Efectividad del uso de seating de posicionamiento en niños con parálisis cerebral discinética: revisión sistemática / Effectiveness of the use of seating devices in children with dyskinetic cerebral palsy: a systematic reviewx

Introduction: To assess the effectiveness of seating devices during the sitting position on postural stability and upper limb functionality in users with dyskinetic type cerebral palsy. Method: A systematic review that included randomized, quasi-randomized, cohort, and pre-post intervention clinical trials with evaluation before and after the intervention. This review included studies of chil-dren with a diagnosis of cerebral palsy, mainly of the dyskinetic type, with ages between 2 and 10 years old. The databases of CINAHL Plus, Cochrane (Central), EMBASE (Via Ovid), Virtual Health Library, OT Seeker, Medline (Via PubMed) and OpenGrey were used. Results: Two studies met the inclusion criteria; however, the analysis was carried out qualitatively due to the methodological quality for these, with presence of a high risk of bias. The study by Cimolin described greater trunk stability and smooth upper extremity movements with the use of a dynamically configured seat. Nwaobi described better upper extre-mity functionality in a seat inclined at 0º and 30º, not referring to trunk stability. Conclusion: From the review of the results it is concluded that there is not enough scientific evidence to determine that the use of seating devices favors the postural control and the functionality of upper extremities in children with cerebral dyskinesia type cerebral palsy.

Introducción: Evaluar la eficacia del posicionamiento sedente en la estabilidad postural y funcionalidad de extremidades superiores, en ni-ños con parálisis cerebral discinética, comparando el uso y el no uso de seating de posicionamiento. Método: Revisión siste-mática incluyendo ensayos clínicos de tipo aleatorio, cuasialeatorizado, de cohorte y casos con evaluación antes y después de la intervención. Se incluyó niños con parálisis cerebral discinético, entre 2 y 10 años de edad. Se utilizó bases de datos de CI-NAHL Plus, Cochrane (Central), EMBASE (Vía Ovid), Biblioteca Virtual de la Salud, OT Seeker, Medline (Via PubMed) y Open Grey. Resultados: Dos estudios cumplieron criterios de inclusión, aunque el análisis se realizó de forma cualitativa por la calidad metodológica de estos. Cimolin detectó mayor estabilidad de tronco y suavidad en los movimientos de extremidades superiores con el uso de un asiento de configuración dinámica. Nwaobi describió mejor funcionalidad de extremidad superior en un asiento inclinado a 0º y 30º, no haciendo referencia a la estabilidad de tronco. Conclusión: De la revisión de los resulta-dos, se concluye que no existe evidencia científica suficiente que determine que el uso de seating favorezca o no el control postural y la funcionalidad de extremidades superiores en niños y jóvenes con parálisis cerebral de tipo discinética.

Posttransplant oxygen inhalation improves the outcome of subcutaneous islet transplantation: A promising clinical alternative to the conventional intrahepatic site.

Subcutaneous tissue is a promising site for islet transplantation, due to its large area and accessibility, which allows minimally invasive procedures for transplantation, graft monitoring, and removal of malignancies as needed. However, relative to the conventional intrahepatic transplantation site, the subcutaneous site requires a large number of islets to achieve engraftment success and diabetes reversal, due to hypoxia and low vascularity. We report that the efficiency of subcutaneous islet transplantation in a Lewis rat model is significantly improved by treating recipients with inhaled 50% oxygen, in conjunction with prevascularization of the graft bed by agarose-basic fibroblast growth factor. Administration of 50% oxygen increased oxygen tension in the subcutaneous site to 140 mm Hg, compared to 45 mm Hg under ambient air. In vitro, islets cultured under 140 mm Hg oxygen showed reduced central necrosis and increased insulin release, compared to those maintained in 45 mm Hg oxygen. Six hundred syngeneic islets subcutaneously transplanted into the prevascularized graft bed reversed diabetes when combined with postoperative 50% oxygen inhalation for 3 days, a number comparable to that required for intrahepatic transplantation; in the absence of oxygen treatment, diabetes was not reversed. Thus, we show oxygen inhalation to be a simple and promising approach to successfully establishing subcutaneous islet transplantation.

SFPQ associates to LSD1 and regulates the migration of newborn pyramidal neurons in the developing cerebral cortex.

