Successful prophylactic measures for the eradication of Staphylococcus aureus infections in elective hip primary and revision arthroplasty.

INTRODUCTION: Staphylococcus aureus stands as the predominant etiological agent in postoperative acute prosthetic joint infections (PJI), contributing to 35-50% of reported cases. This study aimed to evaluate the efficacy of dual prophylaxis incorporating cefuroxime and teicoplanin, in combination with nasal decolonization utilizing 70% alcohol, and oral and body lavage with chlorhexidine. MATERIAL AND METHODS: We conducted a retrospective review of electronic health records regarding primary and revision arthroplasties conducted at our institution from 2020 to 2021. Relevant variables linked to prosthetic joint infections (PJI) were documented until the latest follow-up. RESULTS: A total of 539 operations (447 primary arthroplasties and 92 revision arthroplasties) were performed on 519 patients. There were 11 cases of postoperative acute PJI, resulting in infection rates of 1.6% for primary arthroplasties and 4.3% for revision surgeries. Infections were more prevalent in male patients, individuals with an ASA classification > II, and those undergoing longer operations (> 90 minutes). Staphylococcus aureus was not isolated in any of the cases. CONCLUSION: The prophylactic measures implemented in our institution have exhibited a high efficacy in preventing postoperative acute PJI caused by Staphylococcus aureus.

Explantador de Cabrera: un nuevo dispositivo para explantar endoprótesis aórticas después de reparo endovascular de aneurisma de aorta, un estudio experimental ex vivo / Cabrera explanter: a new device to explant aortic stents after endovascular aortic aneurysm repair, an ex vivo experimental study

Introducción. Las complicaciones posteriores a la reparación endovascular de aneurisma (EVAR) pueden resolverse con técnicas endovasculares. Sin embargo, cuando está indicada, la explantación de una endoprótesis es un procedimiento complejo, que se asocia a lesiones vasculares o viscerales, con alta morbimortalidad, en pacientes con edad avanzada y múltiples comorbilidades, y por lo tanto, alto riesgo quirúrgico. No existen dispositivos producidos por la industria para explantar las endoprótesis aórticas, por lo que el objetivo de este trabajo fue desarrollar un dispositivo para la explantación de endoprótesis aórticas. Métodos. Se llevó a cabo un estudio experimental, en fase preclínica, para desarrollar un dispositivo para la explantación de endoprótesis aórticas, con pruebas en modelos 3D y en un modelo animal porcino cadavérico. Resultados. Es factible desarrollar un modelo experimental de un nuevo dispositivo para explantar endoprótesis aórticas, denominado explantador de Cabrera, y comprobar su funcionamiento en un modelo animal cadavérico. El uso del explantador de Cabrera limitó el daño de la pared aórtica por parte de la endoprótesis en un 100 % al momento de su explantación en un modelo experimental ex vivo. Conclusión. Usando una jeringa septo, el explantador de Cabrera es superior a la técnica estándar de explantación de una endoprótesis al limitar la lesión de la pared aórtica, al colapsar y liberar los ganchos de fijación suprarrenal de forma controlada y segura al interior de la luz aórtica y, posteriormente, extraerla de forma rápida y efectiva, conservando la mayor cantidad de aorta sana para la posterior reconstrucción aorto-ilíaca.

Introduction. Complications after endovascular aneurysm repair (EVAR) can be resolved with endovascular techniques; however, when indicated, stent explantation is a complex procedure, which is associated with vascular or visceral injuries, with high morbidity and mortality in patients, with advanced age and multiple comorbidities, and therefore high surgical risk. There are no devices produced by the industry to explant aortic endoprostheses, so the objective of this work was to develop a device for the explantation of aortic endoprostheses. Methods. An experimental study was carried out, in the preclinical phase, to develop a device for the explantation of aortic endoprostheses, with tests in 3D models and in a cadaveric porcine animal model. Results. It is feasible to develop an experimental model of a new device for explanting aortic endoprostheses, called Cabrera explanter, and verify its operation in a cadaveric animal model. The use of the Cabrera explanter limited damage to the aortic wall by the endoprosthesis by 100% at the time of explantation in an ex vivo experimental model. Conclusions. Using a septum syringe, the Cabrera explanter is superior to the standard stent explantation technique by limiting injury to the aortic wall, collapsing and releasing the adrenal fixation hooks in a controlled and safe manner into the aortic lumen, and subsequently, extract it quickly and effectively, preserving the greatest amount of healthy aorta for the subsequent aorto-iliac reconstruction.

Challenges in implementing a total hip arthroplasty program in a developing country: Our experience at Monkole Hospital in the Democratic Republic of Congo. / Desafíos al implementar un programa de artroplastia total de cadera en un país en vías de desarrollo: nuestra experiencia en el Hospital Monkole de la República Democrática del Congo.

BACKGROUND AND OBJECTIVES: Total hip arthroplasty (THA) is an effective surgery for treating hip osteoarthritis, but access is limited in Sub-Saharan Africa due to multiple challenges. This article describes the implementation of a THA program at Monkole Hospital in the Democratic Republic of Congo, focusing on the technical challenges and surgical complications. The objective is to share our experience to assist other professionals and organizations in similar settings. MATERIALS AND METHODS: Eight THA surgery campaigns were conducted between July 2019 and February 2023. Most patients presented with femoral head necrosis secondary to sickle cell anemia. Demographic and surgical data, technical difficulties, and complications were prospectively collected, and follow-up was conducted by a local orthopedic surgeon. RESULTS: Seventy-three surgeries were performed on 63 patients with a mean age of 34 years and an average follow-up of 24 months. Seventeen intraoperative technical incidents (23.2%) were observed. The postoperative complication rate was 9.5%, and three patients required revision surgery due to complications. CONCLUSIONS: The THA program at Monkole Hospital demonstrates that it is feasible to perform complex surgeries in developing countries and that it is a cost-effective procedure that improves patients' quality of life, provided there are adequate hospital infrastructures, team training, availability of implants, and ensured proper care and follow-up. Training local surgeons and investing in resources are key to the sustainability of the program and the improvement of surgical care.

