Fetal Anemia: Determinants and Perinatal Outcomes according to the Method of Intrauterine Blood Transfusion.

INTRODUCTION: Fetal anemia from hemolytic disease treated by intrauterine transfusion (IUT) can be performed by intraperitoneal, intracardiac, and intravascular transfusion (IVT). Objective of our study was to compare different transfusion techniques. METHODS: Retrospective review of IUT secondary to red cell alloimmunization was conducted at eight international centers from 2012 to 2020. Severe anemia suspected if middle cerebral artery peaks systolic velocity ≥1.5 multiples of the median. Demographic, delivery, and postnatal variables were analyzed. RESULTS: Total of 344 procedures, 325 IVT and 19 other techniques (non-IVT) included. No difference in demographics, history of stillbirth (20.5 vs. 15.8%, p = 0.7), prior pregnancy IUT (25.6 vs. 31.6%, p = 0.5) or neonatal transfusion (36.1 vs. 43.8%, p = 0.5). At first IUT, non-IVT had higher hydrops (42.1% vs. 20.4%, p = 0.03), lower starting hematocrit (13.3% [±6] vs. 17.7% [±8.2], p = 0.04), and trend toward lower gestational age (24.6 [20.1-27] vs. 26.4 [23.2-29.6] weeks, p = 0.08). No difference in birthweight, neonatal phototherapy, exchange, or simple transfusion was observed. CONCLUSION: This is one of the largest studies comparing techniques to treat fetal anemia. IVT was most performed, other techniques were more likely performed in hydrops, and lower starting hematocrit was seen. Neither technique affected outcomes. This study may suggest that physician's experience may be the strongest contributor of outcomes.

Practice patterns amongst fetal centers performing intrauterine transfusions (PACT): An international survey study.

OBJECTIVES: Fetal anemia secondary to incompatibility between maternal-fetal blood types can result in hydrops and demise. Intrauterine transfusions have improved survival in experience centers. Our objective was to determine the practice patterns amongst fetal centers. STUDY DESIGN: Thirteen fetal centers across the world were surveyed. Results from all participating centers were recorded, analyzed, and presented as ratios. Questions on the survey were related to experience of the physician, preferred methods of transfusion, fetal surveillance, and timing of delivery. RESULTS: Differences amongst centers were as follows: 54% of the centers performed transfusions in operating room, the remaining did them in a clinic room or close to the operating room; 31% did not use maternal anesthesia, 31% used oral or intravenous sedation and 38% used a combination of local with oral or intravenous sedation. The similarities include: 84% performed intravenous transfusions, while 2 centers reported intraperitoneal and intracardiac transfusions were performed for very early cases; 85% of centers performed the last transfusion at 34-35 weeks and 77% electively delivered their patients at 37 weeks. CONCLUSION: Method of transfusion and delivery timing was similar in most centers; however, differences were seen in location of procedure, anesthetic coverage, and surveillance. Further assessment is needed to determine if these differences in practice have any potential neonatal effects.

Small-bowel atresias: a case series with review of the disease and imaging findings.

Small-bowel atresias are among the most common causes of intestinal obstruction in newborns, and they often require urgent surgical treatment. Imaging techniques play a very important role in their diagnosis, which is often suspected on prenatal obstetric ultrasound and confirmed on postnatal plain-film X-rays. Abdominal ultrasound's lack of ionizing radiation, wide availability, low cost, and high resolution is making this technique increasingly important in confirming atresias and in detecting possible complications in newborns. This review analyzes a series of cases seen at our center. It summarizes the different types of small-bowel atresias, focusing on the clinical presentation, imaging findings on different modalities, presence of associated disease, management, clinical course, and outcomes.

