(R)) in patients treated by avascular necrosis. Material and methods: Between 2010 and 2014, 9 patients who underwent partial resurfacing of humeral head were evaluated. All the patients were treated by avascular necrosis. The mean follow-up was 44 months (minimum 24 months). The average age was 47 years (range 32-57 years). The patients were evaluated clinically and radiologically. Complications were reported. Results: The patients had a significant improvement in functional scores and mobility between the pre-operative and last follow-up control. The Constant score improved from 35 to 79 points (P<.001), ASES score improved from 31 to 76 points (P<.001), forward flexion and external rotation improved from 101 to 150° (P<.001), and from 24 to 45° (P<.001), respectively. One patient presented symptomatic glenoid wear during follow-up, requiring revision surgery. Conclusion: In our patients treated by avascular necrosis, the partial resurfacing of humeral head (HemiCup(R)) demonstrated a significant improvement in functional scores and mobility with an average follow-up of 44 months

Results of partial resurfacing of humeral head in patients with avascular necrosis. / Resultados de la artroplastia parcial de superficie para el tratamiento de pacientes con necrosis ósea avascular del húmero proximal.

OBJECTIVE: The aim of this study was to report the short-term results and complications of partial humeral head resurfacing (HemiCup®) in patients treated by avascular necrosis. MATERIAL AND METHODS: Between 2010 and 2014, 9 patients who underwent partial resurfacing of humeral head were evaluated. All the patients were treated by avascular necrosis. The mean follow-up was 44 months (minimum 24 months). The average age was 47 years (range 32-57 years). The patients were evaluated clinically and radiologically. Complications were reported. RESULTS: The patients had a significant improvement in functional scores and mobility between the pre-operative and last follow-up control. The Constant score improved from 35 to 79 points (P<.001), ASES score improved from 31 to 76 points (P<.001), forward flexion and external rotation improved from 101 to 150° (P<.001), and from 24 to 45° (P<.001), respectively. One patient presented symptomatic glenoid wear during follow-up, requiring revision surgery. CONCLUSION: In our patients treated by avascular necrosis, the partial resurfacing of humeral head (HemiCup®) demonstrated a significant improvement in functional scores and mobility with an average follow-up of 44 months.

Developmental expression and location of IGF-I and IGF-II mRNA and protein in skeletal muscle.

To investigate the role of IGF in muscle development in vivo, developmental expression and location of IGF-I and -II protein and mRNA were examined in fetal, postnatal, and adult skeletal muscle. Muscle tissue was collected from 30-, 44-, 59-, 68-, 75-, 89-, and 109-d porcine fetuses, 21-d neonatal pigs, and 6-mo-old (adult) pigs. Relative amounts of IGF-II mRNA peaked (P < .05) in 59-d fetal muscle and decreased thereafter. Inversely, muscle IGF-I expression increased (P < .05) to maximal levels around birth. For in situ hybridization, frozen muscle tissue sections (10 microm) were hybridized with a hydrolyzed form of the same riboprobes or incubated with polyclonal or monoclonal antibodies to IGF-I or -II, respectively. The majority of IGF-I and IGF-II mRNA was localized to developing muscle fibers, whereas little signal was found in the surrounding connective tissues. Immunofluorescent localization of IGF-I and -II confirmed that muscle IGF are present in developing muscle fibers. Collectively, these data show that IGF-I and -II are expressed and produced primarily in muscle cells within developing muscle tissue and support the hypothesis that IGF-I and -II modulate fetal muscle development.

Leptin expression in porcine adipose tissue is not increased by endotoxin but is reduced by growth hormone.

