Predicción preoperatoria del diámetro de la plastia autóloga de isquiotibiales en reconstrucción de ligamento cruzado anterior / reoperative prediction of autologous hamstring graft diameter in anterior cruciate ligament reconstruction

ANTECEDENTES Y OBJETIVO: Actualmente no existe un modelo establecido en la práctica clínica que permita predecir de forma fiable este parámetro. El objetivo del estudio fue valorar si existe correlación entre el área total sumada de los tendones recto interno (TRI) y semitendinoso (ST) en estudios preoperatorios de resonancia magnética (RM) y el diámetro intraoperatorio de la plastia. MÉTODOS: Estudio retrospectivo que analizó 89 pacientes intervenidos de reconstrucción de ligamento cruzado anterior con plastia autóloga de isquiotibiales. Las variables analizadas fueron: área en mm2 de ST y TRI en estudio preoperatorio de RM, diámetro intraoperatorio de plastia, edad, sexo, lateralidad de intervención, peso, talla e índice de masa corporal. RESULTADOS: Se halló una correlación fuerte-moderada entre el diámetro final de la plastia y el sumatorio del área total del ST y del TRI (Índice de correlación de Pearson 0,6911; p < 0,001). También se observó que, si la combinación de las áreas mencionadas es de 19mm2 o más, la probabilidad de tener una plastia de diámetro mayor o igual a 8mm es de al menos 91,8%. El análisis de la curva ROC demostró que este método predictivo discrimina correctamente en más del 95,6% de las ocasiones entre obtener una plastia de diámetro mayor o igual de 8mm o no tenerla. La concordancia inter e intraobservador de las mediciones realizadas en RM fue excelente en ambos casos con índices de correlación intraclase intraobservador (CCI) de 0,79 y CCI interobservador de 0,84, CCI 0,77 para tendón ST y TRI respectivamente. CONCLUSIONES: El área total de los tendones ST y TRI (mm2), medida preoperatoriamente en el estudio de RM, se correlaciona con el diámetro final de la plastia y constituye un método fiable y reproducible para predecir el grosor de la plastia autóloga de isquiotibiales. NIVEL DE EVIDENCIA: Cohortes retrospectivo, nivel de evidencia IV. RELEVANCIA CLÍNICA: En la literatura revisada se establece que una plastia menor de 8mm de diámetro se asocia a una mayor probabilidad de rerotura y/o fallo. Pese a ser un factor determinante actualmente no existe un modelo establecido en la práctica clínica que permita predecir de forma fiable el diámetro final de la plastia. Conocer de antemano las probabilidades de que la plastia autóloga de isquiotibiales alcance un diámetro suficiente (igual o mayor a 8mm) permitiría al cirujano ortopédico planificar mejor la intervención y anticipar cuándo se van a tener que utilizar otras alternativas de injerto (utilización de autoinjerto tipo HTH o de aloinjerto, entre otras opciones)

BACKGROUND AND OBJECTIVE: Currently, there is no stablished pre-operative model that helps the orthopaedic surgeon predict the final graft diameter in anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to determine whether there is a correlation between semitendinosus (ST) and gracilis (GT) cross-sectional area (CSA) evaluated pre-operatively in mm2 using magnetic resonance imaging (MRI) and the final intra-operative ST-GT autograft diameter in mm2. METHODS: A retrospective study was designed, 89 patients undergoing ACLR with hamstring autograft participated. We analysed ST-CSA (mm2) and GT-CSA (mm2) using pre-operative MRI, intra-operative autograft diameter, age, sex, side of the injury, weight, height and body mass index (BMI). RESULTS: A moderate-strong correlation was identified between final autograft diameter and ST-GT CSA in MRI (Pearson correlation coefficient .6911 P<.001). We observed that, if the combination of ST-CSA and GT-STA is at least 19mm2, the probability of obtaining an autograft with a diameter greater than or equal to 8mm is 91.8% or more. The ROC curve analysis demonstrated, in this model, that this predictive method on MRI correctly discriminates in over 95.6% of cases between achieving or otherwise an autograft greater than or equal to 8mm during surgery. Intra and interobserver concordance of the MRI measurements were excellent, as shown in the intraobserver intraclass correlation coefficient (CCI) of .79 and the interobserver CCI of .84 and .77 for the ST and GT respectively. CONCLUSIONS: Preoperative determinations of ST-CSA and GT-CSA (mm2) using MRI correlate with the final autograft diameter. This method represents a reliable and reproducible model to predict the hamstring autograft diameter in ACLR. LEVEL OF EVIDENCE: Retrospective cohort study, level IV. CLINICAL RELEVANCE: A review of the available literature reveals a higher risk of ACL failure or re-rupture if the graft is smaller than 8mm in diameter. Despite being an important factor there is no established pre-operative model that predicts the final graft diameter. Knowing beforehand the possibilities of obtaining a hamstring autograft with a diameter greater than or equal to 8mm would help the orthopaedic surgeon to better plan the surgery and to anticipate the need for other graft options (such as bone-patellar-tendon-bone autograft or allografts, amongst other alternatives)

