Treatment Options for Failed Back Surgery Syndrome: An Umbrella Systematic Review of Systematic Reviews on the Effectiveness of Therapeutic Interventions.

Background: Failed back surgery syndrome (FBSS) is a common and incapacitating condition affecting patients with previous spine surgery in whom treatment approach can be challenging. This study aimed to summarize existing secondary studies and up-to-date randomized clinical trials (RCTs) that assess the effectiveness of available treatment options for FBSS. Methods: Systematic searches were carried out in five databases (PubMed, Cochrane, Scielo, Epistemonikos, and Google scholar) for all systematic reviews on the effectiveness of treatment options for FBSS published after 2012. Outcomes of interest were pain levels measured through visual analog scale or numeric rating scale, Oswestry Disability Index, and quality of life. Methodological and risk of bias assessments were performed with the AMSTAR-2 tool for systematic reviews and the Joanna Briggs Institute checklist for RCT. Prospective PROSPERO registration: CRD42022307609. Results: Fifteen studies, seven systematic reviews, and eight RCTs met the inclusion criteria and fulfilled the methodological quality assessment. Of the 15 included studies, 8 were on neurostimulation, 4 on adhesiolysis, 4 on epidural or intrathecal injections, and 3 on other treatment modalities. The risk of bias was low in seven studies, moderate in five, and high in three. Conclusions: Based on this systematic overview and the considerable heterogeneity among studies, the FBSS therapeutic approach must be individualized. FBSS treatment should start with conservative management, considering the implementation of neurostimulation, a technique with the most robust evidence of effective results, in cases of refractory axial or neuropathic pain. As the last resource, in light of the evidence found, more invasive procedures or new surgical interventions are indicated.

Reparación artroscópica transósea sin anclajes del manguito rotador con encondroma del húmero proximal. Reporte de un caso / Arthroscopic transosseous repair without anchorage of the rotator cuff with enchondroma of the proximal humerus. Case report

A 55-year-old woman presented to our service with chronic pain in her right shoulder with no history of trauma. Shoulder x-ray and CT scan revealed an enchondroma of the proximal humerus with no associated fracture. The MRI also showed a complete rupture of the supraspinatus and infraspinatus tendons. An arthroscopic transosseous rotator cuff repair without anchors was performed. At 12 months of follow-up, the patient had recovered functionality and the enchondromatous lesion remained stable. Anchorless transosseous arthroscopic repair of a rotator cuff tear may represent a good surgical option for patients whose bone quality makes anchor placement inappropriate, such as in the presence of a benign bone tumor such as enchondroma. Level III of evidence: Level IV; case report.

Inestabilidad de hombro en adolescentes: Indicaciones para cirugía. Reporte de caso y estado del arte / Shoulder instability in adolescents: Indications for surgery. Case report

La inestabilidad de hombro es una condición frecuente en personas involucradas en actividades deportivas de alta demanda física. Debido a sus particularidades anatómicas, los adolescentes presentan mayor riesgo de recidiva luego de un primer episodio de luxación de hombro. El sexo masculino, edad y participación en actividades deportivas de alto impacto son los principales factores de riesgo para recurrencia. En esta publicación, reportamos el caso de una adolescente porrista con inestabilidad anterior de hombro con evolución favorable luego de estabilización abierta complementado por una revisión del estado del arte de las aproximaciones terapéuticas de la inestabilidad recurrente de hombro en adolescentes.

Shoulder instability is a frequent condition in people involved in sport activities of high-physical demand. Due to their anatomical features, adolescents are at greater risk of recurrence after a first episode of shoulder dislocation. Male gender, age and participation in high-impact sport activities are the main risk factors for recurrence. We report the case of a cheerleader teenager with anterior shoulder instability with favorable evolution after open stabilization complemented by a review of the state of the art of the therapeutic approaches of recurrent shoulder instability in adolescents.

Subacute Acromioclavicular Dislocation After Basal Coracoid Process Fracture: Indirect Reduction without Open Reduction and Internal Fixation: A Case Report.

