[Functional assessment in total knee arthroplasty comparing the posterior cruciate ligament preservation versus postero-stabilization]. / Valoración funcional en artroplastía total de rodilla comparando la preservación del ligamento cruzado posterior versus posteroestabilización.

INTRODUCTION: The two most commonly used types of prostheses are the total knee prosthesis with posterior cruciate ligament preservation and posterior cruciate ligament replacement. OBJECTIVE: To assess whether there is a difference in functionality between the two procedures. MATERIAL AND METHODS: Observational, retrospective and cross-sectional study with 134 patients divided into group A (N = 67) with ligament preservation and group B (N = 67) with posterior substituting. Using the American Association Scale for Knee Prosthetics with Insall modification to assess functionality. Statistical analysis: use of 2 with Yates correction. RESULTS: In group A the results: excellent (31%); good (24%); regular (22%) bad (22%). In group B the results: excellent (34%); good (31%); regular (16%) and bad (19%); without statistical difference between the two groups. CONCLUSIONS: No statistically significant difference was observed between age, gender, laterality of injury, or between number of patients with excellent results, good regular and bad according to the scale used. The high percentage of poor results in both groups of this series for the knee prosthesis is striking.

INTRODUCCIÓN: Los dos tipos de prótesis que más se utilizan en la actualidad son la prótesis total de rodilla con preservación del ligamento cruzado posterior y con sustitución del ligamento cruzado posterior. OBJETIVO: Valorar si existe diferencia en la funcionalidad entre ambos procedimientos. MATERIAL Y MÉTODOS: Estudio observacional, retrospectivo y transversal con 134 pacientes divididos en grupo A (N = 67) con preservación del ligamento y grupo B (N = 67) con posteroestabilización. Uso de la Escala de la Asociación Americana para Prótesis de Rodilla con la modificación de Insall para valorar funcionalidad. Análisis estadístico: Uso de 2 con corrección de Yates. RESULTADOS: En el grupo A los resultados: excelentes (31%); buenos (24%); regulares (22%) y malos (22%). En el grupo B los resultados: excelentes (34%); buenos (31%); regulares (16%) y malos (19%); sin diferencia estadísticamente entre ambos grupos. CONCLUSIONES: No se observó diferencia estadísticamente significativa entre edad, género, lateralidad de la lesión ni entre número de pacientes, con resultados excelentes, buenos regulares y malos de acuerdo con la escala utilizada. Llama la atención el elevado porcentaje de malos resultados en ambos grupos de esta serie en la prótesis de rodilla.

[Injury of the anterior branch of the posterior interosseous nerve]. / Lesión de la rama anterior del nervio interóseo posterior.

INTRODUCTION: Posterior interosseous nerve syndrome, a branch of the radial nerve at the level of the forearm, is characterized by the motor function loss of some or all of the muscles innervated distally. CLINICAL CASE: A 26-year-old male with a history of proximal radius fracture associated to radial nerve injury, treated with osteosynthesis 7 years earlier, with full recovery, who currently presented intense pain 4 cm distal to the radial head, accompanied by paralysis of Extensor pollicis longus, Extesnor pollicis brevis and Abductor pollicis longus, with paresis of the Extensor indicis propius, in which a diagnosis of entrapment syndrome of the anterior descending branch of the posterior interosseous nerve (SNIP) was performed. DISCUSSION: The conservative management of SNIP is indicated during the first 8-12 weeks, if no improvement is found, the indication for surgical exploration is indicated, and the removal of osteosynthesis material is controversial.

INTRODUCCIÓN: El síndrome del nervio interóseo posterior, rama del nervio radial a nivel del antebrazo se caracteriza por la pérdida de función motora de algunos o todos los músculos inervados distalmente. CASO CLÍNICO: Masculino de 26 años con antecedente de fractura de radio proximal manejado con osteosíntesis que cursó con lesión del nervio radial siete años antes con recuperación completa, acude con dolor intenso a 4 cm distal a cabeza radial, acompañado de parálisis del extensor largo y corto del pulgar y del abductor del pulgar, con paresia del extensor propio del índice, en el que se efectúa diagnóstico de síndrome de atrapamiento de la rama anterior descendente del nervio interóseo posterior (SNIP). DISCUSIÓN: El manejo conservador del SNIP está indicado durante las primeras ocho a 12 semanas, de no mostrar mejoría la indicación de exploración quirúrgica está indicada, siendo el retiro de material de osteosíntesis controvertido.

[Parathyroid carcinoma: diagnosis by a femur fracture]. / Carcinoma de paratiroides: diagnóstico por fractura de fémur.