Preoperative prediction of autologous hamstring graft diameter in anterior cruciate ligament reconstruction. / Predicción preoperatoria del diámetro de la plastia autóloga de isquiotibiales en reconstrucción de ligamento cruzado anterior.

BACKGROUND AND OBJECTIVE: Currently, there is no stablished pre-operative model that helps the orthopaedic surgeon predict the final graft diameter in anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to determine whether there is a correlation between semitendinosus (ST) and gracilis (GT) cross-sectional area (CSA) evaluated pre-operatively in mm2 using magnetic resonance imaging (MRI) and the final intra-operative ST-GT autograft diameter in mm2. METHODS: A retrospective study was designed, 89 patients undergoing ACLR with hamstring autograft participated. We analysed ST-CSA (mm2) and GT-CSA (mm2) using pre-operative MRI, intra-operative autograft diameter, age, sex, side of the injury, weight, height and body mass index (BMI). RESULTS: A moderate-strong correlation was identified between final autograft diameter and ST-GT CSA in MRI (Pearson correlation coefficient .6911 P<.001). We observed that, if the combination of ST-CSA and GT-STA is at least 19mm2, the probability of obtaining an autograft with a diameter greater than or equal to 8mm is 91.8% or more. The ROC curve analysis demonstrated, in this model, that this predictive method on MRI correctly discriminates in over 95.6% of cases between achieving or otherwise an autograft greater than or equal to 8mm during surgery. Intra and interobserver concordance of the MRI measurements were excellent, as shown in the intraobserver intraclass correlation coefficient (CCI) of .79 and the interobserver CCI of .84 and .77 for the ST and GT respectively. CONCLUSIONS: Preoperative determinations of ST-CSA and GT-CSA (mm2) using MRI correlate with the final autograft diameter. This method represents a reliable and reproducible model to predict the hamstring autograft diameter in ACLR. LEVEL OF EVIDENCE: Retrospective cohort study, level IV. CLINICAL RELEVANCE: A review of the available literature reveals a higher risk of ACL failure or re-rupture if the graft is smaller than 8mm in diameter. Despite being an important factor there is no established pre-operative model that predicts the final graft diameter. Knowing beforehand the possibilities of obtaining a hamstring autograft with a diameter greater than or equal to 8mm would help the orthopaedic surgeon to better plan the surgery and to anticipate the need for other graft options (such as bone-patellar-tendon-bone autograft or allografts, amongst other alternatives).

Analysis of the diet in a Spanish prison and the level of perception in a sample of prisoners.