Atresias de intestino delgado. Revisión de la patología y hallazgos radiológicos asociados a distintos casos / Small-bowel atresias: a case series with review of the disease and imaging findings

Las atresias de intestino delgado son una de las causas más frecuentes de obstrucción intestinal en el neonato y habitualmente requieren tratamiento quirúrgico urgente. Las técnicas de imagen conforman una parte muy importante del diagnóstico, aportando la ecografía obstétrica prenatal la sospecha inicial y siendo la radiografía simple de abdomen la prueba que confirma el diagnóstico tras el nacimiento. La ecografía abdominal en el recién nacido está cobrando cada vez mayor importancia, debido a su inocuidad, disponibilidad, bajo coste y alta capacidad de resolución, tanto para la confirmación del diagnóstico como para la detección de las posibles complicaciones asociadas. En este artículo analizamos una serie de casos vistos en nuestro centro y elaboramos un resumen de los diferentes tipos de atresias de intestino delgado, haciendo hincapié en la clínica, los hallazgos radiológicos obtenidos en las diferentes modalidades de imagen, la existencia de patología asociada, su manejo y su evolución.(AU)

Small-bowel atresias are among the most common causes of intestinal obstruction in newborns, and they often require urgent surgical treatment. Imaging techniques play a very important role in their diagnosis, which is often suspected on prenatal obstetric ultrasound and confirmed on postnatal plain-film X-rays. Abdominal ultrasound's lack of ionizing radiation, wide availability, low cost, and high resolution is making this technique increasingly important in confirming atresias and in detecting possible complications in newborns. This review analyzes a series of cases seen at our center. It summarizes the different types of small-bowel atresias, focusing on the clinical presentation, imaging findings on different modalities, presence of associated disease, management, clinical course, and outcomes.(AU)

Small-bowel atresias: a case series with review of the disease and imaging findings. / Atresias de intestino delgado. Revisión de la patología y hallazgos radiológicos asociados a distintos casos.

Small-bowel atresias are among the most common causes of intestinal obstruction in newborns, and they often require urgent surgical treatment. Imaging techniques play a very important role in their diagnosis, which is often suspected on prenatal obstetric ultrasound and confirmed on postnatal plain-film X-rays. Abdominal ultrasound's lack of ionizing radiation, wide availability, low cost, and high resolution is making this technique increasingly important in confirming atresias and in detecting possible complications in newborns. This review analyzes a series of cases seen at our center. It summarizes the different types of small-bowel atresias, focusing on the clinical presentation, imaging findings on different modalities, presence of associated disease, management, clinical course, and outcomes.

Diagnostic accuracy of first-trimester combined screening for early-onset and preterm pre-eclampsia at 8-10 compared with 11-13 weeks' gestation.

OBJECTIVES: To compare the ability of first-trimester combined screening for pre-eclampsia (PE) to predict early-onset and preterm PE when pregnancy-associated plasma protein-A (PAPP-A) and placental growth factor (PlGF) were assessed before vs after 11 weeks' gestation. METHODS: This was a secondary analysis of a prospective cohort study of singleton pregnancies undergoing routine first-trimester screening conducted at Vall d'Hebron University Hospital, Barcelona, Spain, between October 2015 and September 2017. Demographic characteristics, obstetric history, maternal history and biophysical markers (mean uterine artery pulsatility index and mean arterial blood pressure (MAP)) were recorded at the first-trimester scan (at 11 + 0 to 13 + 6 weeks' gestation). Maternal serum concentrations of PAPP-A and PlGF were assessed from the routine first-trimester blood test (at 8 + 0 to 13 + 6 weeks). Women were classified into two groups depending on whether serum biomarkers were assessed at 8 + 0 to 10 + 6 weeks or at 11 + 0 to 13 + 6 weeks. Probability scores for early-onset and preterm PE were calculated by using two different algorithms: the multivariate Gaussian-distribution model and The Fetal Medicine Foundation (FMF) competing-risks model. Receiver-operating-characteristics (ROC) curves were produced and detection rates at fixed 5% and 10% false-positive rates were computed to compare the performance of these algorithms when PAPP-A and PlGF were assessed before vs after 11 weeks. RESULTS: Of the 2641 women included, serum biomarkers were assessed before 11 weeks in 1675 (63.4%) and at or after 11 weeks in 966 (36.6%). Of these, 90 (3.4%) women developed PE, including 11 (0.4%) cases of early-onset PE and 30 (1.1%) of preterm PE. Five (45.5%) cases of early-onset and 16 (53.3%) of preterm PE were identified in the group in which serum biomarkers were assessed at 8 + 0 to 10 + 6 weeks and six (54.5%) cases of early-onset and 14 (46.7%) of preterm PE in the group in which serum biomarkers were assessed at 11 + 0 to 13 + 6 weeks. In the prediction of early-onset and preterm PE using the Gaussian algorithm, no differences were observed between the areas under the ROC curves (AUCs) when PAPP-A and PlGF were measured before or after 11 weeks. In the prediction of early-onset and preterm PE using the FMF algorithm, no differences were observed between AUCs for any of the combinations used for risk calculation when the serum biomarkers were obtained before vs after 11 weeks, except for the combination of PAPP-A and MAP, which showed a greater AUC for the prediction of early-onset PE when PAPP-A was measured at or after 11 weeks. CONCLUSIONS: The prediction of early-onset and preterm PE is similar when serum biomarkers are measured before or after 11 weeks. This allows the use of a two-step approach for PE risk assessment that permits immediate risk calculation at the time of the first-trimester scan. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

