Implantes intramedulares enterrados para fracturas de antebrazo pediátricas. ¿Mejora la tasa de refracturas? / Buried intramedullary implants for paediatric forearm fractures. Does the refracture rate improve?

INTRODUCCIÓN: Las fracturas inestables de antebrazo pueden requerir un manejo quirúrgico mediante reducción y osteosíntesis con agujas intramedulares. Esta fijación debe retirarse precozmente si se ha dejado expuesta, pero esto podría aumentar el riesgo de refracturas sobre un hueso en periodo de remodelado. Como alternativa podemos mantener durante más tiempo las agujas, enterradas a nivel subcutáneo, para proteger el callo óseo. OBJETIVO: Valorar si hay diferencias entre utilizar agujas expuestas respecto a enterrarlas en pacientes pediátricos con fracturas de antebrazo. Nuestra hipótesis es que al enterrar las agujas las mantenemos más tiempo reduciendo las refracturas de antebrazo. MATERIAL Y MÉTODOS: Presentamos una cohorte de 75 pacientes pediátricos con fractura de antebrazo entre 2010 y 2016. Se recogieron datos demográficos, técnica quirúrgica, complicaciones y seguimiento del paciente. RESULTADOS: Los implantes se dejaron expuestos en 50 pacientes y 25 de forma enterrada. El tiempo medio de retirada de los implantes expuestos fue de 6,8 semanas, y de 17,6semanas en los enterrados. No se hallaron diferencias significativas en cuanto a consolidación (p = 0,19) ni en tiempo de inmovilización (p = 0,22). Respecto a las refracturas, se observa un mayor número en el grupo de la osteosíntesis expuesta (4pacientes) respecto a solo un caso con osteosíntesis enterrada, pero sin llegar a presentar diferencias significativas (p = 0,49). No se detectaron complicaciones posquirúrgicas y la funcionalidad fue excelente al final del seguimiento en ambos grupos. CONCLUSIÓN: Dejar los implantes enterrados respecto a expuestos a piel no condiciona una disminución en el número de refracturas ni otras complicaciones, con una adecuada funcionalidad del paciente en ambos casos

INTRODUCTION: Unstable forearm fractures may require surgical management by reduction and osteosynthesis with intramedullary needles. This fixation should be removed early if it has been left exposed, but this could increase the risk of refracture in a bone in the period of remodelling. As an alternative we can keep the needles, buried subcutaneously, for a longer time, to protect the bone callus. OBJECTIVE: To assess whether there are differences between using exposed needles with respect to burying them in paediatric patients with forearm fractures. Our hypothesis is that by burying the needles we keep them longer by reducing forearm refractures. MATERIAL AND METHODS: We present a cohort of 75 paediatric patients with a forearm fracture between 2010 and 2016. Demographic data, surgical technique, complications and patient follow-up were collected. RESULTS: The implants were left exposed in 50 patients and 25 buried. The average time of removal of the exposed implants was 6.8 weeks and 17.6weeks in the buried ones. No significant differences were found in terms of consolidation (P=.19) or immobilization time (P=.22). Regarding refractures, a greater number was observed in the exposed osteosynthesis group (4patients) compared to only one case with buried osteosynthesis, but there were no significant differences (P=.49). No postsurgical complications were detected and the functionality was excellent at the end of the follow-up in both groups. CONCLUSION: Leaving implants buried in relation to skin exposed does not cause a decrease in the number of refractures or other complications, with adequate patient functionality in both cases

Lesión de aorta torácica por tubo pleural / Thoracic aortic injury caused by chest tube

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Postoperative effects on lower third molars of using mouthwashes with super-oxidized solution versus 0.2% chlorhexidine gel: A randomized double-blind trial.

BACKGROUND: The main objective of the present study is to evaluate the effects and possible benefits with regard to the postoperative period of lower third molar extractions, comparing the intraalveolar application of a bioadhesive gel of 0.2% chlorhexidine (CHX) to the use of a mouthwash with a super-oxidized solution, (SOS) Dermacyn® Wound Care (Oculus Innovative Sciences lnc., California, USA). MATERIAL AND METHODS: A randomized double-blind study was carried out in 20 patients with a split-mouth design, with a total of 40 extractions of symmetrically impacted bilateral lower third molars. Patients were divided into two groups, a control group (C = 20) and an experimental group (D = 20). Any infectious complications, wound healing, plaque accumulation in the stitches, and presence of trismus and inflammation were evaluated using the distance between different facial points, at three, eight, and fifteen days after extraction. Pain, swelling, and amount of analgesics taken were evaluated using the VAS scale throughout the 15 days following extraction. Tolerance to treatment was evaluated using a verbal scale. Results were statistically compared using the Student's t- and chi-squared tests. RESULTS: No statistically significant differences were found between the two groups with regard to infectious complications, swelling, or wound healing. Use of analgesics and self-reported pain levels were slightly lower in the experimental group than in the control group during days 6 and 7 of the study (p < 0.05). The global treatment tolerance was satisfactory and similar in both groups. CONCLUSIONS: Both CHX and SOS are effective at improving the postoperative period after extraction of lower third molars.