CASE: A 55-year-old man presented with an isolated undisplaced basal coracoid process (CP) fracture after direct trauma over his right shoulder. One week later, he presented with pain and anatomical deformity over the acromioclavicular joint (ACJ). Shoulder x-rays and computerized tomography revealed a complete acromioclavicular (AC) dislocation and displaced CP fracture. Anatomical AC reduction and ipsilateral coracoid fracture reduction were obtained using fixation with a hook plate. At 12-month follow-up, the patient regained functionality and showed complete CP consolidation and anatomic alignment of the ACJ. CONCLUSION: Our alternative treatment of coracoid fracture associated with secondary subacute AC dislocation showed satisfactory functional results.

Método para la reconstrucción del ligamento patelofemoral medial utilizando el tendón del cuádriceps: descripción de la técnica y resultados / A Modified method for reconstruction of the medial patellofemoral ligament using quadriceps tendon: a technical tip and results

Introducción La inestabilidad rotuliana y la luxación recurrente es un trastorno prevalente en niños y adolescentes que requiere la reparación quirúrgica del ligamento patelofemoral medial (LPFM), con especial atención en la preservación de las placas de crecimiento en esta población. Materiales y métodos Se describe un método modificado para la reconstrucción del ligamento patelofemoral medial utilizando un autoinjerto del tendón del cuádriceps, que se une con suturas de anclaje al punto isométrico epifisario de la inserción de LPFM. Desde el año 2012 se ha usado esta técnica en pacientes pediátricos en nuestra institución; aquí se presentan los resultados del seguimiento de esta cohorte de pacientes. Resultados Se ha utilizado esta técnica en 5 pacientes con inestabilidad patelofemoral con luxación rotuliana recidivante con una mediana de tiempo de seguimiento posquirúrgico de cuatro años (rango 2-5 años). La mediana del índice Insall­Salvati prequirúrgico fue 1.41. La mediana de puntuación de Kujala antes y después de la cirugía durante la última evaluación fue 76.5 (rango 34-100) y 98.5 (rango 75-100), respectivamente. No hubo casos de reluxación o episodios de subluxación durante el seguimiento. Un paciente presentaba como antecedente síndrome de West que dificultó las mediciones objetivas pre y postquirúrgicas; sin embargo, sus resultados fueron satisfactorios. Discusión Este método modificado constituye una técnica alternativa de fijación del injerto, que, en nuestra experiencia, proporciona resultados satisfactorios, con estabilidad rotuliana causada por la tensión fija del injerto. En los pacientes intervenidos no se han presentado recurrencias ni complicaciones.

Background Patellar instability and recurrent dislocation is a prevalent disorder in children and adolescents that require surgical repair of the medial patellar femoral ligament (MPFL), paying particular attention in preserving the open growth plates in this population. Methods We describe a modified method for reconstruction of the medial patellofemoral ligament using an autograft from the quadriceps tendon, which is attached with anchor sutures to the epiphysial isometric point of the MPFL insertion. Since 2012, this technique has been used in pediatric patients in our institution; here, we present the long-term results of this cohort. Results We have used this technique in 5 patients with patellar instability with recurrent patellar dislocation with a median postsurgical follow-up time of four years (range 2-5 years). The median preoperative Insall­Salvati ratio was 1.41. The median Kujala score before and after surgery during the last evaluation was 76.5 (range 34-100) and 98.5 (range 75-100), respectively. No cases of redislocation or episodes of subluxation were present during the follow-up. One patient presented West syndrome which made difficult pre and postoperative objective assessment; however, his results were satisfactory. Discussion This modified method constitutes an alternative technique of graft fixation, that in our experience, provides satisfactory results, with patellar stability caused by fixed graft tension. In the operated patients, no recurrences nor complications have been present.