The development of the cerebral cortex requires the coordination of multiple processes ranging from the proliferation of progenitors to the migration and establishment of connectivity of the newborn neurons. Epigenetic regulation carried out by the COREST/LSD1 complex has been identified as a mechanism that regulates the development of pyramidal neurons of the cerebral cortex. We now identify the association of the multifunctional RNA-binding protein SFPQ to LSD1 during the development of the cerebral cortex. In vivo reduction of SFPQ dosage by in utero electroporation of a shRNA results in impaired radial migration of newborn pyramidal neurons, in a similar way to that observed when COREST or LSD1 expressions are decreased. Diminished SFPQ expression also associates to decreased proliferation of progenitor cells, while it does not affect the acquisition of neuronal fate. These results are compatible with the idea that SFPQ, plays an important role regulating proliferation and migration during the development of the cerebral cortex.

[Anterior knee pain in knee arthroplasty with or without a patellar component]. / Dolor anterior de rodilla en pacientes operados de artroplastía de rodilla con o sin remplazo del componente patelar.

INTRODUCTION: The appearance of patellofemoral pain after a knee arthroplasty, particularly in rheumatic diseases, resulted in the incorporation of the substitution of the patellar component in all designs. The replacement of the patella became a standard part of knee arthroplasty, but the controversy over whether to restore it or not continues among orthopedists that perform knee arthroplasties. OBJECTIVE: To analyze the incidence of anterior knee pain in patients who underwent primary knee arthroplasty with or without replacement of the patellar component. MATERIAL AND METHODS: Observational, retrospective, descriptive and transversal study from January 2011 to December 2013. RESULTS: A total of 54 patients were included, 12 men (with an average age of 63 years) and 42 women (with an average age of 71 years), totaling 64 knees that were surgically intervened. CONCLUSION: This study found no significant difference in anterior knee pain and in the function of the patellofemoral joint and the knee in the groups of patients who were tested with the different scales.

La aparición de dolor patelofemoral postoperatorio en la artroplastía de rodilla, sobre todo en pacientes reumáticos, resultó en la incorporación de la sustitución del componente patelar en la mayoría de los diseños. Esta se convirtió en una parte estándar de la artroplastía total de rodilla; la controversia sobre si restituir o no el componente patelar continúa siendo debatida por los cirujanos ortopedistas que realizan artroplastías de rodilla.

Dolor anterior de rodilla en pacientes operados de artroplastía de rodilla con o sin remplazo del componente patelar / Anterior knee pain in knee arthroplasty with or without a patellar component

Resumen: Introducción: La aparición de dolor patelofemoral postoperatorio en la artroplastía de rodilla, sobre todo en pacientes reumáticos, resultó en la incorporación de la sustitución del componente patelar en la mayoría de los diseños. Esta se convirtió en una parte estándar de la artroplastía total de rodilla; la controversia sobre si restituir o no el componente patelar continúa siendo debatida por los cirujanos ortopedistas que realizan artroplastías de rodilla. Objetivo: Realizar un análisis de la incidencia de dolor anterior de rodilla en pacientes sometidos a artroplastía primaria de rodilla con o sin remplazo del componente patelar. Material y métodos: Estudio observacional, retrospectivo, descriptivo y transversal de Enero de 2011 a Diciembre de 2013. Resultados: 54 individuos, 12 hombres (con un promedio de edad de 63 años) y 42 mujeres (con un promedio de edad de 71 años), que dieron un total de 64 rodillas intervenidas quirúrgicamente. Conclusión: No se encontró diferencia significativa en cuanto al dolor anterior de rodilla, en la función de la articulación patelofemoral y de la rodilla en los grupos de sujetos que fueron analizados con las diferentes escalas.

Abstract: Introduction: The appearance of patellofemoral pain after a knee arthroplasty, particularly in rheumatic diseases, resulted in the incorporation of the substitution of the patellar component in all designs. The replacement of the patella became a standard part of knee arthroplasty, but the controversy over whether to restore it or not continues among orthopedists that perform knee arthroplasties. Objective: To analyze the incidence of anterior knee pain in patients who underwent primary knee arthroplasty with or without replacement of the patellar component. Material and methods: Observational, retrospective, descriptive and transversal study from January 2011 to December 2013. Results: A total of 54 patients were included, 12 men (with an average age of 63 years) and 42 women (with an average age of 71 years), totaling 64 knees that were surgically intervened. Conclusion: This study found no significant difference in anterior knee pain and in the function of the patellofemoral joint and the knee in the groups of patients who were tested with the different scales.