Simuladores en Cirugía Torácica: actualización / No disponible

Los simuladores quirúrgicos son una gran herramienta para la formación, desarrollo y práctica de nuevas técnicas quirúrgicas en un ambiente de seguridad. En este artículo se revisan los diferentes modelos descritos, realizando para ello una lectura y análisis de las publicaciones aparecidas hasta la fecha. Existen múltiples dispositivos para la simulación quirúrgica en cirugía torácica, incluyendo tanto modelos biológicos como virtuales. Aunque todos los modelos tienen algún tipo de limitación, los estudios demuestran la importancia de los simuladores en la formación y la enseñanza. No hay ningún modelo a considerar superior, pero sí un desarrollo cada vez mayor de modelos virtuales

Surgical simulation devices are a useful resource in training, development and new surgical techniques training, all of them in a safe environment. In this paper we have reviewed the different models described, by searching and analyzing several articles published so far. There are several devices for surgical simulation in Thoracic Surgery, and include both biological and virtual models. Though all models are somehow limited, studies show us their relevance for training and teaching. There is still not a clearly superior model, but virtual devices are getting a huge development

GEINOFOTE: efficacy and safety of fotemustine in patients with high-grade recurrent gliomas and poor performance status

Purpose: The treatment of recurrent high-grade gliomas (HGG) is controversial. There are different therapeutic schedules but without a clear orientation about which of them should be used in each clinical situation. In addition, when patients suffer a second recurrence or they have poor performance status, they are excluded from clinical trials, although second recurrences and poor performance status are indeed more and more real and common situations in the clinical setting. In this study, we assessed the efficacy and safety of fotemustine (FTM) in HGG [fundamentally, glioblastomas (GB)], independent of time of recurrence or performance status. Methods/patients: Retrospective study in HGG patients treated with FTM in second or further line according to standard, the Addeo or any other scheme, starting treatment prior to 30 November 2012. Included patients reflect the regular situation in which the drug is used in terms of comorbidities and analytic situation (hematologic, renal and hepatic functions). Response assessment was performed by MRI and according to the clinical protocols of each center (every 8-12 weeks). Clinical situation and supportive care drugs were evaluated in each medical consultation. Clinical end-points analyzed, among others, were: PFS-6, PFS, OS, response rates, toxicity, quality of life and neurocognitive impact. Results: In terms of activity, an overall response rate of 8 % was observed: partial response 6 % (7 patients) and complete response 2 % (2 patients). The median time to achieve the greater response with FTM was 73 days (4-841 days). Patients treated according to the Addeo schedule had a shorter time to greater response in comparison with other schedules (85.9 vs 114 days), although without statistical significance. There were no significant differences in progression-free survival (PFS) when comparing different FTM schedules or using FTM in first or second recurrence. Median PFS: 3 months. PFS-6: 30.3 %. Overall survival (OS): although without significant differences, a tendency to better survival when using the Addeo schedule versus other schedules was observed (at 6 months, 44.6 vs 34.5 %; at 12 months, 25 vs 23.6 %; at 18 months, 11.5 vs 7.9 %), as well as if earlier use (second vs third line) concerning OS-12 (33.7 vs 18.2 %). Median OS: 5.2 months. Grades 3-4 toxicity was 28 % (31 patients), being neutropenia (4 %) and thrombocytopenia (17 %) the most frequent adverse reactions. From quality of life and neuro-cognitive function perspectives, 11 patients (10 %) and 16 (14 %) improved the Karnofsky Index and neurological impairment, respectively, after FTM treatment. Conclusion: This study has shown that FTM is safe and has a comparable activity with other available therapeutic options of use in the treatment of recurrent HGG (AU)

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Mortalidad en el síndrome de obesidad-hipoventilación y factores de riesgo pronóstico / Mortality in obesity-hypoventilation syndrome and prognostic risk factors