Fracturas inestables de radio distal intra y extraarticulares: análisis comparativo de resultados a mediano plazo del tratamiento quirúrgico con placas volares / Intra- and extra-articular distal radius unstable fractures: comparative analysis of the medium-term results of volar plate surgical treatment

Introducción Comparar los resultados radiológicos y recuperación postoperatoria de la función de la muñeca a mediano plazo en las fracturas inestables extra e intra articulares de radio distal, después de la reducción abierta con abordaje palmar y osteosíntesis con placa volar. Materiales y métodos Estudio de casos y controles en 52 pacientes divididos en los grupos de fracturas extra o intra articulares de acuerdo a la clasificación AO. Las radiografías preoperatorias y postoperatorias fueron evaluadas para determinar la restauración anatómica de la longitud radial, ángulo radial e inclinación palmar del radio. Se evaluó además el resultado, seis meses después de la cirugía, del rango activo de movimiento y la fuerza de agarre, a la vez, que se hizo evaluación del puntaje de QuickDASH. Resultados La edad promedio fue 53,7±16,8 (DE) años; el 63% mujeres. Las fracturas extra articulares fueron más frecuentes en las mujeres, pero las intra articulares presentaron distribución similar por sexo (p=0.023). La fuerza de agarre de la mano operada fue 73.7% y 67.5% de la mano opuesta en las fracturas extra e intra articulares, respectivamente. El puntaje QuickDASH promedio fue 2.36 (DE 2.01) y 4.16 (DE 3.82) en fracturas extra e intra articulares respectivamente (p=0.111). Discusión Para fracturas de radio distal la reducción abierta con abordaje palmar y estabilización con placa volar ofrece resultados funcionales satisfactorios tanto para las fracturas extra articulares como para las intra articulares, con una leve, aunque esperada, ventaja en las primeras debido a su menor complejidad.

Background To examine and compare the radiological results and postoperative recovery of the medium-term wrist function in unstable extra- and intra-articular fractures of distal radius, after open reduction with a palmar approach and osteosynthesis with a volar plate. Materials and methods Retrospective case control study in 52 patients, divided into groups according to the Orthopaedic Association (AO) classification as extra- or intra-articular fractures. The pre-operative and post-operative radiographs were evaluated to determine the anatomical restoration of the radial length, radial angle, and palmar inclination of the radius. The medium-term results of the active range of motion and the grip strength, as well as the Quick DASH score, were evaluated six months after surgery. Results The mean age was 53.7±16.8 (SD) years and 63% were women. Extra-articular fractures were more frequent in women, but intra-articular fractures had a similar distribution by gender (P=.023). The grip strength of the operated hand was 73.7% and 67.5% of the opposite hand in the extra- and intra-articular fractures, respectively. The mean Quick DASH score was 2.36 (SD 2.01) and 4.16 (SD 3.82) in extra- and intra-articular fractures, respectively (P=.111). Discussion For unstable distal radius fractures, open reduction with palmar approach and volar plate stabilisation offers satisfactory functional results for both extra-articular and intra-articular fractures, with a slight, but expected, advantage in the former due to its lesser complexity.

Bilateral Macrodactyly of the Halluces in an Adolescent Girl Corrected with Shortening Osteotomies of the First Metatarsal and the Phalangeal Bones: A Case Report.

CASE: A 14-year-old girl presented with painful high-arched feet and unusual, asymptomatic, bilateral macrodactyly of the halluces. After a year of observation, a surgical reduction was performed because of the psychological effect that the abnormality had on the patient. Bilateral shortening osteotomies of the metatarsal and the proximal phalangeal bones were performed. At 2 months after surgery, complete bone healing and alignment had been achieved. At the 5-year follow-up, we noted fully functional big toes, plantigrade feet, bilateral proper toe formula, and extreme patient satisfaction with the cosmetic results. CONCLUSION: Dual osteotomies for toe shortening in a patient with bilateral nondysmorphic macrodactyly provided appropriate length reduction and satisfactory aesthetic and functional results.

Limitation of Knee Flexion by a Fibrotic Band of a Fifth Component of the Quadriceps Muscle in a Child: A Case Report.

CASE: We describe the case of a 3-year-old boy who presented with limited flexion in the left knee. High-resolution magnetic resonance imaging allowed visualization of a fibrotic muscle band in the anatomic position of the fifth component of the quadriceps muscle, which was confirmed by surgical findings. After surgical resection, the patient achieved full recovery of range of motion of the knee. CONCLUSION: To our knowledge, this is the first reported case of a fibrotic muscle band in the anatomic position of a previously described fifth accessory component of the quadriceps muscle that caused limited knee flexion in a child.