Spanish adaptation of the Quality of Life Index-Spinal Cord Injury version.

STUDY DESIGN: A cross-sectional, validation study. OBJECTIVES: To (a) develop the Spanish version of the Quality of Life Index-Spinal Cord Injury version (SV-QLI/SCI) and (b) assess its psychometric characteristics among permanent wheelchair users and specifically among those with SCI. SETTING: Associations of wheelchair users in Mallorca (Spain). METHODS: Two forward and backward translations of the QLI/SCI into Spanish were carried out separately. Seventy-seven subjects were randomly selected among the members of the associations. They completed the SV-QLI/SCI and validated instruments to measure depression and spinal pain upon recruitment and 14 days later. Assessments included comprehensibility, reproducibility, floor and ceiling effects and correlations between quality of life, pain and depression (Spearman's correlation coefficient). Analyses were repeated excluding data from subjects without SCI. RESULTS: Three items of the SV-QLI/SCI required rephrasing. Reproducibility was 'almost perfect' for the entire questionnaire and its 'Health and functioning' subscale, 'substantial' for the 'Social and economic' and 'Family' subscales and 'moderate' for the 'Psychological/spiritual' subscale. Floor effect was not observed, and only for the 'Family' subscale >3% of the subjects reached the maximum possible score. The correlation between quality of life and depression was the strongest (r=-0.628). Results were virtually identical in the subsample with SCI. CONCLUSION: These results support the use of the SV-QLI/SCI among Spanish-speaking wheelchair users.

[Intravenous infusion of adult adipose tissue stem cells for repairing spinal cord ischaemic lesions. An experimental study on animals]. / Infusión intravenosa de células madre adultas procedentes del tejido adiposo para la reparación de lesiones medulares isquémicas. Estudio experimental en conejos.

OBJECTIVE: To assess if a peripheral intravenous infusion of adipose tissue stem cells (ATSC), after an ischemic spinal cord injury can promote selective cell migration and cell survival in the damaged neural tissue. ANIMALS AND METHOD: An ischaemic spinal cord injury was provoked by trapping the abdominal aorta for 20 minutes in 11 male New Zealand rabbits (2.5±0.5kg). They were randomised into two groups: one group (n=5) received an intravenous transfusion of 10±2×10(6) ATSC at 24 hours from the injury, and the control group (n=6) were only given the vehicle. The functional status was assessed, using the Tarlov scale at 24h, and 7 and 14 days. The animals were sacrificed at 14 days and a histological and immunohistochemical study was performed. RESULTS: Complete paraplegia was achieved in both groups. There were no significant differences as regards neurological recovery, which was nil in both cases. In the histological and immunohistochemical study, it was tested to see if there was any bromodeoxyuridine-marked ATSC in the area of the lesion, but there was only a small amount. CONCLUSION: ATSC are able to migrate and survive in the injured spinal cord after aortic ischaemia after they have been administered intravenously. Intravenous infusion is a harmless procedure with no side effect. No neurological recovery was achieved.

Infusión intravenosa de células madre adultas procedentes del tejido adiposo para la reparación de lesiones medulares isquémicas. Estudio experimental en conejos / Intravenous infusion of adult adipose tissue stem cells for repairing spinal cord ischaemic lesions. An experimental study on animals

Objetivo. Valorar si la infusión intravenosa periférica de células madre procedentes del tejido adiposo (CMDG) después de una lesión medular isquémica, promueve la migración celular selectiva y la supervivencia celular en el tejido neural dañado. Animales y método. Se utilizaron 11 conejos macho de la raza Nueva Zelanda (2,5±0,5kg) a los que se les provocó una lesión medular isquémica mediante pinzamiento de la aorta abdominal durante 20min. Se aleatorizaron en 2 grupos: un grupo (n=5) recibió una infusión intravenosa de 10±2×106 CMDG a las 24h de la lesión y el grupo control (n=6) solo el vehículo. Se valoró el estado funcional a las 24h, 7 y 14 días mediante la escala de Tarlov. A los 14 días los animales fueron sacrificados y se realizó el estudio histológico e inmunohistoquímico. Resultados. En todos los casos de ambos grupos se obtuvo una paraplejía completa. No hubo diferencias significativas en cuanto a la recuperación neurológica que fue nula en ambos grupos. En el estudio histológico e inmunohistoquímico se comprobó la presencia de CMDG marcadas con bromodeoxiuridina en la zona de la lesión, aunque en poca cantidad. Conclusión. Las CMDG tienen capacidad de migrar y sobrevivir en la médula espinal lesionada tras isquemia aórtica una vez que se han administrado de forma intravenosa. La infusión intravenosa es un procedimiento inocuo y sin efectos secundarios. No hemos obtenido recuperación neurológica (AU)