[Acromioclavicular dislocation management with use of Tight Rope luxation acromioclavicular con Tight Rope]. / Manejo quirúrgico de la luxación acromioclavicular grado III con sistema de anclaje doble botón.

INTRODUCTION: The acromioclavicular joint, important part of the shoulder complex is formed by clavicular lateral end and acromial medial border, with high index of injury in different grades, associated to physical activity and work accidents, most commonly in active young adults. OBJECTIVE: To analyze functional outcomes in patients with acromioclavicular dislocation with use of tight rope in one year. Material and methods: Descriptive, prospective, longitudinal, unicentric study, from March 2015 and July 2016 in post-operated patients with diagnosis of acromioclavicular dislocation grade III in Hospital de Traumatología y Ortopedia de Puebla. Patients aged 18 to 45 years were included, active workers, with evolution time 7 days. RESULTS: 17 patients with diagnosis of acromioclavicular dislocation, fourteen (82.4%) male and 3 (17.6%) female. Average age: 29.5 (19 to 44 years) ± 7.475 years; lesion occurred 9 (52.9%) patients in right shoulder and 8 (47.1%) in left side. Average time of the injury: 2.88 (1-7) ± 2,147 days. Average inability granted: 42.06 days. CONCLUSIONS: The open reduction technique and dynamic stabilization of the joint with Tight Rope offers short hospital stay, short time of inability and rapid reintegration to work activity, at 1 year of evolution.

INTRODUCCIÓN: La articulación acromioclavicular es parte importante del complejo articular del hombro, formada por el extremo lateral de la clavícula y el borde medial del acromion. Tiene un alto índice de lesión en grados asociados a actividad física y accidentes laborales. Predomina en jóvenes laboralmente activos. OBJETIVO: Analizar la funcionalidad a un año en pacientes con luxación acromioclavicular grado III, operados con sistema anclaje doble botón. MATERIAL Y MÉTODOS: Estudio descriptivo, prospectivo, longitudinal, unicéntrico, durante Marzo de 2015 a Julio de 2016, en pacientes con luxación acromioclavicular grado III en el Hospital de Traumatología y Ortopedia de Puebla. Se incluyeron pacientes con edad de 18 a 45 años, trabajadores, con evolución mayor de siete días. La estadística fue descriptiva. RESULTADOS: Fueron 17 pacientes; 14 (82.4%) hombres y tres (17.6%) mujeres. Edad promedio: 29.5 (19 a 44 años) ± 7.475 años; nueve (52.9%) pacientes en el hombro derecho y ocho (47.1%) en el izquierdo. Promedio de evolución: 2.88 (1 a 7) ± 2.147 días. Incapacidad promedio: 42.06 días. CONCLUSIONES: La reducción abierta y estabilización dinámica mediante el sistema anclaje doble botón (Tight Rope) ofrece estancia intrahospitalaria corta, poco tiempo de incapacidad, reintegración rápida a la actividad laboral y resultados funcionales adecuados a un año de evolución.

[Results of percutaneous discectomy in the management of lumbar disc herniation]. / Resultados de la nucleotomía percutánea en el manejo de la hernia discal lumbar.

