[Calcific myonecrosis of the leg]. / Mionecrosis calcificante de la pierna.

Calcific myonecrosis is a rare post-traumatic sequela almost exclusively located in the lower extremity, which can be mistaken for an aggressive primary neoplasm. This lesion, initially described by Gallei and Thompson in 1960, is characterized by the formation of a calcified mass that appears decades after trauma. The pathophysiologic mechanism is not fully understood, although the lesion most likely results from post-traumatic ischemia and it may be associated with a common peroneal nerve injury. The typical radiographic image is a fusiform soft tissue mass with linear calcifications. The treatment of choice is conservative in asymptomatic patients because the surgical treatment has a high complication rate. We report four cases of calcific myonecrosis treated surgically in our hospital. Three of the cases had an infection as a complication that required subsequent debridement and special therapies to achieve the resolution of the cases.

¿Qué necesitan saber los cirujanos ortopédicos del radiólogo? / What do orthopedic surgeons need to know from radiologists?

El diagnóstico de las lesiones tumorales y pseudotumorales se asienta en un trípode formado por el clínico, el radiólogo y el anatomopatólogo. Los 2 primeros son los que podrán establecer un diagnóstico de presunción con la clínica y las pruebas complementarias realizadas, mientras que el patólogo será el que nos deberá dar el diagnóstico definitivo, una vez analizadas las muestras obtenidas mediante la biopsia. Es evidente que la orientación diagnóstica deber ser consensuada entre el clínico y el radiólogo, pero para que esto sea una realidad se precisa que exista una relación entre ambos y se trabaje de forma interdisciplinaria, en beneficio del paciente. Al cirujano ortopédico, como a cualquier otro especialista, le gustaría disponer en su centro de trabajo de especialistas en radiología dedicados a la patología del aparato locomotor y que fueran estos los que le dieran su opinión en la interpretación de las distintas imágenes obtenidas. Este punto es muy importante en especial en patología tumoral, ya que es poco frecuente y que son pocos los especialistas dedicados a ella. Por esto, al cirujano ortopédico ante una lesión de características tumorales le gustaría que hiciera una descripción lo más precisa posible de las imágenes y definiera las características de benignidad o malignidad del proceso y también que nos indicara el riesgo de fractura en una lesión metastásica. Por otro lado, le pediríamos una descripción clara y comprensible de las imágenes obtenidas en las pruebas complementarias, ya que es un tipo de exploraciones en la que el cirujano ortopédico tiene menos experiencia y muchas veces son difíciles de interpretar. Otro aspecto que se menciona en nuestro trabajo es el referente a la importancia de que un centro hospitalario disponga de un servicio de Radiología con vocación intervencionista ya que ello puede facilitar mucho la labor del cirujano ortopédico, tanto desde el punto de vista diagnóstico como en el tratamiento de determinados tumores óseos. Finalmente, queremos manifestar la importancia que tiene para un cirujano ortopédico disponer de un radiólogo colaborador e interesado en el tema, haciendo hincapié, sin ánimo de crítica, en la importancia que tiene para mantener una buena relación médico-paciente, que el radiólogo, como todo profesional, sea conocedor de su responsabilidad y limitaciones en aspectos relacionados con el intervencionismo y en la elaboración de los informes correspondientes (AU)

The diagnosis of tumors and pseudotumors depends on three pillars: the clinician, the radiologist, and the pathologist. The first two can establish a presumptive diagnosis on the basis of the clinical presentation and findings on complementary tests, whereas the pathologist will have to reach the definitive diagnosis after analyzing the biopsy specimens. Obviously, the clinician and radiologist should reach a consensus regarding the diagnostic orientation; however, for this to happen there must be a relationship between the two professionals and they must work together for the benefit of the patient. Orthopedic surgeons, like any other group of specialists, would like to have radiologists working in their own center who are dedicated to the organ/system they treat, in this case the locomotor apparatus, and who can provide them with their opinion about the different images obtained. This point is very important and especially so for tumors, because this type of disease is uncommon and few specialists are dedicated to it. For this reason, when faced with a lesion that has the characteristics of a tumor, orthopedic surgeons would like radiologists to give the most accurate description of the images as possible, defining the characteristics of benignity or malignancy of the process as well as indicating the risk of fracture in a metastatic lesion. On the other hand, orthopedic surgeons would ask for a clear and comprehensible description of the images obtained in complementary tests, because orthopedic surgeons have less experience in this type of images and they are often difficult to interpret. Another aspect that is often mentioned in discussions among orthopedic surgeons is the importance of having a radiology department that performs interventional procedures. Radiologists that perform interventional procedures can facilitate our work very much, both in the diagnosis and in the treatment of certain bone tumors. Finally, we would like to stress the importance of having a radiologist who collaborates with us and is interested in our work, supporting us without being overly critical. This is also important for our relations with patients; radiologists, like all professionals, must know their responsibilities and limitations in aspects related to intervention and in elaborating the corresponding reports (AU)

[What do orthopedic surgeons need to know from radiologists?]. / ¿Qué necesitan saber los cirujanos ortopédicos del radiólogo?

