[Partial exchange of components in chronic hip infection]. / Intercambio parcial de componentes en infección crónica de cadera.

INTRODUCTION: one- or two-stage total revision is considered the gold standard for the treatment of hip arthroplasty with chronic infection. However, during the removal of a fixed prosthetic component, the host bone may be damaged, making definitive prosthetic reimplantation difficult. OBJECTIVE: we present a series of patients treated for chronic periprosthetic hip infection with preservation of one fixed component. MATERIAL AND METHODS: this study included 12 patients with hip arthroplasty and chronic periprosthetic infection scheduled for one or two-stage partial replacement with retention of a fixed component between June 2015 and January 2021. The minimum follow-up period was 2 years (mean, 4.08 years). None of the 12 patients in this series was lost to follow-up. We evaluated the evolution through clinical examination, Harris Hip Score, laboratory and radiological studies. RESULTS: at a mean follow-up of 4.08 years after prosthetic reimplantation, two of the 12 patients had recurrence of infection (16.6%), and the mean Harris hip score reached 63.6 points at the last follow-up assessment. CONCLUSIONS: fixed implant preservation may be an acceptable option for patients with chronic periprosthetic hip infection when removal of the fixed component results in significant bone loss compromising future reimplantation. However, more studies are required on this treatment method.

INTRODUCCIÓN: la revisión total en una o dos etapas se considera el estándar de oro para el tratamiento de la artroplastía de cadera con infección crónica. Sin embargo, durante la extracción de un componente protésico fijo, el hueso del huésped puede dañarse, lo que dificulta la reimplantación definitiva de la prótesis. OBJETIVO: presentamos una serie de pacientes tratados por infección crónica periprotésica de cadera con la preservación de un componente fijo. MATERIAL Y MÉTODOS: este estudio retrospectivo incluyó a 12 pacientes con artroplastía de cadera e infección periprotésica crónica programadas para revisión parcial en una o dos etapas con retención de un componente fijo entre Junio de 2015 y Enero de 2021. El período mínimo de seguimiento fue de dos años (media, 4.08 años). Ninguno de los 12 pacientes de esta serie se perdió en el seguimiento. Evaluamos la evolución a través del examen clínico, puntuación de cadera de Harris, estudios de laboratorio y radiológicos. RESULTADOS: con un seguimiento promedio de 4.08 años después de la reimplantación protésica, dos de los 12 pacientes presentaron recurrencia de la infección (16.6%) y la puntuación media de Harris en la cadera alcanzó 63.6 puntos en la última evaluación de seguimiento. CONCLUSIONES: la preservación del implante fijo puede ser una opción aceptable para pacientes estrictamente seleccionados con infección periprotésica crónica de cadera cuando la extracción del componente fijo produce una pérdida ósea significativa que compromete la reconstrucción futura. Se necesitan más estudios sobre este método de tratamiento.

A quality improvement intervention on surgical prophylaxis impact in antibiotic consumption and cost in selected surgical procedures.

BACKGROUND: Improper compliance with antibiotic prophylaxis (AP) in surgery is associated with an increased risk of surgical site infection (SSI), and impacts the efficiency of healthcare. OBJECTIVE: Evaluate the impact of an intervention in compliance with AP in selected surgical procedures and its effect on antibiotic consumption and cost. METHODS: A prospective interventional study was performed in a community hospital from January to December 2022. The baseline period was considered January-April 2022 and the intervention period May-December 2022. All patients who underwent cesarean section, appendectomies, hernia surgery, open reduction and internal fixation (ORIF), abdominoplasty, and cholecystectomy during the study period were selected. The intervention includes staff education, pharmacy interventions, monitoring the quality of prescriptions and feedback, and improved role of anesthesia staff, and department champions. RESULTS: The study involved 192 and 617 surgical procedures in the baseline and intervention periods respectively. The compliance with timing, selection, dose, and discontinuation achieved 100%, 99.2%, and 97.6% from baseline figures of 92.7%, 95.8%, and 81.3%, respectively. The antibiotic consumption was reduced by 55.1% during the intervention with a higher contribution of other antibiotics (94.1% reduction) in comparison with antibiotics as per policy (31.2% reduction). The cost was reduced by 47.2% (antibiotic as per policy 31.9%, other antibiotics 94.2%). CONCLUSION: The implemented strategy was effective in improving the quality of antibiotic prophylaxis with a significant impact in reducing antibiotic consumption and cost.