INTRODUCCIÓN: An analysis is carried out of the diet provided at the Quatre Camins prison (Barcelona), where meals were modified in the first quarter of 2017 to provide a healthier diet. OBJECTIVES: The new meals are described in relation to the most prevalent chronic and metabolic pathologies in the prison population and it is checked if they correspond to a healthy diet. The food offered at the prison shops and the perception of prisoners regarding prison food are also analysed. MATERIALS AND METHODS: A mixed methodology study was carried out: a) a descriptive analysis of the new food offered by the kitchen service; and b) an analysis of the meals using the Spanish Healthy Eating Index (IASE) as a reference; as well as a description of the most prevalent pathologies in the prison. To determine the prisoners' perceptions, an ad hoc self-completed questionnaire was designed that consisted of four closed Likert questions and four open questions about the perception of prison food. The prisoners who responded to the questionnaire did so voluntarily, anonymously and under informed consent. RESULTS: A sample of 22 prisoners was used. The score according to the IASE is 60.5 points. The assessments of the sample of 22 prisoners regarding quality, quantity and perception of diet as healthy does not reach pass. DISCUSSION: Access to safe water and food meets the requirements for healthiness, quality and quantity regulated by the current Prison Regulation. The results obtained suggest that the diet in the prison "needs changes" according to the IASE.

Clinical and radiological short-term complications after single-stage bilateral uncemented total hip arthroplasty.

PURPOSE: Economic crisis time gives to efficient procedures an important role in healthy system. Total hip replacement is a common bilateral orthopedic procedure, but there exists an important controversy to perform it in single or two stages. Our aim is to report our clinical and radiological short-term complications of bilateral uncemented total hip arthroplasty in a single time. MATERIALS AND METHODS: We have retrospectively reviewed the patients treated between 2000 and 2011 in our center by bilateral uncemented total hip replacement in a single time. We have reviewed the medical history and analyzed by age, diagnosis and ASA parameters related to the procedure, hospital stay, transfusion requirements and clinical complications. Radiological evaluation was made with anteroposterior hip radiograph evaluation (acetabular radiolucencies and stem migration). Functional assessment was carried out by the Merle D'Aubigné score. RESULTS: Seventeen patients with mean age of 47.4 (18-68) years were reviewed with a mean follow-up of 44.3 (6-172) months. ASA distribution: 29.4 % grade I; 52.9 % grade II and 17.6 % grade III. Merlé D'Aubigné score improved from 11.01 to 16.45. Hospital stay was 6 days. Transfusion requirements were two hematic concentrates for each patient. Two external popliteal sciatic nerve neurapraxias fully recovered at follow-up. Radiological results showed one case of axial migration. CONCLUSIONS: With proper patient selection and multidisciplinary team, the bilateral uncemented total hip arthroplasty in a single time has low complication rates. Our results could be used in the development of future randomized controlled trials or prospective cohort studies. LEVEL OF EVIDENCE: IV.

Experimental in situ exposure of the seagrass Posidonia oceanica (L.) Delile to 15 trace elements.

The Mediterranean seagrass Posidonia oceanica (L.) Delile has been used for trace element (TE) biomonitoring since decades ago. However, present informations for this bioindicator are limited mainly to plant TE levels, while virtually nothing is known about their fluxes through P. oceanica meadows. We therefore contaminated seagrass bed portions in situ at two experimental TE levels with a mix of 15 TEs (Al, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Mo, Ag, Cd, Pb and Bi) to study their uptake and loss kinetics in P. oceanica. Shoots immediately accumulated pollutants from the beginning of exposures. Once contaminations ended, TE concentrations came back to their original levels within two weeks, or at least showed a clear decrease. P. oceanica leaves exhibited different uptake kinetics depending on elements and leaf age: the younger growing leaves forming new tissues incorporated TEs more rapidly than the older senescent leaves. Leaf epiphytes also exhibited a net uptake of most TEs, partly similar to that of P. oceanica shoots. The principal route of TE uptake was through the water column, as no contamination of superficial sediments was observed. However, rhizomes indirectly accumulated many TEs during the overall experiments through leaf to rhizome translocation processes. This study thus experimentally confirmed that P. oceanica shoots are undoubtedly an excellent short-term bioindicator and that long-term accumulations could be recorded in P. oceanica rhizomes.

Prominencia esternoclavicular: hiperostosis u osificación interarticular ¿Un cajón de sastre? / Sterno-clavicular prominence: hyperostosis or interarticular ossifiction. ¿it is a ragbag?