Resultados del uso de prótesis endoscópica colorrectal. 15 años de experiencia

Objetivo: Describir morbimortalidad asociada al uso de prótesis colorrectales (PC) e identificar factores asociados a sus complicaciones durante los años 2007 a 2022 en Clínica INDISA. Material y Método: Estudio transversal retrospectivo basado en registro clínico. Resultados: Se instalaron 49 PC con un 100% de éxito de desobstrucción. El 87,8% en colon izquierdo. La etiología principal fue la patología maligna 91,8% y el 85,7% de ellos fueron primarios colorrectales. Se instalaron 34 como tratamiento paliativo (TP), 12 como puente a cirugía electiva (PCE) y 3 por patología benigna. La tasa de complicaciones fue de 26,5% (7 estenosis, 4 perforaciones y 2 migraciones). La mortalidad asociada fue de 4,1% (2 pacientes). El grupo de complicados fue más joven, con etapas oncológicas más avanzadas y con estenosis en rectosigmoides(p < 0,005). Los menores de 50 años tuvieron 5 veces más riesgo de alguna complicación (OR = 5,0;IC95%:1,09-23,0; p = 0,039). Discusión: El uso de PC tiene baja morbimortalidad. Su uso principal es como TP o PCE en obstrucción colorrectal maligna, con alta tasa de desobstrucción. Está asociado con menor morbilidad que la cirugía de urgencia, menor tasa de ostomía y mayor cosecha ganglionar. La instalación como puente se asocia además a mayor tasa de anastomosis primaria. Nuestra serie mostró mayor tasa de complicación en aquellos con tumores avanzados y más jóvenes. Conclusión: El uso de PC es seguro y con baja morbimortalidad. La principal indicación es en neoplasia colorrectal obstructiva como TP. Tienen mayor riesgo de complicación los pacientes jóvenes y los tumores colorrectales avanzados con ganglios peri tumorales.

Objective: To describe morbidity and mortality associated with colorectal prostheses (CP) and identify factors associated with their complications during the 2007 to 2022 at INDISA Clinic. Material and Method: Retrospective cross-sectional study based on clinical registry. Results: 49 CPs were installed with 100% clearing success. 87.8% in left colon. The main etiology was malignant 91.8% and 85.7% were primary colorectal. 34 were installed with palliative intention, 12 as a bridge to elective surgery (BTS) and 3 for benign pathology. There were 13 (26.5%) patients with adverse effects (7 strictures, 4 perforations and 2 migrations). Associated mortality was 4.1% (2 patients). The complicated group was younger, with more advanced oncological stages and rectosigmoid stenosis (p < 0.005). Those under 50 years of age had 5 times higher risk of some complication (OR = 5.0; 95% CI: 1.09-23.0; p = 0.039). Discussion: The use of CPs has low short-term morbidity and mortality. Its main use is as palliative treatment or BTS in malignant colorectal obstruction. It's a high clearance rate. It is associated with less morbidity than emergency surgery, a lower ostomy rate, and a higher lymph node harvest. Installation as a bridge is also associated with a higher rate of primary anastomosis. Our group showed a higher complication rate in those with advanced and younger tumors. Conclusion: The use of CPs is safe, with low morbidity and mortality. The main indication is in obstructive colorectal neoplasia as palliative treatment. Young patients and advanced colorectal tumors with peritumoral nodes have a higher risk of complications.

Resultado de las sobredentaduras superiores según número de implantes dentales en pacientes edéntulos totales / Outcome of maxillary overdentures according to the number of dental implants in full edentulous patients

RESUMEN Objetivo: Realizar una revisión de la literatura sobre el resultado de las sobredentaduras maxilares según el número de implantes dentales en pacientes edéntulos totales. Materiales y Métodos: Se realizó una búsqueda bibliográfica sistematizada en los motores de búsqueda Pubmed, Scopus y Web of Science y luego de establecer los criterios y filtros de la misma, se utilizaron 6 artículos. De los 6 artículos analizados, 4 fueron estudios de tipo ensayo clínico aleatorizado, 1 estudio prospectivo y 1 estudio retrospectivo. Resultados: Los resultados clínicos de las sobredentaduras maxilares, basados en el número de implantes sobre los cuales fueron soportadas, y comparando los protocolos más difundidos e investigados como los de All-on-4 y All-on-6, fueron similares. Se consideran óptimos, confiables, exitosos y longevos, sin diferencia significativa según el número de implantes dentales colocados. Conclusiones: Las sobredentaduras maxilares soportadas por 4 o 6 implantes fueron técnicas de tratamiento confiables, y ofrecen resultados comparables. Las complicaciones fueron limitadas y los resultados óptimos y duraderos.

ABSTRACT Objective: To review the literature on the outcome of maxillary overdentures according to the number of dental implants in edentulous patients. Materials and Methods: A systematic bibliographic search was carried out in the Pubmed, Scopus and Web of Science search engines and, after appliying the criteria and filters, 6 articles were used. Of the 6 articles analyzed, 4 were randomized clinical trial type studies, 1 prospective study and 1 retrospective study. Results: The results of maxillary overdentures, according to the number of implants used to support them, and comparing the most widespread and researched protocols such as All-on-4 and All-on-6, were similar. They are considered optimal, reliable, successful and long-lived, with no significant difference within the number of dental implants placed. Conclusions: Maxillary overdentures supported by 4 or 6 implants were reliable, and exhibit comparable results. The complications were limited, and the results were optimal and enduring.