Eficacia del hierro aminoquelado en comparación con el sulfato ferroso como fortificante de un complemento alimentario en preescolares con deficiencia de hierro, Medellín, 2011 / Effectiveness of iron amino acid chelate versus ferrous sulfate as part of a food complement in preschool children with iron deficiency, Medellín, 2011

Introducción. La disminución de los depósitos de hierro constituye el primer eslabón de la cadena conducente a la deficiencia de hierro, la carencia nutricional más prevalente y principal causa de anemia en todo el mundo, situación que puede prevenirse mediante la fortificación de alimentos. Objetivo. Comparar la eficacia del hierro aminoquelado con el sulfato ferroso como fortificante de un complemento alimentario en preescolares con deficiencia de hierro. Materiales y métodos. Se llevó a cabo un ensayo clínico triple ciego con distribución aleatoria de grupos. Se analizaron 56 preescolares con deficiencia de hierro (ferritina menor de 24 ng/ml) a los que se les dio diariamente 13 g de leche con 12,5 mg de hierro,. Después de dos meses se midieron los niveles de hemoglobina, hematocrito y ferritina sérica. Resultados. En el grupo con sulfato ferroso la concentración de ferritina sérica aumentó de 18,8 a 24,1 ng/ml, mientras que dicha variación fue de 18,4 a 29,7 ng/ml con el hierro aminoquelado, en ambos casos con diferencias significativas. El nivel de ferritina final difirió según el grupo de estudio, siendo mayor en el grupo con hierro aminoquelado (p=0,022). La hemoglobina y el hematocrito no variaron después de la intervención. Las reacciones adversas en el grupo con sulfato ferroso fueron de 35,7 %, en contraste con el 42,9 % en el grupo con hierro aminoquelado; cinco niños presentaron infección de las vías respiratorias, sin diferencias estadísticas. Conclusiones. Los dos compuestos aumentan los niveles de ferritina, siendo mayor el aumento entre quienes toman leche con hierro aminoquelado. No fue diferente la incidencia de reacciones adversas o de infecciones entre los grupos.

Introduction: Iron depleted deposits are the first link in the chain of events leading to iron deficiency which is the most prevalent nutritional shortage and main cause of anemia worldwide. This situation can be prevented through food fortification. Objective: To compare the efficacy of amino acid chelate iron with ferrous sulfate as fortifier of a dietary complement in preschoolers with iron deficiency. Materials and methods: This study was a blinded clinical trial with randomized groups. We analyzed 56 preschoolers with iron deficiency (ferritin < 24 ng/ml) that received 13 g of milk with 12.5 mg of iron, either amino acid chelate or in the ferrous sulfate form. After two months, hemoglobin, hematocrit and serum ferritin concentrations were measured. Results: In the ferrous sulfate group, ferritin concentration increased from 18.8 ng/ml to 24.1 ng/ml, while the variation was of 18.4 ng/ml to 29.7 ng/ml in the amino acid chelate group, with statistically differences in both cases. Serum ferritin was different between groups, being higher in iron amino acid chelate group (p=0.022). Hemoglobin and hematocrit levels did not change after the intervention. Adverse reactions in the ferrous sulfate group were 35.7%, compared with 42.9% in the iron amino acid chelate group; 5 children had respiratory tract infection, without statistical differences. Conclusions: Both compounds increased serum ferritin concentration, with a higher increase in those who were given milk with iron amino acid chelate. There were no differences in the adverse reactions and infections incidences between the groups.

[Effectiveness of iron amino acid chelate versus ferrous sulfate as part of a food complement in preschool children with iron deficiency, Medellín, 2011]. / Eficacia del hierro aminoquelado en comparación con el sulfato ferroso como fortificante de un complemento alimentario en preescolares con deficiencia de hierro, Medellín, 2011.

