Case report: Disease phenotype associated with simultaneous biallelic mutations in ABCA4 and USH2A due to uniparental disomy of chromosome 1.

Inherited retinal diseases (IRDs) represent a spectrum of clinically and genetically heterogeneous disorders. Our study describes an IRD patient carrying ABCA4 and USH2A pathogenic biallelic mutations as a result of paternal uniparental disomy (UPD) in chromosome 1. The proband is a 9-year-old girl born from non-consanguineous parents. Both parents were asymptomatic and denied family history of ocular disease. Clinical history and ophthalmologic examination of the proband were consistent with Stargardt disease. Whispered voice testing disclosed moderate hearing loss. Next-generation sequencing and Sanger sequencing identified pathogenic variants in ABCA4 (c.4926C>G and c.5044_5058del) and USH2A (c.2276G>T). All variants were present homozygously in DNA from the proband and heterozygously in DNA from the father. No variants were found in maternal DNA. Further analysis of single nucleotide polymorphisms confirmed paternal UPD of chromosome 1. This is the first known patient with confirmed UPD for two recessively mutated IRD genes. Our study expands on the genetic heterogeneity of IRDs and highlights the importance of UPD as a mechanism of autosomal recessive disease in non-consanguineous parents. Moreover, a long-term follow-up is essential for the identification of retinal features that may develop as a result of USH2A-related conditions.

[Distal biceps brachii rupture in a patient with COVID-19]. / Ruptura de bíceps braquial distal en paciente con COVID-19.

INTRODUCTION: distal biceps tendon injury commonly occurs in male patients between the fifth and sixth decade of life. The mechanism of the injury is an eccentric contraction with the elbow in flexion of 90 degrees. For its surgical treatment, several options have been described in the literature with different approaches, type of suture to be used and various methods of fixing the repair of the distal biceps tendon. The musculoskeletal clinical manifestations of COVID-19 are fatigue, myalgia, arthralgia, but the musculoskeletal effects of COVID-19 remain unclear. CASE REPORT: 46-year-old COVID-19 positive male patient with acute distal biceps tendon injury and secondary to minimal trauma, with no other risk factors. The patient was treated surgically following orthopedic and safety guidelines for the patient and medical staff due to the COVID-19 pandemic. The surgical procedure of the double tension slide (DTS) technique with a single incision in a reliable option and our case of a low morbidity, few complications and a good cosmetic option. CONCLUSION: the management of orthopedic pathologies in COVID-19 positive patients is increasing as well as the ethical and orthopedic implications of the management of these injuries and/or the delay of their care during the pandemic.

INTRODUCCIÓN: la lesión del tendón distal del bíceps se presenta comúnmente en pacientes masculinos entre la quinta y sexta década de la vida. El mecanismo de la lesión es una contracción excéntrica con el codo en flexión de 90o. Para su tratamiento quirúrgico, en la literatura se describen varias opciones con diferentes abordajes, tipo de sutura a utilizar y diversos métodos de fijación de la reparación del tendón distal de bíceps. Las manifestaciones clínicas musculoesqueléticas del COVID-19 son fatiga, mialgia, artralgia, pero los efectos musculoesqueléticos del COVID-19 continúan siendo poco claros. CASO CLÍNICO: paciente masculino de 46 años, COVID-19 positivo, con una lesión aguda del tendón distal del bíceps y secundaria a un trauma mínimo, sin otros factores de riesgo. El paciente fue tratado quirúrgicamente siguiendo las guías ortopédicas y de seguridad para el paciente y el personal médico debido a la pandemia COVID-19. El procedimiento quirúrgico de la técnica de double tension slide (DTS) con una sola incisión es una opción confiable y en nuestro caso de una baja morbilidad, con pocas complicaciones y una buena opción cosmética. CONCLUSIÓN: el manejo de patologías ortopédicas en pacientes COVID-19 positivos va en aumento, así como las implicaciones éticas y ortopédicas del manejo de estas lesiones y/o el retraso de su atención durante la pandemia.

