Anafilaxia perioperatoria severa: Incidencia en un hospital terciario en España durante 20 años. Estudio de cohorte histórico / Severe perioperative anaphylaxis: Incidence in a tertiary hospital in Spain over a 20-year period. A historical cohort study

Objetivo: Determinar la incidencia de reacciones perioperatorias graves, los mecanismos implicados, los tratamientos realizados y la utilidad del protocolo diagnóstico propuesto. Métodos: Estudio de cohorte histórico en un hospital público terciario en España. Se incluyeron pacientes que recibieron anestesia durante 20 años. En pacientes con sospecha de anafilaxia grave, se determinaron los niveles de histamina en sangre en menos de 15 min y triptasa sérica a las 2, 6 y 24 h después de la reacción. Se realizaron pruebas cutáneas e IgE específica a las 4-8 semanas. Resultados: Durante el período de 20 años, se realizaron 288.594 procedimientos anestésicos. Observamos 66 reacciones de anafilaxia grave (59% hombres; edad: 60,8 ± 17,3 años). Los síntomas fueron cardiovasculares (86%), respiratorios (73%) y mucocutáneos (56%). Los niveles elevados de triptasa sérica se asociaron con un mayor nivel de gravedad a las 2 (p < 0,0001) y 6 h (p = 0,026) y fueron más elevados en las reacciones IgE mediadas (p = 0,020). Todos los pacientes requirieron tratamiento y la muerte ocurrió en tres casos. En el 84,8% de los pacientes las pruebas cutáneas y/o IgE específicas fueron positivas a antibióticos (35,8%), antiinflamatorios no esteroideos (23,1%), bloqueantes neuromusculares (15,4%) y látex (15,4%). Conclusiones: La incidencia de anafilaxia grave en nuestro hospital fue 1:4.373 procedimientos anestésicos, con una mortalidad del 4,5%. Todos los casos requirieron tratamiento. La triptasa sérica fue un buen predictor de la gravedad de la reacción. Los agentes etiológicos más frecuentes fueron antibióticos, antiinflamatorios no esteroideos, bloqueantes neuromusculares y látex.(AU)

Objective: To assess the incidence of severe perioperative anaphylaxis, the mechanisms involved, the value of laboratory/skin tests, and the most effective treatments. Methods: A historical cohort study conducted in a tertiary public hospital in Spain. Patients that had undergone anaesthesia during the 20-year period were included. In these patients, 66 cases of severe anaphylaxis were found. In patients with suspicion of severe anaphylaxis, levels of blood histamine at less than 15 minutes and serum tryptase at 2, 6, and 24 hours following the reaction were determined. Skin and specific IgE tests were performed between 4 and 8 weeks later. Results: Over the 20-year period, 288 594 anaesthetic procedures were performed. We observed cases of 66 severe anaphylaxis reaction (59% men; age, 60.8 ± 17.3 years. Symptoms observed were cardiovascular (86%), respiratory (73%), and mucocutaneous (56%). Elevated serum tryptase levels were associated with degree of severity at 2 (p < 0.0001) and 6 hours (p = 0.026) and were highest in IgE-mediated reactions (p = 0.020). All patients required treatment, and 3 events were fatal. In 84.8% of patients, skin and/or specific IgE tests were positive for antibiotics (35.8%), non-steroidal anti-inflammatory drugs (23.1%), neuromuscular blocking agents (15.4%) and latex (15.4%). Conclusions: The incidence of severe anaphylaxis in our hospital was 1 in 4 373 anaesthetic procedures, with a death rate of 4.5%. All cases required treatment. Serum tryptase was a good predictor of reaction severity. The most frequent causative agents were antibiotics, non-steroidal anti-inflammatory drugs, neuromuscular blocking agents and latex.(AU)

Severe perioperative anaphylaxis: Incidence in a tertiary hospital in Spain over a 20-year period. A historical cohort study.