Resultado de las sobredentaduras superiores según número de implantes dentales en pacientes edéntulos totales / dental implants

Objetivo: Realizar una revisión de la literatura sobre el resultado de las sobredentaduras maxilares según el número de implantes dentales en pacientes edéntulos totales. Materiales y Métodos: Se realizó una búsqueda bibliográfica sistematizada en los motores de búsqueda Pubmed, Scopus y Web of Science y luego de establecer los criterios y filtros de la misma, se utilizaron 6 artículos. De los 6 artículos analizados, 4 fueron estudios de tipo ensayo clínico aleatorizado, 1 estudio prospectivo y 1 estudio retrospectivo. Resultados: Los resultados clínicos de las sobredentaduras maxilares, basados en el número de implantes sobre los cuales fueron soportadas, y comparando los protocolos más difundidos e investigados como los de All-on-4 y All-on-6, fueron similares. Se consideran óptimos, confiables, exitosos y longevos, sin diferencia significativa según el número de implantes dentales colocados. Conclusiones: Las sobredentaduras maxilares soportadas por 4 o 6 implantes fueron técnicas de tratamiento confiables, y ofrecen resultados comparables. Las complicaciones fueron limitadas y los resultados óptimos y duraderos.

Objective: To review the literature on the outcome of maxillary overdentures according to the number of dental implants in edentulous patients. Materials and Methods: A systematic bibliographic search was carried out in the Pubmed, Scopus and Web of Science search engines and, after appliying the criteria and filters, 6 articles were used. Of the 6 articles analyzed, 4 were randomized clinical trial type studies, 1 prospective study and 1 retrospective study. Results: The results of maxillary overdentures, according to the number of implants used to support them, and comparing the most widespread and researched protocols such as All-on-4 and All-on-6, were similar. They are considered optimal, reliable, successful and long-lived, with no significant difference within the number of dental implants placed. Conclusions: Maxillary overdentures supported by 4 or 6 implants were reliable, and exhibit comparable results. The complications were limited, and the results were optimal and enduring.

Secondary uncovered versus fully-covered metal stents for the management of occluded stent in unresectable distal malignant biliary obstruction.

INTRODUCTION: Self-expandable metallic stents (SEMS) have been widely placed for unresectable distal malignant biliary obstruction (UDMBO). However, the dysfunction rate is 19-40% and its treatment is controversial. We aimed asses the efficacy and safety of a secondary biliary stents (uncovered (UC) versus fully-covered (FC) stent) for the management of occluded SEMS. PATIENTS AND METHODS: Between 2015 and June 2023, 41 patients with UDMBO underwent secondary biliary stent placement as "stent-in-stent" (20 FCSEMS and 21 UCSEMS). The primary outcomes were technical and clinical success of SEMS placement. Secondary outcomes included adverse events (AEs), patency and survival. Patients were prospectively followed until death or loss of follow-up. RESULTS: Technical (100% vs 85.5%) and clinical (100% vs 95.2%) success rates were similar in FCSEMS and UCSEMS groups. The median follow-up period was 510 days (range 290-630). The median duration of stent patency of FCSEMS (220 days, IQR 137.5-442.5) was longer than UCSEMS (150 days, IQR 110-362.5) (P=0.395), although stent dysfunction within 6 months was not different between groups. Multivariate analysis indicated that sex (HR=0.909, 0.852-0.970), antitumor treatment (HR=0.248, 0.032-0.441), stent patency (HR=0.992, 0.986-0.998) and clinical success (HR=0.133, 0.026-0.690) were significant factors for overall survival. There were no remarkable differences in AEs. CONCLUSIONS: The placement of additional biliary stent using the stent-in-stent method is an effective and safe rescue treatment for patients with UDMBO and occluded stent. In addition, the use of FCSEMS compared UCSEMS has unclear benefits regarding stent patency and overall survival.

Risk factors for complications in total hip arthroplasty. / Factores de riesgo para complicaciones en artroplastia total de cadera.

INTRODUCTION AND OBJECTIVE: Hip arthroplasty represents a significant advancement in the treatment of refractory chronic joint pain, improving quality of life and functionality. The objective of this study is to identify the risk factors associated with local and systemic complications in patients treated with total hip arthroplasty. METHODS: Observational, analytical, retrospective cohort study, which included 304 participants treated with total hip replacement. Comparison of variables between two groups was performed; 38 participants in the group with complications and 266 participants in the group without complications. RESULTS: The mean age in the complication group was 66 years (SD 18.7) and in the uncomplicated group it was 67,1 years (SD 15.1) (p 0,686). Female sex was observed in 73.3% of the group with complications and 65% in the group without complications. (p 0.292). Risk factors were: hip fracture as an indication for arthroplasty RR 1.33 [95% CI 1.004;1.775 p 0.047], coronary heart disease RR 1.31 [95% CI 1.067;1.616 p 0.010] and surgical bleeding equal to or greater than 400 cc RR 1.11 [95% CI 1.012;1.218 p 0.028]. CONCLUSIONS: The risk factors for complications in total hip arthroplasty were: hip fracture as the indication for arthroplasty, coronary artery disease, and surgical bleeding equal to or greater than 400 cc.