Quantification of multi-oocyte follicles in ovaries of bitches / [Quantificação de folículos multiócitos em ovários de cadelas]

The objective of this study was to quantify the number and frequency of monocyte (MnOF) and multi-oocyte (MtOF) follicles in ovaries of bitches subjected to ovary salpingohysterectomy (OSH). Right and left ovaries of 38 bitches were collected after OSH, prepared, and a histological analysis was carried out. The ovaries were subjected to surface and deep histological cuts; the follicles were classified, and the number of follicles and cumulus oophorus complexes (COC) per follicle were quantified for each histological cut. MnOF and MtOF were found in all ovaries, at different developmental stages; primary follicles were grouped in the ovarian cortex, and follicles at other follicular stages presented a random distribution. MtOF containing two, three, four, or more COC were found in the ovaries of bitches, with a decreasing frequency trend, according to the number of COC in the MtOF. The effect of the age, number of estrus, estrus interval, and number of progenies per delivery was not significant for the number and frequency of MtOF in the ovaries of the bitches, whereas the size, number of pregnancies, use and number of contraceptive applications had some effect on the number and frequency of MtOF in the ovaries of the bitches.(AU)

Objetivou-se, com este estudo, quantificar o número e a frequência de folículos monocitários (MOF) e polioocitários (POF) provenientes de ovários de cadelas submetidas à ovariossalpingo-histerectomia (OSH). Para tanto, coletaram-se os ovários (direito e esquerdo) de 38 cadelas após OSH, com posterior preparação e análise histológica. Cada ovário foi submetido a dois cortes histológicos (superficial e profundo) onde se quantificou o número e a classificação dos folículos, bem como o número de complexos cumulus oophorus (COCs) por folículo em cada corte histológico. Observaram-se MOF e POF em todos os ovários estudados, em diferentes estádios de desenvolvimento, sendo os folículos primários agrupados no córtex ovariano, frente a uma distribuição aleatória dos outros estádios foliculares. FOPs contendo dois, três, quatro ou mais COCs foram observados nos ovários de todas as fêmeas estudadas, e sua frequência tendeu a diminuir de acordo com o número de COC presente no POF. Não se observou influência da idade, do número e do intervalo de estros, assim como do número de filhotes por gestação sobre o número/frequência de FOP nos ovários das cadelas estudadas, enquanto o porte, o número de gestações, o uso e o número de contraceptivo apresentaram algum grau de influência sobre o número/frequência de FOP nos ovários das cadelas estudadas.(AU)

[Hallux valgus mild and moderate; treatment by minimally invasive surgery and its follow-up to 2 years]. / Hallux valgus leve y moderado; tratamiento mediante cirugía de invasión mínima y su seguimiento a 2 años.

INTRODUCTION: The hallux valgus is a very frequent and complex orthopedic pathology. It involves the bone and soft tissue structures of the first toe. There are multiple techniques described for the alignment of the first toe. All technics aim to restore the normal angulation of the toe while using a stable osteotomy through a painless surgical procedure. The minimal invasive techniques have been growing in acceptance since the year 2000, as a viable surgical alternative to treat this pathology. MATERIAL AND METHODS: We included patients with a diagnostic of mild or moderate hallux valgus on whom a minimal invasive procedure was performed to correct the deformity of the first toe. We performed a distal Reverdin/Isham osteotomy on the first metatarsal and an akin osteotomy in the proximal phalanx, a lateral capsular release and a abductor tenotomy. These patients were followed for 24 months after their surgery. RESULTS: Our patients had an adequate correction angular correction, for a distal osteotomy. They had a good pain control, with an adequate mobility in the postoperative period. The patients presented an adequate personal satisfaction, 87% of them had good results. We found an important and statistically significant improvement in the Kitaoka scale. CONCLUSION: The minimal invasive technics for the correction of mild or moderated hallux valgus are a good alternative. Our patients are satisfied with the functional, and cosmetic results.

INTRODUCCIÓN: El hallux valgus es una de las patologías más frecuentes y complejas en la ortopedia. Afecta a los tejidos blandos y óseos del primer dedo. Se encuentran descritas múltiples técnicas para su corrección, todas con un último fin: lograr restaurar el ángulo fisiológico del primer dedo mediante una osteotomía estable y con el menor dolor postquirúrgico posible. Las técnicas de invasión mínima han venido ganando adeptos desde los años 2000 como una alternativa para el tratamiento de esta patología. MATERIAL Y MÉTODOS: Se incluyeron pacientes con diagnóstico de hallux valgus leve o moderado en los que se realizó un procedimiento mínimamente invasivo para corregir la deformidad del primer dedo del pie. Se realizó una osteotomía distal de Reverdin/Isham en el primer metatarsiano y una osteotomía de Akin en la falange proximal, una liberación capsular lateral y una tenotomía abductora. Estos casos fueron seguidos durante 24 meses después de su cirugía. RESULTADO: Nuestros pacientes presentaron una adecuada corrección de la sintomatología dolorosa, retorno a la movilidad articular prequirúrgica y una adecuada satisfacción personal con 87.3% de buenos resultados. Encontramos una mejoría importante en la escala de Kitaoka. Tenemos una adecuada corrección angular para una osteotomía distal. CONCLUSIONES: Las técnicas de invasión mínima para la corrección de hallux valgus moderado y leve son una adecuada herramienta. Nuestros pacientes se encuentran satisfechos con los resultados estéticos y funcionales.

