20 years of alveolar distraction: A systematic review of the literature.

BACKGROUND: The Vertical Alveolar Distraction Osteogenesis (VADO) technique is an excellent solution for bone and soft tissue neoformation in areas in which there has been significant bone atrophy that hinders normal rehabilitation using dental implants. The goal of this systematic review is to analyze the most relevant articles published on VADO in the literature over the past 20 years. MATERIAL AND METHODS: The review was performed by using the keywords: "alveolar ridge", "distraction ostegenesis" and "dental implant". This search produced a total result of 240 articles. The clinical studies and cases reported in humans amounted to 113 articles, 18 articles referred to studies developed on animals and 33 review articles. The presentation of this systematic analysis follows the criteria described in the PRISMA declaration. RESULTS: 22 articles complied with the inclusion criteria and 7 articles more were added manually, reaching a total sample of 29 studies. Following the analysis of the studies, they were classified into 18 high-quality, 10 mediumquality and 1 low-quality study. Only 4 studies achieved a maximum score of 9 (according to NewCastle Ottawa Scale, NOS). CONCLUSIONS: VADO is a technique with greater potential in vertical gain. The performance of dental implants has a success and survival rate similar to dental implants placed on bones that are not subject to increase techniques.

[Prophylactic antibiotherapy in hip arthroplasty. Cohort study]. / Antibioterapia profiláctica en la artroplastia de cadera. Estudio de cohortes.

OBJECTIVE: The surgical site infection is the main cause of nosocomial infection in surgical patients, being antibiotic prophylaxis one of the most important factors for preventing it. This study evaluates adequacy of antibiotic prophylaxis in hip arthroplasty surgery as well as its effect on preventing surgical site infection. METHODS: A prospective cohort study was carried out from January 2011 to December 2016. We assessed the degree of adequacy of antibiotic prophylaxis in hip arthroplasty. Incidence of surgical site infection was studied after a maximum incubation period of 90 days. In order to assess the effect of inadequate prophylaxis on surgical site infection we used the relative risk adjusted with a logistic regression model. RESULTS: We studied 681 patients. Incidence of surgical site infection was 4% (95% CI 2.5-5.5). Antibiotic prophylaxis was administered in 99% of cases, with an overall protocol adequacy of 74%. The main cause of non-compliance was the length of prescription (22.2%; 149 patients). The effect of inadequate prophylaxis on surgical site infection was RRadjusted=0.47; 95%CI 0.19-1.17, (p>0.05). CONCLUSIONS: Adequacy of antibiotic prophylaxis was high. No relationship between prophylaxis adequacy and incidence of surgical site infection was founded. Surveillance allows us to assess surgical site infection and risk factors.

Adecuación de la profilaxis antibiótica en la artroplastia de rodilla e infección del sitio quirúrgico: estudio de cohortes prospectivo / Antibiotic prophylaxis adequacy in knee arthroplasty and surgical wound infection: prospective cohort study

Objetivo. Evaluar el grado de adecuación al protocolo de profilaxis antibiótica en pacientes intervenidos de artroplastia de rodilla y su influencia en la infección quirúrgica. Material y método. Se realizó un estudio de cohortes prospectivo. El grado de adecuación se estudió mediante la comparación de las características de la profilaxis recibida por los pacientes y la estipulada en el protocolo vigente de nuestro hospital. El efecto de la profilaxis en la incidencia de la infección quirúrgica se estimó con el riesgo relativo. Resultados. Se incluyeron 1.749 intervenciones. La incidencia de infección del sitio quirúrgico fue del 1,43% (n=25). La adecuación global al protocolo de profilaxis antibiótica fue del 77,6%. La causa más frecuente de inadecuación al protocolo fue la duración prescrita de los antibióticos de la profilaxis (46,5%). La adecuación de la profilaxis antibiótica no influyó en la infección del sitio quirúrgico (RR=1,15; IC 95%: 0,31-2,99; p>0,05). Discusión. Los programas de vigilancia y control de la infección permiten evaluar factores de riesgo de infección y evaluar medidas de mejora. La vigilancia de las tasas de infección quirúrgica nos permite tomar las medidas oportunas encaminadas a reducir progresivamente su incidencia. Conclusiones. La adecuación de la profilaxis antibiótica fue alta, pero se puede mejorar. No hubo relación entre la adecuación de la profilaxis y la incidencia de infección de la herida quirúrgica en artroplastia de rodilla (AU)

