Reconstrucción secundaria de seudoartrosis del cuerpo del astrágalo tras fractura no diagnosticada / Secondary reconstruction of pseudoarthrosis of the astragalus body after undiagnosed fracture

La seudoartrosis es una complicación que se presenta en hasta un 12% de las fracturas del astrágalo. Ante esta situación se plantean 2opciones de tratamiento principales, la artrodesis y la reconstrucción secundaria. En este texto presentamos el caso de un paciente que sufrió dicha complicación tras no diagnosticarse la fractura que presentaba y se optó por la reconstrucción secundaria, con buenos resultados

Pseudoarthrosis is a complication that occurs in up to 12% of astragalus fractures. In this situation, 2main treatment options are considered: arthrodesis and secondary reconstruction. In this text we present the case of a patient who suffered this complication after not being diagnosed with the fracture he suffered and opted for secondary reconstruction with good results. Fracture nonunion affects up to 12% of patients suffering a talar fracture. Classically, most authors proceed to joint arthrodesis when facing such complication. A more recent approach consists on secondary reconstruction of the nonunion. In this paper we present the case of a reconstructed talar nonunion after an unnoticed talar body fracture with encouraging results

Secondary reconstruction of pseudoarthrosis of the astragalus body after undiagnosed fracture. / Reconstrucción secundaria de seudoartrosis del cuerpo del astrágalo tras fractura no diagnosticada.

Pseudoarthrosis is a complication that occurs in up to 12% of astragalus fractures. In this situation, 2main treatment options are considered: arthrodesis and secondary reconstruction. In this text we present the case of a patient who suffered this complication after not being diagnosed with the fracture he suffered and opted for secondary reconstruction with good results. Fracture nonunion affects up to 12% of patients suffering a talar fracture. Classically, most authors proceed to joint arthrodesis when facing such complication. A more recent approach consists on secondary reconstruction of the nonunion. In this paper we present the case of a reconstructed talar nonunion after an unnoticed talar body fracture with encouraging results.

Preparation and characterisation of fried chicken as a laboratory reference material for the analysis of heterocyclic amines.

The preparation of a laboratory reference material (LRM) for the determination of naturally occurring heterocyclic amines (HAs) in processed foods is presented in this work. A LRM was prepared from raw chicken breast meat, which was fried under controlled cooking temperature and time. The cooked meat was ground, lyophilised, sieved, homogenised, bottled, and labelled. The HAs DMIP, PhIP, MeIQx, 4,8-DiMeIQx, Norharman and Harman were analysed in the LRM. Homogeneity and stability studies of the bulk LRM were carried out and no statistical differences were observed in the content of the studied HAs in between-bottle and within-bottle comparisons at different storage temperatures (-18, +4, +25 and +40 degrees C) and times (1, 3, 6 and 9 months) by means of HAs determination and analysis of the results. Consequently, the material can be considered homogeneous and stable and can be used in intercomparison exercises for the determination of HAs as well as for quality control purposes in the routine analysis of HAs in foodstuffs. This is the first LRM for the analysis of HAs where these analytes were naturally formed in the material.

New method for the analysis of heterocyclic amines in meat extracts using pressurised liquid extraction and liquid chromatography-tandem mass spectrometry.

Heterocyclic amines (HAs) were analysed in meat extract samples using a new method based on pressurised liquid extraction (PLE) and liquid chromatography-tandem mass spectrometry. This method combines the use of a pressurised fluid with a triple quadrupole MS/MS system, resulting in benefits from both systems: high extraction efficiency and sensitivity. The effects of solvent type and PLE operational parameters, such as temperature and extraction time, were studied to obtain maximum recovery of the analytes with minimum contamination. HA extraction was best achieved using dichloromethane/acetone (50/50, v/v) at 80 degrees C for 10 min. Recoveries ranged from 45% to 79% with good quality parameters: limit of detection values between 0.02 and 1 ng g(-1), linearity (r(2)>0.997), and run-to-run and day-to-day precisions with relative standard deviations lower than 13% achieved at both low (0.20 microg g(-1)) and medium (1.0 microg g(-1)) concentrations. This method reduces sample manipulation and total extraction time by nearly four-fold compared to conventional solid phase extraction. The optimised method was validated using laboratory reference material based on a meat extract, and was successfully applied to HA analysis in several cooked beef samples.

Liquid chromatography-tandem mass spectrometry analysis of 2-amino-1-methyl-6-(4-hydroxyphenyl)imidazo[4,5-b]pyridine in cooked meats.

