Análisis funcional comparativo entre la prótesis de carbón pirolítico y la artroplastia de suspensión-reconstrucción ligamentosa para el tratamiento de la rizartrosis del pulgar / Comparative functional analysis between pyrolytic carbon prostheses and ligamentous suspension/reconstruction in the treatment of rhizarthrosis

Objetivo: Evaluar el resultado funcional a medio plazo de la utilización del implante de carbón pirolítico (PyroDisk) en el tratamiento de la rizartrosis del pulgar, comparando sus resultados con la artroplastia de resección-suspensión-reconstrucción ligamentosa. Material y método: Estudio transversal que compara de forma retrospectiva 2grupos de pacientes entre 40 y 65 años con rizartrosis del pulgar. Los 32 pacientes intervenidos entre 2009 y 2013 se distribuyeron entre el grupo I (artroplastia de interposición con el implante PyroDisk y el grupo II (artroplastia de resección-suspensión-reconstrucción ligamentosa). En 2015 se recogieron el dolor, la funcionalidad (cuestionario Quick-Dash) y el balance articular. Además, se realizó un estudio radiológico con radiografías y TC. Resultados: Se siguió a 32 pacientes, 16 en cada grupo, con un seguimiento medio de 35 meses (23-47). El dolor al final del seguimiento fue mayor en el grupo intervenido con la prótesis de carbón pirolítico (p=0,000). En la funcionalidad según el test de QuickDash, los pacientes del grupo i obtuvieron una media de 31,14 (0-70) puntos frente a 15,81 (8-24) puntos del grupo ii (p=0,027). No se encontraron diferencias en el grado de movilidad al final del seguimiento (p=0,46). En 6 casos fue necesario retirar la prótesis. Discusión: La prótesis de carbón pirolítico se ha presentado como alternativa para el tratamiendo de la rizartrosis del pulgar. En los trabajos publicados hasta el momento destaca la discrepancia en los resultados funcionales a medio plazo. Conclusiones: La prótesis de carbón pirolítico ha mostrado resultados funcionales inferiores a medio plazo comparada con la artroplastia de resección-suspensión-reconstrucción ligamentosa

Objective: To evaluate midterm functional outcome after pyrolytic carbon prosthesis (PyroDisk) implantation in the treatment of rhizarthrosis of the thumb, comparing outcomes with those of ligamentous resection/suspension/reconstruction. Material and methods: A cross-sectional study retrospectively comparing 2patient groups aged between 40 and 65 years with rhizarthrosis of the thumb. Thirty-two patients operated between 2009 and 2013 were distributed between group I (interposition arthroplasy with PyroDisk implant) and group II (ligamentous resection/suspension/reconstruction arthroplasty). Data on pain, functionality (Quick-Dash questionnaire) and articular movement were collected in 2015. In addition, a radiological study was undertaken using radiographs and CT. Results: Thirty-two patients, 16 in each group with mean follow-up of 35 months (23-47). Pain at the end of follow-up was greater in the group with the pyrolytic carbon prosthesis (p=0.000). According to the QuickDash questionnaire, the patients in group i achieved a mean functionality of 31.14 (0-70) points compared to 15.81 (8-24) points for group ii (p=0.027). No differences were found in degree of mobility at the end of follow-up (p=0.46). The prosthesis had to be removed in 6 cases. Discussion: The pyrolytic carbon prosthesis has been presented as an alternative treatment for rhizarthrosis of the thumb. The papers pubslished to date highlight the discrepancies in midterm functional outcomes. Conclusions: Pyrolitic carbon prostheses have shown inferior functional outcomes, compared with resection/suspension/reconstruction arthroplasties

Comparative functional analysis between pyrolytic carbon prostheses and ligamentous suspension/reconstruction in the treatment of rhizarthrosis. / Análisis funcional comparativo entre la prótesis de carbón pirolítico y la artroplastia de suspensión-reconstrucción ligamentosa para el tratamiento de la rizartrosis del pulgar.