Presynchronization with prostaglandin F2α and gonadotropin-releasing hormone simultaneously improved first-service pregnancy per artificial insemination in lactating Holstein cows compared with Presynch-14 when combined with detection of estrus.

This study aimed to determine the effect of 2 simple breeding strategies combining artificial insemination (AI) after detection of estrus (AIED) and timed AI (TAI) on first-service fertility in lactating Holstein cows. Weekly, lactating Holstein cows (n = l,049) between 40 and 46 d in milk (DIM) were randomly assigned to initiate 1 of 2 breeding strategies for first service: Presynch-14 and PG+G. Presynch-14 is a presynchronization strategy with 2 PGF2α treatments 14 d apart with the last PGF2α 14 d before the initiation of the Ovsynch protocol. Cows treated with PG+G receive a simpler presynchronization program that uses PGF2α and GnRH simultaneously 7 d before Ovsynch. In both treatments, cows detected in standing estrus by tail chalk at any time ≥55 DIM were inseminated, and treatment was discontinued (n = 525). Cows completing treatment received TAI from 78 to 84 DIM (n = 526). In a subgroup of cows that received TAI, blood was collected (n = 163) to assess circulating concentrations of progesterone, and ultrasonographic evaluations of ovaries were performed on the day of first GnRH of Ovsynch (n = 162) and PGF2α of Ovsynch (n = 122). The proportion of cows that received TAI was greater for PG+G compared with Presynch-14 (63.5 vs. 31.9%), which increased DIM at first service for cows treated with PG+G compared with Presynch-14 (75.5 ± 0.4 vs. 68.7 ± 0.4). For cows receiving TAI, the ovulatory response to first GnRH of Ovsynch (73.8 vs. 48.8%) and the proportion of cows with functional corpora lutea (92.6 vs. 73.1%) were greater for PG+G than Presynch-14. Cows treated with PG+G had greater overall pregnancy per AI (P/AI) 42 ± 7 d after AI (40.2 vs. 33.6%) and calving per AI (32.1 vs. 25.2%) than Presynch-14. For cows receiving AIED, treatment did not affect P/AI 42 ± 7 d after AI. However, for cows receiving TAI, PG+G increased P/AI compared with Presynch-14 (44.6 vs. 35.2%). Overall, cows receiving TAI had greater P/AI 42 ± 7 d after AI (42.5 vs. 31.5%) and calving per AI (34.1 vs. 23.7%) and decreased pregnancy loss (16.8 vs. 25.2%) than cows receiving AIED. In summary, PG+G increased the proportion of cows receiving TAI and the DIM at first service, P/AI, and calving per AI compared with Presynch-14 when both TAI programs were combined with AIED.

Detección ecográfica y pronóstico de la ventriculomegalia fetal / Ultrasound detection and prognosis of fetal ventriculomegaly

Antecedentes: La ventriculomegalia fetal es un signo ecográfico muy sensible para las alteraciones del sistema nervioso central fetal. La morbilidad asociada a la misma depende principalmente de la etiología y de la presencia de otras malformaciones asociadas. Si es aislada y no progresiva se puede preveer un resultado posnatal favorable hasta en el 70 por ciento de los casos aunque hay una gran disparidad de cifras entre distintos centros y autores. Objetivo: Establecer la relación entre ventriculomegalia y pronóstico perinatal. Método: Se han revisado 60 casos diagnosticados mediante ecografía prenatal en el Hospital Universitario de Canarias siguiendo los criterios ecográficos de ventriculomegalia (astas posteriores mayores de 10 mm). Se realizaron cariotipos y serología materna y en líquido amniótico para completar el estudio. Resultados: Hubo un total de 23 interrupciones voluntarias de la gestación y 28 recién nacidos sin secuelas (47 por ciento). Un 70 por ciento de las ventriculomegalias aisladas correspondieron a recién nacidos sin secuelas. El 10 por ciento de las ventriculomegalias aparecieron en fetos con aneuploidías. Conclusión: El pronóstico fue favorable en los casos de ventriculomegalia no progresiva y aislada. La medida de la ventriculomegalia no predice el resultado. La variabilidad de resultados en la literatura obliga a cada centro a disponer de sus protocolos y datos para aconsejar a la pareja que ha de tomar una decisión sobre el futuro de su embarazo.