Introducción. En la práctica clínica observamos con cierta frecuencia una prominencia esternoclavicular dolorosa, deformidad que constituye el principal signo de dos entidades con baja incidencia, aunque bien definidas: la hiperostosis esterno-costo-clavicular (HECC) y la osificación inter-esterno-costo-clavicular (OIECC). El diagnóstico diferencial de estas afecciones debe incluir la artrosis esterno-clavicular, la enfermedad de Paget, la osteitis condensante, la osteomielitis, la pustulosis, la enfermedad de Friederich, el síndrome de Tietze y el osteoma osteoide. Esto es especialmente importante en los casos en los que la afectación sea unilateral. Material y método. Presentamos una serie de nueve pacientes cuyo motivo de consulta fue una prominencia esterno-costo-clavicular, compatible con HECC u OIECC. El motivo de consulta en la mayoría de los pacientes fue el descartar la presencia de un tumor en esa localización. Resultados. Los estudios radiológicos mostraron un aumento variable tanto de la densidad como de la masa ósea, así como diferentes intensidades de afectación de la articulación esterno-costo-clavicular. Discusión. Descartado un tumor y con un diagnóstico concreto de la causa de la prominencia, generalmente, se considera suficiente con el tratamiento antiinflamatorio en la mayoría de los pacientes. En la práctica clínica parece irrelevante la diferenciación entre HECC y OIECC, ya que el tratamiento y el pronóstico de ambas afecciones son superponibles. La biopsia de la articulación y los procedimientos diagnósticos invasivos pueden ser innecesarios(AU)

Introduction. In clinical practice, we see quite often painful sterno-clavicular prominence, deformity, which is the hallmark of two entities with a low incidence, although well defined hyperostosis cost sterno-clavicular (HECC) and ossification cost inter-sterno-clavicular (OIECC). The differential diagnosis of these conditions, you must include sterno-clavicular arthritis, Paget's disease, condensing osteitis, osteomyelitis, pustulosis, Friederich's disease, Tietze's syndrome and osteoid osteoma. This is especially important in cases where the involvement is unilateral. Material and methods. We present a series of nine patients complaining of a painful sterno- clavicular prominence, compatible with HECC or OIECC. The reason for consultation in most patients was rule out the presence of a tumor in that location. Results. Image studies showed a variable increase both the density and bone mass as well as different intensities of joint involvement sterno-clavicular cost. Conclusion. Ruled out a tumor and a specific diagnosis of these, you do not need aggressive treatment, is generally considered sufficient anti-inflammatory treatment in most patients. In clinical practice, it is irrelevant and OIECC HECC differentiation, since treatment and prognosis of both conditions are similar. The biopsy of the joint and aggressive diagnostic procedures may be unnecessary (AU)

Polirradiculopatía torácica diabética: un dolor olvidado / Diabetic thoracic polyradiculopathy: a forgotten pain

La polirradiculopatía torácica diabética (PTD) es una manifestación neuropáticainfrecuente que suele presentarse en pacientes con diabetes de larga evoluciónjunto a otras complicaciones crónicas microangiopáticas. Se manifiestacomo un cuadro doloroso que afecta a la región torácica o a la abdominaldependiendo de las raíces implicadas. El dolor puede llegar a ser de gran intensidade incapacitante, y a menudo el diagnóstico se retrasa al valorarseprimeramente otras causas más frecuentes de aquél. El diagnóstico se confirmamediante estudio electromiográfico, debiéndose descartar otras etiologíasorgánicas, en particular las tumorales. El tratamiento incluye los fármacos comúnmenteempleados en la neuropatía diabética dolorosa, precisándose aveces la administración de corticoides, la estimulación neural transcutánea ola plasmaféresis. Presentamos un caso de PTD en un paciente joven con diabetestipo 2 de reciente diagnóstico, de un tiempo de evolución indeterminadoy con severas manifestaciones microangiopáticas. Se exponen las característicasdel cuadro clínico, el planteamiento diagnóstico y la actitud terapéutica(AU)