Objective. Antibiotic prophylaxis is the most suitable tool for preventing surgical wound infection. This study evaluated adequacy of antibiotic prophylaxis in surgery for knee arthroplasty and its effect on surgical site infection. Material and method. Prospective cohort study. We assessed the degree of adequacy of antibiotic prophylaxis, the causes of non-adequacy, and the effect of non-adequacy on surgical site infection. Incidence of surgical site infection was studied after a maximum incubation period of a year. To assess the effect of prophylaxis non-adequacy on surgical site infection we used the relative risk adjusted with the aid of a logistic regression model. Results. The study covered a total of 1749 patients. Antibiotic prophylaxis was indicated in all patients and administered in 99.8% of cases, with an overall protocol adequacy of 77.6%. The principal cause of non-compliance was the duration of prescription of the antibiotics (46.5%). Cumulative incidence of surgical site infection was 1.43%. No relationship was found between prophylaxis adequacy and surgical infection (RR=1.15; 95% CI: .31-2.99) (P>.05). Discussion. Surveillance and infection control programs enable risk factors of infection and improvement measures to be assessed. Monitoring infection rates enables us to reduce their incidence. Conclusions. Adequacy of antibiotic prophylaxis was high but could be improved. We did not find a relationship between prophylaxis adequacy and surgical site infection rate (AU)

Antibiotic prophylaxis adequacy in knee arthroplasty and surgical wound infection: Prospective cohort study. / Adecuación de la profilaxis antibiótica en la artroplastia de rodilla e infección del sitio quirúrgico: estudio de cohortes prospectivo.

OBJECTIVE: Antibiotic prophylaxis is the most suitable tool for preventing surgical wound infection. This study evaluated adequacy of antibiotic prophylaxis in surgery for knee arthroplasty and its effect on surgical site infection. MATERIAL AND METHOD: Prospective cohort study. We assessed the degree of adequacy of antibiotic prophylaxis, the causes of non-adequacy, and the effect of non-adequacy on surgical site infection. Incidence of surgical site infection was studied after a maximum incubation period of a year. To assess the effect of prophylaxis non-adequacy on surgical site infection we used the relative risk adjusted with the aid of a logistic regression model. RESULTS: The study covered a total of 1749 patients. Antibiotic prophylaxis was indicated in all patients and administered in 99.8% of cases, with an overall protocol adequacy of 77.6%. The principal cause of non-compliance was the duration of prescription of the antibiotics (46.5%). Cumulative incidence of surgical site infection was 1.43%. No relationship was found between prophylaxis adequacy and surgical infection (RR=1.15; 95% CI: .31-2.99) (P>.05). DISCUSSION: Surveillance and infection control programs enable risk factors of infection and improvement measures to be assessed. Monitoring infection rates enables us to reduce their incidence. CONCLUSIONS: Adequacy of antibiotic prophylaxis was high but could be improved. We did not find a relationship between prophylaxis adequacy and surgical site infection rate.

Absceso de Brodie como forma de osteomielitis subaguda: a propósito de un caso / Abscess of Brodie as form of osteomyelitis subacute: purpose of a case

Presentamos el caso de un varón de 29 años con dolor coxofemoral de un mes de evolución, con asociación de fiebre alta. Su único antecedente de interés es la colocación de una tracción transesquelética supracondílea femoral a los 8 años de edad. En los estudios radiográficos se demuestran signos propios de esta patología. Ingresa para antibioterapia intravenosa y a la semana se realiza desbridamiento quirúrgico, curetaje y lavado. Pese a todo ello, persisten datos de infección activa y se opta por una tercera intervención de desbridamiento mediante fresado-irrigación anterógrada del fémur (AU)

We report the case of a 29 years old man, with hip pain from one month earlier, associated with high fever. The only previous interest presented is placing a transfemoral traction at 8 years old. Radiological studies show the finding of this condition. The patient is admitted for intravenous antibiotics but the evolution is torpid and after one week surgical debridement, curettage and washing are carried out. Despite all this, active infection persists and debridement third surgery is necessary, by milling-femoral anterograde irrigation (AU)