Several cooked meats such as beef (fried, coated-fried), pork (fried, coated-fried), and chicken (fried, griddled, coated-fried, roasted) were analyzed for the heterocyclic amine 2-amino-1-methyl-6-(4-hydroxyphenyl)imidazo[4,5- b]pyridine (4'-OH-PhIP) not commonly determined in food and 2-amino-1-methyl-6-phenylimidazo[4,5- b]pyridine (PhIP). The highest content of 4'-OH-PhIP was found in fried and griddled chicken breast, the concentration being 43.7 and 13.4 ng/g, respectively, whereas the corresponding PhIP concentrations were 19.2 and 5.8 ng/g. The estimated concentration of both pyridines in fried pork loin, in fried pork sausages, and in coated-fried chicken was below 2.5 ng/g. In the rest of the samples, 4'-OH-PhIP was not detected. The analyses were performed by solid-phase extraction and LC-MS/MS. The fragmentation of 4'-OH-PhIP in an ion trap mass analyzer was studied in order to provide information for the identification of 4'-OH-PhIP. Additionally, the effect of red wine marinades on the formation of 4'-OH-PhIP in fried chicken was examined, finding a notable reduction (69%) in the amine's occurrence.

Heterocyclic amines in griddled beef steak analysed using a single extract clean-up procedure.

Heterocyclic amines (HAs), which are potent mutagenic and carcinogenic substances, are formed in muscle meats during their cooking under ordinary conditions. In this work, we measured the concentration of 15 HAs in different samples of griddled beef steak, which is one of the most consumed meat items is Spain. Three samples were obtained from different restaurants, and the other sample was cooked under controlled conditions to a well-done degree of doneness. A low-time consuming solid-phase extraction procedure was used to purify the samples, and liquid chromatography-tandem mass spectrometry with an ion trap mass analyzer was used as determination technique. A second well-established purification procedure was used to demonstrate the applicability of the method to the analysis of these kind of samples. 8-MeIQx, 4,8-DiMeIQx, PhIP and the comutagens Harman and Norharman were found in all the samples, at levels ranging from 0.28 to 21.2ngg(-1). AalphaC was found in three samples (0.18-1.41ngg(-1)), whereas Trp-P-1 was detected in two samples (0.35ngg(-1)). MeAalphaC was found in three samples but could only be quantified in one (0.15ngg(-1)). Trp-P-2 and DMIP were also detected in some cases at levels below their limit of quantification. The remaining HAs analyzed were not detected in any of the samples.

Preparation of a beef-extract as a laboratory reference material for the determination of heterocyclic amines.

The present paper describes the preparation of a suitable laboratory reference material (LRM) to validate analytical methods for the determination of heterocyclic amines (HAs) in foods. Three different lots of reference material were prepared using a beef extract which was contaminated with a well-known quantity of amines at different levels ranging from 10 to 75 ng/g. These materials were then lyophilised under determined conditions and, after grinding and sieving, homogenised and, finally, bottled and labelled. Homogeneity and stability studies were performed and no statistical differences were observed in the analysis of variances for within- and between-bottle results, thus demonstrating the homogeneity of the material. Stability at different storage temperatures (-18, +4, +25 and +40 degrees C) and times (1, 2, 3 and 6 months) was also tested. Therefore, the material can be considered homogeneous and stable and can be proposed for use in inter-comparison exercises for the determination of HAs.

Occurrence of heterocyclic amines in several home-cooked meat dishes of the Spanish diet.

Heterocyclic amines (HAs) were determined in several of the most frequently eaten meat dishes in Spain such as fried beef hamburger, fried pork loin, fried chicken breast, fried pork sausages, griddled chicken breast, griddled lamb steak and griddled beef steak. All of the products tested were household cooked. The HAs were analysed in the selected meat dishes using an analytical method based on solid-phase extraction followed by liquid chromatography coupled to tandem mass spectrometry. DMIP, MeIQx, 4,8-DiMeIQx, Norharman, Harman, PhIP, Trp-P-1, AalphaC and MeAalphaC were the amines most frequently found at concentrations of up to 47 ng g(-1) of cooked meat. Glu-P-2, IQ, MeIQ, Glu-P-1, 7,8-DiMeIQx and Trp-P-2 were only found in a few of the meat dishes and their concentrations were lower than 1 ng g(-1) of cooked meat. The highest amounts of HAs, especially PhIP and DMIP, were formed in fried chicken breast and the lowest were formed in fried beef hamburger and in fried pork sausages. Daily intake of HAs in Spain was estimated at 606 ng of mutagenic HAs per capita and day, DMIP and PhIP being the main contributors.