[Identification by images of the patient with diabetic foot of the type of injuries that required or will require amputation]. / Identificación por imágenes del paciente con pie diabético del tipo de lesiones que requirieron o requerirán amputación.

INTRODUCTION: Diabetes is a chronic-degenerative disease that develops after pancreatic dysfunction. An estimated 422 million people in the world are currently diagnosed with diabetes. One of its most common complications is diabetic foot. It is estimated that about 15% of diabetic patients will have lower extremities ulcers. MATERIAL AND METHODS: It is an observational, descriptive, prospective and cross-sectional study. It aims to know what the initial injuries that triggered an amputation in a complicated diabetic foot. Patients were presented with clinical photographs with images typical of pathologies for recognition. RESULTS: A total of 50 patients were included between January 2017 and July 2019. Of these 78% (38) patients were male, 22% (11) female. 22 patients (44%) recognized as the onset of diabetic foot an ulcer, 13 with blisters (26%), 10 with hyperkeratosis (20%), 5 with hammer toes (10%). CONCLUSIONS: 96% of patients were able to identify at least one injury as a predisposing factor for the onset of their complicated diabetic foot. The presentation of clinical photographs proved to be a patient-accepted tool. By identifying their initial injury we can determine which injury and where, where, it gave rise to the complication that led them to amputation. This information can help to perform preventive measures to limit amputations in the pelvic limbs of diabetic patients.

INTRODUCCIÓN: La diabetes es una enfermedad crónico degenerativa que se desarrolla posterior a una disfunción del páncreas. Se estima que actualmente hay 422 millones de personas en el mundo que cuentan con el diagnóstico de diabetes. Una de sus complicaciones más frecuentes es el pie diabético. Se estima que alrededor de 15% de los pacientes diabéticos tendrán úlceras en las extremidades inferiores. MATERIAL Y MÉTODOS: Es un estudio observacional, descriptivo, prospectivo y transversal. Su objetivo es conocer cuáles son las lesiones iniciales que desencadenaron una amputación en un pie diabético complicado. A los pacientes se les mostraron fotografías clínicas con las imágenes típicas de las patologías para su reconocimiento. RESULTADOS: Se incluyó un total de 50 pacientes entre Enero de 2017 y Julio de 2019. De éstos, 78% (38) pacientes fueron masculinos, 22% (11) femeninos. 22 pacientes (44%) reconocieron el inicio del pie diabético con una úlcera, 13 con flictenas (26%), 10 con hiperqueratosis (20%), cinco con dedos en martillo (10%). CONCLUSIONES: 96% de los pacientes lograron identificar al menos una lesión como factor predisponente para la aparición de pie diabético complicado. La presentación de fotografías clínicas resultó ser una herramienta aceptada por los pacientes. Mediante la identificación de su lesión inicial podemos determinar qué lesión y en qué sitio dio origen a la complicación que los llevó a la amputación. Esta información puede contribuir a tomar medidas preventivas para limitar las amputaciones en los miembros pélvicos de los pacientes diabéticos.

[Anterior ankle impingement: follow-up in 52 cases]. / Pinzamiento anterior de tobillo: seguimiento de la evolución en 52 casos.

INTRODUCTION: The anterior ankle impingement is a common pathology. It is mostly seen in athletes. Pain in the anterior portion of the ankle and limitation in the ankle's dorsiflexion are the most common symptoms. These lesions are commonly preceded by an inversion movement most commonly during soccer. MATERIAL AND METHODS: This is a observational, descriptive, prospective and longitudinal study of 52 consecutive patients with anterior ankle impingement in whom an anterior ankle arthroscopy was perform. The objective is to know the clinical follow-up at least one year. We evaluated numeric pain scale, functional outcomes and personal satisfaction. RESULTS: Of the 52 patients, we had 36 males, and 16 females. Pain scale moved from 5.75 to 0.98 points. The AOFAS scale moved from 73.65 preoperative to 92.98 postoperatively the SFMCP scale went form 72.44 preoperative to 94.48 postop. 23 patients (44.23%) returned to there previous level of sport with in four to seven months form the intervention. CONCLUSIONS: Arthroscopic treatment of the anterior ankle impingement showed significant improvement to 12 months of follow-up. The return to sports activity at the same level prior to the injury was four to seven months.