INTRODUCTION: Iron depleted deposits are the first link in the chain of events leading to iron deficiency which is the most prevalent nutritional shortage and main cause of anemia worldwide. This situation can be prevented through food fortification. OBJECTIVE: To compare the efficacy of amino acid chelate iron with ferrous sulfate as fortifier of a dietary complement in preschoolers with iron deficiency. MATERIALS AND METHODS: This study was a blinded clinical trial with randomized groups. We analyzed 56 preschoolers with iron deficiency (ferritin < 24 ng/ml) that received 13 g of milk with 12.5 mg of iron, either amino acid chelate or in the ferrous sulfate form. After two months, hemoglobin, hematocrit and serum ferritin concentrations were measured. RESULTS: In the ferrous sulfate group, ferritin concentration increased from 18.8 ng/ml to 24.1 ng/ml, while the variation was of 18.4 ng/ml to 29.7 ng/ml in the amino acid chelate group, with statistically differences in both cases. Serum ferritin was different between groups, being higher in iron amino acid chelate group (p=0.022). Hemoglobin and hematocrit levels did not change after the intervention. Adverse reactions in the ferrous sulfate group were 35.7%, compared with 42.9% in the iron amino acid chelate group; 5 children had respiratory tract infection, without statistical differences. CONCLUSIONS: Both compounds increased serum ferritin concentration, with a higher increase in those who were given milk with iron amino acid chelate. There were no differences in the adverse reactions and infections incidences between the groups.

Evaluación de resultados de la osteotomía tipo Chevron con desplazamiento plantar para corrección de hallux valgus / Functional results of Chevron osteotomy with plantar displacement of the first metatarsal head for hallux valgus correction

Introducción: se describe una osteotomía tipo Chevron modificada para la corrección de hallux valgus adicionando el desplazamiento plantar de la osteotomía convencional. La motivación para llevar a cabo dicha modificación se basa en que la osteotomía de Chevron presenta grados variables de acortamiento del primer metatarsiano que pueden generar metatarsalgia por transferencia en pacientes con pie griego (index minus) en el cual el segundo metatarsiano es más largo. Materiales y métodos: se diseñó un estudio descriptivo prospectivo de los pacientes con diagnóstico de hallux valgus asociado a pie griego clínico o radiológico, metatarsalgia o callo plantar que fueron sometidos a cirugía de osteotomía tipo Chevron con desplazamiento plantar entre el 2008 y el 2010 en la Clínica del Campestre, Medellín. Todas las cirugías fueron realizadas por el mismo cirujano. En el posquirúrgico se evaluó la presencia y la intensidad del dolor, la persistencia del callo plantar y la presencia de arco transverso. Se usaron las escalas AOFAS y VASFA. Resultados: se evaluaron 27 cirugías, con una mediana de seguimiento de 5 meses (rango entre 1 y 18 meses). La mediana de edad de los pacientes fue 51 años (rango entre 31 y 68 años). La mayoría de los pacientes fueron de sexo femenino. En la evaluación prequirúrgica, 93% presentaban pie tipo griego clínico y 96% radiológico (index minus). El tipo de arco plantar transverso predominante fue el convexo en el 59% de los casos, cóncavo en el 22,5% y plano en el 18,5%. El 78% presentaban metatarsalgia; 85%, callo plantar, y 29%, deformidad del segundo dedo. La mediana de los ángulos IM y MTF fue 11° (rango entre 6° y 16°) y 27,5° (rango entre 13° y 38°), respectivamente. En la evaluación posquirúrgica, 7 casos continuaban presentando metatarsalgia ocasional y 1 callo plantar. El 95% de los casos recuperaron o mantuvieron el arco transverso; el 86% no tenían limitación o ésta era mínima con el uso del calzado. En cuanto a la actividad, 80% no presentaban limitaciones de ningún tipo. Discusión: los resultados obtenidos en esta serie de pacientes muestran hallazgos positivos a corto plazo por la pérdida del callo plantar y la recuperación del arco transverso con mejoría de la sintomatología.

Fibrotic response of tissue remodeling in COPD.

