Tratamiento de la osteocondritis disecante de rodilla con aloinjerto congelado / Treatment of osteochondritis dissecans of the knee using frozen allografts

Objetivo. Estudio retrospectivo de tres casos de osteocondritis disecante de la rodilla tratados con aloinjertos osteocondrales congelados de banco de huesos. Material y método. Tres casos tratados con un tiempo de evolución que va desde los 2,7 a los 4,5 años (media 3,4 años).Resultados. Para su valoración se utilizó la escala modificada de Merle D'Aubigné y Postel, siendo dos casos excelentes y bueno el otro. No hubo complicaciones relacionadas con el acto operatorio, ni con la colocación del aloinjerto, ni reacción inmunológica alguna. Mediante estudios Rx seriados y resonancia magnética nuclear (RMN) se ha comprobado en todos los casos la buena osteointegración del aloinjerto osteocondral. Conclusiones. Es una técnica sencilla, indicada en adultos jóvenes activos con una zona amplia de osteocondritis, en los cuales no está indicada la artroplastia total de la rodilla (AU)

Aloinjerto masivo del aparato extensor de la rodilla / Massive allograft of the knee extensor mechanism

Se presenta un caso de rotura antigua del tendón rotuliano de la rodilla derecha, en una paciente de 49 años de edad afecta de una artritis reumatoide seropositiva de 20 años de evolución. Quince meses después de la rotura acude a nuestra consulta por primera vez, en silla de ruedas, refiriendo que durante todos estos meses presenta una impotencia funcional absoluta para la extensión de la rodilla que le impide la marcha. Fue intervenida quirúrgicamente realizándole un aloinjerto masivo del aparato extensor de la rodilla rótula tendón rotuliano - tuberosidad tibial. Tras una evolución postoperatoria de tres años, la paciente camina prácticamente normal y presenta una movilidad de la rodilla de 120° de flexión con una extensión activa de -20° y pasiva completa. En los estudios radiográficos se comprueba la plena osteointegración del aloinjerto (AU)

Changes of acetylcholinesterase activity in brain areas and liver of sucrose- and ethanol-fed rats.

The effects of chronic ethanol or sucrose administration to rats on acetylcholinesterase from brain and liver were investigated. Membrane-bound and soluble acetylcholinesterase activities were determined in fractions prepared by centrifugation. The thermal stability and the effects of temperature and different types of alcohols on acetylcholinesterase activity were also studied. Membrane-bound acetylcholinesterase activity increased (p < 0.01) in the liver after chronic ethanol administration, whereas no differences among groups in the encephalic areas, except in the brain stem soluble form, were found. Membrane-bound acetylcholinesterase from the ethanol- and sucrose-treated groups was more stable at the different temperatures assayed between 10 and 50 degrees C than that corresponding to the control group. Non-linear Arrhenius plots were obtained with preparations of membrane-bound acetylcholinesterase from rat liver, with discontinuities at 30 degrees C (control or sucrose groups) or 34-35 degrees C (alcohol group). Assays made with membrane-bound or soluble enzyme from brain showed linear Arrhenius plots in all groups studied. The inhibitory effects of increasing concentrations of ethanol, n-propanol and n-butanol on acetylcholinesterase preparations from forebrain, cerebellum, brain stem and liver of the three experimental groups (control, sucrose-fed and ethanol-fed) were very similar. However, n-butanol displayed a biphasic action on particulate or soluble preparations of rat forebrain. n-butanol inhibited (competitive inhibition) at higher concentrations (250-500 mM), while at lower concentrations (10-25 mM), the alcohol inhibited at low substrate concentrations but activated at high substrate concentration. These results suggest that the liver is more affected by ethanol than the brain. Moreover, the lipid composition of membranes is probably modified by ethanol or sucrose ingestion and this would affect membrane fluidity and consequently the behaviour of acetylcholinesterase.

Levels of serum cathepsin L and several glycosidases in patients operated for colorectal cancer.

The activities of several glycosidases and cathepsin L were determined in the blood serum of a control group of ten healthy humans in comparison with a group (group I: 32 subjects) of preoperative colorectal cancer patients (1 week before surgical exeresis) and with another two groups: group II, comprising 18 operated subjects (1 week after surgery), and group III, of 15 operated subjects (4 months after surgery). All subjects were 48-88 years old. Both 'enzyme activity' and 'specific activity' determinations of serum beta-galactosidase, alpha-L-fucosidase and cathepsin L revealed peculiar profiles that differed from one another. Control values differed from those of some stages of the pathological groups, but not of others. These values were compared also with the levels of total, lipid- and glycoprotein-associated serum sialic acid. The usefulness of some assays (especially cathepsin L activity measurement) in the follow-up of the health status of humans operated for colorectal cancer is discussed.