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Termodilución en la arteria pulmonar vs. termodilución transcardiopulmonar en pacientes con cortocircuito izquierda-derecha secundario a rotura del septo interventricular posinfarto / Pulmonary artery thermodilution vs. transcardiopulmonary thermodilution in patients with left-right shunts secondary to post-infarction interventricular septal rupture

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Combinación de índices de gravedad con biomarcadores en la valoración pronóstica de la neumonía adquirida en la comunidad / No disponible

Introducción: La neumonía adquirida en la comunidad (NAC) supone la sexta causa de muerte en nuestro medio y la principal indicación de antibióticos. Para su valoración pronóstica se emplean índices de gravedad (PSI, CURB-65) y marcadores biológicos de sepsis como la proteína C reactiva (PCR) y la procalcitonina. Objetivo: Analizar el valor pronóstico (mortalidad, ingreso en unidad de cuidados intensivos -UCI-, reingresos) de la combinación de estos índices de gravedad con biomarcadores en pacientes con NAC. acientes y métodos: Estudio prospectivo observacional de pacientes ingresados por NAC en Medicina Interna y Neumología de un hospital terciario. Se analizaron parámetros clínicos, analíticos, riesgo según índices de gravedad y tratamiento. Se registraron durante 90 días eventos de mala evolución (ingreso en UCI y mortalidad). Resultados: Se incluyeron 155 pacientes con edad media de 71 años, el 94% varones. Los pacientes con alta puntuación de los índices de gravedad (73,6%) presentaron evolución desfavorable. La mortalidad global fue de 12,9%; a los 30 días se asoció a alta puntuación del índice PSI, y a los 90 días a niveles elevados de procalcitonina. En pacientes de bajo riesgo según los índices de gravedad los niveles de procalcitonina fueron bajos. El resto de parámetros biológicos no se asociaron con la evolución. Conclusión: La procalcitonina complementa a los índices de gravedad a la hora de definir pacientes de bajo riesgo, decidir el ingreso hospitalario y valorar la gravedad en pacientes con NAC

Introduction: Community-acquired pneumonia (CAP) is the sixth leading cause of death in our country and the main indication for antibiotic prescription. Assessing its severity can be done using gravity index (PSI, CURB- 65) or sepsis biomarkers such as C-reactive protein (CRP) and procalcitonin. Objective: To analyze the predictive value (mortality, admission to intensive care unit, readmissions) of the gravity index, biomarkers and the combination of both groups in the severity assessment of CAP. Patients and methods: A prospective observational study was carried out with patients admitted with CAP in Internal Medicine and Pneumology of a tertiary hospital. We analyzed clinical and analytical parameters, risk classes of the gravity index and treatment received. Poor outcome events were recorded (ICU admission and mortality) during 90 days. Results: 155 patients were included with mean age of 71 years, 94% male. A 73.6% belonged to high risk classes of the gravity index, which had worse outcome. Overall mortality was 12.9%: at 30 days it was associated with high score of PSI, and at 90 days with high levels of procalcitonin. In patients at low risk of death based on gravity index, procalcitonin levels were low. The other biological parameters were not associated with the prognosis. Conclusion: The combination of procalcitonin with clinical scales helps defining low-risk patients, deciding admission and assessing severity in patients with CAP

Should we continue temozolomide beyond six cycles in the adjuvant treatment of glioblastoma without an evidence of clinical benefit? A cost analysis based on prescribing patterns in Spain

PURPOSE: The standard adjuvant treatment for glioblastoma is temozolomide concomitant with radiotherapy, followed by a further six cycles of temozolomide. However, due to the lack of empirical evidence and international consensus regarding the optimal duration of temozolomide treatment, it is often extended to 12 or more cycles, even in the absence of residual disease. No clinical trial has shown clear evidence of clinical benefit of this extended treatment. We have explored the economic impact of this practice in Spain. MATERIALS AND METHODS: Spanish neuro-oncologists completed a questionnaire on the clinical management of glioblastomas in their centers. Based on their responses and on available clinical and demographic data, we estimated the number of patients who receive more than six cycles of temozolomide and calculated the cost of this extended treatment. RESULTS: Temozolomide treatment is continued for more than six cycles by 80.5 % of neuro-oncologists: 44.4 % only if there is residual disease; 27.8 % for 12 cycles even in the absence of residual disease; and 8.3 % until progression. Thus, 292 patients annually will continue treatment beyond six cycles in spite of a lack of clear evidence of clinical benefit. Temozolomide is covered by the National Health Insurance System, and the additional economic burden to society of this extended treatment is nearly 1.5 million euros a year. CONCLUSIONS: The optimal duration of adjuvant temozolomide treatment merits investigation in a clinical trial due to the economic consequences of prolonged treatment without evidence of greater patient benefit (AU)

