Tratamiento del equinismo con yesos progresivos / Treatment of equinus with serial casting

Introducción El pie equino en niños produce un patrón de marcha inestable e ineficiente y un inadecuado posicionamiento en silla de ruedas. El tratamiento mediante ciclo de yesos seriados mantiene el rango de movimiento, facilitando el desarrollo de patrones de movimiento normales. Su uso combinado con toxina botulínica tiene efectos beneficiosos demostrados, pero faltan pautas para establecer el protocolo de tratamiento óptimo. Objetivo Describir las características de la población con equinismo de diversa etiología y determinar la efectividad del tratamiento con yesos. Valorar su uso junto con toxina botulínica en pacientes con parálisis cerebral espástica. Material y método Estudio analítico longitudinal retrospectivo sobre una muestra de 95 tendones de Aquiles de niños atendidos en consulta de rehabilitación infantil entre 2012 y 2018, con flexión dorsal de tobillo menor de 10°, tratados mediante ciclo de yesos con o sin toxina botulínica. Variables analizadas: sexo, año de comienzo, edad, IMC, diagnóstico, tratamiento previo y/o posterior, espasticidad (Ashworth modificada), lateralidad, rango articular pasivo y activo de flexión dorsal y plantar junto con R1 (escala de Tardieu). Mediciones realizadas con inclinómetro mecánico antes del primer, segundo y tercer yeso, tras el tercer yeso y a los 2, 8 y 14 meses. Fue analizado estadísticamente mediante SPSS. Resultados Existe una mejora estadísticamente significativa de 10,02° (p<0,01) entre flexión dorsal pasiva previa al primer yeso y tras el tercero, manteniéndose en 6,66° (p=0,02) entre la previa y a los 14 meses. Conclusiones Los yesos progresivos son un método efectivo en el control del equinismo de cualquier etiología, con una tasa mínima de complicaciones (AU)

Introduction Equinus in children produces a pattern of unsteady gait and inefficient and inadequate positioning in the wheelchair. Treatment with a serial casting cycle maintains range of motion and facilitates the development of normal movement patterns. Its use in combination with botulinum toxin has proven benefits, but there is a lack of guidance on the optimal management protocol. Objective The aim of this study were to describe the characteristics of the population with equinus of diverse aetiology and to determine the effectiveness of treatment with serial casting. We also aimed to assess its use in conjunction with botulinum toxin in patients with spastic cerebral palsy. Material and method This longitudinal retrospective study included a sample of 95 Achilles tendons of children attended in a children's rehabilitation clinic between 2012 and 2018, with ankle dorsal flexion less than 10°, treated by a cycle of serial casts with or without botulinum toxin. The variables analysed were sex, year when treatment started, age, BMI, diagnosis, previous and/or later treatment, spasticity (modified Ashworth), laterality, active and passive joint range of dorsal and plantar flexion along with R1 (Tardieu). Measurements were carried out with a mechanical inclinometer prior to the first, second and third cast, after the third cast and at 2, 8 and 14 months. The statistical analysis was performed with SPSS®. Results There was a statistically significant improvement of 10.02° between passive dorsal flexion prior to the first cast and after the third cast, which remained at 6.66° (P=.02) between the former and after 14 months. Conclusions Serial casting is an effective method in the management of equinus of any aetiology and has a minimal complication rate (AU)

[Treatment of equinus with serial casting]. / Tratamiento del equinismo con yesos progresivos.

INTRODUCTION: Equinus in children produces a pattern of unsteady gait and inefficient and inadequate positioning in the wheelchair. Treatment with a serial casting cycle maintains range of motion and facilitates the development of normal movement patterns. Its use in combination with botulinum toxin has proven benefits, but there is a lack of guidance on the optimal management protocol. OBJECTIVE: The aim of this study were to describe the characteristics of the population with equinus of diverse aetiology and to determine the effectiveness of treatment with serial casting. We also aimed to assess its use in conjunction with botulinum toxin in patients with spastic cerebral palsy. MATERIAL AND METHOD: This longitudinal retrospective study included a sample of 95 Achilles tendons of children attended in a children's rehabilitation clinic between 2012 and 2018, with ankle dorsal flexion less than 10°, treated by a cycle of serial casts with or without botulinum toxin. The variables analysed were sex, year when treatment started, age, BMI, diagnosis, previous and/or later treatment, spasticity (modified Ashworth), laterality, active and passive joint range of dorsal and plantar flexion along with R1 (Tardieu). Measurements were carried out with a mechanical inclinometer prior to the first, second and third cast, after the third cast and at 2, 8 and 14 months. The statistical analysis was performed with SPSS®. RESULTS: There was a statistically significant improvement of 10.02° between passive dorsal flexion prior to the first cast and after the third cast, which remained at 6.66° (P=.02) between the former and after 14 months. CONCLUSIONS: Serial casting is an effective method in the management of equinus of any aetiology and has a minimal complication rate.

