Paul Klee y la esclerosis sistémica / Paul Klee and systemic sclerosis

Paul Klee representa uno de los pilares del arte de vanguardia del principio del siglo XX. Produjo una ingente cantidad de obras artísticas en sus 60 años de vida. La esclerosis sistémica se manifestó cinco años antes de morir, pero no por ello redujo su actividad creadora. En este artículo se analiza su historia y su enfermedad que tanto influyeron en su obra, y que lo convirtieron en ejemplo paradigmático de resiliencia ante la adversidad.

Paul Klee represents one of the pillars of avant-garde art of the early 20th century. He produced an enormous amount of artistic works in the sixty years of his life. Systemic sclerosis appeared five years before he died, but this did not reduce his creative activity. This article analyzes his life and his illness that so influenced his work and that is a paradigmatic example of resilience in the face of adversity.

Lisfranc Joint Ligament Complex Reconstruction: A Promising Solution for Missed, Delayed, or Chronic Lisfranc Injury Without Arthritis.

The current classifications of "Lisfranc injury" can be purely ligamentous (low-grade midfoot sprains) or involve the osseous and articular structures (high-grade Lisfranc fracture displacements). The first type is often difficult to detect. If these patients are not properly treated, long-term disability can result. The rate of missed or delayed diagnoses has ranged from 13% to 24%, primarily owing to the subtlety of the radiographic findings. This is relatively more common in cases of subtle ligamentous injury (19%). The aim of the present report was to provide a new technique for missed or delayed Lisfranc injury without degenerative local signs. The Lisfranc ligament complex reconstruction is performed with a gracilis tendon graft and is protected by temporary screw fixation. We performed this technique in 3 patients. All 3 patients obtained good results, have been able to resume their previous activities, and have stated they would undergo this type of procedure again. The minimum follow-up length was 2 years.

'Patient blood management' en cirugía ortopédica / 'Patient blood management' in orthopaedic surgery

Los procedimientos de cirugía ortopédica y traumatológica (COT) pueden ocasionar pérdidas significativas de sangre y anemia postoperatoria aguda, que en muchos casos requiere transfusión de sangre alogénica (TSA). Las desventajas clínicas, económicas y logísticas de la TSA han promovido el desarrollo de programas multidisciplinares y multimodales, genéricamente conocidos como programas de Patient Blood Management (PBM), cuyo objetivo es el de reducir o eliminar la necesidad de TSA y mejorar el resultado clínico. Estos programas se apoyan en la aplicación de cuatro grupos de medidas perioperatorias: 1) uso de criterios restrictivos de transfusión; 2) estimulación de la eritropoyesis; 3) reducción del sangrado; y 4) transfusión de sangre autóloga. En este artículo, revisamos la eficacia, seguridad y recomendaciones de las estrategias aplicables en COT, así como los condicionantes para el desarrollo e implementación de los programas de PBM en esta especialidad (AU)

Orthopaedic and trauma surgical procedures (OTS) can lead to significant blood losses and acute postoperative anaemia, which in many cases requires allogeneic blood transfusions (ABT). The clinical, economic and logistical disadvantages of ABT have promoted the development of multidisciplinary and multimodal programs generically known as Patient Blood Management (PBM) programs, which have as their objective to reduce or eliminate the need for ABT and improve clinical outcomes. These programs are supported by the implementation of four groups of perioperative measures: (1) use of restrictive transfusion criteria; (2) stimulation of erythropoiesis; (3) reduction of bleeding; and (4) autologous blood transfusion. In this article, a review is presented of the effectiveness, safety and recommendations of applicable strategies in OTS, as well as the barriers and requirements to the development and implementation of PBM programs in this surgical specialty (AU)

"Patient blood management" in orthopaedic surgery.

Orthopaedic and trauma surgical procedures (OTS) can lead to significant blood losses and acute postoperative anaemia, which in many cases requires allogeneic blood transfusions (ABT). The clinical, economic and logistical disadvantages of ABT have promoted the development of multidisciplinary and multimodal programs generically known as Patient Blood Management (PBM) programs, which have as their objective to reduce or eliminate the need for ABT and improve clinical outcomes. These programs are supported by the implementation of four groups of perioperative measures: (1) use of restrictive transfusion criteria; (2) stimulation of erythropoiesis; (3) reduction of bleeding; and (4) autologous blood transfusion. In this article, a review is presented of the effectiveness, safety and recommendations of applicable strategies in OTS, as well as the barriers and requirements to the development and implementation of PBM programs in this surgical specialty.