OBJECTIVE: To assess the incidence of severe perioperative anaphylaxis, the mechanisms involved, the value of laboratory/skin tests, and the most effective treatments. METHODS: A historical cohort study conducted in a tertiary public hospital in Spain. Patients that had undergone anaesthesia during the 20-year period were included. In these patients, 66 cases of severe anaphylaxis were found. In patients with suspicion of severe anaphylaxis, levels of blood histamine at less than 15min and serum tryptase at 2, 6, and 24h following the reaction were determined. Skin and specific IgE tests were performed between 4 and 8 weeks later. RESULTS: Over the 20-year period, 288 594 anaesthetic procedures were performed. We observed cases of 66 severe anaphylaxis reaction (59% men; age, 60.8±17.3 years. Symptoms observed were cardiovascular (86%), respiratory (73%), and mucocutaneous (56%). Elevated serum tryptase levels were associated with degree of severity at 2 (P<.0001) and 6h (P=.026) and were highest in IgE-mediated reactions (P=.020). All patients required treatment, and 3 events were fatal. In 84.8% of patients, skin and/or specific IgE tests were positive for antibiotics (35.8%), non-steroidal anti-inflammatory drugs (23.1%), neuromuscular blocking agents (15.4%) and latex (15.4%). CONCLUSIONS: The incidence of severe anaphylaxis in our hospital was 1 in 4.373 anaesthetic procedures, with a death rate of 4.5%. All cases required treatment. Serum tryptase was a good predictor of reaction severity. The most frequent causative agents were antibiotics, non-steroidal anti-inflammatory drugs, neuromuscular blocking agents and latex.

Anthropometrical study of the human glenoid in a normal Spanish population. / Estudio antropométrico de la glena humana en una población española normal.

OBJECTIVE: To evaluate the size of the glenoid in a southern Spanish population, to compare it with previous results from other populations and determine the size of the implants that are marketed for shoulder arthroplasty. MATERIAL AND METHODS: Between January 2015 and December 2017, an anthropometrical study of the human glenoid was performed using computed axial tomography scans (CT) of 154 patients over 30 years old. The glenoid dimensions were analysed 3-dimensionally using 2mm interval thicknesses, determining the average height and width of the glenoid. The upper point of the glenoid geometry was determined as the supraglenoid tubercle of the ovoid glenoid surface, where the long head of the biceps tendon is thought to originate. The lower point was then positioned at the furthest point from the upper point on the glenoid contour. Anterior and posterior points were determined such that the 3-dimensional anterior-posterior distance was maximized on the plane perpendicular to the upper-lower axis. Sex differences and correlations between sides and among the respective parameters in the glenohumeral dimensions were also evaluated. RESULTS: The glenoid had an average height of 28.78mm and width of 20.27mm. The values were significantly different between the men and the women, being greater in the men. The glenoid size is well correlated with the patient's size. Direct correlations exist between the glenoid height and width and the glenoid size and the patient's height. The available metaglenoids currently on the market are no bigger than 25-24mm. CONCLUSION: In comparison, the southern Spanish population have a glenoid size similar to the Caucasian population, but smaller than that of the American population. The data shown could be useful to improve the design of shoulder prostheses for the southern Spanish population.

Superior capsular reconstruction of irreparable rotator cuff tear using autologous hamstring graft. / Reconstrucción de la cápsula superior en las roturas irreparables del manguito mediante injerto autógeno de isquiotibiales.

OBJECTIVE: The aim of this study was to investigate the clinical results and radiographic findings after superior capsular reconstruction (SCR) of postero-superior symptomatic irreparable rotator cuff tears (PSIRCT) using a new SCR technique using autologous hamstring graft MATERIAL AND METHODS: From 2014 to 2016, 8 shoulders of 8 patients (mean age 59.6 years) with PSIRCT underwent SCR using autologous hamstring graft. Physical examination, X-ray and MRI were performed before the surgery and 12 months after it. A descriptive analysis was performed of the variables, and the non-parametric test of signs comparing the measurements taken before the operation and 12 months after it. RESULTS: We found an improvement in the Constant test from 49 before the SCR to 77.25 one year after the operation. The mean active flexion significantly increased from 99.3° to 142.5°. The mean preoperative AH distance increased from 5.25 (range from 3 to 7) before surgery to 8.18 (range from 6 to 10.5) after the SCR. There were no tears of the graft during follow-up. CONCLUSION: SCR with a hamstring graft improves the function of the shoulder in PSIRCT, and is an alternative technique for treating these injuries without closing the door to other types of surgery.