BACKGROUND: Carcinoma of the parathyroid gland (PC) described by De Quervain since 1909, it represents the least common neoplasm, with an incidence of 1,25/10,000,000 peoples. It has been reported approximately 1,000 cases of CP in world literature. There are two series in Mexico, one of eight patients and other with four cases. Because CP is functionally active, its early clinical behavior is similar to that of parathyroid benign neoplasms. CLINICAL CASE: A 66-year-old female with history of thighbone pain and spontaneous femoral fracture, osteolytic lesions, hypercalcemia, elevated levels of alkaline phosphatase and parathyroid hormone detected; the scintigraphy showed a functioning tumor located in upper mediastinum. By hemithyroidectomy in block, the tumor was resected. Histopathological study reported parathyroid carcinoma. DISCUSSION: PC is the least common neoplasia, in patients with parathyroid hormone levels greater than 1,000 pg/ml and hypercalcemia upper of 14 mg/dl this disease should be suspected.

ANTECEDENTES: El carcinoma de las glándulas paratiroides (CP) descrito por De Quervain en 1909 representa la neoplasia menos frecuente, siendo su incidencia de 1.25/10,000,000 personas. Se han reportado aproximadamente 1,000 casos de carcinoma paratiroideo en la literatura mundial. En México existen dos series, una de ocho pacientes y otra de cuatro, además de tres reportes de casos aislados. Dado que el CP es funcionalmente activo el comportamiento clínico inicial es similar a las neoplasias paratiroideas benignas. CASO CLÍNICO: Femenino de 66 años de edad con dolor óseo en muslo y fractura espontánea de fémur, en la que se detectaron lesiones osteolíticas, hipercalcemia, niveles elevados de fosfatasa alcalina y de paratohormona; con gammagrama que mostró un tumor funcionante localizado en mediastino superior, fue sometida a extirpación en bloque con hemitiroidectomía derecha con tumor de la glándula paratiroides. El estudio histopatológico reportó CP. DISCUSIÓN: El CP representa la neoplasia menos común; en pacientes con niveles de paratohormona mayores de 1,000 pg/ml e hipercalcemia mayor de 14 mg/dl debe sospecharse dicha patología.

[Shoulder injuries in the elderly and their functional impact on the DASH scale]. / Lesiones de hombro en la tercera edad y su repercusión funcional en escala de DASH.

INTRODUCTION: Disabling shoulder problems in the elderly are common. OBJECTIVE: To quantify the diagnoses found in 100 consecutive shoulders cases in rehabilitation and its functional impact on the DASH scale. MATERIAL AND METHODS: 100 consecutive patients with age 65 years received in the Rehabilitation Department, performing diagnosis and functional assessment in the DASH scale. RESULTS: Distribution by gender with predominance of the female (67%); the age showed variation from 65 to 98 years with average and SD 78 ± 12. Ten different diagnoses were found: supraspinatus tendon rupture (58%); gleno-humeral osteoarthritis (11%); impingement syndrome (9%); proximal humeral fracture (9%); acromio-clavicular osteoarthritis (7%); long biceps tendon rupture (2%); scapula fracture (1%); humeral head avascular necrosis (1%); neglected gleno-humeral dislocation (1%) and circumflex nerve injury (1%). The distribution corresponded to 52% right, 40% left and 8% bilateral. The DASH scale showed variation from 94 to 52% with mean and SD 71 ± 22.3. Elderly shoulder problems are associated with disability, its relation with DASH is not clear.

INTRODUCCIÓN: Los problemas discapacitantes de hombro en la tercera edad son frecuentes. OBJETIVO: Cuantificar los diagnósticos encontrados en 100 casos consecutivos en rehabilitación y su repercusión funcional en la escala de DASH. MATERIAL Y MÉTODOS: 100 pacientes consecutivos con edad 65 años recibidos en rehabilitación, se efectuó diagnóstico y valoración funcional en la escala de DASH. RESULTADOS: La distribución por género con predominio del femenino (67%); la edad mostró variación de 65 a 98 años con promedio y DE 78 ± 12; los 10 diferentes diagnósticos correspondieron a ruptura del tendón supraespino (58%); artrosis glenohumeral (11%); síndrome de pinzamiento (9%); secuelas de fractura de tercio proximal de húmero (9%); artrosis acromioclavicular (7%); ruptura del tendón de la porción larga del bíceps (2%); fractura de la escápula (1%); necrosis avascular de cabeza humeral (1%); luxación escápulo- humeral recidivante inveterada (1%) y lesión del nervio circunflejo (1%). La distribución correspondió a 52% derechas, 40% izquierdas y 8% bilaterales. La escala de DASH mostró variación de 94 a 52% con promedio y DE 71 ± 22.3. Los problemas de hombro en la tercera edad se asocian siempre a discapacidad importante.

[Iliacus muscle injury caused by inadequate exercise]. / Lesión del músculo ilíaco por ejercicio inadecuado.