Objective. To assess if a peripheral intravenous infusion of adipose tissue stem cells (ATSC), after an ischemic spinal cord injury can promote selective cell migration and cell survival in the damaged neural tissue. Animals and method. An ischaemic spinal cord injury was provoked by trapping the abdominal aorta for 20minutes in 11 male New Zealand rabbits (2.5±0.5kg). They were randomised into two groups: one group (n=5) received an intravenous transfusion of 10±2×106 ATSC at 24hours from the injury, and the control group (n=6) were only given the vehicle. The functional status was assessed, using the Tarlov scale at 24h, and 7 and 14 days. The animals were sacrificed at 14 days and a histological and immunohistochemical study was performed. Results. Complete paraplegia was achieved in both groups. There were no significant differences as regards neurological recovery, which was nil in both cases. In the histological and immunohistochemical study, it was tested to see if there was any bromodeoxyuridine-marked ATSC in the area of the lesion, but there was only a small amount. Conclusion. ATSC are able to migrate and survive in the injured spinal cord after aortic ischaemia after they have been administered intravenously. Intravenous infusion is a harmless procedure with no side effect. No neurological recovery was achieved (AU)

The extremophile Acidithiobacillus ferrooxidans possesses a c-di-GMP signalling pathway that could play a significant role during bioleaching of minerals.

AIMS: The primary goal of this study was to characterize the existence of a functional c-di-GMP pathway in the bioleaching bacterium Acidithiobacillus ferrooxidans. METHODS AND RESULTS: A bioinformatic search revealed that the genome sequence of At. ferrooxidans ATCC 23270 codes for several proteins involved in the c-di-GMP pathway, including diguanylate cyclases (DGC), phosphodiesterases and PilZ effector proteins. Overexpression in Escherichia coli demonstrated that four At. ferrooxidans genes code for proteins containing GGDEF/EAL domains with functional DGC activity. MS/MS analysis allowed the identification of c-di-GMP in nucleotide preparations obtained from At. ferrooxidans cells. In addition, c-di-GMP levels in cells grown on the surface of solid energetic substrates such as sulfur prills or pyrite were higher than those measured in ferrous iron planktonic cells. CONCLUSIONS: At. ferrooxidans possesses a functional c-di-GMP pathway that could play a key role in At. ferrooxidans biofilm formation during bioleaching processes. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first global study about the c-di-GMP pathway in an acidophilic bacterium of great interest for the biomining industry. It opens a new way to explore the regulation of biofilm formation by biomining micro-organisms during the bioleaching process.

Valoración clínico-radiológica del vástago CLS Spotorno a largo plazo / Long-term clinical-radiological evaluation of the CLS Spotorno stem

Objetivo: Analizar los resultados a largo plazo del vástago no cementado de anclaje metafisario tipo CLS Spotorno (Sulzer/Zimmer). Material y métodos: Se han revisado 166 pacientes a los que se colocó, de forma primaria y consecutiva 189 vástagos CLS (CementLess Spotorno) (Sulzer/Zimmer). El seguimiento mínimo ha sido de 13 a˜nos. Los parámetros clínicos se han valorado según la escala de Harris modificada, y los radiológicos según las zonas de Gruen. También se ha analizado la medición del hundimiento del vástago. Resultados: El seguimiento medio ha sido de 180 meses (156-228) 12 pacientes (12 vástagos) habían fallecido y no se ha completado el seguimiento por diferentes motivos en 24 pacientes (29 vástagos). Así, el trabajo se ha realizado sobre 130 pacientes (148 vástagos) que tienen el seguimiento mínimo. La tasa de supervivencia global del vástago ha sido del 95% al final del seguimiento (intervalo de confianza 89-98). Las mediciones de la escala de Harris han pasado de 48 (9-76) puntos antes de la cirugía a 90 (63-100) puntos al final del seguimiento. Conclusiones: El vástago femoral CLS obtiene unos excelentes resultados tanto clínicos como de supervivencia a largo plazo (AU)

