Coxa profunda in the diagnosis of pincer-type femoroacetabular impingement and its prevalence in asymptomatic subjects.

In many papers, the diagnosis of pincer-type femoroacetabular impingement (FAI) is attributed to the presence of coxa profunda. However, little is known about the prevalence of coxa profunda in the general population and its clinical relevance. In order to ascertain its prevalence in asymptomatic subjects and whether it is a reliable indicator of pincer-type FAI, we undertook a cross-sectional study between July and December 2013. A total of 226 subjects (452 hips) were initially screened. According to strict inclusion criteria, 129 asymptomatic patients (257 hips) were included in the study. The coxa profunda sign, the crossover sign, the acetabular index (AI) and lateral centre-edge (LCE) angle were measured on the radiographs. The median age of the patients was 36.5 years (28 to 50) and 138 (53.7%) were women. Coxa profunda was present in 199 hips (77.4%). There was a significantly increased prevalence of coxa profunda in women (p < 0.05) and a significant association between coxa profunda and female gender (p < 0.001) (92% vs 60.5%). The crossover sign was seen in 36 hips (14%), an LCE > 40° in 28 hips (10.9%) and an AI < 0º in 79 hips (30.7%). A total of 221 normal hips (79.2%) (normal considering the crossover) had coxa profunda, a total of 229 normal hips (75.5%) (normal considering the LCE) had coxa profunda and a total of 178 normal hips (75.3%) (normal considering AI) had coxa profunda. When the presence of all radiological signs in the same subject was considered, pincer-type FAI was found in only two hips (one subject). We therefore consider that the coxa profunda sign should not be used as a radiological indicator of pincer-type FAI. We consider profunda to be a benign alteration in the morphology of the hip with low prevalence and a lack of association with other radiological markers of FAI. We suggest that the diagnosis of pincer-type FAI should be based on objective measures, in association with clinical findings.

Prevalence of mef and ermB genes in invasive pediatric erythromycin-resistant Streptococcus pneumoniae isolates from Argentina / Prevalencia de los genes mef y ermB en aislamientos invasivos de Streptococcus pneumoniae resistentes a eritromicina recuperados de pacientes pediátricos en Argentina

During the period 1993-2001, a total of 1,499 pneumococci isolates were recovered through the Argentinean surveillance of Streptococcus pneumoniae causing invasive disease in children under 6 years of age, 3.5% of which were erythromycin resistant. Among the 50 erythromycin-resistant strains available, 58% (n=29) harbored mefA/E genes (15 mefA, 30%; and 14 mefE, 28%), 34% (n=17) ermB, and 6% (n=3) both mefA/E plus ermB genes, while one isolate was negative for all the acquired genes studied. The England14-9 (42%), Poland6B-20 (20%) and Spain9v-3 (16%) clones were responsible for the emergence of pneumococcal macrolide resistance in pediatric population from Argentina.

En el marco del programa de vigilancia regional SIREVA, se analizaron 1499 aislamientos de Streptococcus pneumoniae causantes de enfermedad invasiva en menores de 6 años, recuperados entre 1993 y 2001. Se detectó un 3,5% de resistencia a eritromicina. De los 50 aislamientos resistentes a eritromicina que pudieron ser estudiados, el 58% (n=29) tenían los genes mefA/E (15 mefA, 30% y 14 mefE, 28%), el 34% (n=17) el gen ermB y el 6% (n=3) la combinación de genes mefA/E y ermB. Sólo un aislamiento fue negativo para todos los genes analizados. Los clones internacionales England14-9, Poland6B-20 y Spain9v-3 representaron el 78% del total de aislamientos resistentes (42, 20 y 16%, respectivamente) y se consideraron los responsables de la emergencia de la resistencia a macrólidos entre los neumococos que afectan a la población pediátrica de Argentina.

Como nos vem, como nos vemos. Un perfil del Médico Fisiatra a partir de un estudio etnográfico / How you look us, how we look us. An profile of the physiatrist from ethnography study

Utilizando métodos de las ciencias sociales, como lo es la investigación etnográfica, profesionales colombianos de un grupo académico y de salud específico, identifican las fortalezas personales y profesionales de estos epecialistas, así como áreas a mejorar. Para los lectores no familiarizados con esta metodologia, los hallazgos aquí mostrados no son generalizables a población diferente de la del estudio, pero ayudará a identificar situaciones similares en le entorno latinoamericano

[Use of Spotorno expansive acetabulum in sequel of acetabular fracture]. / Uso del acetabulo expansivo de spotorno en secuela de fractura acetabular.

A series of 14 total hip arthroplasties using the cementless Spotorno expansive acetabular component was performed to treat post traumatic osteoarthrosis that had developed following an acetabular fracture. The mean age of the patients at the time of the arthroplasty was 47 years (range 28-77 years). This study was performed between 1989 to 1999 (11 years), and the mean follow-up was 4 years and 9 months. Clinical results were evaluated by Merle d'Aubigné and Postel scale, which revealed that 78, 50% of the patients presented good and very good results. The radiological evaluation based on DeLee and Charnley criteria demonstrated a radio-lucent-lin in 3 patients. According to the results obtained in the series the authors concluded that the traumatic acetabular osteoarthrosis can be properly handled with the Spotorno acetabular component when arthroplasty is indicated.

Uso del acetabulo expansivo de spotorno en secuela de fractura acetabular. / [Use of Spotorno expansive acetabulum in sequel of acetabular fracture]

A series of 14 total hip arthroplasties using the cementless Spotorno expansive acetabular component was performed to treat post traumatic osteoarthrosis that had developed following an acetabular fracture. The mean age of the patients at the time of the arthroplasty was 47 years (range 28-77 years). This study was performed between 1989 to 1999 (11 years), and the mean follow-up was 4 years and 9 months. Clinical results were evaluated by Merle dAubigné and Postel scale, which revealed that 78, 50

of the patients presented good and very good results. The radiological evaluation based on DeLee and Charnley criteria demonstrated a radio-lucent-lin in 3 patients. According to the results obtained in the series the authors concluded that the traumatic acetabular osteoarthrosis can be properly handled with the Spotorno acetabular component when arthroplasty is indicated.

[Comparation of the antero-lateral and posterior approaches in primary total hip arthroplasty]. / Comparación de abordajes antero lateral y posterior en artroplastia total primaria de cadera.

Comparison between the antero-lateral and posterior approaches in primary total hip arthroplasty. In this retrospective study, 184 patients were enrolled, 95 submitted to the anterolateral (Watson jones) and 89 to the posterior approach (Moore) from June 1993 to June 1997. The outcomes assessed were perioperative data (operative time, hospital stay, time from surgery until hospital discharge, surgical bleeding and the need for blood transfusion), as well as late complications (deep venous thrombosis DVP, pulmonary embolism, periopheral nerve injury, prothesis instability and others). Both groups did not differ in terms of preoperative parameters. Those submitted to the posterior approach had shorter operative times (p < 0.001), as well as reduced bleeding (p < 0.05) and need for blood transfusion (p < 0.001) during surgery. The outcomes, such as late complications, had similar reduced frequency in both groups. The posterior approach has been successfully applied in our service and proves to be an excellent alternative surgical access to the total hip arthroplasty.