Lung tissue remodeling in chronic obstructive pulmonary disease (COPD) involves diverse processes characterized by epithelial disruption, smooth muscle hypertrophy/hyperplasia, airway wall fibrosis, and alveolar destruction. According to the accepted current theory of COPD pathogenesis, tissue remodeling in COPD is predominantly a consequence of an imbalance between proteolytic and antiproteolytic activities. However, most of the studies carried out during the last few years have focused on mechanisms related to degradation of extracellular matrix (ECM) structural proteins, neglecting those involved in ECM protein deposition. This review revisits some of the latest findings related to fibrotic changes that occur in the airway wall of COPD patients, as well as the main cellular phenotypes relevant to these processes.

Técnica de luxación quirúrgica de la cadera para el deslizamiento epifisario femoral proximal: resultado radiológico posquirúrgico inmediato / Surgical dislocation of the hip for slipped capital femoral. Immediate postsurgery radiologic results

Introducción: el deslizamiento epifisario femoral (DEF) ocurre usualmente en el adolescente, predominantemente en hombres. Se caracteriza por pérdida de la relación de la epífisis femoral con su cuello generando un cuadro clínico de dolor en la región inguinal o en la rodilla, asociado a acortamiento con rotación externa del miembro afetado. El tratamiento quirúrgico busca la reducción anatómica y estable de la cabeza femoral, así como la disminución del riesgo de necrosis avascular de la cabeza femoral, reducción incompleta de la epífisis femoral y artrosis de la cadera. Materiales y métodos: se describe la técnica quirúrgica y los resultados radiológicos posquirúrgicos inmediatos de 5 casos de pacientes con DEF operados por el mismo cirujano ortopedista infantil mediante luxación quirúrgica de la cadera y reducción abierta anatómica. Resultados: se evaluaron cuatro hombres y una mujer con edad promedio de 14,2 y 2,6 años, diagnosticados con DEF moderada a severa según la clasificación radiológica. De acuerdo al criterio clínico 2 pacientes presentaron DEF moderada a crónico. La cadera derecha se encontraba afectada en 3 pacientes . En la evaluación radiológica, todos los pacientes presentaron reducción anatómica de la epífisis femoral. Discusión: el seguimiento de largo plazo en este grupo de pacientes es mandatorio, pero de acuerdo a los resultados rediológicos posquirúrgicos inmediatos aquí reportados y el cuidado en la preservación de la vascularización esta técnica podría ser una alternativa para el tratamiento de DEF dado que restituye la anatomía y protege el aporte vascular a la epífisis.

Age-related morphological changes in smooth muscle and collagen content in human corpus cavernosum.

INTRODUCTION: Aging process has been related to erectile dysfunction (ED) possibly due to morphological changes in corpus cavernosum among many other causes. AIM: To evaluate smooth muscle and collagen content in human corpus cavernosum and to correlate it to age. METHODS: Cadaveric human cavernosal tissue was collected during the period of 1 year. Morphological analysis of a whole corpus cavernosum was performed in tissue sections stained with Masson's trichromic method to differentiate smooth muscle (red) from collagen (blue) content. MAIN OUTCOME MEASURES: Analysis was performed with specialized micrographs image analysis software. Pearson's correlation test was used to establish correlation between corpus cavernosum morphology (smooth muscle and collagen content) and age. RESULTS: A total sample of 89 tissues from different male cadavers were analyzed. The average age of the sample was 49.2 ± 19.1 years, with a range between 14 and 90 years. There was a statistically significant inverse correlation between age and the percentage of smooth muscle content (P = 0.012), direct correlation between age and percentage of collagen content (P = 0.019), and inverse correlation between age and the ratio of smooth muscle : collagen content (P = 0.007). CONCLUSIONS: Age-related morphological changes in terms of smooth muscle and collagen content are observed in human corpus cavernosum as a possible contributing factor to the development of ED.