Infección de prótesis aórtica abdominal: tratamiento alternativo / Infected abdominal aortic prosthesis: an alternative therapy

Introducción: la infección de prótesis aórtica en la cirugía vascular convencional es un evento catastrófico, con una alta tasa de morbilidad y de mortalidad. El tratamiento tradicional ha sido la remoción de la prótesis y la reconstrucción con bypass extraanatómico. En algunos casos, se ha llevado a cabo el reemplazo con prótesis impregnadas en antibiótico; en otros, el reemplazo con vena femoral superficial y también la cirugía abierta con drenaje de las colecciones asociadas y antibioticoterapia de por vida. Caso clínico: se presenta el reporte de un caso de infección protésica tratada con drenajes de las colecciones y antibioticoterapia de larga duración, con un resultado favorable un año después de su complicación. Discusión: en algunos casos, dada la severidad del paciente, es posible intentar un tratamiento conservador de esta nefasta complicación.(AU)

Introduction: in traditional vascular surgery, aortic prosthesis infection is a catastrophic event with high morbidity andmortality rates. Traditional treatment is the removal of the valve followed by extra-anatomic bypass reconstruction. Insome cases, antibiotic-impregnated prosthesis replacement has been performed. In others, superficial femoral veinreplacement, and open surgery with drainage of the associated collections and lifelong antibiotic therapy.Case report: this is the case of a patient with aortic prosthesis infection undergoing draining collections and lifelongantibiotic therapy with a favorable outcome 1 year after the complication.Discussion: in some cases, given the severity of the patient, we can try to treat this dreaded complication conservativel.(AU)

Toxina botulínica y neumoperitoneo secuencial en el manejo de hernia inguinoescrotal gigante: Reporte de caso / Botulinum toxin and sequential pneumoperitoneum in the management of giant inguinoscrotal hernia: Case report

Introducción. Las hernias gigantes con pérdida de domicilio son aquellas cuyo saco herniario alcanza el punto medio del muslo en bipedestación y su contenido excede el volumen de la cavidad abdominal. Estas hernias son un reto quirúrgico dada la difícil reducción de su contenido y del cierre primario de la fascia. Tienen mayor riesgo de complicaciones asociadas al síndrome compartimental abdominal, así como mayor tasa de recurrencia y morbilidad en los pacientes. Caso clínico. Paciente masculino de 81 años, reconsultante por hernia inguinoescrotal derecha gigante, de dos años de evolución, sintomática, con índice de Tanaka de 24 %. Se decidió aplicar el protocolo de neumoperitoneo secuencial (hasta 11.000 ml en total en cavidad) además de toxina botulínica en pared abdominal (dos sesiones). Resultados. Se logró la corrección exitosa de la hernia inguinoescrotal gigante, sin recaídas de su patología abdomino-inguinal. El paciente manifestó satisfacción con el tratamiento un año después del procedimiento. Conclusiones. El protocolo de neumoperitoneo secuencial es una alternativa en casos de hernias complejas, con alto riesgo de complicaciones, que requieren técnicas reconstructivas adicionales. La aplicación previa de toxina botulínica es un adyuvante considerable para aumentar la probabilidad de resultados favorables. Sin embargo, debe incentivarse la investigación en esta área para evaluar su efectividad.

Introduction. Giant hernias with loss of domain are those whose hernial sac reaches the midpoint of the thigh in standing position and whose content exceeds the volume of the abdominal cavity. These hernias are a surgical challenge given the difficult reduction of their contents and the primary fascial closure, with a higher risk of complications associated with abdominal compartment syndrome, as well as a higher rate of recurrence and morbidity in patients. Clinical case. A 81-year-old male patient with comorbidity, reconsulting due to a symptomatic giant right inguinoscrotal hernia of two years of evolution, with a Tanaka index of 24%, eligible for a sequential pneumoperitoneum protocol (up to a total of 11,000 cc in cavity) plus application of botulinum toxin (two sessions) in the abdominal wall. Results. Successful correction of the patient's giant inguinoscrotal hernia was achieved using this protocol, without recurrence of his abdomino-inguinal pathology and satisfaction with the procedure after one year. Conclusion. The sequential pneumoperitoneum protocol continues to be an important alternative in cases with a high risk of complications that require additional reconstructive techniques, while the previous application of botulinum toxin is a considerable adjuvant to further increase the rate of favorable results. However, research in the area should be encouraged to reaffirm its effectiveness.

Experiencia de la histeropexia vaginal, usando prótesis de polipropileno

Introducción: El prolapso de órganos pélvicos (POP) o distopia genital, es el descenso o desplazamiento de los órganos del suelo pélvico a través del canal vaginal o fuera de este. Objetivo: Evaluar los resultados de la histeropexia vaginal en la corrección quirúrgica del prolapso genital apical grado III o IV, usando prótesis de polipropileno; además describir la tasa de éxito, recurrencias y complicaciones. Método: Estudio de cohorte, en 42 mujeres sometidas a histeropexia vaginal (histero-cistopexia ortotópica) mediante prótesis de polipropileno (Splentis®), entre 2016 y 2021. Se realizaron tres evaluaciones postoperatorias (tres, seis y 12 meses). Se hizo muestreo no probabilístico. Se utilizó estadística descriptiva. Resultados: La edad media fue de 56,19 ± 9,27 años. El tiempo quirúrgico de 58,95 ± 13,74 minutos, el sangrado quirúrgico de 119,85 ± 68,73 ml. La tasa de éxito a los 12 meses fue del 90,47%. La recurrencia del prolapso apical fue del 4,76% a los seis meses y del 9,52% a los 12 meses; el de compartimento anterior a los seis meses arrojó un 7,14%, frente al 11,9% a los 12 meses. El 14,28% de las pacientes presentaron complicaciones menores. La incidencia de incontinencia urinaria de esfuerzo a los 12 meses fue del 16,66%. Conclusiones: la histeropexia vaginal es un procedimiento efectivo y seguro, con bajas tasas de recurrencias o complicaciones. Es importante que se sigan haciendo estudios con mejores diseños estadísticos.