OBJECTIVE: To evaluate midterm functional outcome after pyrolytic carbon prosthesis (PyroDisk) implantation in the treatment of rhizarthrosis of the thumb, comparing outcomes with those of ligamentous resection/suspension/reconstruction. MATERIAL AND METHODS: A cross-sectional study retrospectively comparing 2patient groups aged between 40 and 65 years with rhizarthrosis of the thumb. Thirty-two patients operated between 2009 and 2013 were distributed between group i (interposition arthroplasy with PyroDisk implant) and group ii (ligamentous resection/suspension/reconstruction arthroplasty). Data on pain, functionality (Quick-Dash questionnaire) and articular movement were collected in 2015. In addition, a radiological study was undertaken using radiographs and CT. RESULTS: Thirty-two patients, 16 in each group with mean follow-up of 35 months (23-47). Pain at the end of follow-up was greater in the group with the pyrolytic carbon prosthesis (p=0.000). According to the QuickDash questionnaire, the patients in group i achieved a mean functionality of 31.14 (0-70) points compared to 15.81 (8-24) points for group ii (p=0.027). No differences were found in degree of mobility at the end of follow-up (p=0.46). The prosthesis had to be removed in 6 cases. DISCUSSION: The pyrolytic carbon prosthesis has been presented as an alternative treatment for rhizarthrosis of the thumb. The papers pubslished to date highlight the discrepancies in midterm functional outcomes. CONCLUSIONS: Pyrolitic carbon prostheses have shown inferior functional outcomes, compared with resection/suspension/reconstruction arthroplasties.

[Delayed healing in long bone fracture: radiologic course and treatment]. / Retraso de consolidación en fractura de hueso grande: evolución radiológica y tratamiento.

Isolated long bone fractures are unusual and may be missed in the initial X-rays, especially when they are minimally displaced. The delayed treatment of these fractures may cause various complications, such as delayed bone healing or seudoarthrosis, which are difficult to manage. Our clinical case shows delayed healing in a long bone fracture and how the radiologic course may assist in the therapeutic management of this complication.

New black blood pulse sequence for studies of the heart.

The black blood concept is based on the signal void principle of the sequences in Spin Echo, SE or FSE, which are very useful for studying the mediastinum and heart. In this setting, new sequences are continuously introduced to eliminate the artifacts caused by breathing and heart movements. One such sequence is the Double-IR preparation Black Blood FSE. We report our experience in 97 patients, using this new pulse sequence to evaluate cardiac pathology, and establish comparisons with the conventional Spin Echo sequences. The study comprises mediastinal disease and aorta and heart explorations. We consider this new Double-IR preparation FSE sequence to be an excellent choice for evaluating chest, mediastinal and cardiac images. The sequence offers improved spatial resolution of both the vessels and other chest structures with respect to conventional Spin Echo imaging. With the exception of patients presenting severe heart problems, or in the presence of intense bradycardia, the required 16 cycles in apnea are well tolerated. The purpose of the present study is to present our initial results with this new pulse sequence as applied to cardiac pathology, in comparison with conventional Spin Echo imaging.

[Acute pancreatitis and acquired immunodeficiency syndrome]. / Pancreatitis aguda y síndrome de inmunodeficiencia adquirida.

Viral acute pancreatitis in Human Immunodeficiency Virus (HIV) infected patients has been occasionally described. We studied nine patients with HIV antibodies and acute pancreatitis attributed to Cytomegalovirus and/or Cryptosporidium infection. In four patients the clinical picture was consistent with acute pancreatitis while in five clinical manifestations were unspecific, and diagnosis was based on ultrasonography and/or computed tomography findings. In the HIV infected patient pancreatic evaluation by imaging techniques may disclose acute pancreatitis even in the absence of abdominal pain.

[Suicides in Zaragoza (1988-1991). Epidemiology and outline of suicides]. / El suicidio consumado en Zaragoza (1988-1991). Aspectos epidemiológicos y perfiles suicidas.

We review 312 suicide cases autopsied in the Forensic Institute of Zaragoza (Spain) during 1988-1991. Suicide rate was notabily higher than official statistics (15.01/100,000 habs. in Zaragoza vs. 4.3/100,000 Habs. from the National Statistic Institute). Reasons for this discrepancy are discussed emphasizing the role of suicide underrecording in the official statistics. Forensic Institute data are considered as a precise source for suicide epidemiologic study in Spain. Profiles for each different suicide type are described according to the results of our study concerning to age, sex, seasonal and month distribution, and other epidemiological data. A National Forensic Suicide Data Bank is proposed to approach properly the problematic of suicide epidemiology, based in the desirable informatic support to the Forensic Institutes. A modification in the Death Certificates is essential to include medico-legal etiology (suicide, accidental or criminal) which is essential in Forensic Reports but is not included, at the present, in the usual Death Certificates.