Luxación temprana en artroplastias total de cadera primarias realizadas mediante vía posterior con reparación capsular y de rotadores externos / Early dislocation in primary total hip arthroplasty using a posterior approach with repair of capsule and external rotators

Objetivo: Determinar la incidencia de luxación después de una artroplastia total de cadera primaria utilizando un abordaje posterior con reparación capsular y reinserción transósea de rotadores externos. Material y método: Estudio de una cohorte histórica entre enero del 2009 y diciembre del 2015 de todos los casos de luxación de artroplastia total de cadera primaria intervenidos mediante un abordaje posterior con reparación capsular y reinserción transósea de rotadores externos. Se recogieron y analizaron los datos demográficos y los datos clínicos referentes al paciente, a la cirugía y a la luxación. Se realizaron un análisis descriptivo y un estudio de supervivencia y función de riesgo por el método de Kaplan-Meier considerando como evento final la aparición de una luxación de cadera. Resultados: La incidencia de luxación en nuestro estudio fue del 1,2% (23 casos). En nuestro estudio, la mayor probabilidad de luxación ocurrió en los primeros 120 días. El 43,5% de pacientes luxados necesitaron cirugía de revisión. Conclusiones: La reparación capsular y la reinserción transósea de los rotadores externos pueden contribuir a reducir la incidencia de luxación en los pacientes operados de una artroplastia total de cadera mediante una vía posterior

Objective: To determine the incidence of dislocation after primary total hip arthroplasty using a posterior approach with repair of capsule and transosseous external rotators. Material and method: Historical cohort study between January 2009 and December 2015 of all the cases of dislocation of primary total hip arthroplasty operated using a posterior approach with repair of capsule and transosseous external rotators. Demographic and clinical data concerning the patient, surgery and dislocation were collected and analyzed. A descriptive analysis and a study of survival and risk function were performed by Kaplan Meier's method considering the appearance of a hip dislocation as the final event. Results: The incidence of dislocation in our study was 1.2% (23 patients). In our study, the highest probability of dislocation occurred in the first 120 days. Forty-three point 5percent of the dislocated patients needed revision surgery. Conclusions: Capsular repair and transosseous reattachment of the external rotators can help to reduce the incidence of dislocation in patients undergoing primary total hip arthroplasty through a posterior approach

Early dislocation in primary total hip arthroplasty using a posterior approach with repair of capsule and external rotators. / Luxación temprana en artroplastias total de cadera primarias realizadas mediante vía posterior con reparación capsular y de rotadores externos.

OBJECTIVE: To determine the incidence of dislocation after primary total hip arthroplasty using a posterior approach with repair of capsule and transosseous external rotators. MATERIAL AND METHOD: Historical cohort study between January 2009 and December 2015 of all the cases of dislocation of primary total hip arthroplasty operated using a posterior approach with repair of capsule and transosseous external rotators. Demographic and clinical data concerning the patient, surgery and dislocation were collected and analyzed. A descriptive analysis and a study of survival and risk function were performed by Kaplan Meier's method considering the appearance of a hip dislocation as the final event. RESULTS: The incidence of dislocation in our study was 1.2% (23 patients). In our study, the highest probability of dislocation occurred in the first 120 days. Forty-three point 5percent of the dislocated patients needed revision surgery. CONCLUSIONS: Capsular repair and transosseous reattachment of the external rotators can help to reduce the incidence of dislocation in patients undergoing primary total hip arthroplasty through a posterior approach.

Normal ventricular-CSF may comfound the diagnosis of tuberculous meningitis hydrocephalus.

BACKGROUND: The standard procedure for the diagnosis of central nervous system (CNS) infections consists of cerebrospinal fluid (CSF) sampling, which is usually accomplished by a lumbar puncture. However, in some patients presenting with acute hydrocephalus submitted to immediate CSF drainage, the fluid is customarily obtained from the placed draining system. In addition, the CSF obtained from the ventricular and lumbar spaces in some cases may show unusual differences, both in physiological and pathological conditions. ILLUSTRATIVE CASES: We report two children who presented with confounding results in the initial studies of their ventricular and lumbar CSF who were subsequently diagnosed with tuberculous meningitis, causing delay in diagnosis and treatment. AIM. By reporting these cases, we wanted to alert the treating physician about the possibility of this discrepancy to avoid the delayed diagnosis and management of the affected patients. DISCUSSION: We comment on the possible pathophysiological mechanisms that may result in this dissociation in ventricular and lumbar CSF composition. CONCLUSIONS; Normal results in CSF studies, especially those of the ventricular fluid, do not always rule out the presence of tuberculous meningitis. We suggest obtaining a CSF sample from the lumbar subarachnoid space in doubtful, or suspicious, cases of CNS infection even in the presence of a normal ventricular CSF.