Introduction: Pelvic organ prolapse (POP), or genital dystopia, is the descent or displacement of pelvic floor organs through the vaginal canal or outside of it. Objective: To evaluate the results of vaginal hysteropexy in the surgical correction of grade III or IV apical genital prolapse, using polypropylene prosthesis; also describe the success rate, recurrences and complications. Method: Cohort study in 42 women undergoing vaginal hysteropexy (orthotopic hystero-cystopexy) using a polypropylene prosthesis (Splentis®); between 2016 and 2021. Three postoperative evaluations were carried out (three, six and twelve months). Non-probabilistic sampling was done. Descriptive statistics were used. Results: The mean age was 56.19 ± 9.27 years. Surgical time of 58.95 ± 13.74 minutes, surgical bleeding of 119.85 ± 68.73 ml. The success rate after twelve months was 90.47%. Apical prolapse recurrence was 4.76% at six months and 9.52% at twelve months; that of the previous compartment, after six months it showed 7.14%, compared to 11.9% after twelve months; 14.28% of the patients presented minor complications. The incidence of stress urinary incontinence, at twelve months, was 16.66%. Conclusions: Vaginal hysteropexy is an effective and safe procedure, with low rates of recurrence or complications. It is important that studies continue to be carried out with better statistical designs.

Reconstrucción auricular con implantes mastoideos utilizando el sistema Novaloc / Implant supported auricular reconstruction using the Novaloc system

La microtia es un padecimiento congénito de etiología desconocida que se puede presentar asociado a síndromes, su frecuencia es mayor en hombres, tiene predilección por el oído derecho. Se han propuesto distintas alternativas de tratamiento tanto estéticas como funcionales que disminuyan riesgos y aumenten la calidad de vida de los pacientes. Entre los tratamientos más comunes se encuentra el injerto costocondral, siendo una alternativa viable, aunque de mayor riesgo y que puede necesitar varios procedimientos quirúrgicos con el fin de lograr el mejor resultado estético; por lo mismo, uno de los tratamientos más realizados actualmente, es la reconstrucción auricular con implantes osteointegrados que se colocan en la región mastoidea y soportan una prótesis auricular. Se presenta el caso de un paciente masculino quien fue rehabilitado con implantes mastoideos ostoeintegrados para reconstrucción auricular implantosoportada. Las prótesis implantosoportadas reducen la necesidad de realizar cirugías correctivas y posibilitan la buena higiene de la prótesis al ser ésta removible, pero sin sacrificar su estabilidad. Los sistemas más utilizados son los mismos que se emplean en sobredentaduras, ya que el diseño del aditamento transmucoso, se adapta perfectamente al grosor del epitelio en la región mastoidea, por lo que es una excelente alternativa de tratamiento (AU)

Microtia is a congenital condition of unknown etiology that can occur associated with syndromes. Its frequency is greater in men and has a predilection for the right ear. Different treatment alternatives, both aesthetic and functional, have been proposed that reduce risks and increase the quality of life of patients. Among the most common treatments can be found the costochondral graft being a good alternative although greater risk of failure and the probability of several surgeries to get the best aesthetic result. Because of that one of the most used treatments is the placement of osseointegrated implants that can hold a prosthetic ear. Here is a case of a male patient who was rehabilitated with osseointegrated mastoid implants for ear reconstruction. Implant-supported prostheses significantly reduce the number of surgeries that must be performed and is a good option to maintain excellent hygiene as the prosthetic ear is removable, without compromising stability. The most common system is the same as those used in overdentures since the design of the transmucosal attachment fits perfectly to the thickness of epithelium in mastoid region (AU)

Use of semi-constrained total knee arthroplasty in gonarthrosis with collateral ligament insufficiency: Clinical and functional outcomes.

INTRODUCTION: Achieving stability in total knee arthroplasty (TKA) is crucial for long-term implant survival. In cases of severe deformity or ligament laxity, constrained implants may be required. Traditionally, increasing constraint involved intramedullary stems. However, there are intermediary alternatives, including employing a constrained polyethylene insert without stems, thereby avoiding complications related to them. The study aims to evaluate our experience with a non-modular constrained (NMC) implant in primary TKA. MATERIAL AND METHODS: We conducted a retrospective review of the clinical and radiographic outcomes of 108 non-stemmed primary TKAs performed at our institution between 2013 and 2021 in patients with at least 10° deformity or 10mm ligament laxity. Data included demographics, preoperative and postoperative deformities, clinical outcomes and revision rates. RESULTS: A total of 103 patients (108 knees) with a mean age of 74 were followed up for a minimum of 2 years. The mean postoperative range of motion was 105°/0°. The median Oxford Knee Score, Knee Society Score and Knee Society Function Score were 43.5, 92 and 90, respectively. 17 knees had varus deformity (mean tibiofemoral angle of 2.7°), and 87 knees had excessive valgus deformity (mean tibiofemoral angle of 15.1°). The remaining 4 knees had a neutral alignment. The mean postoperative tibiofemoral angle was 6.8°. The overall revision rate was 6.5% (7 patients): 3 deep periprosthetic infections, 2 patellar dislocations, 1 stiffness and 1 aseptic loosening. CONCLUSION: Our experience demonstrates favorable mid-term outcomes with the NMC implant, providing a safe alternative to stemmed implants in primary TKA, particularly in cases of severe deformity or ligament laxity.