INTRODUCTION: Percutaneous discectomy is a disc decompression technique approved by the FDA that is useful to improve pain caused by a herniated disc. However, its practice is under discussion because the benefits of the technique are controversial. OBJECTIVES: To describe the clinical course of patients with low lumbar disc herniation (L4-L5, L5-S1) treated by percutaneous surgery within one year of surgery and prove that it is a useful surgical option for the relief of symptoms caused by this pathological entity. MATERIAL AND METHODS: Cohort study; the clinical course of 21 patients with lumbar disc herniation treated with percutaneous discectomy manually during March 2011-November 2013, is presented. The evaluation was made before surgery and at four, 30, 180 and 365 days after surgery by numerical pain scale (NPS), Oswestry (IDO) and MacNab criteria. We used nonparametric inferential statistics (Wilcoxon) for differences in proportions. RESULTS: n = 21, six (28.57%) men, 15 (71.42%) women; average age: 37.95, (14-56) ± 10.60 years; the most affected vertebral level was L4-L5 in 57.14% of the patients; the NPS preoperative average was 7.75 (5-9) ± 1.12; at 365 days: average 2.14 (0-7) ± 2.37. The IDO preoperative average was 37% (28-40%) ± 3.06, and at 365 days: 9.52% (0-40%) ± 13.92. The prognosis (IDO) in the presurgical was good to zero (0%) patients and in 15 (71.42%) at 365 days, regular in five (23.80%) and poor in one (4.78%) (p = 0.00, CI 95% 0.00 to 0.13, Wilcoxon); according to MacNab criteria, in 15 (71.42%) patients were excellent and good, poor in four (19.04%) and bad in two (9.52%) (p = 0.00). CONCLUSIONS: Percutaneous discectomy provides good results for the treatment of lumbar disc herniation (L4-L5, L5-S1) at 365 days after surgery.

La nucleotomía percutánea es una técnica de descompresión discal aprobada por la FDA que ha mostrado ser útil para mejorar el dolor causado por hernia discal. No obstante, su práctica se encuentra en discusión debido a que los beneficios de la técnica son controversiales.

Late-onset neutropenia: defining limits of neutrophil count in very low birth weight infants.

OBJECTIVE: To evaluate the incidence, onset, duration, characteristics and importance of late-onset neutropenia (defined as absolute neutrophil count<1500 µl(-1) at 3 weeks of age or later) in a group of very low birth weight (VLBW) infants. STUDY DESIGN: Routine complete blood cell counts (CBCs) obtained from VLBW infants over a period of 7 years were gathered retrospectively, including those of newborns with weekly CBCs taken over a duration of at least 3 weeks. Data were obtained from between January 2003 and December 2009. RESULT: CBCs of 399 newborns were included. Values were obtained from birth to 36 weeks of postnatal age. Late-onset neutropenia was observed in 259 cases (65%). Neutropenic infants had a mean of 0.5 weeks lower gestational age. Late-onset neutropenia was more frequent in children with intraventricular hemorrhage but not in patients who received erythropoietin. The median age of neutropenia onset was 7 weeks in extremely low birth weight infants and 6 weeks in VLBW infants. The fifth percentile of neutrophils between weeks 3 and 4 was 1280 µl(-1) and between weeks 13 and 15 was 500 µl(-1). The average duration was 2 weeks with normalized values after 18 weeks. CONCLUSION: A neutrophil count <1500 µl(-1) after the third week of life is frequently observed in VLBW infants and should not be used as a lower reference limit. The fifth percentile varies according to postnatal age from around 1300 µl(-1) in week 4 of life, decreasing to a nadir of 500 µl(-1) between 3 and 4 months of age. Values normalize in the first year of life.