Objective: To analyse the long-term results of the cementless, metaphyseal anchorage type, CLS Spotorno stem (Sulzer/Zimmer). Material y methods: A review has been made of 166 patients in whom were implanted, primarily and consecutively, 189 CLS (CementLess Spotorno) (Sulzer/Zimmer) stems. The mean follow up was 13 years. The clinical parameters were assessed using a modified Harris scale, and the radiological ones according to the Gruen zones. The stem sinking measurements were also analysed. Results: The mean follow up was 180 (156-228) months. Twelve patients (12 stems) died and 24 patients (29 stems) did not complete the follow up for different reasons. Thus the study was carried out on 130 patients (148 stems) who had the minimum follow up. The overall survival rate of the stem was 95% (confidence interval 89-98%) at the end of follow up. The Harris scale scores increased from 48 (9-76) points before surgery to 90 (63-100) points at the end of follow up (AU)

Tratamiento de las fracturas periprotésicas de rodilla de fémur distal mediante clavo intramedular retrógrado / Treatment of periprosthetic knee fractures in the distal femur by means of retrograde intramedullary nailing

Objetivos. Valorar nuestros resultados radiológicos y funcionales tras la estabilización de fracturas periprotésicas de rodilla en fémur distal mediante clavo intramedular acerrojado retrógrado. Material y método. Estudio retrospectivo de 12 pacientes afectados de fractura supracondílea periprotésica de fémur distal. El seguimiento medio fue de 14 meses (6-24 meses). Resultados. Entre las posibles causas de la fractura periprotésica encontramos la existencia de una osteotomía femoral anterior excesiva en cinco de los doce pacientes de nuestro estudio. Se consiguió la consolidación clínica y radiológica en todos los pacientes, tras un período medio de 15 semanas. Como complicaciones cabe señalar la consolidación en mala posición en 3 de los 12 pacientes por falta de reducción durante la cirugía; ninguna precisó tratamiento secundario. Conclusiones. La existencia de una osteotomía anterior excesiva que debilita la cortical femoral podría ser una de las causas de fractura periprotésica, por lo que debe ser evitada. El enclavado intramedular retrógrado para el tratamiento de fracturas periprotésicas de fémur distal es una técnica que proporciona buenos resultados con un índice bajo de complicaciones

Purpose. To assess the radiological and functional results obtained after stabilization of periprosthetic knee fractures in the distal femur by means of a retrograde locked intramedullary nail. Materials and methods. Retrospective study of 12 patients that sustained a periprosthetic supracondylar distal femoral fracture. Mean follow-up was 14 months (range: 6-24 months). Results. Clinical and radiological healing was achieved in all patients over a mean period of 15 weeks. As regards complications, the presence of a malunion in 3 out of the 12 patients was probable related the fact that the fracture was not reduced intraoperatively; however, these did not require secondary treatment. Among the possible causes for the periprosthetic fracture, we could mention the existence of an excessive previous femoral osteotomy in five of the 12 patients in our study. Conclusions. Retrograde intramedullary nailing for the treatment of periprosthetic distal femoral fractures is a technique that has afforded us good results with a low complications rate. The presence of an overly aggressive previous osteotomy that weakened the femoral cortex could be construed to be a likely cause for the periprosthetic fracture; therefore these should be avoided (AU)

Problemas ortopédicos en la picnodisostosis / Pycnodysostosis. Orthopedic aspects

Se presentan dos casos de picnodisostosis y se exponen los hallazgos clínicos, fisiopatológicos, genéticos y radiológicos. Esta enfermedad es una displasia cráneo-metafisaria caracterizada por aumento de la densidad ósea, cuya fisiopatología molecular se ha atribuido a una deficiencia enzimática

Two cases of pycnodysostosis are presented. Clinical, physiopatological, radiographic and genetic findings are described. Pycnodysostosis is a sclerosing bone dysplasia characterized by generalized increased bone density, due to an enzimatic deficit

Herniación discal múltiple tras manipulación quiropráctica cervical / Multiple disc herniation after chiropractic manipulation