Lesiones vasculares asociadas a luxación de rodilla: protocolo diagnóstico / Vascular injuries associated with dislocation of the knee: diagnosis protocol

Introducción. La luxación de rodilla es una entidad infrecuente. Puede tener consecuencias devastadoras, no solo por las lesiones ligamentosas, sino también por las complicaciones vasculares y nerviosas. Objetivo. Analizar la eficacia de un protocolo para el diagnóstico precoz de lesiones vasculares asociadas a las luxaciones de rodilla. Material y métodos. Se presenta un estudio retrospectivo de las luxaciones de rodilla agudas tratadas entre 1999-2010 con un seguimiento mínimo de 12 meses. Se utilizó un protocolo diagnóstico basado en la exploración física y el índice tobillo-brazo como pruebas de cribado inicial de lesión vascular. Resultados. Se obtuvo una muestra de 10 luxaciones, de las que en un 30% se produjo lesión de la arteria poplítea que fueron diagnosticadas precozmente, recibiendo tratamiento quirúrgico urgente antes de 8 horas. Dos pacientes tuvieron lesiones nerviosas asociadas a la vascular. Ningún caso acabó en amputación. Conclusiones. La utilización sistemática del protocolo ha evitado consecuencias derivadas de un diagnóstico tardío y ha reducido drásticamente el uso abusivo de pruebas invasivas como la arteriografía (AU)

Introduction. Knee dislocation is an unusual condition, and can have catastrophic consequences, such as vascular and neurological complications, in addition to the ligament injuries. Objective. The aim of this study is to analyse the effectiveness of a protocol of early diagnosis of vascular injuries associated with knee dislocations. Materials and methods. A retrospective study was conducted which included acute knee dislocations treated in our institution, with a minimum of 12 months follow-up, between 1999-2010. A diagnostic protocol based on physical examination and ankle-brachial index was used in order to detect vascular injuries. Results. Ten dislocations, 30% with popliteal artery injury, were diagnosed early and received emergency treatment within 8hours. There were associated neurological injuries in two patients. There were no amputations. Conclusions. The systematic use of this protocol has avoided consequences of late diagnosis and has drastically reduced the abusive use of invasive tests, such as arteriography (AU)

[Vascular injuries associated with dislocation of the knee: diagnosis protocol]. / Lesiones vasculares asociadas a luxación de rodilla: protocolo diagnóstico.

INTRODUCTION: Knee dislocation is an unusual condition, and can have catastrophic consequences, such as vascular and neurological complications, in addition to the ligament injuries. OBJECTIVE: The aim of this study is to analyse the effectiveness of a protocol of early diagnosis of vascular injuries associated with knee dislocations. MATERIALS AND METHODS: A retrospective study was conducted which included acute knee dislocations treated in our institution, with a minimum of 12 months follow-up, between 1999-2010. A diagnostic protocol based on physical examination and ankle-brachial index was used in order to detect vascular injuries. RESULTS: Ten dislocations, 30% with popliteal artery injury, were diagnosed early and received emergency treatment within 8 hours. There were associated neurological injuries in two patients. There were no amputations. CONCLUSIONS: The systematic use of this protocol has avoided consequences of late diagnosis and has drastically reduced the abusive use of invasive tests, such as arteriography.

Systemic blockade of TNF-α does not improve insulin resistance in humans.

The purpose of this study was to determine whether long-term modulation of inflammatory activity by tumor necrosis factor (TNF)-α inhibitors has some influence on insulin resistance (IR). 16 active rheumatoid arthritis (RA) patients without CV risk factors treated with anti-TNF-α agents were included in this study. RA activity by disease activity score 28, IR by HOMA2-IR, body composition by impedance analysis, physical activity by accelerometry, abdominal fat distribution by magnetic resonance imaging, and serum level of key adipokines by ELISA were measured at baseline and during a 1-year follow-up period. Patient body mass index increased significantly (26.94 ± 3.88 vs. 28.06 ± 4.57 kg/m2, p=0.02) after 1 year of treatment. Body composition, in terms of fat and fat-free mass, remained unchanged except for a significant elevation in body cell mass (25.50 ± 4.60 vs. 26.60 ± 3.17 kg, p=0.02). Basal levels of IR in the RA patients included in this study were significantly higher than healthy controls (1.6 ± 0.8 vs. 1.11 ± 0.56, p=0.011) but did not change during the follow-up. Nor did basal concentrations of adiponectin, visfatin, leptin, ghrelin, resistin, and apelin in response to anti-TNF-α treatment; only retinol-binding protein 4, showed a significant increase (51.7 ± 32.7 vs. 64.9 ± 28.4 µg/ml, p=0.03) at the end of the study. IR, adiposity distribution, and serum levels of most adipokines are not significantly affected by long-term inhibition of TNF-α in RA patients. Our data suggest that although systemic blockade of TNF-α exerts an anticachectic effect in RA patients, it does not seem to play a major role in IR.