BACKGROUND: Traumatic iliacus muscle injury is rare; it is usually caused by trauma or intense exercise involving the pelvic girdle; it can produce a hematoma with femoral nerve neuropathy. Spontaneous muscle hematomas occur in patients with coagulation disorders. CLINICAL CASE: A 45-year-old male with 18 days of evolution, with an intense pain in the right buttock, groin and iliac fossa, with an inability for hip flexion and ambulation caused by inadequate exercise (supine double leg lifts). On the physical examination: intense pain with bending and/or internal rotation of the right hip, positive Thomas maneuver, quadriceps rated 3/5; area of paresthesia in the right femoral nerve territory. Pelvic magnetic resonance imaging showed: right iliacus muscle tear with blood between its fibers. Initial treatment was rest and analgesics for eight days and gradual extension of the hip, axillary crutches with partial weight bearing and diathermy on the right abdominal lower quadrant, active hip exercises, bicycle and right quadriceps strengthening. The evolution was satisfactory, with full recovery in six weeks.

La lesión traumática del músculo ilíaco es rara; generalmente es causada por trauma o ejercicio intenso, que ocasiona hematoma del músculo con neuropatía del nervio femoral como complicación. Los hematomas espontáneos del mismo ocurren en pacientes con trastornos de la coagulación.

[Quadratus femoris muscle tear]. / Ruptura del músculo cuadrado crural.

BACKGROUND: Quadratus femoris tear is an uncommon injury that usually cause hip pain, it incidence is unknown. The patient can suffer of posterior gluteal pain or groin pain or both, which makes accurate diagnosis difficult, because the differential diagnosis of hip pain is broad. CLINICAL CASE: A 65 years old male, with gluteal and groin pain presented during tennis; evaluated by neurologist with lumbosacral magnetic resonance imaging (MRI) (normal) and referred to physical therapy, a pelvic MRI was required, finding an unsuspected quadratus femoris tear. CONCLUSION: MRI with its superior soft-tissue resolution and multiplanar capability is an excellent adjunct to physical examination because it shows the anatomic location of the abnormality, aiding the clinician to make unsuspected diagnoses.

ANTECEDENTES: La ruptura del músculo cuadrado crural es una lesión poco frecuente que se manifiesta por dolor en cadera y cuya incidencia se desconoce. El paciente puede manifestar dolor en región glútea y/o inguinal, su diagnóstico clínico es difícil por su rareza y porque el diagnóstico diferencial de problemas de cadera es amplio. CASO CLÍNICO: Masculino de 65 años con dolor en regiones glútea e inguinal derechas manifestadas durante la práctica de tenis, evaluado por neurología con resonancia magnética nuclear (RMN) lumbosacra (normal) y canalizado a rehabilitación. Se solicitó RMN de pelvis, la cual reveló ruptura del cuadrado crural derecho no sospechada previamente. CONCLUSIÓN: La RMN por su capacidad para mostrar cortes multiplanares es el estudio de elección en problemas de tejidos blandos en cadera, ya que permite localización y auxilia en diagnóstico de problemas no sospechados.

Efficient Bragg gratings in phosphosilicate and germanosilicate photonic crystal fiber.

We present ArF laser-induced dynamics of Bragg grating (BG) growths in phosphosilicate-doped or germanosilicate-doped core photonic crystal fibers (PCFs). To this end, we have adapted the technique of H2 loading, usually used in conventional fiber, to the case of microstructured fiber, allowing both the concentration of hydrogen in the PCFs to be kept nearly constant for the time of the exposure and the BG spectra to be easily recorded. We compared the characteristics of BG growths in the two types of PCF to those in conventional step-index fibers. We then conducted a study of the thermal stability of the BGs in PCFs through 30 min of isochronal annealing. At the same time we discuss the role played by the microstructuration and the doping with regard to the grating contrast and the Bragg wavelength stability.

Light transmission in multiple or single subwavelength trefoil channels of microstructured fibers.

We evaluate the trefoil channels present between the holes of microstructured fibers as a potential dense array of small waveguides. In channels with an inner radius of 330nm, calculations indicate possible propagation with a mode waist of ~350nm at lambda=670nm, near to the diffraction limit. Actual measurements have been performed on a 1-meter fiber section, with injection by a microlensed fiber and mapping of output by near-field scanning optical microscopy. They show that light can be output in individual channels or in several of them, depending on the injection. The observed waist is ~500nm, possibly due to experimental widening. Estimated propagation losses are <20dB/m. Since each channel occupies only 2microm2, this structure opens a way to dense parallel optical processing.

Case Report: epignathus-clinical, radiologic, and pathologic considerations.

In retrospect, a diagram could hace been made from the antenatal radiological examination of the case of epignathus presented here. The features of the epignathus are considered with respect to antenatal diagnosis and subsequent reparative surgery. Specific features such as axial organization, maturity of all tissues, and identical ossification points between host and parasite-all of which are evident in this case-favor the malformative origin of epignathi, thus distinguishing them from teratomata.