Factores sociodemográficos, audiológicos y audioprotésicos relacionados con la calidad de vida en pacientes con prótesis auditivas en Madrid (España) / Sociodemographic, audiological and audioprosthetic factors related to quality of life in patients with hearing aids, in Madrid, Spain

Antecedentes y objetivo: El propósito de una adaptación protésica no es únicamente mejorar el entendimiento del lenguaje, sino mejorar la calidad de vida. El objetivo de esta investigación es medir la calidad de vida de los pacientes con prótesis auditivas e indagar qué variables sociodemográficas, audiológicas y audioprotésicas la afectan. Material y métodos: Estudio descriptivo transversal multicéntrico en la Comunidad de Madrid (España). Muestra formada por 54 pacientes. Se usó la escala Effectiveness of auditory rehabilitation (EAR). Resultados: Edad media de 66.4 años; el 55.6% eran hombres. La puntuación media de 10 ítems de la escala EAR audiológica fue 64.54 (DE 16.43). La puntuación media de 10 ítems de la EAR audioprotésica fue 71.84 (DE 13.49). La edad, sexo, actividad laboral, nivel de estudios, grado de pérdida auditiva, resultados de logoaudiometría, campo libre, número y formato de prótesis auditivas, prescriptor de las prótesis y año de fabricación de las prótesis se asocian con diferentes ítems de la escala EAR (p<.05). Conclusiones: La calidad de vida audiológica oscila entre regular y buena, y la audioprotésica se acerca a buena. Tener menor edad, ser de sexo femenino y tener actividad laboral se asocian con mejor calidad de vida. Las personas con buenos resultados logoaudiométricos se asocian con mejor calidad de vida. Las adaptaciones monoaurales, los audífonos retroauriculares, los audífonos más modernos y que el paciente no se autoprescriba prótesis auditivas se asocian con mejor calidad de vida. Las prótesis auditivas mejoran la calidad de vida de los pacientes siempre que se tengan en cuenta las características sociodemográficas, audiológicas y audioprotésicas específicas de cada paciente para realizar un ajuste audioprotésico personalizado y óptimo.(AU)

Background and objective: The purpose of a prosthetic adaptation is not only to improve language understanding and sound recognition, but to improve the patient's quality of life. The purpose of this investigation is to measure quality of life of patients with hearing aids, and investigate which sociodemographic, audiological and audioprosthetic variables affect it. Material and methods: Multicenter cross-sectional descriptive study in the Community of Madrid (España). Sample 54 patients and Effectiveness of Auditory Rehabilitation (EAR) scale was used. Results: Mean age 66.4 years; 55.6% men. The mean score of 10 audiological EAR items was 64.54 (SD 16.43). The mean score of 10 ear audioprosthetic items was 71.84 (SD 13.49). Age, sex, work activity, level of education, degree of hearing loss, logoaudiometry results, free field, number and format of hearing aids, prescriber of the prostheses and year of manufacture of the prostheses, are associated with different items of the EAR scale (P<.05). Conclusions: The audiological quality of life ranges from regular to good, and audioprosthetics is close to good.Younger age, female sex and work activity are associated with better quality of life. People with good logoaudiometric results are associated with better quality of life. Monaural adaptations, retroauricular hearing aids, more modern hearing aids and that the patient does not self-describe hearing aids, are associated with better quality of life. Hearing aids improve the quality of life of patients, provided that sociodemographic, audiological and audioprosthetic characteristics, specific to each patient are taken into account to make a personalized and optimal audioprosthetic adjustment.(AU)

AVIP Project (Prosthetic Virtual Friend): Study of clinical-functional outcomes and satisfaction with a mobile application in the perioperative management and follow-up of hip arthroplasty. / Proyecto AVIP (Amigo VIrtual Protésico): estudio de resultados clínico-funcionales y de satisfacción con una aplicación móvil en el manejo perioperatorio y seguimiento de implantes protésicos de cadera.

OBJECTIVE: To analyze the clinical, quality of life, and healthcare quality outcomes obtained in a series of patients undergoing total hip arthroplasty (THA), who were empowered and monitored using the AVIP application. These results will be compared with a control group followed through a standard protocol. MATERIAL AND METHOD: Randomized clinical trial with parallel groups involving patients with an indication for THA. Clinical variables were measured and compared using the WOMAC and mHHS, pain assessed by the VAS, quality of life with the SF-12 test. Walking capabilities were analyzed using the Functional Gait Assessment Scale, along with satisfaction levels assessed through the SUCE questionnaire, and perceived anxiety levels related to the process. RESULTS: A total of 68 patients were evaluated, with 31 patients in the AVIP group and 33 in the Control group completing the follow-up. Both groups demonstrated improvement in clinical outcomes based on the WOMAC and mHHS hip tests, a reduction in perceived pain, and an enhancement in quality of life according to the SF-12 test. Patients in the AVIP study group exhibited non-inferiority in clinical outcomes and satisfaction compared to the control group, as well as lower anxiety levels and improved walking capabilities after the first month of follow-up. Notably, 82.25% of the follow-up visits for this group were conducted remotely. CONCLUSION: The implementation of a mHealth application like AVIP can be safely offered to selected patients undergoing hip arthroplasty, enabling effective monitoring and providing continuous information and training.