Evaluation of the activities of eight lysosomal hydrolases in sera of humans, rats and pigs of different ages.

The activities of 21 enzymes (belonging to four classes of enzymes) involved in different metabolic pathways were assayed in blood sera of healthy young and adult/elderly groups of humans, rats and pigs, to determine whether activity changes coinciding with changes in age and aging could be detected. In all three species analysed, measurable activities (performed by highly specific and sensitive techniques, generally spectrofluorimetric procedures) were found, usually following a decreasing order of: among glycosidases, beta-N-acetylglucosaminidase (NAG) > alpha-L-fucosidase > alpha-mannosidase > beta-glucuronidase > beta-galactosidase > alpha-galactosidase. In addition, among esterases very high values were found for arylesterase and acid phosphatase. By contrast, no measurable activity was found for the remaining enzymes assayed (8 hydrolases, 1 oxidoreductase, 3 transferases and 1 lyase). In the elderly group of humans, significantly higher activities (P < or = 0.05) were found for NAG, alpha-mannosidase and beta-glucuronidase in comparison to the adult and young groups. However, several activities in rats and all activities in pigs decreased with age. In conclusion, differences in the activities of 6 lysosomal glycosidases and 2 esterases (but no significant differences for another 13 enzymes belonging to several enzyme classes) are found in the sera of healthy humans, rats and pigs. These differences coincide with changes observed in aging.

Increased levels of several lysosomal enzymes in sera from women using oral contraceptives.

The activities of eight lysosomal enzymes were measured by spectrophotometric/spectrofluorimetric techniques in the blood sera of 19-24 apparently healthy women using an oral contraceptive (progestin and oestradiol synthetic derivative, desogestrel+ethinyloestradiol) in comparison with 15-16 non-pregnant women not using contraceptives (controls), in a randomised, double-blind, controlled study. beta-Glucuronidase and arylesterase showed statistically increased activities (P < or = 0.05) in the experimental group in comparison to the controls. No significant differences were found for the remaining enzymes assayed (beta-N-acetylhexosaminidase, alpha-L-fucosidase, alpha-mannosidase, beta-galactosidase, alpha-galactosidase and acid phosphatase). Similar results were obtained when the contraceptive formed by the combination of levonorgestrel and ethinyloestradiol was used by an experimental group of eight healthy women. These results suggest that the significant increases in the above-mentioned activities might be the physiological response of the organism (through catabolic processes catalysed by lysosomal enzymes) to the administration of exogenous synthetic compounds, such as the oral contraceptives used.

Variation in serum arylesterase, beta-glucuronidase, cathepsin L and plasminogen activators during pregnancy.

To determine whether the activities of certain hydrolases (arylesterase, beta-glucuronidase, cathepsin L, plasminogen activators, arginase, glutaminase, asparaginase and adenosine deaminase) are changed during pregnancy, three groups of 15 apparently healthy women (aged 18-38 years) in their first, second and third trimester of pregnancy were compared to a control group formed of 15 non-pregnant women of similar ages. Enzyme and specific activities gradually increased from the first to the end of the third trimester of pregnancy for arylesterase and beta-glucuronidase, these increases being statistically significant (P < 0.01) in comparison to controls. However, as regards cathepsin L and plasminogen activators, the greatest increase was found in the second trimester. Arginase, glutaminase and asparaginase activities were very low and not distinguishable from the controls. In conclusion, differences in the activities of several hydrolases have been found in the sera of healthy pregnant women in comparison to controls.

Subtalar dislocation. A study of nineteen cases.

This is a retrospective study of 19 cases of subtalar dislocation treated in our Department during the last 15 years. The average age of the patients was 31, and the majority were male (63%). Medial dislocations predominated (84%) and 37% were open. Associated osteocartilaginous lesions were very frequent and affected 13 patients (68%). Surgery was required for all the open injuries and for 2 of the closed dislocations. Closed reduction was impossible in one, and another required surgery to treat an associated vascular injury. Seventeen of the 19 patients were reviewed after an average of 7.9 years. The results were good in 6, fair in another 6, and poor in the remaining 5. The results of all the open lesions was only fair or poor. Four patients needed a triple arthrodesis. Factors resulting in a poor result were open lesions, associated bone lesions, and prolonged immobilization.