The physiologic response to infection includes reductions in tissue concentrations of anabolic growth factors as a means of reducing growth and conserving nutrients for immunologic processes. This repartitioning of nutrients is accompanied by anorexia, which has been linked to increased leptin expression. Furthermore, leptin and growth hormone (GH) concentrations are inversely related, with leptin being required for normal GH release. The objective of this study was to determine if pretreatment with GH would influence endotoxin-induced changes in leptin expression or attenuate endotoxin-induced reductions in serum insulin-like growth factor-1 (IGF-1) and IGF-1 expression in liver and longissimus muscle. In experiment 1, 40 pigs were assigned to four treatments (n = 10 per treatment) arranged as a 2x2 factorial with GH (s.c. injection, 2 mg 1 h before challenge and 2 mg 2 h after challenge) and endotoxin (single i.m. injection, 25 microg/kg body weight) as main effect variables. Pretreatment with GH resulted in a marked increase (p<0.001) in serum GH within 1 h that was sustained throughout the study. Endotoxin challenge reduced (p<0.003) serum IGF-1 independent of GH (GH x endotoxin, p>0.682), and reduced (p<0.05) IGF-1 expression in longissimus muscle but not liver. Leptin mRNA abundance was reduced 56% (p<0.005) by GH but was not affected by endotoxin (p>0.81). In experiment 2, 36 pigs (n = 12 per treatment) were either allowed ad libitum feed consumption with no injection or deprived of feed and injected twice with either saline or endotoxin 24 h apart. Feed deprivation reduced leptin expression (p<0.05). However, endotoxin did not change leptin expression but markedly increased (p<0.05) serum haptoglobin. These data indicate that changes in IGF-1 status in endotoxin-challenged pigs are independent of serum GH and that leptin expression is not increased by endotoxin challenge in the pig. These data also indicate a regulatory linkage between GH and leptin in vivo.

Disseminated cutaneous eruption after BCG vaccination.

We present nine infants (3 to 10 months of age) with numerous small, papular, papular-lichenoid, and papulo-pustular lesions predominantly on the upper and lower limbs associated with local (axillary) lymphadenopathy which appeared after BCG vaccination. Histopathology of the lesions showed small tuberculoid granulomas mainly in the papillary dermis. The presence of BCG bacillus was demonstrated in five out of seven samples from the lymph nodes after culture and in one skin biopsy specimen. All cases, whether treated or not, evolved to complete resolution of the skin lesions. We believe that this peculiar association results from hematogenous spread of the bacillus, which regresses after an adequate immune system reaction.

Fox-Fordyce disease in two prepubertal girls: histopathologic demonstration of eccrine sweat gland involvement.

This report presents two prepubertal girls with Fox-Fordyce disease. The pruritic papules extensively affected the areas where apocrine glands are distributed (axillae, periareolar and intermammary zones, pubes, infraumbilical midline), and also extended to the neck and face near the external angle of the eyes in one child. Analyses of several biopsy specimens showed that the main lesion was a spongiotic vesicle containing inflammatory cells and keratinocytes affecting the hair infundibula and acrosyringia, together, with hyperkeratosis of both adnexa. The cause of the disease remains elusive, but the microscopic findings may explain the good results obtained with keratolytic agents.

Congenital hemangioma of eccrine sweat glands.

We present six patients with congenital hemangioma of eccrine sweat glands. In every one the lesion was congenital, clinically angiomatous, painless, and nonsweating, with progressive involution over months. Histologically all specimens showed many dilated capillaries with prominent endothelial cells associated with the eccrine sweat gland coils.

[Augmentation of the phagocytic activity of monocytes in patients with Darier's disease by the oral administration of retinoic acid]. / Aumento de la actividad fagocigótica de monocitos de pacientes con enfermedad de Darier por administración oral de ácido retinoico.

Other tissue involvement has been described in Darier's disease, eg: susceptibility to infection. In order to know if this susceptibility is due to abnormal phagocytosis and if this can revert by administration of retinoic acid (RA), blood monocyte-derived macrophages, from four individuals with Darier's disease were obtained prior and after administration of RA to determine in them morphological, cytochemical and phagocytic activity changes. It was observed that phagocytosis was diminished and RA administration increased it, without changes in enzyme distribution. This modification of phagocytosis could be due to a reordenation of cytoskeleton.