Association of severe malaria with ABO-blood group types in an endemic zone of Colombia / Asociación de malaria severa con tipo de grupo sanguíneo ABO en una zona endémica de Colombia

Introduction: malaria is considered one of the most important tropical illnesses in public health causing millions of infections and deaths each year. Many studies have tried to establish an association between the severe form of the disease and the ABO-blood group type. In Colombia, a country with large endemic zones for malaria there are not enough studies or statistic data about this possible association. Methods: a retrospective case-control study of patients with severe and uncomplicated malaria in the endemic zone of Apartadó, Colombia, was performed between January 2000 and June 2006. Only the clinical records with blood group ABO and Rh classification were included. Results: a total sample of 92 patients was obtained: 49 with severe malaria and 43 with uncomplicated malaria. From the total sample, 68.5% were women and the median age of 21.5 years (min 1-max 80). Of the patients with diagnosis of severe malaria, 59.2% were women. The more frequent parasite species was Plasmodium falciparum. Severe malaria was more frequent among patients classified with blood group O (65.3%) and positive Rh (93.9%), but this association was not statistically significant. Conclusion: even though severe malaria was more frequent among patients classified with blood group O and positive Rh, an association between blood group and severe malaria could not be established. The controversial association of these variables previously found in other populations could be probably explained by the demographic distribution and characteristics of those.

Introducción: la malaria es considerada una de las más importantes enfermedades tropicales en salud pública, causando millones de infecciones y muertes cada año. Muchos estudios han tratado de establecer una asociación entre la forma grave de la enfermedad y la clasificación sanguínea ABO. En Colombia, un país con grandes zonas endémicas de malaria, no existen suficientes estudios y datos estadísticos acerca de esta posible asociación. Métodos: se realizó un estudio de casos y controles de pacientes con malaria severa y no complicada en la zona endémica de Apartadó, Colombia y ejecutado entre enero de 2000 y junio de 2006. Sólo las historias clínicas con información acerca de la clasificación sanguínea ABO o Rh fueron incluidas. Resultados: la muestra total fue de 92 pacientes, 49 con malaria grave y 43 con malaria no complicada. De la muestra total, 68,5% eran mujeres y la edad media de 21,5 años (mínimo1-máximo 80). De los pacientes con diagnóstico de malaria grave, 59,2 % eran mujeres. El parásito más frecuente fue la especie de P. falciparum. La malaria grave fue mas frecuente entre los pacientes clasificados con grupo sanguíneo O (65,3%) y Rh positivo (93,9%), pero esta asociación no fue estadísticamente significativa. Conclusión: aunque la malaria severa fue mas frecuente en pacientes con grupo sanguíneo O y Rh positivo, una asociación entre la severidad de la malaria y la clasificación sanguínea no pudo ser establecida. La controvertida asociación entre estas variables previamente encontrada en otras poblaciones, probablemente puede ser explicada por la distribución y características demográficas de dichas poblaciones.

Early clinical and radiological outcomes after double osteotomy in patients with late presentation Legg-Calvé-Perthes disease.

PURPOSE: Legg-Calvé-Perthes disease is an idiopathic avascular necrosis of the femoral head. Although many surgical approaches to treat the late presentation of this pathology have been proposed, there are few reports about the early results of the double osteotomy procedure (femoral varus osteotomy combined with Salter innominate osteotomy). The purpose of this study was to describe the early results obtained with the double osteotomy in patients with late presentation of Legg-Calvé-Perthes disease. METHODS: Cross-sectional evaluation of ten patients intervened with double osteotomy. There were seven males and three females with a mean age of 9.2 +/- 1.7 years [standard deviation (SD)]. The average post-surgical time of evaluation was of 46.5 +/- 26.2 months. RESULTS: Of the ten evaluated patients, four had a Catterall III and six had a Catterall IV disease. According to Herring classification, three patients were Herring B and seven were Herring C. The epiphyseal extrusion average before and after the surgical procedure was 19.3 +/- 12.4 and 12.1 +/- 14.9%, respectively. In accordance with the Ratliff classification and Lloyd Roberts radiological results, the following were the postoperative clinical results: four good, five fair and one poor. Based on the Stulberg classification, there was one patient in class I, five in class II, three in class III and one in class IV. CONCLUSION: The surgical treatment for late Perthes disease with the best expected outcome is still a challenge. According to the resultsreported here, the double osteotomy could be considered as an alternative to treat this entity.