Background: Fetal ventriculomegaly is the most sensitive sonographic sign for central nervous system anomalies. Neonatal morbidity and mortality depends on the etiology of the ventriculomegaly and the presence of other malformations. Isolated non-progressive ventriculomegaly is associated with 70 percent favorable results, with a great disparity among studies. Aims: To establish the relationships between ventriculomegaly and perinatal outcome. Methods: The authors reviewed 60 cases of prenatally diagnosed fetal ventriculomegaly in the Canary Islands University Hospital. An ultrasonographic measurement of the lateral ventricles of 10 mm or more was considered as ventriculomegaly. Fetal and maternal serology was performed as well as fetal karyotyping. Results: 23 patients decided to terminate the pregnancy due to unfavorable prognosis. In 28 cases outcome was favorable. 70 percent of isolated ventriculomegaly corresponded to healthy newborns. 10 percent of the fetuses had aneuploidies. Conclusion: Prognosis is favorable if ventriculomegaly is isolated and non-progressive. Measurement of the lateral ventricle does not predict outcome. Disparity of results in literature makes it necessary for each Hospital to rely on their own data and guidelines to assess parents on the fate of the pregnancy.

[Bilateral pseudo-Kaposi sarcoma in upper limbs]. / Pseudosarcoma de Kaposi bilateral en miembros superiores.

Acroangiodermatitis or pseudo-Kaposi sarcoma is an angioproliferative, self-limited entity that includes a group of diseases, congenital or acquired, with cutaneous lesions similar to Kaposi sarcoma (KS). This term can lead to confusion because it comprises several entities that are completely different, nonetheless, it has an important clinical value as it guides the diagnosis and management of these patients. We report the case of a 67-year-old patient with lesions of acroangiodermatitis in both forearms secondary to arteriovenous shunts from hemodialysis. Doppler ultrasound showed a former arteriovenous fistula in addition to the one already known. Immunohistochemical study showed CD34+ staining in endotelial cells and absence of HHV-8 expression.

Pseudosarcoma de Kaposi bilateral en miembros superiores / Bilateral pseudo-Kaposi sarcoma in upper limbs

El término acroangiodermatitis o pseudosarcoma de Kaposi (PSK) se refiere a una entidad angioproliferativa autolimitada que incluye un grupo de enfermedades, congénitas o adquiridas, con lesiones cutáneas similares al sarcoma de Kaposi (SK). Este término puede llevar a confusión puesto que engloba varias entidades completamente diferentes, sin embargo, tiene un valor clínico importante, ya que orienta al diagnóstico y al manejo de estos enfermos. Presentamos el caso de un paciente de 67 años con lesiones de acroangiodermatitis en ambos antebrazos secundarias a fístulas arteriovenosas para hemodiálisis. La eco-doppler permitió descubrir una fístula arteriovenosa antigua, además de la que ya conocíamos. Las técnicas de inmunohistoquímica demostraron CD34 + en las células endoteliales y la expresión del herpesvirus 8 humano (HHV8) fue negativa

Acroangiodermatitis or pseudo-Kaposi sarcoma is an angioproliferative, self-limited entity that includes a group of diseases, congenital or acquired, with cutaneous lesions similar to Kaposi sarcoma (KS). This term can lead to confusion because it comprises several entities that are completely different, nonetheless, it has an important clinical value as it guides the diagnosis and management of these patients. We report the case of a 67-year-old patient with lesions of acroangiodermatitis in both forearms secondary to arteriovenous shunts from hemodialysis. Doppler ultrasound showed a former arteriovenous fistula in addition to the one already known. Immunohistochemical study showed CD34+ staining in endotelial cells and absence of HHV-8 expression

[Fatal Sweet syndrome associated to chronic idiopathic systemic inflammatory response syndrome]. / Síndrome de Sweet de evolución fatal asociado a síndrome de respuesta inflamatoria sistémica crónico idiopático.