Cellular Phone Overuse as A Cause for Trapeziometacarpal Osteoarthritis: A Two Case Report.

INTRODUCTION: New technologies have been related to upper limb diseases Trapeziometacarpal osteoarthritis in young patients has not been described yet as one of these "overuse pathologies". CASE REPORT: We present two cases. A 33 and a 32 year-old women, right handed, suffering from trapeziometacarpal pain. Neither previous trauma nor rheumatic disease was reported. Excessive use of last generation cellular phone was the only background reported. Pain and joint crepitation were found on physical examination and osteoarthritis signs were seen on MRI scans. One of the patients improved after using a cast, physical activity restrictions and a specific rehabilitation program; whilst the other required a corticosteroid joint injection. CONCLUSION: We warn about the potential growth of these pathologies caused by an indiscriminate use (or abuse) of touch-screen cellular phones.

Does the epiphyseal cartilage of the long bones have one or two ossification fronts?

Epiphyseal cartilage is hyaline cartilage tissue with a gelatinous texture, and it is responsible for the longitudinal growth of the long bones in birds and mammals. It is located between the epiphysis and the diaphysis. Epiphyseal cartilage also is called a growth plate or physis. It is protected by three bone components: the epiphysis, the bone bar of the perichondrial ring and the metaphysis. The epiphysis, which lies over the epiphyseal cartilage in the form a cupola, contains a juxtaposed bone plate that is near the epiphyseal cartilage and is in direct contact with the epiphyseal side of the epiphyseal cartilage. The germinal zone corresponds to a group of cells called chondrocytes. These chondrocytes belong to a group of chondral cells, which are distributed in rows and columns; this architecture is commonly known as a growth plate. The growth plate is responsible for endochondral bone growth. The aim of this study was to elucidate the causal relationship between the juxtaposed bone plate and epiphyseal cartilage in mammals. Our hypothesis is that cells from the germinal zone of the epiphyseal side of the epiphyseal cartilage are involved in forming a second ossification front that is responsible for the origin of the juxtaposed bone plate. We report the following: (a) The juxtaposed bone plate has a morphology and function that differs from that of the epiphyseal trabeculae; (b) on the epiphyseal edge of the epiphyseal cartilage, a new ossification front starts on the chondrocytes of the germinal area, which forms the juxtaposed bone plate. This ossification front is formed by chondrocytes from the germinal zone through a process of mineralisation and ossification, and (c) the process of mineralisation and ossification has a certain morphological analogy to the process of ossification in the metaphyseal cartilage of amphibians and differs from the endochondral ossification process in the metaphyseal side of the growth plate. The close relationship between the juxtaposed bone plate and the epiphyseal cartilage, in which the chondrocytes that migrate from the germinal area play an important role in the mineralisation and ossification process of the juxtaposed bone plate, supports the hypothesis of a new ossification front in the epiphyseal layer of the epiphyseal plate. This hypothesis has several implications: (a) epiphyseal cartilage is a morphological entity with two different ossification fronts and two different functions, (b) epiphyseal cartilage may be a morphological structure with three parts: perichondrial ring, metaphyseal ossification front or growth plate, and epiphyseal ossification front, (c) all disease (traumatic or dysplastic) that affects some of these parts can have an impact on the morphology of the epiphyseal region of the bone, (d) there is a certain analogy between metaphyseal cartilage in amphibians and mammalian epiphyseal cartilage, although the former is not responsible for bone growth, (e) comparative histological and anatomy studies are also warranted, to shed light on the phylogenetic study of epiphyseal cartilage throughout the changes that occur in the animal species.

Early regression of left ventricular hypertrophy after treatment with esmolol in an experimental rat model of primary hypertension.