Endometriosis intestinal como causa de abdomen agudo / Intestinal endometriosis as a cause of acute abdomen

El dolor abdominal es motivo de consulta médica muy frecuente y además es un síntoma inespecífico que aparece en un gran número de patologías tanto digestivas como extra digestivas. La endometriosis intestinal es una enfermedad poco frecuente y común gran espectro clínico, lo cual hace difícil su diagnóstico. Se presenta el caso clínico de paciente que curso son síndrome abdominal agudo secundario a endometriosis intestinal. Se hace una revisión del tema en la literatura mundial (AU)

Abdominal pain is a frequent cause of medical consultation and is also a nonspecific symptom that occurs in a large number of both digestive and extraintestinal disorders. Intestinal endometriosis is a rare disease with a broad clinical spectrum, hampering diagnosis. We report the case of a patient with acute abdomen secondary to intestinal endometriosis. A review of the topic in the world literature is provided (AU)

SEOM clinical guidelines for treatment of prostate cancer

Prostate cancer (PC) is the most common cancer in men. Many patients have prolonged survival and die of other diseases, so treatment decisions are often influenced by age and coexisting comorbidities. The main procedure to diagnose PC is an ultrasound-guided core needle biopsy, which is indicated when a digital rectal examination (DRE) finds nodularity or when PSA is >10 ng/ml, but is also recommended with PSA between 4.0 and 10 ng/ml. Depending on age, PSA, Gleason score and characteristics of the tumour, treatment options for localised PC are active surveillance, radical prostatectomy and radiation therapy. Androgen deprivation treatment (ADT) should be added to radiotherapy for men with intermediate- or high-risk PC. ADT is the current standard first-line treatment for metastatic PC. Castration-resistant PC is a heterogeneous entity. Several treatments such as sipuleucel-T, docetaxel-based chemotherapy, radium 223, cabazitaxel or abiraterone plus prednisone, zoledronic and denosumab, are useful for this situation (AU)

Aumento de la extensibilidad isquiotibial tras aplicar elongación muscular eléctrica / Hamstring extensibility increase after applying electrical muscular elongation

Objetivo Conocer el efecto inmediato de la elongación muscular eléctrica por medio de corrientes interferenciales sobre la amplitud articular en sujetos con cortedad isquiotibial. Material y método Se realizó una valoración inicial (pretest) y final (postest) en donde la variable sometida a estudio fue la amplitud articular. Los test aplicados fueron el test de elevación de la pierna recta (EPR) y test de ángulo poplíteo (TAP). Se empleó una corriente interferencial bipolar con una modulación de la amplitud de la frecuencia de 100Hz y una frecuencia portadora de 4Khz.ResultadosSe obtuvieron mejoras estadísticamente significativas en la extensibilidad isquiosural tras aplicar elongación muscular eléctrica para ambos test angulares (p≤0,0001), siendo el tamaño efecto de R2=0,833 para TAP y de R2=0,752 para EPR. Conclusiones La aplicación de elongación muscular mediante corrientes interferenciales logra un aumento inmediato en la extensibilidad de la musculatura isquiosural tras ser medida con EPR y TAP(AU)

Objective To determine the immediate effect of electrical muscle elongation interferential currents through joint range of subjects with hamstring shortness. Material and method We performed an initial (pre-test) and final (post-test) assessment where the variable under study was the joint range. The tests applied were the straight leg raise test (SLR) and passive knee extension test (PKE). We used a bipolar interferential current with an amplitude modulation frequency of 100Hz and 4kHz carrier frequency. Results Statistically significant improvements were obtained in hamstring extensibility after applying electrical muscle elongation angle for both test (p ≤ 0.0001), with effect size for PKE of R2=0.833 and of R2=0.752 and for SLR. Conclusions The use of muscle elongation by interferential currents achieved an immediate increase in hamstring muscle extensibility after being measured by SLR and PKE (AU)

Histerectomía obstétrica por sepsis en el puerperio / Obstetric hysterectomy due to sepsis in the puerperium

Los sangrados de origen obstétrico y las infecciones pélvicas severas constituyen las primeras causas para la realización de una histerectomía en el estado grávido puerperal. La decisión de realizar una histerectomía con un diagnóstico oportuno va a influir en la evolución y pronóstico de estas pacientes. El objetivo principal del presente estudio es analizar la histerectomía obstétrica por procesos infecciosos pélvicos severos, mediante un análisis retrospectivo de 5 años en pacientes del Hospital General de México y del Centro de Esterilidad y Ginecología Integral. Se incluyeron 17 casos de histerectomía obstétrica, el grupo de edad promedio fue entre los 20 y 30 años, la principal indicación fue la deciduomiometritis en el 35,2%, el tiempo promedio de la cirugía fue de 124,4min, las complicaciones principales fueron lesiones al tracto urinario y aquellas secundarias al proceso séptico (CID), la mortalidad fue del 35% (AU)