Geriatric Characterization of Older Persons with Deficient Removable Dental Prostheses

Aging is a gradual and adaptive process that entails a series of changes, leading to reduced functional and physiological capacity. Each elderly person presents heterogeneous health conditions that must be considered by the interdisciplinary team responsible for their functional maintenance and overall health. This descriptive, cross-sectional study was conducted on elderly individuals with deficient removable dental prostheses, treated at the dental prosthetic rehabilitation centre of Hospital Del Salvador, in Santiago de Chile between the years 2021 and 2023. Instruments and indices were used to record and measure muscular conditions, such as the hand grip strength measurements, the Timed Up and Go test, and the calf circumference measurement. Information on educational levels, geriatric syndromes, chronic diseases, and medication consumption was collected. Of the participants, 58.9 % were female, and 41.1 % were male, with a mean age of 84.2 years for males and 80.4 years for females. 20.8 % had access to higher education, and 22.6 % lived alone. 78.5 % had lost all posterior support zones. 81.5 % had visual impairments; 36.3 % had auditory impairments, and 31.5 % had experienced one or more falls in the last 6 months. The mean sum of medications consumed per person was 4.32. The most prevalent morbidities were arterial hypertension (66.4 %) and type II diabetes (32.7 %). Means values for male/ female were: Hand Grip Strength 27.84 Kg/17.99 kg, Timed Up and Go 14.3 sec/14.9sec, BMI 27.16/ 26.44, and calf circumference 35.5 cm /35.2cm, values were within the normal range of values. The data collected is important to consider when treatment planning and implementing actions aimed at maintaining oral and general functionality. These aspects should be addressed from a multidimensional perspective, including risk factors, in both the diagnosis and dental treatments.

Envejecer es un proceso gradual y adaptativo que conlleva cambios, que reducen la capacidad funcional y fisiológica. Cada persona mayor presenta condiciones de salud heterogéneas que deben ser consideradas por el equipo interdisciplinario a cargo de su mantención funcional y estado de salud. Estudio descriptivo, corte transversal, en personas mayores portadoras de prótesis dentales removibles deficientes, del servicio dental de rehabilitación protésica del Hospital Del Salvador de Santiago de Chile, entre los años 2021-2023. Se emplearon instrumentos e índices para realizar registro y medición de condiciones musculares como fuerza de presión manual, prueba Timed Up and Go y medición del perímetro de pantorrilla. Se recolectó información asociada a nivel de escolaridad, síndromes geriátricos, enfermedades crónicas y cantidad de fármacos que consumen. Un 58,9 % eran mujeres, la edad media de hombres fue de 84,2 años y la de mujeres fue de 80,4 años. Un 20,8 % tuvo acceso a educación superior. El 22,6 % vive solo. Un 78,5 % ha perdido todas las zonas de soporte dentario posterior. Un 81.5 % tiene alteraciones visuales; un 36.3 % alteraciones auditivas; un 31.5 % ha tenido 1 o más caídas en los últimos 6 meses. La media de fármacos fue de 4.32 por persona. Las morbilidades más prevalentes fueron hipertensión arterial (66.4 %) y diabetes tipo II (32,7 %). Los valores promedios encontrados para hombres/mujeres en fuerza de prensión manual fueron 27,84 Kg/17,99 kg, Timed Up and Go fueron 14,3 sec / 14,9 sec, IMC 27,16/ 26,44 y perímetro de pantorrilla 35,5 cm / 35,2 cm. Todos los datos clasificaron en el rango de normalidad. Las características observadas son importantes a considerar al momento de planificar tratamientos e implementar medidas orientadas a mantener funcionalidad oral y general. Éstas deben ser abordadas desde una mirada multidimensional, incluyendo los factores de riesgo, tanto en el diagnóstico como su tratamiento odontológico.

Pectus excavatum. Surgical treatment: Structural or aesthetic?

INTRODUCTION: Pectus excavatum is a wall deformity that often warrants medical evaluation. In most cases, it's a purely visual aesthetic alteration, while in others, it comes with symptoms. Several surgical techniques have been described, but their outcomes are difficult to assess due to the heterogeneity of presentations and the lack of long-term follow-up. We present our experience as thoracic surgeons, assessing correction as either structural (remodeling of the thoracic cage through open surgery) or aesthetic (design and implantation of a customized 3D prosthesis). MATERIAL AND METHODS: Retrospective observational study of the indication for surgical treatment of pectus excavatum carried out by a team of thoracic surgeons and the short- to mid-term results. RESULTS: Between 2021 and 2023, we treated 36 cases surgically, either through thoracic cage remodeling techniques or with 3D prostheses. There were few minor complications, and the short- to mid-term results were positive: alleviation of symptoms or compression of structures when present, or aesthetic correction of the defect in other cases. CONCLUSIONS: Surgery for pectus excavatum should be evaluated for structural correction of the wall or aesthetics. In the former, thoracic cage remodeling requiring cartilage excision and possibly osteotomies is necessary. In the latter, the defect is corrected with a customized 3D prosthesis.

Prótesis colónicas en el tratamiento paliativo del cáncer colónico. Nuestra evaluación tras 10 años de experiencia / Self-expanding metal stents in the palliative treatmentof coloncancer. Results of 10 years of experience