Outcomes of rotator cuff augmentation surgery with autologous fascia lata. / Resultados de la cirugía de refuerzo del manguito rotador con fascia lata autógena.

OBJECTIVE: To evaluate whether augmentation grafts using autologous fascia lata improve functional results for rotator cuff repairs and reduce the retear rate compared to those without augmentation. MATERIAL AND METHODS: This is a prospective evaluation comprising 20 patients with a complete symptomatic rotator cuff tear. The operations were carried out from a superior approach performing a total cuff repair, for 10 patients we used a suture augmented with an autologous graft taken from their own fascia lata while unaugmented sutures were used for the other 10 patients. The follow-up period lasted for one year post-intervention. We measured variables for tear type, functionality and pain, both baseline and at 6 and 12-month follow ups. We evaluated retear incidence in each group as well as each group's pain and functionality response. RESULTS: The improved pain levels in the non-graft group evolved gradually over time. Conversely, in the group with the augmentation grafts, average Constant-Murley shoulder outcome scores at six months were already above 10 and were maintained at 12 months. One retear occurred in the graft group and 2 in the group without grafts, thus presenting no significant differences. There were no significant changes in pain and function values at the one year follow up in either group. CONCLUSION: Our preliminary results regarding rotator cuff augmentation surgery with autologous fascia lata showed a significant improvement in pain levels after 6 months compared to the patients with no augmentation, who required 12 months to reach the same values. After a year of follow up, there were no differences between the mean Constant and pain scores in either intervention group The number of retears in the non-graft group was greater than that in the group with grafts although the difference was not significant.

Coronal patellar osteotomy of the external facet combined with the release of the lateral retinaculum improves the clinical outcomes of isolated lateral release in lateral knee compartment syndrome. / La osteotomía patelar coronal de la faceta externa asociada a liberación del retináculo lateral mejora los resultados clínicos de la liberación lateral aislada en el síndrome de compresión lateral de rótula.

OBJECTIVE: To describe a novel coronal osteotomy of the external facet of the patella, and to evaluate if the outcomes of the treatment of lateral knee compartment syndrome (LKCS) with this osteotomy, combined with the release of the external lateral retinaculum, are better than the isolated lateral retinacular release. MATERIAL AND METHODS: A prospective study with a 2 year follow up that included 70 patients diagnosed with LKCS, distributed into 2 groups. The first group included 50 patients on whom the lateral retinacular release combined with osteotomy was performed, and a second group on whom an isolated retinacular release was performed. Measurements were made using the Werner functional scale before the surgery and at 3, 12, and 24 months follow-up. RESULTS: There were significant differences in the overall functional state between the two groups after the surgery (better in the osteotomy group at all the intervals, P<.05). The improvement, which was progressive up to 12 months, was slightly less at 24 months, although the values were still better than the pre-surgical ones in both groups. Pain was the variable that showed most improvement. The patients with LKCS with degenerative signs showed a benefit in all cases. CONCLUSION: The results demonstrate that the described patellar osteotomy technique, combined with lateral retinacular release, significantly improves the pain and the functional scale score of patients with LKCS after 2 years of follow-up, to a greater extent than isolated lateral retinacular release, including those in which there was evidence of degenerative signs.

Variación de los indicadores radiográficos de la patología patelofemoral intrínseca con la rehabilitación / Rehabilitation-related variability in the x-ray indicators of intrinsic paellofemoral pathology