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Tratamiento ortodóncico de pacientes con esclerosis múltiple. A propósito de un caso / No disponible

La Esclerosis Múltiple es una enfermedad de causa desconocida que afecta fundamentalmente a adultos jóvenes, su diagnóstico sigue siendo clínico pero la aparición de nuevos tratamientos hace necesario el apoyo de pruebas complementarias con las que el ortodoncista tiene que estar familiarizado puesto que cada vez es más frecuente que estos pacientes soliciten tratamientos de ortodoncia (AU)

Multiple sclerosis is an unknown origin disease affecting mostly young people, diagnostic was based almost entirely on clinical findings but with the apparition of the news treatments makes necessary the support of complementary test, with which the orthodontic doctor has to be acquainted since every time it is more frequent than this patients request orthodontic treatments (AU)

El óxido nítrico como mediador de la respuesta inflamatoria. Su importancia en el movimiento dental / Nitric oxide as mediator of the inflammatory response. His importance in the dental movement

El movimiento dental ortodóncico induce per se cambios inflamatorios en los tejidos dentales. En este artículo analizamos el papel dual que puede desempeñar el óxido nítrico, pudiendo comportarse como cito protector y antiinflamatorio o bien como citotóxico y mediador del daño celular. Valoramos su función como mediador de la respuesta inflamatoria y su posible efecto protector, así como su papel de modulador de la respuesta inflamatoria tanto a nivel sistémico como local (AU)

The orthodontic tooth movement induces per se inflammatory changes in the dental tissues. In this article we analyze the dual role that can have the nitric oxide, being able to behave as citoprotective and anti.inflammatory or as citotoxic and mediator of the cellular damage. We value his function as mediator of the inflammatory response and his possible protective effect, as well as his role of modulator of the inflammatory response both at systemic and local level (AU)

Análisis de la correlación entre la calidad de la prescripción de antipsicóticos y el estado clínico en pacientes con esquizofrenia / Correlation analysis between antipsychotic prescription quality and clinical status

Objetivo: Describir la terapia psicofarmacológica, en un grupo de pacientes con esquizofrenia, evaluar su adherencia a las guías de tratamiento y contrastar el estado mental del paciente en función de la adherencia a tales guías. Método: Se han seleccionado seis recomendaciones referentes al tratamiento psicofarmacológico, a partir de guías basadas en la evidencia médica, para ser contrastadas con los hábitos de prescripción reales. Se ha evaluado el estado psicopatológico de los pacientes con la Brief Psychiatric Rating Scale (BPRS). La puntuación BPRS de los pacientes se compara en función de la adherencia o no a las guías. Resultados: Más del 60% de los pacientes incumple al menos 4 de las 6 recomendaciones; la adherencia a las recomendaciones se asocia con menores puntuaciones BPRS. Las diferencias en la puntuación BPRS del grupo que cumple las recomendaciones referentes a 3 recomendaciones (dosis antipsicótica de mantenimiento, asociación de antipsicóticos y fármacos con efecto negativo sobre la función cognitiva), son significativamente menores (p < 0,05; bilateral) que las del grupo que las incumple. Discusión: Una práctica terapéutica apegada a las guías de tratamiento revierte en una mejor respuesta clínica

Objective: The aim of this study is to describe the psychopharmacological aspects of psychiatric practice in a group of schizophrenic patients and to evaluate whether or not practice agrees with treatment guidelines. The study also intends to objectively measure the psychopathological state of patients in order to establish correlation between different pharmacological aspects of treatment and their clinical outcomes. Method: We have elaborated six recommendations concerning the pharmacological treatment of schizophrenia, taken from several guides, which are based on evidence. The psychopathological state of patients has been evaluated with the Brief Psychiatric Rating Scale (BPRS) and real prescription practice has been analysed. BPRS rates are compared depending on compliance with guidelines. Results: More than 60% of patients do not comply with at least 4 of 6 evidence-based recommendations; compliance with recommendations being associated with a minor BPRS punctuation. Differences in BPRS punctuation between compliant and not-compliant groups for 3 recommendations (maintenance antipsychotic dosage, antipsychotic association and drugs with a negative effect on cognitive functions), are statistically significant (p < 0,05; bilateral). Discussion: Medical practice which closely follows treatment guidelines results in satisfactory clinical outcomes