Trapezius transfer for shoulder paralysis. 6 patients with brachial plexus injuries followed for 1 year.

We transferred the trapezius with its bone insertion to the proximal humerus in 6 patients for treatment of a paralytic shoulder secondary to traumatic lesions of the brachial plexus. After 1 year, the shoulder abduction was improved from average 13 degrees (0 degrees-30 degrees) preoperatively to 76 degrees (50 degrees-100 degrees) postoperatively, and the shoulder flexion from 18 degrees (0 degrees-40 degrees) to 78 degrees (45 degrees-110 degrees) postoperatively. All the patients were satisfied with the outcome. We consider that transfer of the trapezius in a paralytic shoulder after brachial plexus injury gives a better outcome than shoulder fusion.

Prevalence of asthma-related symptoms and bronchial responsiveness to exercise in children aged 13-14 yrs in Barcelona, Spain.

It is not clear whether asymptomatic bronchial responsiveness is a risk factor for development of asthma. A cross-sectional study was conducted to determine the prevalence of asthma among schoolchildren from Barcelona (Spain). The association between respiratory symptoms and bronchial responsiveness to exercise was examined. For this study 3,033 schoolchildren aged 13-14 yrs were studied from the general population. Participants answered a respiratory questionnaire and a self-reporting video-questionnaire. A total of 2,842 children underwent bronchial responsiveness testing by exercise challenge. The study was part of the International Study of Asthma and Allergies in Childhood (ISAAC) project. The prevalence of "current asthma" (recent wheezing and bronchial responsiveness to exercise) was 4% and the prevalence of "wheezing only" 10%. A fall in peak expiratory flow rate (PEFR) > or = 15% after exercise testing was found in 324 (11%) children, 29 (9%) of whom presented clinical symptoms of asthma. Bronchial responsiveness to exercise was significantly associated with all items of the asthma questionnaire. The prevalence of asthma-related symptoms in this inner-city area was lower than frequently reported rates in other countries, although the prevalence of exercise-induced bronchoconstriction was relatively high, and threefold greater than in a geographical area in the vicinity of Barcelona. These findings are consistent with the current view that asthma-related symptoms and bronchial responsiveness to exercise have different meanings in a community survey, and that local environmental factors could influence the prevalence of bronchial responsiveness.

Contralateral median nerve autograft.

Interfascicular nerve autografting is a useful method to repair nerves with gaps, mainly if the removal of a nerve does not imply a defect to the donor area. Final results of peripheral nerve repair definitely depend on the size of the nerve gap, the level of the injury and the time elapsed from the time of injury until the nerve is repaired.

[A proposal for the development of the program of family and community medicine]. / Una propuesta para el desarrollo del programa de medicina familiar y comunitaria.

We present a methodological innovation for the Teaching Unit of Family and Community Medicine in Valencia, consisting in a stage of the first year residents in the Health Centers during the first week after their incorporation to the teaching program. At the same time, we attempt to evaluate the level of clinical knowledge of these residents about common problems in primary care; to assess their knowledge about organization, information systems, health programs, etc.; to evaluate their degree of preference for the specialty and to analyze how such an experience may be helpful for the education of the family physicians. The mean number of correct answers to a test-type examination about common clinical problems in that level of care was 31.6%. The mean level of knowledge about primary care was self-rated as poor. Only 2 out of 22 residents had freely chosen this specialty, and only as a third choice. At the end of the stage, 74.7% of the residents evaluated it as useful or highly useful. We propose some recommendations which might improve the structure and implementation of the teaching.

Brucellosis treated with rifampicin.

14 children, aged between 15 months and 14 years, with brucellosis were treated with oral rifampicin only (20 mg/kg per day) for 3 weeks. Laboratory diagnosis depended on blood culture (positive for Brucella melitensis in 11 of the cases), serum agglutination, complement-fixation test, and Coomb's test. Response was good in each child, with fever clearing between the 2nd and 8th day. 2 children relapsed, but one relapse was probably a reinfection from contaminated cheese. Both children were given a further course of treatment (rifampicin and co-trimoxazole) which was successful. Despite the reasonably good results with rifampicin alone, it is advisable to combine the drug with co-trimoxazole when treating brucellosis.