Introducción. La rehabilitación es un método aceptado para el tratamiento inicial de la patología intrínseca de la articulación patelofemoral, obteniendo en muchos casos una importante mejoría de las manifestaciones clínicas.Objetivos. En el presente estudio se intenta comprobar si la terapia rehabilitadora produce alguna variación en los índices radiológicos que definen un síndrome rotuliano doloroso o una inestabilidad femoropatelar.Material y método. Hemos realizado un estudio prospectivo, sobre 50 sujetos, divididos en dos grupos. Un primer grupo se constituyó con 25 individuos afectos de un síndrome rotuliano doloroso, sin signos de inestabilidad, y un segundo grupo con otros 25 que presentaban una inestabilidad femoropatelar. En todos ellos se realizó un estudio radiográfico estandarizado previo y posterior a la aplicación de unprotocolo de rehabilitación.Resultados y conclusiones. La rehabilitación hizo variar el índice fémoro-rotuliano de forma significativa en los individuos con un síndrome rotuliano doloroso, y este índice y el ángulo de congruencia en los pacientes con una inestabilidad femoropatelar

Introduction. Rehabilitation is an accepted method for the initial treatment of pathologies intrinsic to the patellofemoral joint, leading in many cases to an improvement of clinical manifestations.Purpose. The purpose of this study is to determine whether rehabilitating therapy causes any variation in the radiological indices that define a painful patellar syndrome or patellofemoral instability.Materials and methods. This is a prospective study of 50subjects, divided up into 2 groups. The first group comprised 25 individuals afflicted with a painful patellar syndrome without signs of instability; the second group comprised another 25 individuals with patellofemoral instability. All the subjects were subjected to standardized x-ray study bothbefore and after undergoing a rehabilitation protocol.Results and conclusions. Rehabilitation led to significant changes in the patellofemoral index of subjects with a painful patellar syndrome and in both this index and the patellofemoral congruence angle in patients with patellofemoral instability

Quemaduras solares: fotoprotección y tratamiento / Sun burn: photoprotection and treatment

La radiación ultravioleta es la principal responsable de los efectos nocivos de la radiación solar sobre el organismo. Las quemaduras solares, reacción aguda y visible de la exposición de la piel a dicha radiación, pueden cursar con lesiones cutáneas graves, destrucción celular y afectación de tejidos anexos, pudiéndose acompañar de edemas y pérdida de líquidos. La revisión tiene por objeto describir y valorar los efectos de la reactividad cutánea frente a la exposición a la radiación ultravioleta y clarifi car las distintas estrategias de prevención y/ o tratamiento de las quemaduras solares. Parece recomendable incidir en la necesidad de adoptar hábitos saludables frente a la exposición a la radiación ultravioleta, especialmente en los primeros 18 años de vida, así como realizar campañas educativas con el objetivo de prevenir la aparición y/ o agravamiento de enfermedades derivadas de dicha exposición

The harmful effects of solar radiation on the organism originate mainly from Ultraviolet rays. Sun burn, an acute and visible reaction arising from skin exposure to such radiation, can cause serious coetaneous lesions, cellular destruction and harmful effects on connective tissue, and may even be accompanied by oedema and loss of liquids. The aims of this work have been to describe and assess the effects of skin reactions to exposure to ultraviolet radiation, to elucidate on different prevention strategies and/or treatment of the sunburn. In general, it seems to be necessary to stress the importance of adopting healthy habits with regard to ultraviolet radiation exposure, especially important in fi rst eighteen y cars of live, and to carry out educational campaigns to prevent the appearance and/or worsening of conditions arising from such

Enfuvirtida: primer fármaco de una nueva familia de antirretrovirales / Enfuvirtide: first drug of a new family of antiretroviral agents

Enfuvirtida o T-20 es el primer fármaco aprobado por la FDAy por la EMEA dentro del grupo de los inhibidores de la fusión. Sumecanismo de acción consiste en el bloqueo de la entrada del VIHen las células del organismo.Enfuvirtida está indicado en combinación con otros fármacosantirretrovirales, en el tratamiento de aquellos pacientes infectadospor el VIH que presentan resistencias o intolerancia a tratamientosantirretrovirales previos.Los ensayos clínicos han demostrado eficacia y seguridad deltratamiento con este fármaco. Los efectos adversos reportadoscon más frecuencia son las reacciones locales en el punto deadministración.Enfuvirtida contribuye a la ampliación del arsenal terapéuticodisponible para el tratamiento de la infección por VIH, permitiendouna terapia de rescate en aquellos pacientes con fracasos previosen el tratamiento