Introducción: la colocación de prótesis metálicas autoexpansibles (PAE) por vía endoscópica surge como opción terapéutica para la obstrucción colónica neoplásica en dos situaciones: como tratamiento paliativo y como puente a la cirugía curativa. Este procedimiento evita cirugías en dos tiempos y disminuye la probabilidad de colostomía definitiva y sus complicaciones con el consecuente deterioro de la calidad de vida. Objetivo: comunicar nuestra experiencia en la colocación de PAE para el tratamiento paliativo de la obstrucción colorrectal neoplásica. Diseño: retrospectivo, longitudinal, descriptivo y observacional. Material y métodos: se incluyeron todos los pacientes a quienes el mismo grupo de endoscopistas les colocó PAE con intención paliativa por cáncer colorrectal avanzado entre agosto de 2008 y diciembre de 2019. Fueron analizadas las variables demográficas y clínicas, el éxito técnico y clínico, las complicaciones tempranas y tardías y la supervivencia. Resultados: se colocó PAE en 54 pacientes. La media de edad fue 71 años. El 85% de las lesiones se localizó en el colon izquierdo. En el 57% de los pacientes se realizó en forma ambulatoria. El éxito técnico y clínico fue del 92 y 90%, respectivamente y la supervivencia media de 209 días. La tasa de complicaciones fue del 29,6%, incluyendo un 14,8% de obstrucción y un 5,6% de migración. La mortalidad tardía atribuible al procedimiento fue del 5,6%, ocasionada por 3 perforaciones tardías: 2 abiertas y 1 microperforación con formación de absceso localizado. Conclusiones: la colocación de PAE como tratamiento paliativo de la obstrucción neoplásica colónica es factible, eficaz y segura. Permitió el manejo ambulatorio o con internación breve y la realimentación temprana, mejorando las condiciones para afrontar un eventual tratamiento quimioterápico paliativo. Las mayoría de las complicaciones fueron tardías y resueltas endoscópicamente en forma ambulatoria. (AU)

Introduction: endoscopic placement of self-expanding metal stents (SEMS) emerges as a therapeutic option for neoplastic obstruction of the colon in two situations: as palliative treatment and as a bridge to curative surgery. This procedure avoids two-stage surgeries and reduces the probability of permanent colostomy and its complications with the consequent deterioration in quality of life. Objective: to report our experience in the placement of SEMS as palliative treatment in neoplastic colorectal obstruction. Design: retrospective, longitudinal, descriptive and observational study. Methods: all patients in whom the same group of endoscopists performed SEMS placement with palliative intent for advanced colorectal cancer between August 2008 and December 2019 were analyzed. Data collected were demographic and clinical variables, technical and clinical success, early and late complications, and survival. Results: SEMS were placed in 54 patients. The average age was 71 years. Eighty-five percent were left-sided tumors. In 57% of the patients the procedure was performed on an outpatient basis. Technical and clinical success was 92 and 90%, respectively, and median survival was 209 days. The complication rate was 29.6%, including 14.8% obstruction and 5.6% migration. Late mortality attributable to the procedure was 5.6%, caused by 3 late perforations: 2 open and 1 microperforation with localized abscess formation. Conclusions: The placement of SEMS as a palliative treatment for neoplastic colonic obstruction is feasible, effective and safe. It allowed outpa-tient management or brief hospitalization and early refeeding, improving the conditions to face an eventual palliative chemotherapy treatment. Most complications were late and resolved endoscopically on an outpatient basis. (AU)

Satisfaction assessment study in patients (and their partners) with/without Peyronie's disease and penile prosthesis implantation.

INTRODUCTION AND OBJECTIVE: Among the many treatments for erectile dysfunction, implantation of a penile prosthesis has been associated with high patient satisfaction rates. However, patients with coexistent Peyronie's disease (PD) and refractory erectile dysfunction and/or severe deformities may show different results. The aim of our study was to assess and to compare the level of satisfaction, with an inflatable penile prosthesis (IPP), in men with/without coexistent PD. MATERIAL AND METHODS: A survey study based on a five-item satisfaction questionnaire was submitted to all those live patients implanted in the period 1992-2022 at our center (n=570) and their partners. Ninety-two percent of implants were inflatable devices. Surgeries were mainly performed by two surgeons. The main outcome measure used was the level of patient and partner satisfaction with sexual intercourse after IPP. RESULTS: Of the 570 eligible patients, 479 (84%) completed the survey (393 Non-PD: GROUP 1; 70 non-complex PD-Group 2; 16 complex PD). Eighty-six per cent of patients in Group 1 reported satisfactory sexual intercourse (very or moderately satisfied). Non-complex PD implanted patients (Group 2) reported a global 81% satisfactory sexual intercourse (very or moderately satisfied) (p>0.05). However, when we evaluated the PD subgroup of patients with severe PD who require incision/excision/grafting at the time of implant (Group 3: n=20), only 61% reported satisfactory sexual intercourse (p<0.01) with predominance of moderately satisfied patients over very satisfied: 78% vs. 22%). Additionally, 84% (Group 1), 80% (Group 2) and 54% (Group 3) of partners reported satisfactory intercourses, respectively (p<0.01). Overall, 84% of Group 1 implants and 79% of Group 2 reported that they would undergo the procedure again if the IPP failed (p>0.05; ns). Only 50% of Group 3 patients would do it again. With regard to cosmetic aspects, 48% of the Group 3 implant reported penile shortness or soft glans as the main causes of their dissatisfaction. Only 2.4% of total PP patients expressed difficulty in manipulating the device. CONCLUSION: The presence of PD alone may not impact PP patient and partner satisfaction, but patients with more severe baseline deformity who require incision/grafting may be less satisfied with outcomes including penile length and glans sensation.

How to create by your own a customized hip cement mega-spacer for a hip megaprosthesis two-stage revision surgery after oncologic limb-salvage surgery - Surgical technique and case report.

Managing chronic periprosthetic infections in patients who have undergone limb-salvage surgery following a malignant bone tumor with megaprosthesis often involves a two-stage revision surgery with the use of a cement-spacer. This paper show details the preparation of a self-made intramedullary metal-stabilized mega-cement spacer for patients needing a two-stage revision surgery due to infection after oncologic bone tumor resection and limb-salvage surgery with megaprosthesis and present two clinical cases treated with this technique. The report provides a practical surgical technique to create a cement hip mega-spacer using readily available tools in most orthopedic surgical settings.