Sweet syndrome is one of the cutaneous processes more frequently associated to systemic diseases. Its association to the systemic inflammatory response syndrome has rarely been described. We report a case of chronic and relapsing Sweet syndrome associated to a chronic and idiopathic systemic inflammatory response syndrome that lasted seven years and proved fatal to the patient. Among the rare cases of Sweet syndrome associated to a systemic inflammatory response syndrome that have been described there have not been any fatal cases as occurred with our patient.

Síndrome de Sweet de evolución fatal asociado a síndrome de respuesta inflamatoria sistémica crónico idiopático / Fatal sweet syndrome associated to chronic idiopathic systemic inflammatory response syndrome

El síndrome de Sweet es uno de los procesos cutáneos ligados con mayor frecuencia a enfermedades de los órganos internos. Su asociación al síndrome de respuesta inflamatoria sistémica ha sido raramente descrita. Presentamos un caso de síndrome de Sweet de evolución crónica y recidivante asociado a un síndrome de respuesta inflamatoria sistémica crónico idiopático de 7 años de evolución que llevaron a la muerte del paciente. De los raros casos descritos de síndrome de Sweet asociado a síndrome de respuesta inflamatoria sistémica, no hay ninguno descrito que haya llevado a la muerte del paciente como en nuestro caso

Sweet syndrome is one of the cutaneous processes more frequently associated to systemic diseases. Its association to the systemic inflammatory response syndrome has rarely been described. We report a case of chronic and relapsing Sweet syndrome associated to a chronic and idiopathic systemic inflammatory response syndrome that lasted seven years and proved fatal to the patient. Among the rare cases of Sweet syndrome associated to a systemic inflammatory response syndrome that have been described there have not been any fatal cases as occurred with our patient

Necrobiotic xanthogranuloma associated with lymphoplasmacytic lymphoma. Palliative treatment with carbon dioxide laser.

Necrobiotic xanthogranuloma (NXG) with paraproteinemia is a rare non-x histiocytosis with conspicuous lesions mainly located on the periorbital skin. A 68-year-old woman, with a previous history of lymphoplasmacytic lymphoma associated with IgG monoclonal gammopathy over a period of almost 4 years, presented typical lesions of NXG on the periorbital regions and left buttock. Treatment with dioxide carbon laser resulted in great improvement of cutaneous lesions, and no evidence of relapse after a 12-month follow-up. The association of NXG with lymphoplasmacytic lymphoma has not been previously described to our knowledge. The treatment of these lesions represents a true challenge for the clinician and palliative treatment of cutaneous lesions of NXG with CO(2) laser may constitute an alternative treatment in selected cases.

Using operational equipment to read accident dosemeters.

Analysis of accident dosemeters usually involves the use of laboratory-based counting equipment. Gamma spectrometers are used for indium, copper and gold, and alpha-beta detectors for sulphur. This equipment is usually not easily transported due to the shielding required and the weight and delicacy of the counters. For intercomparison studies that require reading the dosemeters on site, a transportable system is required unless the site operating the study can count samples for all the participants. In the case of an actual accident these systems would have a difficulty in counting a large number of accident dosemeters. In an accident, personnel are usually subdivided according to their level of exposure. Those exposed to higher doses are treated immediately. An alternate system should be made available to handle the dosemeters worn by those personnel are likely to receive lower doses. Improvements in portable operational equipment for gamma and beta monitoring allow their use as spectrometers. Such a system was used for the SILENE intercomparison conducted at IRSN Valduc on 12 June and 19, 2002, and the preliminary results compared well with the other participants.

Fixed drug eruption from piroxicam.

The pathogenetic mechanism of fixed drug eruption (FDE) is still unknown. One of the most common causes of FDE is the use of nonsteroidal antiinflammatory drugs (NSAIDs). Oxicams are in the NSAID group and piroxicam is one of the most used of these drugs. FDE caused by piroxicam is rare but a few cases have been reported. Patch tests are useful for diagnosing some cases of FDE; they give variable results on previously affected skin while no reaction appears on unaffected skin. Some cases of cross-sensitivity among piroxicam and other substances have been reported. We report two new cases of FDE due to piroxicam with negative patch test on normal skin and positive results on affected skin.

