Enclavado percutáneo de fracturas complejas intraarticulares de la extremidad distal del radio. A propósito de dos casos / Percutaneous pinning in complex intraarthicular fractures of the distal radius. Report of two cases

Objetivo: Señalar el buen resultado con enclavijado percutáneo combinado de estas lesiones y analizar la literatura al respecto. Pacientes y metodología: Presentamos dos casos de fractura compleja e intraarticular de la extremidad distal del radio, tratadas mediante enclavijado percutáneo con agujas de Kirschner. Seguimiento anual. Valoración radiológica y funcional. Resultados: Evolución muy satisfactoria, uno con mínima limitación en la movilidad y ambos con algodistrofia, con total recuperación. Los dos se reintegraron a sus trabajos previos. Conclusión: Con calidad ósea subyacente, este tratamiento es idóneo por sencillez, rapidez y economía, pudiendo realizarse incluso por un único cirujano. Por contra, precisa un exhaustivo seguimiento postoperatorio e inmovilización temporal (AU)

Objective: To note the good results with combined percutaneous pinning of these lesions and to analyze literature related to this topic. Material and method: We present two cases with complex and intra-articular distal radius fractures, treated by percutaneous pinning with Kirschner wires. Anual follow-up. Radiological and functional outcomes. Results: Quite good evolution, one with minimal mobility limitation and both with algodystrophy with total recovery. Both returned to previous works. Conclusion: If the bone has a good quality, this orthopedic fixation device is useful because it is simply, fast and a low-cost method. One surgeon can do it alone. On the other hand, it needs an exhaustive postoperative follow-up and a cast is imperative during a variable period (AU)

[Monostotic patellar Paget's disease]. / Enfermedad de Paget monostótica rotuliana.

Paget's disease or osteitis deformans is a bone metabolic disease characterized by an increased bone resorption followed by an increased but irregular bone formation. This results in a weakened, deformed bone and an increase bone mass with collagen fibers forming an irregular and pathologic mosaic instead of the parallel symmetry that characterizes healthy bone. It is considered as a non-neoplastic disorder that mimics a bone tumor. Its origin is still uncertain; however, it has been postulated that genetic or environmental factors are involved in its etiology. It rarely occurs in young patients and its prevalence increases with age. It usually affects both genders with a slight predominance of males. It may be symptomatic or asymptomatic depending on the bones involved, with the most common clinical manifestation being pain of the affected bone. Lesion distribution varies from monostotic involvement (25%) to generalized disease (75%). The most frequent complication is a fracture in a pathological area, while the most serious one is sarcomatous degeneration (approximately 1%; higher in the generalized form). The diagnosis is usually radiologic, by means of plain X-rays and biochemical markers such as alkaline phosphatase, among others, which is elevated in 85% of patients. Treatment of this disease consists of bisphosphonates, which have a proven efficacy and high remission rates. They are indicated in patients with clinical manifestations and in asymptomatic patients with evidence of disease activity. We report the case of a patient with Paget's disease in an infrequent location as is the patella.

Tratamiento de la retinopatía diabética / Treatment of diabetic retinopathy

La retinopatía diabética (RD) es la principal causa de ceguera en población de edad laboral en los países industrializados. La fotocoagulación con láser continúa siendo la principal arma terapéutica para evitar la progresión de la RD, pero pierde efectividad cuando se indica demasiado tarde, y no está exenta de efectos secundarios. Por tanto, es indispensable seguir una estrategia de cribado estandarizada para poder identificar a los pacientes en estadios inicial ese indicar, en el momento oportuno, la fotocoagulación. En casos de RD muy avanzada deberá practicarse la vitrectomía, que requiere la presencia de un oftalmólogo experto, es cara y presenta un elevado índice de fracasos. Por ello, es necesario el desarrollo de nuevos tratamientos basados en el conocimiento fisiopatológico de la enfermedad. En este sentido, se están ensayando fármacos para bloquear tanto las vías metabólicas relacionadas con la hiperglucemia (p. ej., inhibidores de la PKC), como la angiogénesis inducida por la hipoxia (p. ej., agentesanti-VEGF) que, sin duda, proporcionarán una nueva perspectiva en el tratamiento de la RD (AU)

Diabetic retinopathy (DR) is the main cause of blindness in the working-age population in industrialized countries. Laser photocoagulation remains the main therapeutic weapon to avoid progression of DR but this treatment is less effective when there is a delay in indication and is not free of adverse effects. Therefore, a standardized screening strategy is essential to identify patients in the initial stages of DR and to indicate timely photocoagulation. In patients with highly advanced DR, vitrectomy should be performed. This procedure requires the presence of an expert ophthalmologist, is expensive, and has a high failure rate. Therefore, new techniques, based on knowledge of the pathophysiology of the disease, are required. Drugs to block both the metabolic pathways related to hyperglycemia(e.g. protein kinase C inhibitors) and hypoxia-induced angiogenesis (e.g.anti-vascular endothelial growth factor[VEGF] agents) are currently being tested. These drugs will undoubtedly provide a new perspective in the treatment of DR (AU)

[Malignant otitis externa and diabetes: report of 4 cases]. / Otitis externa maligna y diabetes: descripción de cuatro casos.

Malignant otitis externa (MOE) is an uncommon infective but potentially fatal entity caused by Pseudomonas aeruginosa. It involves almost exclusively advanced aged diabetic patients. We report here four cases diagnosed at our hospital during the last 7 years. Clinical manifestations included otalgia, purulent otorrhoea, involvement of different cranial nerves and bony destruction; one patient died because of bronchoaspiration and two are alive but with sequelae. MOE should be suspected in every diabetic patient with otitis which goes unresolved with the usual antibiotic therapy. On the other hand, facial palsy should not always be attributed to a diabetic mononeuropathy and the presence of MOE should be ruled out when otitis coexists or precedes it.

[Acromegaly and Graves-Basedow disease. Report of 3 cases]. / Acromegalia y enfermedad de Graves-Basedow. A propósito de 3 casos.

Acromegaly is associated to thyroidal disorders such as hyperthyroidism. The Graves-Basedow disease as a cause of thyroid hyperfunction is very infrequent, with only 8 cases having been reported up to 1993. The authors present 3 patients with acromegaly who developed hyperthyroidism due to Graves-Basedow disease in the course of their disease. Two of the patients had acromegaly of 30 years of evolution and the third patient underwent consultation for clinical symptoms of hyperthyroidism with acromegaly being simultaneously diagnosed. All the patients had weight loss prior to diagnosis and the possibility of neoplasia associated to acromegaly was excluded. The hyperthyroidism responded well to initial treatment with antithyroid drugs in the three cases. The authors conclude that hyperthyroidism should be taken into consideration in the diagnosis of a patient with acromegaly and weight loss.