Tenotomía percutánea ecoguiada en entesopatía crónica de extensores de muñeca / Ultrasound-guided percutaneous tenotomy in chronic wrist extensor enthesopathy

La epicondilitis es una entidad que provoca discapacidad y tiende a cronificar. Histológicamente, existen lesiones degenerativas en el tendón extensor común del antebrazo, visibles mediante ecografía o resonancia magnética. Existen diversas medidas terapéuticas conservadoras, incluida la infiltración con corticoide por referencia anatómica; pero en ocasiones fracasan, y los pacientes son propuestos para cirugía. La ecografía como herramienta terapéutica permite realizar procedimientos sin apertura cutánea sobre los tendones. En 2006, se publicó la realización de una tenotomía percutánea ecoguiada para el tratamiento de la epicondilitis crónica. La técnica, mostrada hasta ahora por cirujanos y radiólogos, intenta transformar un proceso degenerativo crónico con fallo en la reparación, en un proceso inflamatorio agudo con perspectivas de autorregeneración. Nuestro objetivo es describir 5 casos clínicos de epicondilitis con fracaso de las medidas terapéuticas habituales, en los que se realiza una tenotomía percutánea ecoguiada en la propia consulta, con resultados favorables

Epicondylitis causes disability and tends to become chronic. Histologically, degenerative lesions are found in the common extensor tendon, which are visible on ultrasound or magnetic resonance imaging. Several conservative therapeutic measures are available, including corticosteroid infiltration by anatomical landmark. However, these measures sometimes fail, in which case patients are proposed for surgery. Ultrasound is a therapeutic tool that allows procedures on tendons to be performed without skin incisions. The technique of ultrasound-guided percutaneous tenotomy for the treatment of chronic epicondylitis was first reported in 2006. This procedure, demonstrated to date by surgeons and radiologists, attempts to transform a chronic degenerative process with failure to repair into an acute inflammatory process with self-regeneration. The aim of this study was to describe 5 cases of epicondylitis that failed to respond to routine therapeutic measures, in which we used ultrasound-guided percutaneous tenotomy with favourable results

Calcificación de discos intervertebrales como causa de tortícolis dolorosa en edad pediátrica / Intervertebral disc calcification as a cause of painful torticollis in children

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[Ultrasound-guided percutaneous tenotomy in chronic wrist extensor enthesopathy]. / Tenotomía percutánea ecoguiada en entesopatía crónica de extensores de muñeca.

Epicondylitis causes disability and tends to become chronic. Histologically, degenerative lesions are found in the common extensor tendon, which are visible on ultrasound or magnetic resonance imaging. Several conservative therapeutic measures are available, including corticosteroid infiltration by anatomical landmark. However, these measures sometimes fail, in which case patients are proposed for surgery. Ultrasound is a therapeutic tool that allows procedures on tendons to be performed without skin incisions. The technique of ultrasound-guided percutaneous tenotomy for the treatment of chronic epicondylitis was first reported in 2006. This procedure, demonstrated to date by surgeons and radiologists, attempts to transform a chronic degenerative process with failure to repair into an acute inflammatory process with self-regeneration. The aim of this study was to describe 5 cases of epicondylitis that failed to respond to routine therapeutic measures, in which we used ultrasound-guided percutaneous tenotomy with favourable results.