Se presenta un caso de herniación cervical múltiple en un paciente previamente sano tras una manipulación cervical quiropráctica. Se realiza una revisión de la literatura sobre las complicaciones surgidas tras manipulaciones vertebrales. Se pretende llamar la atención sobre los peligros de estas técnicas de manipulación raquídea, ampliamente extendidas, en muchas ocasiones realizadas por personal sin titulación sanitaria con un insuficiente estudio médico previo sobre la causa del dolor del paciente

We present a case of multiple cervical spine disc herniation in a previously healthy patient following chiropractic manipulation. The aim of this paper is to review the medical literature about the complications following spinal manipulation to emphasize the potential risks of this widely extended therapeutic procedure, performed in many cases by non-qualified personnel without medical training

Idiopathic osteonecrosis of the medial tibial plateau.

Osteonecrosis of the medial tibial plateau is characterized by acute pain on the medial aspect of the knee. Progression can lead to articular collapse and requires early diagnosis and treatment. We studied seven patients affected of idiopathic osteonecrosis of the tibial plateau. The mean age was 62 years and the mean follow-up 42 months. We performed roentgenograms in all patients, bone scans in three patients and magnetic resonance image (MRI) in five. MRI shows T1-weighted low-intensity signal and T2-weighted high-intensity signal with a surrounding area of intermediate low-intensity signal. An increased focal uptake was seen at bone scan. Histological findings showed necrotic bone with empty lacunae. Surgical treatment consisted of tibial subchondral drilling in four patients-two of them by failure of conservative treatment, and a total knee arthroplasty in other two. One patient had a satisfactory evolution with conservative treatment. Idiopathic osteonecrosis of the tibial plateau must be considered in elderly patients with knee pain over the medial tibial plateau. At early stages, decompression with tibial drilling must be considered. This procedure allows a prompt and effective relief of symptoms.

[Multiple disc herniation after chiropractic manipulation]. / Herniación discal múltiple tras manipulación quiropráctica cervical.

We present a case of multiple cervical spine disc herniation in a previously healthy patient following chiropractic manipulation. The aim of this paper is to review the medical literature about the complications following spinal manipulation to emphasize the potential risks of this widely extended therapeutic procedure, performed in many cases by non-qualified personnel without medical training.

Técnica de Krogius-Lecène en el tratamiento de la luxación habitual de rótula. Resultados a largo plazo / Krogius-Lecène technique in the treatment of recurrent patellar dislocation. Long-term results

Objetivo. La luxación habitual de rótula se trata de una patología en la que se produce una luxación de la misma cada vez que el paciente realiza una flexión de la rodilla, volviendo a su posición correcta en el surco intercondíleo con la rodilla en extensión. El tratamiento debe ir encaminado al recentraje rotuliano, y es importante realizarlo de forma precoz, para evitar daños irreparables producidos por las constantes luxaciones y choques de los cóndilos con el cartílago rotuliano. Cuando esta patología se produce en pacientes en los que el cartílago de crecimiento se encuentra todavía activo, la cirugía ósea no se puede llevar a cabo. El objeto del trabajo es valorar en este grupo de pacientes la cirugía de realineamiento rotuliano actuando exclusivamente sobre partes blandas. Material y método. Estudiamos la evolución de las rodillas de 11 pacientes (14 rodillas) afectos de luxación habitual de rótula antes de la madurez esquelética en los que se realizó realineamiento rotuliano mediante la técnica Krogius-Lecène. Resultados. El seguimiento medio de estos pacientes fue de 21,9 años, período tras el cual los resultados clínicos obtenidos fueron excelentes en 10 rodillas, buenos en tres y regulares en una. En ningún caso la rodilla volvió a sufrir episodios de luxación. Conclusión. La técnica de Krogius-Lecène para el tratamiento de la luxación habitual de rótula es un método que consigue buenos resultados a largo plazo en pacientes con el cartílago de crecimiento activo (AU)

Frozen cancellous bone allografts: positive cultures of implanted grafts in posterior fusions of the spine.