Enfuvirtide or T-20 is the first drug approved by the FDA andthe EMEA within the group of fusion inhibitors. Its mechanism ofaction is based on the blockade of the entry of the HIV to thebody cells.Enfuvirtide is recommended in combination with other antiretroviraldrugs for the treatment of patients infected by HIV thathave developed resistance or intolerance to other prior antirretroviraltherapies.Clinical trials have shown the effectiveness and safety of thetreatment with this drug. Side effects most commonly reportedare local reactions in the injection siteEnfuvirtide contributes to increase the therapeutic arsenal availablefor the management of the HIV infection, providing rescuetherapy for patients in which prior treatments have failed

[Enfuvirtide: first drug of a new family of antiretroviral agents]. / Enfuvirtida: primer fármaco de una nueva familia de antirretrovirales.

Enfuvirtide or T-20 is the first drug approved by the FDA and the EMEA within the group of fusion inhibitors. Its mechanism of action is based on the blockade of the entry of the HIV to the body cells. Enfuvirtide is recommended in combination with other antiretroviral drugs for the treatment of patients infected by HIV that have developed resistance or intolerance to other prior antiretroviral therapies. Clinical trials have shown the effectiveness and safety of the treatment with this drug. Side effects most commonly reported are local reactions in the injection site. Enfuvirtide contributes to increase the therapeutic arsenal available for the management of the HIV infection, providing rescue therapy for patients in which prior treatments have failed.

Virologic outcome and predictors of virologic failure of highly active antiretroviral therapy containing protease inhibitors.

In this observational single-center cohort study outside the clinical trial setting, outcome and predictors of virologic failure of highly active antiretroviral therapy (HAART) containing a protease inhibitor were evaluated in human immunodeficiency (HIV)-infected persons. The study population consisted of 807 protease inhibitor-naive HIV-seropositive patients who initiated antiretroviral therapy with reverse transcriptase inhibitors and protease inhibitors (indinavir, nelfinavir, ritonavir) between January 1997 and January 1999. Demographic variable, plasma HIV-1 RNA levels, CD4+ T-cell count, adverse drug reactions, and adherence to HAART were assessed. Virologic treatment response was defined as a decrease in plasma HIV-1 RNA load from baseline to below 500 copies per milliliter after 12 months of therapy. Levels of HIV-1 RNA were undetectable in 43% of patients at 12 months. Factors associated with failure to suppress viral load included age 40 years or younger, baseline CD4+ T cell count less than 200 x 10(6) per liter baseline viral load greater than 4.3 log(10) per milliliter, and non-adherence to HAART. After adjustment by logistic regression, non-adherence was the only statistically significant variable associated with virologic failure (odds ratio 0.38, 95% confidence interval 0.21 to 0.67). Unselected patients in whom protease inhibitor is started in a usual clinical setting achieve viral suppression less frequently than do patients in controlled clinical trials. Failure to adherence to HAART was the strongest predictor of virologic failure.

Calcification of lumbar ligamentum flavum and facet joints capsule.

STUDY DESIGN: The incidence of calcification in ligamentum flavum and posterior capsule demonstrated by computed tomography was reviewed in a series of 147 patients in whom 419 lumbar levels were studied. OBJECTIVES: To find a relationship between mechanical lumbar pathology and the calcification of the ligamentum flavum and posterior capsule. SUMMARY OF BACKGROUND DATA: Calcification of the ligamentum flavum and posterior capsule has been found in diffuse idiopathic skeletal hyperostosis and in metabolic disorders. Although this fact is considered a manifestation of degenerative disease of the spine, it barely has been studied, and many questions remain unresolved. METHODS: Calcifications were classified according to location as follows: 1) ligamentum flavum: upper attachment, lateral or capsular extension, caudal attachment, interlaminar portion or 2) posterior capsule. RESULTS: The following statistical associations were found: 1) degenerative facet joint disease with posterior capsule and lateral or capsular extension calcifications, 2) lumbarized vertebra with lateral or capsular extension and upper attachment calcifications, and 3) isthmic spondylolisthesis with lateral or capsular extension calcification.