[Conventional and quantitative electroencephalography in patients with Steinert's myotonic dystrophy]. / Electroencefalografía convencional y cuantitativa en pacientes con distrofia miotónica de Steinert.

INTRODUCTION: Steinert's myotonic dystrophy (SMD) is a systemic-type dominant autosomal disease, with variable clinical expression. Recent magnetic resonance studies conducted in patients with this disease have described the presence of lesions in the white matter of the brain and there have also been reports of a correlation between these and the presence of cognitive disorders. Nevertheless, very little work has been published about the electroencephalographic (EEG) findings in this disease. PATIENTS AND METHODS: In this study both conventional and quantitative EEG were performed on 10 patients with SMD aged between 17 and 50 years. RESULTS: 90% of the patients showed a posterior alpha rhythm that was disorganised but which reacted on opening and closing the eyes, as well as the presence of continuous theta activity over the base activity that was bilaterally more pronounced towards the frontal-central regions. In the quantitative analysis we observed an increase in the absolute energies for the slow bands and a decrease for the fast bands on the frequency spectrum. In most patients (80%) spectral peaks were found within the theta range of frequencies as a correlate of the slow activity observed in the conventional analysis. CONCLUSIONS: It can be concluded that a quantitative EEG could be useful in the study of what, for many years, has been considered to be a 'neuromuscular' disease and that the use of other more precise methods, such as cerebral coherence and brain electrical tomography, could shed new light on the functional management of these patients.

Conventional and quantitative electroencephalography in patients with Steinert's myotonic dystrophy / Conventional and quantitative electroencephalography in patients with Steinert's myotonic dystrophy

Steinert's myotonic dystrophy (SMD) is a systemic-type dominant autosomal disease, with variable clinical expression. Recent magnetic resonance studies conducted in patients with this disease have described the presence of lesions in the white matter of the brain and there have also been reports of a correlation between these and the presence of cognitive disorders. Nevertheless, very little work has been published about the electroencephalographic (EEG) findings in this disease. In this study both conventional and quantitative EEG were performed on 10 patients with SMD aged between 17 and 50 years. 90 percent of the patients showed a posterior alpha rhythm that was disorganised but which reacted on opening and closing the eyes, as well as the presence of continuous theta activity over the base activity that was bilaterally more pronounced towards the frontal-central regions. In the quantitative analysis we observed an increase in the absolute energies for the slow bands and a decrease for the fast bands on the frequency spectrum. In most patients (80 percent) spectral peaks were found within the theta range of frequencies as a correlate of the slow activity observed in the conventional analysis...(AU)

Pilomatrixoma: diagnóstico ecotomográfico / Pilomatrixoma: ultrasound diagnosis

BACKGROUND: Pilomatrixoma is a benign tumor of the skin, preferentially found in children. The final diagnosis is made by biopsy. High resolution ultrasound (US) is a non invasive method for its diagnosis. AIM: To describe the US findings in children with pilomatrixoma. MATERIAL AND METHODS: Fifty five patients with 62 clinically suspected pilomatrixomas were studied by US. All examinations were done with an ATL HDI 5000, linear 5-12 MHz transducer. Pathological study confirmed the diagnosis pilomatrixoma in 52 cases. RESULTS: Fifty of 52 pilomatrixomas were diagnosed by US, with a sensitivity of 96 per cent. The mean age of patients was 7.5 years. Forty seven lesions (90 per cent) were located in the head, neck or upper extremities and their mean size was 8.5 mm. Thirty two lesions were hypodermal, 14 were dermohypodermal and 6 were dermal. In 44 lesions the contour was regular and non delineated, 44 lesions were oval, 41 lesions had an acoustic shadow, 36 were echogenic or hyperechogenic, 31 had a peripheral halo (60 per cent), 55 had calcifications (98 per cent), nine had perilesional vessels, 2 had intratumoral vessels and 7 had inflammatory changes. US excluded the diagnosis of pilomatrixoma in 10 lesions formulating a correct differential diagnosis in eight, with a specificity of 80 per cent. CONCLUSIONS: Pilomatrixomas had two US types of presentation. The first is a well defined nodule with peripheral halo partially calcified or with microcalcifications. The second is a completely calcified nodule without peripheral halo and with a strong acoustic shadow. US is a useful, sensitive and specific diagnostic method for pilomatrixoma.