The diabetic thoracic polyradiculopathy (DTP) is an uncommon neuropathicmanifestation that usually appears in patients with long evolution diabetes togetherwith microangiopathic chronic complications. It appears as a painfulpicture that affects the thoracic and abdominal region depending from the affectedroots. The pain can be of great intensity and disabling and very often thediagnosis is delayed when assessing other more frequent causes first. The diagnosisis confirmed through an electromyography, having to rule out otherorganic etiologies, specially the tumoral ones. The treatment includes the mostused drugs for painful diabetic neuropathy, being sometimes the administrationof corticosteroids, transcutaneous neural stimulation or plasmapheresis required.We present the case of DTP in a young patient with a recent diagnosedT2D with an undetermined evolution time and with serious microangiopathicmanifestations, standing out the characteristics of the medical profile, the diagnosticapproach and the therapeutic attitude(AU)

Modification of the number and phenotype of striatal dopaminergic cells by carotid body graft.

In non-human primates, striatal tyrosine hydroxylase-immunoreactive (TH-ir) cells are increased in number after dopamine depletion and in response to trophic factor delivery. As carotid body cells contain the dopaminotrophic glial cell line-derived neurotrophic factor (GDNF), we evaluated the number, morphology and neurochemistry of these TH-ir cells, in the anterior and posterior striatum of five monkeys treated with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) which received a graft of carotid body cell aggregates (CBCA) (n = 3) or sham surgery (n = 2), and six MPTP-monkeys that were sacrificed 6 months and 3 years after the last MPTP dose [MPTP I (n = 3) and MPTP II (n = 3), respectively]. Three intact monkeys served as controls. A disability rating scale was used for the assessment of parkinsonism in all lesioned animals, both before and after surgery. For the neurochemical examination, tissue sections were double-labelled with antibodies to TH, dopamine transporter, dopa decarboxylase-67, vesicular monoamine transporter 2, glutamic acid decarboxylase -67, calbindin, parvalbumin, calretinin, neuronal nitric oxide synthase and GDNF. Only animals receiving CBCA graft showed a moderate but significant recovery of parkinsonism that persisted 12 months after the graft. The grafted striatum contained the greatest TH-ir cell density (120.4 +/- 10.3 cells/100 mm2), while the control striatum displayed the lowest (15.4 +/- 6.8 cells/100 mm2), and MPTP I, MPTP II and sham-operated monkeys showed a similar intermediate value (66.1 +/- 6.2, 58.3 +/- 17.2 and 57.7 +/- 7.0 cells/100 mm2, respectively). In addition, in the post-commissural striatum, only CBCA graft induced a significant increase in the TH-ir cell density compared to control animals (47.9 +/- 15.9 and 7.9 +/- 3.2, respectively). Phenotypically, TH-ir cells were striatal dopaminergic interneurons. However, in the grafted animals, the phenotype was different from that in control, MPTP and sham-operated monkeys, with the appearance of TH/GDNF-ir cells and the emergence of two TH-ir subpopulations of different size as the two main differentiating features. Our data confirm and extend previous studies demonstrating that striatal CBCA grafts produce a long-lasting motor recovery of MPTP-monkeys along with an increase in the number and phenotype changes of the striatal TH-ir interneurons, probably by the action of the trophic factors contained in carotid body cells. The increased number of striatal TH-ir cells observed in the grafted striatum may contribute to the improvement of parkinsonism observed after the graft.

Prótesis total de cadera tras artroplastia de resección / Total hip replacement after resection arthroplasty