Lysosomal enzyme activities in liver and sera from guinea pigs fed oil related to the toxic oil syndrome.

beta-N-Acetylglucosaminidase and beta-galactosidase activities were determined in serum and liver from guinea pigs fed "toxic oil" (related to cases of TOS) under different experimental conditions. The results obtained were compared with those of guinea pigs fed non "toxic oil" (case-unrelated oil; controls 1) and animals fed no oil (controls 2). In serum, both activities were significantly increased after all treatments with case-related oil as compared with controls 1 and 2. In the liver, beta-galactosidase activity did not show significant differences in any of the treatments when compared with controls 2. However, NAG activity decreased significantly after 7 days of treatment with non-heated oil--either case-related or not--when compared with controls 2; it also decreased significantly after 28 days of treatment with heated case-unrelated oil, both with respect to controls 2 and the animals fed case-related oil. Liver weights tended to increase in the animals fed oil--toxic or not--with respect to those of the livers from untreated animals. Morphologically, a slight vacuolization of the hepatocytes was observed in some of the samples from the treated animals.

Occipital-cervical instability.

A retrospective clinicoroentgenographic study was done on 26 patients with atlantoaxial instability, 17 traumatic and nine nontraumatic. All were treated by means of surgical C1-C2 and occipital-C2 stabilization. The traumatic instability was associated with lesions of the odontoid process and the atlas transverse ligament. Instability may be endogenous or associated with fracture of the atlas. Surgical indication was determined by the level of the fracture line, neurologic symptoms, age, and presence of multiple lesions. C1-C2 stabilization by means of wiring and iliac graft was the selected treatment. Fusion between the occipital and C2 segment was indicated in case of irreducible dens pseudoarthrosis. Fracture on the os odontoideum was very unstable and required greater C1-C2 fusion. Nontraumatic C1-C2 instability was either congenital or secondary to pathologic fractures. Rheumatoid arthritis, which produces anterior displacement of the atlas over the dens to more than 10 mm, neurologic symptoms, or untreatable pain must be stabilized by means of C1-C2 fusion. When elevation of the dens or irreducible displacement of the atlas exists, the results were relatively poor. Tumorous instability produced pathologic fracture of the body of the axis and had to be treated with C1-C2 wiring on bone cement. Down's syndrome instability required occipitoaxial fusion and strict postoperative immobilization.

Prediction of overgrowth in femoral shaft fractures in children.

A prospective study of femoral shaft fractures in children under the age of 14 years has been carried out in 71 patients who were reviewed both clinically and radiographically at yearly intervals. The processing of data has been carried out by univariate and multivariate analysis. Femoral overgrowth (F.O.) averaged 8.63 mm (range 1-21 mm), and was found to be influenced by age (greater overgrowth in children between 3 and 9 years), the initial displacement of the fracture (greater overgrowth in severely displaced fractures), and overriding of the fragments at the time of healing (the greater the overriding the lesser the overgrowth). Consideration of these factors allowed overgrowth to be predicted from the time of fracture. Overgrowth occurred in all children over 2 years of age, and took place mainly during the first year after the fracture. It continued, although to a lesser extent, during the second year, and for as long as the fifth year in 27%. After this time the growth rate of both femurs was equal in all the children. Ipsilateral tibial overgrowth was present in only 60% of the children and averaged 1.05 mm (1-5 mm).

Prediction of overgrowth in femoral shaft fractures in children.

A prospective study of femoral shaft fractures in children under the age of 14 years has been carried out in 71 patients who were reviewed both clinically and radiographically at yearly intervals. The processing of data has been carried out by univariate and multivariate analysis.Femoral overgrowth (F.O.) averaged 8.63 mm (range 1-21 mm), and was found to be influenced by age (greater overgrowth in children between 3 and 9 years), the initial displacement of the fracture (greater overgrowth in severely displaced fractures), and overriding of the fragments at the time of healing (the greater the overriding the lesser the overgrowth). Consideration of these factors allowed overgrowth to be predicted from the time of fracture. Overgrowth occurred in all children over 2 years of age, and took place mainly during the first year after the fracture. It continued, although to a lesser extent, during the second year, and for as long as the fifth year in 27%. After this time the growth rate of both femurs was equal in all the children. Ipsilateral tibial overgrowth was present in only 60% of the children and averaged 1.05 mm (1-5 mm).