Bleeding of obstetric origin and severe pelvic infections are the main causes of hysterectomy in the puerperium. Timely diagnosis and hysterectomy influence the outcome of these patients. The main objective of the present study was to analyze obstetric hysterectomy for severe pelvic infectious processes. We retrospectively analyzed obstetric hysterectomies for severe pelvic infectious processes and sepsis in the puerperium performed over a 5-year period in the General Hospital of Mexico. Seventeen cases of obstetric hysterectomy were analyzed. Most patients were aged between 20 and 30 years. The main indication was endometritis in 35.2%, and the mean operating time was 124.4min. The main complications were urinary tract lesions and those secondary to the septic process (disseminated intravascular coagulation). Mortality was 35% (AU)

First trimester serum angiogenic/anti-angiogenic status in twin pregnancies: relationship with assisted reproduction technology.

BACKGROUND: The risk of pre-eclampsia (PE) increases in twin pregnancies, especially when assisted reproduction technologies (ART) are used. The aim of this study was to assess angiogenic/anti-angiogenic factors in maternal serum in the first trimester of twin pregnancies and establish if the mode of conception influences angiogenic status. METHODS: This prospective study enrolled women with twin (n = 61) and singleton (n = 50) pregnancies. Dichorionic twin pregnancies were divided into two groups according to their mode of conception. Singleton pregnancies were used as the control group. Soluble fms-like tyrosine kinase (sFlt-1), free placental growth factor (PlGF) and soluble endoglin (sEng) concentrations were measured in the first trimester maternal serum. RESULTS: In the first trimester, women with twin pregnancies had higher serum concentrations of the anti-angiogenic factor sFlt-1 than that with singleton pregnancies (3924 ± 250 versus 2426 ± 162 pg/ml, respectively; P < 0.001). Maternal serum PlGF concentrations were lower in singleton pregnancies than those in twin pregnancies (37 ± 3.7 versus 59 ± 5.6, respectively; P < 0.001). Serum concentrations of sFlt-1 were higher in twin pregnancies conceived by ART than those in spontaneous twin pregnancies (4313 ± 389 versus 3522 ± 300 pg/ml, respectively; P < 0.05). No differences between groups were observed for sEng. CONCLUSIONS: In the first trimester, twin pregnancies conceived using ART showed a heightened anti-angiogenic status that could explain the increased risk of PE in these cases.

Efectos del vendaje neuromuscular (kinesiotaping) en el síndrome del supraespinoso / Kinesio taping effects of the supraspinatus syndrome

El objetivo principal de este trabajo es conocer la eficacia del vendaje neuromuscular en un deportista de élite con síndrome del supraespinoso respecto a otros tratamientos conservadores en los que no se aplica. Se ha realizado una valoración inicial (pretest) y final (postest) en donde las variables sometidas a estudio fueron el dolor, la amplitud articular del hombro, la fuerza muscular y el índice de esfuerzo percibido. Los tratamientos aplicados con duración de 3 semanas se dividen en dos fases: fase 1, termoterapia de alta frecuencia, ultrasonidos y masoterapia, y fase 2, el tratamiento anterior combinado con la técnica de vendaje neuromuscular. Los resultados indican una reducción del dolor en ambas fases (mayor en la fase 2) y aumento y estabilización en cantidad y/o calidad de la movilidad glenohumeral en la fase 2. El vendaje neuromuscular podría considerarse una técnica complementaria al tratamiento conservador ya que podría reducir el dolor y mejorar la movilidad articular (AU)

The main objective of this work is to determine the effectiveness of kinesio taping in an elite athlete with supraspinatus syndrome compared to other conservative treatments in which this Taping was not used. An initial assessment (pretest) and final assessment (posttest) were carried out in which the variables studied were pain, shoulder range of motion, muscle strength and the Perceived Exertion Index. The treatments were applied for three weeks and were divided into two phases: Phase 1, high frequency thermotherapy, ultrasound and massage therapy and phase 2, previous treatment combined with the kinesio taping technique. The results indicate a reduction in pain in both phases (higher in phase 2) and an increase as well as stabilization in quantity and/or quality of glenohumeral mobility in phase 2. Kinesio taping can be considered a complementary technique to the conservative treatment as it may reduce pain and improve joint mobility (AU)