Certain ß-adrenergic blockers have proven useful in the regression of ventricular remodeling when administered as long-term treatment. However, early regression of left ventricular hypertrophy (LVH) has not been reported, following short-term administration of these drugs. We tested the hypothesis that short-term administration of the cardioselective ß-blocker esmolol induces early regression of LVH in spontaneously hypertensive rats (SHR). Fourteen-month-old male SHRs were treated i.v. with vehicle (SHR) or esmolol (SHR-E) (300 µg kg(-1) min(-1)). Age-matched vehicle-treated male Wistar-Kyoto (WKY) rats served as controls. After 48 h, left ventricular morphology and function were assessed using M-mode echocardiograms (left ventricular mass index (LVMI), ejection fraction and transmitral Doppler (early-to-atrial filling velocity ratio (E/A), E-wave deceleration time (Edec time)). The standardized uptake value (SUV) was applied to evaluate FDG (2-deoxy-2[18F]fluoro-D-glucose) uptake by the heart using PET/CT. Left ventricular subendocardial and subepicardial biopsies were taken to analyze changes in cross-sectional area (CSA) of left ventricular cardiomyocytes and the fibrosis was expressed as collagen volume fraction (CVF). LVMI was lower in SHR-E with respect to SHR (P=0.009). There were no significant differences in EF, E/A ratio or Edec time in SHR-E compared with SHR (P=0.17, 0.55 and P=0.80, respectively). PET acquisitions in SHR-E showed lower (18)F-FDG uptake than SHR (P=0.003). Interestingly, there were no significant differences in SUV in either SHR-E or WKY (P=0.63). CSA in subendocardial and subepicardial regions was minor in SHR-E with respect to SHR (P<0.001), and there were no significant differences in CVF between both groups. Esmolol reverses early LVH in the SHR model of stable compensated ventricular hypertrophy. This is the first study to associate early regression of LVH with administration of a short-term ß-blocker.

Contribution to the initial pathodynamics of hip luxation in young rats.

BACKGROUND: An anatomo-functional system has been described for the normal hip of some young mammals. This system includes the ligamentum teres, the transverse acetabular ligament, and the meniscoid of the hip. PURPOSE: This report analyzes morphologic changes in the anatomo-functional system of young rats in an experimental model of hip luxation, and on the initial pathodynamics of luxation produced experimentally. METHODS: Hyperextension of the left knee was induced in 58 young rats through fixation of the tibia and femur with Kirschner wire. Radiographic, macroscopic, and microscopic parameters were analyzed for 3 study periods (group 1: 4 d, group 2: 1 wk, group 3: 2 wk), and macroscopic parameters were studied in a late group (group 4: 6 wk). RESULTS: Breaks in the Shenton line were observed from group 1 (subluxation) onward (luxation). Hypertrophy of the round and transverse acetabular ligaments of the acetabulum and meniscoid, progressive elevation of the meniscoid, and fibrosis of the fibrofatty (pulvinar) tissue occurred from group 1 onward. Radiographic and morphometric studies showed triplane innominate bone deformation (anterior bending, lateral tilt, and rotation of the ischium), which resulted in decreased joint space. As time progressed, the increase in these injuries was accompanied by morphologic changes in the acetabulum, posterosuperior displacement and reorientation of the acetabulum and extrusion of the femoral head. CONCLUSIONS: Under the conditions of this study, the temporospatial morphologic changes in the acetabulum due to injury of the anatomo-functional system, and the triplane pelvic deformity in the initial period of the injury, produced femoral head extrusion of the acetabulum. RELEVANT SYMPTOMS: These disorders may help us understand the pathogenic and clinical phenomena that appear in early stages of hip luxation disease.

Intra-articular osteoid osteoma simulating a painful fabella syndrome.

We present a case of an intra-articular osteoid osteoma in the knee that was mistaken for a painful fabella syndrome after unsuccessful knee arthroscopy for the treatment of postero-lateral knee pain. In this case both the initial clinical presentation and the imaging proved to be deceiving. The diagnosis of intra-articular osteoid osteoma was considered only once typical clinical features appeared and a Computerized Tomography scan was performed. We discuss the difficult of diagnosing an intra-articular osteoid osteoma and the imaging of choice.