We have carried out a study on the behaviour pattern of implanted allografts initially stored in perfect conditions (aseptically processed, culture-negative and stored at -80 degrees C) but which presented positive cultures at the implantation stage. There is no information available on how to deal with this type of situation, so our aim was to set guidelines on the course of action which would be required in such a case. This was a retrospective study of 112 patients who underwent a spinal arthrodesis and in whom a total of 189 allograft pieces were used. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV (via PCR techniques) were negative. The allografts were stored by freezing them at -80 degrees C. A sample of the allograft was taken for culture in the operating theatre just before its implantation in all cases. The results of the cultures were obtained 3-5 days after the operation. There were 22 allografts with positive culture results (12%) after implantation. These allografts were implanted in 16 patients (14%). Cultures were positive for staphylococci coagulase negative (ECN) in 10 grafts (46%), Pseudomonas stutzeri in two grafts (9%), Corynebacterium jeikeium in two grafts (9%), staphylococci coagulase positive in two grafts (9%) and for each of the following organisms in one case each (4%): Corynebacterium spp., Actinomyces odontolyticus, Streptococcus mitis, Peptostreptococcus spp., Rhodococcus equi and Bacillus spp. No clinical infection was seen in any of these patients. Positive cultures could be caused by non-detected contamination at harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment different from our antibiotic protocol is required in the case of positive culture results of a graft piece after implantation.

Prevención de la luxación de cadera en niños con parálisis cerebral mediante tenotomía de adductores y psoas / Prevention of hip dislocation in children with cerebral palsy by psoas and adductors tenotomies

Se realizó un estudio retrospectivo de 18 caderas en 9 pacientes afectos de parálisis cerebral infantil espástica (7 dipléjicos y 2 tetrapléjicos) con una edad media en el momento de la cirugía de 5,8 años y durante un período de seguimiento de 3,1 años. En el preoperatorio, la media del porcentaje de extrusión fue del 23,9 por ciento. Tres caderas tuvieron una extrusión menor del 10 por ciento, 11 tuvieron del 10 por ciento al 30 por ciento y 4 más del 30 por ciento. La línea de Shenton estaba interrumpida en 11 caderas con una separación media de 10,3 mm. La media del ángulo acetabular fue de 22,7º. Las medias del flexo y de la abducción de cadera fueron 19º y 36º respectivamente. En la evaluación postoperatoria se obtuvo una media del porcentaje de extrusión del 19,1 por ciento. Tres caderas persistieron con una línea de Shenton interrumpida. La media del ángulo acetabular fue de 22,3º. La media del flexo fue de 8,1º y la abducción de 65,2º. Se realizó una osteotomía femoral y pélvica en una cadera que evolucionaba hacia la luxación. Obtuvimos un 94 por ciento de buenos resultados. Se ha empleado la tenotomía de los adductores y del psoas como procedimiento adecuado de prevención de la luxación de cadera en niños con parálisis cerebral espástica, aunque en nuestra serie el tiempo de seguimiento ha sido corto (AU)

Positive culture in allograft ACL-reconstruction: what to do?

The transmission of disease or infection from the donor to the recipient is always a risk with the use of allografts. We carried out a research study on the behavioural pattern of implanted allografts, which were initially stored in perfect conditions (all cultures being negative) but later presented positive cultures at the implantation stage. Because there is no information available on how to deal with this type of situation, our aim was to set guidelines on the course of action which would be required in such a case. We conducted a retrospective study of 181 patients who underwent an ACL reconstruction using BPTB allografts. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV were negative. An allograft sample was taken for culture in the operating theatre just before its implantation. The results of the cultures were obtained 3-5 days after the operation. We had 24 allografts with positive culture (13.25%) after the implantation with no clinical infection in any of these patients. Positive cultures could be caused by undetected contamination while harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment-other than an antibiotic protocol-would be required when facing a case of positive culture of a graft piece after its implantation.

[Cauda equina syndrome due to giant disc herniation]. / Síndrome de cauda equina por hernia discal gigante.

In cases of acute or progressive development in a few hours of bilateral sciatica, severe foot and occasional quadriceps weakness and/or retention or incontinence of urine with perineal hypalgesia or anesthesia, acute compression of the cauda equina should be suspected, which is usually due to a lumbar disc herniation. Cauda equina syndrome requires emergency spinal surgery. To identify and confirm this syndrome by MR, Ismanoatory. Early surgical decompression must be achieved. Decompression within 24-48 hours significantly improves the neurological and urological outcome. We present the case of a patient who had previously been treated for low back pain who developed a cauda equina syndrome a few days later.