Teledermatología en Atención Primaria / Teledermatology in Primary Care

Las nuevas tecnologías son una herramienta cada vez más utilizada en el desarrollo de la asistencia clínica. La teledermatología pretende establecer una comunicación rápida y eficaz entre el facultativo de Atención Primaria y el especialista en Dermatología. Se expone una muestra del proyecto de calidad llevado a cabo entre los pediatras de un centro de salud del sector 1 de Zaragoza y un especialista en Dermatología del Hospital Royo Villanova. Se describe el cuadro clínico y las imágenes realizadas en la consulta de Atención Primaria de cinco pacientes en edad pediátrica, así como la respuesta por parte del especialista. La teledermatología es un proyecto con buena aceptación por parte de pacientes y profesionales; disminuye listas de espera, evita derivaciones innecesarias y fomenta el aprendizaje por parte del pediatra (AU)

New technologies are an increasingly used tool in the development of clinical care. Teledermatology aims to establish a fast and efficient communication between the primary care physician and the specialist in dermatology. We exposed a sample of the quality project carried out between the pediatricians at a health centre in sector 1 in Zaragoza and a specialist in dermatology of the Hospital Royo Villanova. Is describes the picture clinical and the images made in the consultation of attention primary of 5 patients in age Pediatric, as well as the response from the specialist. Teledermatology is a project with good acceptance by patients and professionals; decreases waiting lists, avoids unnecessary referrals and encourages learning by the pediatrician (AU)

Análisis de la concordancia y validación de las ecuaciones de Framingham-REGICOR y DORICA en la población diabética de un Centro de Salud seguida durante 10 años / Analysis of the concordance and validation of the Framingham-REGICOR and DORICA equations in diabetic population in a Health Care Center followed-up for 10 years

INTRODUCCIÓN. Analizar la concordancia y validación a diez años de dos ecuaciones de riesgo coronario que utilizan la función de Framingham calibrada para población española (REGICOR y DORICA) en pacientes diabéticos tipo 2. PACIENTES Y MÉTODOS. Estudio descriptivo, longitudinal, de seguimiento de una cohorte durante 10 años. Un total de 131 pacientes diabéticos de un centro de salud urbano, de 35 a 64 años de edad, sin antecedentes de cardiopatía isquémica, a quienes se les pudo calcular el riesgo coronario antes del 1-01-1995. RESULTADOS. El porcentaje real de eventos coronarios fue del 9,9% (8,8% en varones y 11,1% en mujeres). El riesgo coronario global calculado en la ecuación de Framingham-REGICOR fue del 8,9%, ajustándose perfectamente al riesgo coronario en varones (8,8%) e infraestimándolo en mujeres (9,0%). En cambio, la ecuación de Framingham-DORICA sobreestimó el riesgo global de la cohorte (17,3% frente al 9,9% de eventos), tanto en varones (19,7%) como en mujeres (14,8%), siendo sus riesgos significativamente distintos (p < 0,05). La concordancia entre las dos funciones fue aceptable (índice Kappa = 0,5). La aplicación inicial de la función de Framingham-DORICA, con un umbral para riesgo coronario alto ≥ 10%, y posteriormente la de Framingham-REGICOR a los pacientes catalogados como de riesgo coronario no alto (< 10%), permitieron clasificar correctamente el riesgo coronario de los pacientes diabéticos. CONCLUSIONES. La concordancia entre las funciones de Framingham-REGICOR y DORICA es aceptable, siendo REGICOR la que más se aproximó al riesgo real de la cohorte. La aplicación secuencial de ambas ecuaciones clasifica correctamente el riesgo coronario de los pacientes diabéticos

INTRODUCTION. Analyze the concordance and validation at ten years of two coronary risk equations that use the calibrated Framingham function for Spanish population (REGICOR and DORICA) in type 2 diabetic patients. PATIENTS AND METHODS. Descriptive, longitudinal, follow-up study of a cohort over 10 years. A total of 131 diabetic patients from an urban health care center, from 35 to 65 years of age, without a background of ischemic heart disease, in whom coronary risk could be calculated before 1-01-1995. RESULTS. The real percentage of coronary events was 99% (8.8% in males and 11.1% in women). Global coronary risk calculated in the Framingham-REGICOR equation was 8.9%, it being perfectly adjusted to coronary risk in males (8.8%) and underestimated in women (9.0%). On the contrary, the Framingham-DORICA equation overestimated the global risk of the cohort (17.3% versus 9.9% of events) in both males (19.7%) and women (14.8%), their risks being significantly different (p < 0.05). Concordance between the two functions was acceptable (Kappa index = 0.5). Initial application of the Framingham-DORICA function with a threshold for high coronary risk ≥ 10% and then the Framingham-REGICOR to patients listed as not high coronary risk (< 10%) made it possible to correctly classify the coronary risk of the diabetic patients. CONCLUSIONS. Concordance between the Framingham-REGICOR and DORICA is acceptable, the REGICOR being that which approached the real risk of the cohort most. The sequential application of both equations correctly classified the coronary risk of diabetic patients