Importancia de la presencia de os peroneum y el síndrome de fricción en el diagnóstico diferencial de la tendinopatía peronea / Importance of the presence of os peroneum and the friction syndrome in the differential diagnosis of peroneal tendinopathy

El objetivo de nuestro estudio se centra en describir la relación entre la presencia de os peroneum y el desarrollo de tendinopatía peronea causada por la existencia de un síndrome de fricción entre el hueso sesamoideo y el músculo peroneo lateral largo. El sujeto estudio fue un joven deportista que padece dolor difuso tipo quemazón en la parte lateral de la pierna derecha. El diagnóstico diferencial mediante radiografía oblicua y dorsoplantar confirma la presencia de os peroneum. La valoración se realiza comparativamente tras el tratamiento conservador y quirúrgico, midiendo el dolor mediante la escala visual analógica, la amplitud articular a la eversión del pie mediante goniometría manual y la funcionalidad mediante el índice de esfuerzo percibido tras realizar el test 6 minutos de marcha y la escala de valoración funcional AOFAS. Como resultados, destacamos la reducción del dolor y la readaptación a la práctica deportiva sin secuelas tras la cirugía (AU)

This study has focused on describing the relationship between the presence of Os peroneum and the development of peroneal tendinopathy caused by the existence of a friction syndrome between the sesamoid bone and the peroneus longus muscle. The subject studied was a young athlete who has diffuse burning pain in the side of the right leg. The differential diagnosis through dorsoplantar oblique radiography confirmed the presence of Os peroneum. Evaluation was made comparatively after conservative and surgical treatment through the measurement of pain with the Visual Analog Scale, the eversion range of motion of the foot using the manual goniometry and functionality using the Perceived Stress Index after the test 6 minute walking test and American Orthopedic Foot and Ankle Society (AOFAS) functional rating scale. As a result, we emphasize the reduction of pain and rehabilitation to sports activity without sequelae after surgery (AU)

Repercusión del tratamiento fisioterápico en los tratamientos quirúrgicos de alargamiento óseo. A propósito de un caso / Impact of physiotherapy in the surgical treatment of bone lengthening. A case report

La incidencia de las complicaciones derivadas de los alargamientos óseos cada vez supone menos en la recuperación íntegra de estos pacientes gracias al abordaje multidisciplinar que reciben, siendo la fisioterapia un elemento clave. El objetivo del estudio es conocer los efectos beneficiosos que logra la fisioterapia en procesos de alargamientos óseos en relación con la amplitud articular y al tono muscular, así como en la prevención de complicaciones a propósito de un caso. Nuestra paciente, diagnosticada de dismetría de miembros inferiores, se somete a elongación tibial mediante una distracción progresiva a partir de fijadores externos distractores. El seguimiento realizado valoró la amplitud articular mediante goniometría manual, tono muscular mediante la escala de Daniels, existencia de linfedema y longitud del miembro mediante cinta métrica y el dolor percibido mediante escala visual analógica. Como resultados, destacamos la ganancia completa del rango articular y la prevención del equinismo y linfedema secundario(AU)

The incidence of complications of bone lengthening is increasingly less in the full recovery of these patients thanks to the multidisciplinary approach received, physiotherapy being a key element. This study has aimed to determine the beneficial effects achieved by physiotherapy in bone lengthening procedures in relationship to range of motion and muscle tone and in the prevention of complications based on a case report. Our patient who was diagnosed with lower limb dysmetria underwent tibial lengthening by gradual distraction from distracting external fixator. The monitoring performed evaluated joint range by means of manual goniometry, muscle tone scale by the Daniels scale, existence of lymphedema and limb length by measuring tape and perceived pain by the Visual Analog Scale. Standing out among the results are the full gain of joint range and prevention of equinus and secondary lymphedema(AU)