Normal ventricular-CSF may confound the diagnosis of tuberculous meningitishydrocephalus / LCR ventricular normal: un factor de confusión en el diagnóstico de hidrocefalia por meningitis tuberculosa

Background. The standard procedure for the diagnosisof central nervous system (CNS) infections consistsof cerebrospinal fluid (CSF) sampling, which isusually accomplished by a lumbar puncture. However,in some patients presenting with acute hydrocephalussubmitted to immediate CSF drainage, the fluid is customarilyobtained from the placed draining system.In addition, the CSF obtained from the ventricularand lumbar spaces in some cases may show unusualdifferences, both in physiological and pathologicalconditions.Illustrative cases. We report two children who presentedwith confounding results in the initial studiesof their ventricular and lumbar CSF who were subsequentlydiagnosed with tuberculous meningitis, causingdelay in diagnosis and treatment.Aim. By reporting these cases, we wanted to alert thetreating physician about the possibility of this discrepancyto avoid the delayed diagnosis and management (..) (AU)

Antecedentes. El procedimiento habitual para eldiagnóstico de infección del sistema nervioso central(CNS) consiste en el estudio del liquido cefalorraquídeo(LCR) mediante la realización de una punción lumbar.Sin embargo, en pacientes que debutan con un cuadrode hidrocefalia aguda que son tratados de urgenciamediante la inserción de un sistema de drenaje deLCR, el líquido es rutinariamente obtenido desde elsistema derivativo implantado. Pero, en ciertos casos,el LCR ventricular y lumbar analizados pueden mostrardiferencias significativas, tanto en condicionesfisiológicas como patológicas.Casos ilustrativos. Se describen los casos de dosniños que presentaron resultados dispares en losestudios iniciales del LCR ventricular y lumbar, enlos que se demostró posteriormente que padecíanuna hidrocefalia por meningitis tuberculosa, lo que (..) (AU)

Anestesia en consultorio / No disponible

La anestesia en consultorio o office based anesthesia (OBA), es una actividad anestésica que ha tenido un aumento muy importante la última década. Requiere un planteamiento diferente del que se ejerce en los hospitales. Se deben de realizar consideraciones especiales respecto al lugar donde se realiza la práctica, la selección del paciente y la selección de los procedimientos quirúrgicos y anestésicos. La seguridad es el objetivo principal de esta actividad. En este trabajo se presentan las características generales de lo que concierne a la actividad de anestesia en el consultorio (AU)

Office based anesthesia (OBA) has increased substantially over the past decade. It requires a different approach than the traditional hospital one. Special considerations have to be stablished in respect to patient selection, type of surgery and monitoring. Patient safetyis our main priority. In this paper we present the main characteristics of this anesthetic approach (AU)

Late prevertebral abscess following anterior cervical plating: the missing screw.

A 51-year-old man underwent a C5-C7 anterior decompression and fusion. Six years later the patient complained of dysphagia caused by displacement of the cervical plate. One week after the scheduled removal of the implanted material, the patient developed a painful cervical swelling and fever. His cervical radiographs showed that a screw was missing compared to previous studies. Computerized tomography showed a large prevertebral abscess anterior to C4-C7. He underwent emergency surgical drainage of the abscess that was followed by total recovery. This report is aimed at describing this unusual complication of cervical instrumentation and to briefly review its pathogenesis and management options.

Late prevertebral abscess following anterior cervical plating: the missing screw

Un hombre de 53 años que había sido operado de descompresión cervical anterior C5-C7 con fijación mediante placa y tornillos, se presentó 6 años después con disfagia atribuida a compresión del esófago por desplazamiento anterior de la placa, lo que motivó la retirada programada de todo el implante. Una semana más tarde, el paciente acudió a nuestro hospital con fiebre y tumoración dolorosa en la parte anterior del cuello. Las radiografías mostraron la ausencia de uno de los tornillos y la tomografía computerizada evidenció un absceso prevertebral cervical C4-C7. El absceso fue drenado de urgencia, y el paciente se recuperó totalmente. Los autores describen esta complicación infrecuente de la instrumentación cervical y revisan supatogenia y las opciones de tratamiento

A 51-year-old man under went a C5-C7 anterior decompression and fusion. Six years later the patient complained of dysphagia caused by displacement of the cervical plate. One week after the scheduled removal of the implanted material, the patient developed a painful cervical swelling and fever. His cervical radiographs showed that a screw was missing compared to previous studies. Computerized tomography showed a large prevertebral abscess anterior to C4-C7. Heunderwent emergency surgical drainage of the abscess that was followed by total recovery. This report is aimed at describing this unusual complication of cervical instrumentation and to briefly review its pathogenesis and management options

Luxación recidivante de prótesis total de cadera / Recurrent dislocation in total hip replacement

Más del 50% de los casos de caderas inestables se pueden resolver mediante la reducción cerrada de la luxación. Un intento sistemático para entender la causa de la inestabilidad, normalmente suele conducir a un tratamiento eficaz del problema cuando hace falta cirugía. Los componentes constreñidos o de retención han mejorado las posibilidades de resolver los problemas difíciles de inestabilidad, pero los efectos negativos potenciales de estos componentes deben tenerse también en cuenta. Los implantes tripolares, cuyos resultados clínicos en la literatura son muy alentadores, ocupan un lugar de elección en el arsenal terapéutico de la inestabilidad protética

Over 50% of unstable hip cases can be solved by carrying out a closed reduction of the dislocation. A systematic attempt to understand the cause of the instability, normally results in an efficient treatment of the condition in cases where surgery is required. Constrained ­ also known as retentive ­ components have enhanced the possibilities of addressing difficult instability problems, although the potential negative effects of these implants also need to be considered. Tripolar implants, whose clinical results are very encouraging according to the literature, should occupy a prominent place among the therapeutic options available for prosthetic instability

Pigmented villonodular synovitis of the knee in a patient with Paget's disease of the adjacent femoral bone.

A 49-year-old male patient, diagnosed as having Paget's disease involving the lumbar vertebrae and both femora, felt persistent pain and swelling in the left knee after trauma. A synovectomy was performed. Clinical and histological findings led to the diagnosis of pigmented villonodular synovitis of the knee joint. Only one previous case of this association has been reported. A common aetiology for both diseases is discussed, and traumatic factors should be considered in the aetiology of the association.