The diagnosis of tumors and pseudotumors depends on three pillars: the clinician, the radiologist, and the pathologist. The first two can establish a presumptive diagnosis on the basis of the clinical presentation and findings on complementary tests, whereas the pathologist will have to reach the definitive diagnosis after analyzing the biopsy specimens. Obviously, the clinician and radiologist should reach a consensus regarding the diagnostic orientation; however, for this to happen there must be a relationship between the two professionals and they must work together for the benefit of the patient. Orthopedic surgeons, like any other group of specialists, would like to have radiologists working in their own center who are dedicated to the organ/system they treat, in this case the locomotor apparatus, and who can provide them with their opinion about the different images obtained. This point is very important and especially so for tumors, because this type of disease is uncommon and few specialists are dedicated to it. For this reason, when faced with a lesion that has the characteristics of a tumor, orthopedic surgeons would like radiologists to give the most accurate description of the images as possible, defining the characteristics of benignity or malignancy of the process as well as indicating the risk of fracture in a metastatic lesion. On the other hand, orthopedic surgeons would ask for a clear and comprehensible description of the images obtained in complementary tests, because orthopedic surgeons have less experience in this type of images and they are often difficult to interpret. Another aspect that is often mentioned in discussions among orthopedic surgeons is the importance of having a radiology department that performs interventional procedures. Radiologists that perform interventional procedures can facilitate our work very much, both in the diagnosis and in the treatment of certain bone tumors. Finally, we would like to stress the importance of having a radiologist who collaborates with us and is interested in our work, supporting us without being overly critical. This is also important for our relations with patients; radiologists, like all professionals, must know their responsibilities and limitations in aspects related to intervention and in elaborating the corresponding reports.

Mionecrosis calcificante de la pierna / Calcific myonecrosis of the leg

La mionecrosis calcificante es una rara secuela postraumática que se localiza casi exclusivamente en la extremidad inferior, y que puede ser confundida con una neoplasia primaria agresiva. Esta lesión, descrita inicialmente por Gallei y Thompson en 1960, se caracteriza por la formación de una masa calcificada que aparece varias décadas después de un traumatismo. El mecanismo fisiopatológico no es conocido, sin embargo la lesión parece que es debida a una isquemia postraumática y puede asociarse con una lesión del ciático poplíteo externo. La imagen radiográfica típica es una masa de partes blandas fusiforme con calcificaciones lineales. El tratamiento de elección es conservador en los casos asintomáticos ya que el tratamiento quirúrgico tiene un alto porcentaje de complicaciones. Presentamos 4 casos de mionecrosis calcificante tratados quirúrgicamente en nuestro hospital. Tres de los casos se infectaron por lo que precisaron sendos desbridamientos y terapias especiales para su resolución definitiva (AU)

Calcific myonecrosis is a rare post-traumatic sequela almost exclusively located in the lower extremity, which can be mistaken for an aggressive primary neoplasm. This lesion, initially described by Gallei and Thompson in 1960, is characterized by the formation of a calcified mass that appears decades after trauma. The pathophysiologic mechanism is not fully understood, although the lesion most likely results from post-traumatic ischemia and it may be associated with a common peroneal nerve injury. The typical radiographic image is a fusiform soft tissue mass with linear calcifications. The treatment of choice is conservative in asymptomatic patients because the surgical treatment has a high complication rate. We report four cases of calcific myonecrosis treated surgically in our hospital. Three of the cases had an infection as a complication that required subsequent debridement and special therapies to achieve the resolution of the cases (AU)

Incidencia de un tercer conducto en la raíz mesial del primer molar inferior: a propósito de un caso / Incident of the third canal in the mesial root of the first mandibular molar: a case clinic

La limpieza mecánica y química del sistema radicular constituye uno de los objetivos de la endodoncia. Para ello es necesaria la localización de todos y cada uno de los conductos que forman parte del entramado radicular. El primer molar inferior es, sin duda, junto al primer molar maxilar, el diente que más tratamientos de conductos precisa. Como sabemos, el primer molar inferior cuenta con dos raíces, generalmente, tres conductos (dos en raíz mesial y uno en la distal), si bien sabemos que pueden existir vacaciones tanto en el número de las raíces como en el número de conductos. En este artículo se expone un caso clínico de un retratamiento de un primer molar inferior con cinco conductos junto a una revisión sobre la incidencia de un tercer conducto en la raíz mesial del primer molar inferior (AU)

Mechanical and chemical cleaning constitutes one of the aims of the canal root treatment. For it, the location is necessary of each and every of the canals that form a part of the studding root. First mandibular molar is, undoubtedly, close to the first maxillary molar, the tooth that needs more treatments. Since we know, first mandibular molar possesses two roots and, generally, three canals (two in the root mesial and one in the distal), though we know that variations can exist both in the number of the roots and in the number of canals. In this article there is exposed a clinical case of a retreatment of the first mandibular molar by five canas close to a review on the incident of the third canal in the root mesial of the first mandibular molar (AU)

Hospital Nacional. Estudio estadístico de las afecciones quirúrgicas de las vías biliares, conespecial interés de la litiasis

Hemos presentado un estudio estadístico de las afecciones de las vías biliares, con especial interés de la litiasis, basado en la revisión de 576 casos de Cirugía General mayor, ingresados en el Hospital Nacional en el período comprendido de julio 12 a diciembre 31 de 1961 y analizando los factores clínicos, diagnósticos y terapéuticos, con la intención de lograr los mejores resultados en el manejo de los pacientes afectados por esta patología (AU)