Objetivo. Revisar nuestra experiencia en la reconstrucción protésica tras una artroplastia de resección, resultado y posibles complicaciones. Material y método. Estudiamos retrospectivamente 23 caderas reconstruidas tras un período medio de 2,2 años. Fueron criterios de inclusión: presentar una artroplastia de resección, haber sido reconstruido con prótesis articular y que tuvieran un seguimiento mínimo de 1 año. La evaluación se realizó con la escala de Merle D´Aubigne para dolor, marcha y movilidad. Resultados. El alargamiento de la extremidad intervenida fue de 2,9 cm (1,2-4,8). El promedio para dolor fue de 4,6, para movilidad de 4,3 y para la marcha de 5,2. El resultado global fue de 14,1 puntos, considerado aceptable. El 47% presentó resultados buenos o muy buenos. Todos los pacientes mejoraron su capacidad de marcha. Cuatro pacientes presentaron luxación de la prótesis tras la reconstrucción y sólo un paciente presentó reinfección. Conclusiones. La reconstrucción protésica después de una artroplastia de resección es técnicamente difícil, debido al deterioro de las partes blandas y a la alteración, en la cantidad y calidad, de la reserva ósea producto de cirugías previas. La principal ganancia se observó en la capacidad de marcha y menos en el dolor y la movilidad. La selección de los pacientes a reconstruir debe ser cuidadosa para evitar complicaciones y falsas expectativas

Aim. To review our cases of resection arthroplasty in order to determine outcomes and possible complications. Materials and methods. We performed a retrospective study of 23 hips that had undergone reconstruction during the last 2.2 years on average. The inclusion criteria were: resection arthroplasty, joint prosthesis reconstruction, and a minimum followup of 1 year. The Merle D'Aubigne scale was used to assess pain, gait and mobility. Results. Lengthening of the operated limb was 2.9 cm (1.2-4.8). Average scores were: pain 4.6, mobility 4.3 and gait 5.2. The overall result was considered acceptable, with a score of 14.1. Good to very good results were seen in 47% of cases. Gait improved in all patients. Four patients suffered from prosthesis dislocation after reconstruction and only one patient suffered re-infection. Conclusions. Prosthetic reconstruction after resection arthroplasty is technically difficult due to the deterioration of soft tissues and alterations in the quantity and quality of the bone stock due to previous surgeries. The main gain is seen in gait, and to a lesser extent in pain and mobility. Patient selection for reconstruction must be very careful to avoid complications and false expectations

Implantes con grabado ácido y pasivado químico: estudio preliminar sobre carga precoz / Implants with acid etching and chemical passivation: preliminar study about early loading

We are submitting a study on a new implant system in which the surface of the implant is treated by means of a process of acid etching and chemical passivation. The fifteen patients that were included in this assay were given a total of seventy implants according to the different states and conditions of bone quality and quantity. After the first stage the results showed a success rate of 95.71%, which means that prothesis loading can be effected within a period of approximately two months, and which has led us to stablish, by way of preliminary conclusions, that this type of implant surface means that the waiting time for our patients can be reduced, and that results similar to those obtained using other, more conventional surfaces can be achieved (AU)

Valoración clínico radiológica a los 3 y 5 años de la función en prótesis fijas implanto soportadas (Sistema Branemark) / Clinical radiology valoration three and five years after function in implantsupport prothesis

Objetivos: valorar la influencia que tiene la función protésica sobre el tejido óseo de soporte del implante. Material y método: se estudiaron 51 prótesis fijas sobre 139 implantes branemark colocados en el master de implantes de la facultad de odontología de Madrid. Se compararon a los 3 y 5 años todos aquellos parámetros encargados de valorar la función de la prótesis con el grado de pérdida y calidad ósea en torno a los implantes que los soportan. Resultados: si bien algunos parámetros prostodóncicos resultan intrascendentes otros como la estabilidad de la prótesis o la longitud del cantilever parecen tener una influencia directa sobre el estado del hueso soporte, de modo que en aquellos casos de falta de estabilidad o con extremos libres demasiado largos, la calidad y cantidad ósea va disminuyendo con el tiempo de función de la prótesis. Conclusiones: es difícil valorar la influencia de la función protésica sobre los tejidos de soporte del implante, ya que la muestra no es grande y la cantidad de variables es muy numerosa (tipo de antagonista, material, tramo edéntulo, n° de implantes, etc.). Sí parece claro que la estabilidad de la misma y la longitud del cantilever son dos factores fundamentales en el pronóstico a largo plazo del tratamiento (AU)