Distribution and diversity of cry genes in native strains of Bacillus thuringiensis obtained from different ecosystems from Colombia.

Colombia is a tropical country located at the north of South America. It is considered to be one of the most important countries in terms of its biodiversity worldwide. One hundred and eight soil samples obtained from agricultural crops and wild ecosystems were evaluated in terms of the presence of Bacillus thuringiensis (Bt) native strains. One hundred and eight different Bt strains were isolated and characterized by the presence of crystal proteins by SDS-PAGE and a multiplex PCR with general and specific primers for cry1 and cry3, cry7, and cry8 gene detection. Most of the Bt strains (73%) reacted with the cry1 general primers; 27.8% of the Bt strains reacted with cry3, cry7, and cry8 general primers and 17.8% of strains did not react with any of these two sets of primers. Thirty different PCR profiles were found in the strains with cry1 genes when they were analyzed with specific primers (cry1A to cry1F). A high frequency of joint occurrence was observed for cry1Aa/cry1Ab, cry1Aa/cry1Ac, cry1Ab/cry1Ac, and cry1C/cry1D genes with a Pearson coefficient of 0.88, 0.74, 0.76, and 0.87, respectively. Other distinctive characteristics were found in the Colombian collection as the presence of 22.2% of native strains which presented, at the same time, lepidopteran and coleopteran active genes. Interesting relations were found as well between the cry gene distribution and the geographical areas sampled. Finally, some strains with moderate to high biopesticide activity against Spodoptera frugiperda (Lepidoptera) and Premnotrypes vorax (Coleoptera) insects were identified, this being important to explore future microbial strategies for the control of these crop pests in the region.

Fistula enterocutanea en abdomen abierto / Enterocutanea fistula in trauma

Se analizó una serie clínica de 23 pacientes con diagnóstico de abdomen abierto complicado con fístula intestinal para evaluar su respuesta a la terapia nutricional en lo que respecta al comportamiento de la fístula y a la incidencia sobre la mortalidad global y otras variables de la hospitalización. La edad promedio fue de 44 años. El análisis inicial mostró una preponderancia de la etiología posquirúrgica no traumática sobre la traumática (61 por ciento vs. 39 por ciento). Un 56 por ciento de pacientes se diagnosticó como malnutrido, con una albúmina de ingreso promedio de 1.9 gr/dl. La fístula fue de alto gasto en el 78 por ciento de los casos, 83 por ciento(21) requirió más de 2 cirugías, con un promedio de 4.7 cirugías / paciente. El soporte nutricional mixto fue el más frecuente 16 (74 por ciento) con un promedio de 1282 cal. /día, 14.3 gramos/ N/día y 17 días/pte. El porcentaje global de cierre fue del 65 por ciento (15), 8 (35 por ciento) con tratamiento conservador y 7 (30 por ciento) con cierre quirúrgico. La estancia hospitalaria fue de 62 días (rango 11-168), los costos de atención oscilan entre (pesos colombianos) 1.619.391 y 58.939.583 y el costo global de atención se calculó en 451.341.680 pesos colombianos. El 60 por ciento (15) de los pacientes tuvieron un costo de atención superior a los 15.000.000. La mortalidad fue del 34 por ciento (8), similar a la reportada mundialmente. El análisis del impacto del soporte nutricional sobre la mortalidad y la estancia no mostró ninguna correlación estadísticamente significativa con variables como tiempo de inicio del soporte, calorías administradas, tipo de cierre, tipo de soporte. Otras usualmente pronosticó como albúmina, proteínas y balance nitrogenado al ingreso y egreso tampoco mostraron correlación con la muerte, la tasa de cierre y el pronóstico. Los datos obtenidos permiten concluir que el abdomen abierto complicado con fístula intestinal en una entidad que demanda un enorme cuidado y manejo multidisciplinario en la que el soporte nutricional intensivo pese a la dificultad en la medición de su valor aditivo a la terapia, es una importante herramienta en el afán de disminuir el perfil de mobimortalidad de este síndrome