Incidencia de infección de herida quirúgica en artroplastia de cadera / Incidence of surgical wound infection after hip replacement

Objetivo: Estudiar la incidencia de infección de herida quirúrgica tras recambio de una prótesis de cadera. Material y Método: Estudio de cohorte prospectivo. Se estudiaron 98 pacientes, 45,9% hombres y 54,1% mujeres (p>0.05), intervenidos de recambio de cadera entre abril y agosto de 2009. Se estudiaron la incidencia acumulada de infección de sitio quirúrgico, la razón estandarizada de infección, la densidad de incidencia y los factores de riesgo relacionados. Resultados: La incidencia acumulada de infección de herida quirúrgica fue del 3,1%, con una razón estandarizada de infección del 0,84% al compararla con la tasa nacional. Todas las infecciones fueron causadas por Staphylococcus aureus (66,6%) y Staphylococcus epidermidis (33,3%). No se encontró ningún factor de riesgo relacionado con la infección. Conclusión: La incidencia de infección del sitio quirúrgico fue ligeramente inferior a la tasa nacional. No encontramos relación con ninguno de los factores de riesgo estudiados (AU)

Objetive: We sought to study the incidence of surgical site infection after hip replacement. Material and Methodology: A Prospective cohort study was conducted with 98 patients, 45.9% men and 54.1% women (p>0.05), covering all patients who underwent HR as elective surgery from April to August 2009. Cumulative incidence, density of incidence of surgical site infection, standardised infection rate and related risk factors were studied. Results: The study covered. Cumulative incidence was 3.1%, with a standardised infection rate of 0.84% visà- vis the national rate. All infections were caused by Staphylococcus aureus (66.6%) and Staphylococcus epidermidis (33.3%). No related risk factor with the infection was found. Conclusion: No risk factor was identified. Incidence of hip infection after implantation of a prosthesis was slightly lower than the national rate (AU)

Estructura y organización de un banco de huesos y tejidos / Structure and organization of a bone and tissue bank

En este artículo se revisan de forma pormenorizada la estructura y organización de un Banco de Huesos y Tejidos (BHT). La instauración de una red de BHT hará que los aloinjertos sean cada vez más disponibles para los pacientes que lo necesiten (AU)

[An adrenal carcinoma producing androgens, estrogens and cortisol]. / Carcinoma suprarrenal productor de andrógenos, estrógenos y cortisol.

Carcinoma of the adrenal cortex is a fairly rare entity, usually with a somber prognosis. The efficacy of treatment depends on early prognosis. We are reporting here a case of carcinoma of the adrenal cortex producing androgens, estrogens and cortisol, in which diagnosis was not achieved until two years after the onset of symptoms. Morphologic studies by CT showed local extension and metastases. After mass-reduction surgery, the patient died due to respiratory failure. This case remarks the importance of early diagnosis in this syndrome.

Intrasellar mass with hypopituitarism as a manifestation of sarcoidosis. Case report.

A 45-year-old woman was admitted suffering from headache, weight loss, asthenia, pedal edema, and amenorrhea. Morphological and functional studies revealed an intrasellar mass causing hypopituitarism without diabetes insipidus. Histological examination of the tissue obtained at transsphenoidal surgery was compatible with a diagnosis of sarcoidosis. The clinical and histological features, together with the presence of cutaneous anergy and ocular lesions, led to the diagnosis of sarcoidosis. The presentation of sarcoidosis in this patient was very unusual because it was not accompanied by characteristic intrathoracic findings or by diabetes insipidus.