Objective: to value the influence of the prosthetic function on the supporting bone tissues. Material and method: fifty-one fixed prosthesis of 139 branemark implants, placed at the master of implants of the dentistry faculty of Madrid, were studied. All parameters that value the function of the prosthesis with the degree of bone loss and quality around the implants that support them, were compared after three and five years. Results: although some prosthodontic parameters reveal to be of no importance, others, such as the prosthesis' stability or the length of the cantilever seem to have a direct influence on the state of the supporting bone. In the case of absence of stability or too large free extremes, the bone quality and quantity diminishes during the implants' function. Conclusions: it is difficult to value the influence of the posthetic function on the supporting tissues of the implant, due to the small sample and the large number of variable ( ... Type, material, ... Edentulous interval, number of implants, etc) it seems clear that the stability and the length of the cantilever are two fundamental factors in the long term prediction of the treatment (AU)

[The induction of a septal infarct as a therapeutic alternative in hypertrophic obstructive cardiomyopathy: new observations apropos a case]. / Inducción de infarto septal como alternativa terapéutica en la miocardiopatía hipertrófica obstructiva: nuevas observaciones a propósito de un caso.

The hypertrophic cardiomyopathy may be associated with a variable degree of left ventricular outflow tract obstruction. There are several available therapeutic strategies for treatment: pharmacological, dual-chamber pacing, surgery and induced septal infarction. This last one is a novel technique with less experience in practice. We present the clinical case of a patient which showed persistent and severe obstruction in spite of the medications and dual-chamber pacing, and who underwent this novel technique. The results were optimal but new observations arise from this particular case.

[Symptomatic ischemia in a patient with a single right coronary artery without lesions]. / Isquemia sintomática en un paciente con coronaria derecha única sin lesiones.

Coronary artery anomalies are not a frequent finding, and a single right coronary artery is extremely rare. This anomaly has been included among the potentially serious ones because its association with infarction and sudden death has been reported. We present the case of a female patient who complained of chest pain, showed a positive exercise treadmill test and had a single right coronary artery in the angiography with no stenotic lesions. The pathophysiology and the clinical implications are discussed.

[Active infective endocarditis complicated by paravalvular abscess. Review of 40 cases]. / Endocarditis infecciosa activa complicada con absceso paravalvular. Revisión de 40 casos.

We have performed a retrospective analysis of the clinical, echocardiographic, surgical and necropsy data in 40 patients affected by infective endocarditis complicated by paravalvular abscess. The abscess developed on prosthetic valve in 13 cases, and on native valve in 27. Aortic valve was the most affected (85%). The clinical course was considered to be acute in 52% of the patients. Fever persisted despite of adequate antibiotic therapy in 57%. In 90%, overt heart failure were present. Staphylococcus were the most frequent causative microorganism (S. aureus, 22.5%; S. epidermidis, 20%). Bundle branch or atrioventricular block were detected in 18 patients (sensibility, 45%; specificity, 88%). Bidimensional echocardiography, along with Doppler techniques when necessary, detected an abscess in 81% of patients (sensibility, 80%; specificity, 84%). Thirty patients were operated. Eight of them (26%) died, two intraoperatively. Ten patients were not operated and nine died (90%). The difference was significant (p less than 0.001). Only age and surgical treatment were related to early survival. Over the follow-up of the operated patients, five presented prosthetic dehiscence, but only two required a new operation 3 months after the first intervention, and none died. In conclusion, the detection of a paravalvular abscess complicating an infective endocarditis is an indication for surgical treatment. Both surgical mortality and postoperative prosthetic dehiscence are acceptable. Bidimensional echocardiography is the most reliable tool for the diagnosis of this complication.

[Ileosigmoid volvulus. A case report]. / Vólvulo íleosigmoideo. Informe de un caso.

This is a case report of an ileosigmoid volvulus in a 68 year old man. The patient had emergency surgery for an acute abdominal condition. Intraoperative diagnosis of an ileosigmoid knot was made and it was necessary to resect the necrotic portion of the ilium, with ilioiliostomy, and to resect the gangrenous section of the sigmoid colon, end colostomy, and Hartmann pouch. Eleven weeks later, a colosigmoidostomy was realized. The evolution of the patient was satisfactory. The literature about ileosigmoid volvulus is reviewed.