INTRODUCCIÓN: El pinzamiento anterior de tobillo es una patología común. Se presenta con mayor frecuencia en deportistas, se caracteriza por dolor en la cara anterior acompañado de limitación funcional al realizar la dorsiflexión del tobillo. Se ha observado que la mayor parte de estas lesiones son generadas por un movimiento de inversión repetida y el deporte que más se ve involucrado es el fútbol. MATERIAL Y MÉTODOS: Se trata de un estudio con diseño observacional, descriptivo, prospectivo y longitudinal de 52 pacientes consecutivos con síntomas de pinzamiento anterior de tobillo a quienes se les realizó tratamiento quirúrgico artroscópico. Su objetivo es conocer la evolución clínica con un año de seguimiento mínimo, se evaluaron variables de EVA del dolor, escalas funcionales y nivel de satisfacción personal. RESULTADOS: Contamos con 52 pacientes, 36 pacientes masculinos y 16 femeninos. La valoración del dolor con EVA 5.75 pasó a 0.98; la valoración funcional mediante una escala AOFAS preoperatoria 73.65 puntos aumentó a 92.98 puntos y la escala SFMCP preoperatoria de 72.44 puntos subió a 95.48 puntos y 23 pacientes (44.23%) regresaron a realizar al mismo nivel previo a la lesión actividad deportiva dentro de cuatro a siete meses posteriores a la cirugía. CONCLUSIONES: El tratamiento artroscópico del pinzamiento anterior de tobillo mostró mejoría significativa a 12 meses de seguimiento. La reincorporación a la actividad deportiva al mismo nivel previo a la lesión fue de cuatro a siete meses.

Effect of the degree of oxidation of graphene oxide on As(III) adsorption.

The study of the interaction between graphene oxide (GO) and arsenic is of great relevance not only in the design of adsorbent materials to remove this contaminant but also in the understanding of its combined nanotoxicity. In this work, we show that As(III) adsorption, primarily H3AsO3, by graphene oxide is affected by its degree of oxidation. Three types of GO with C/O ratios between 1.35 and 1.98 were produced, resulting in important variations in the concentration of COH and COC functional groups. The less oxidized material reached a maximum As(III) adsorption capacity of 123 mg/g, whereas the GO with the highest degree of oxidation reached a value of 288 mg/g at pH 7, the highest reported in the literature. We also show that sulfates and carbonates present in water strongly inhibit As(III) adsorption. The interaction between graphene oxide and As(III) was also studied by Density Functional Theory (DFT) computer models showing that graphene oxide interacts with As(III) primarily through hydrogen bonds, having interaction energies with the hydroxyl and epoxide groups of 1508.6 and 1583.6 kJ/mol, respectively. Finally, cytotoxicity tests showed that the graphene oxide maintained cellular viability of 57% with 50 µg/ml, regardless of its degree of oxidation.

18F-FDG PET/CT in staging and delineation of radiotherapy volume for head and neck cancer. / 18F-FDG PET/TC para la estadificación y la delineación del volumen de radioterapia en el cáncer de cabeza y cuello.

PURPOSE: The aim is to investigate the use of 18F-FDG (fluorine-18 fluorodeoxyglucose) PET/CT in head and neck cancer (HNC) staging and its effect on the therapeutic strategy and radiotherapy (RT) planning. METHODS AND MATERIALS: One hundred patients with HNC were included. Primary tumor sites: 18% oral cavity, 20% oropharynx, 12% hypopharynx, 11% nasopharynx, 37% larynx, 2% paranasal sinuses. Patients were staged according to the American Joint Committee of Cancer 7th edition. Stage: 5% stage I, 7% stage II, 14% stage III, 61% stage IVA, 7% stage IVB and 6% stage IVC. A contrast-enhanced CT and a 18F-FDG PET/CT acquired under RT position were performed. Both exams were compared to analyze patients' staging reclassification. Changes in therapeutic strategy were analyzed. RESULTS: 18F-FDG PET/CT detected 6 distant metastases and treatment intention changed to palliative. Eight synchronous tumors were detected; one received palliative treatment. 18F-FDG PET/CT reclassified cTNM staging in 27patients. Tumor extension changed in 28 (14% up-staged; 14% down-staged), implying a change in GTV (Gross Tumor Volume) delineation. Nodal detection was reclassified in 47 patients: 8 patients down-staged (N2C to N2A/N2B/N1) and 2 were false positive. Nineteen patients were false negatives and 5 staged as N+(N1/N2A/N2B) turned out into N2C. These staging modifications imply adapting the nodal volume to be irradiated. CONCLUSIONS: 18F-FDG PET/CT reclassification was higher than 10% in almost all categories studied (cTNM, tumor extension and nodal disease) and detects more metastases and synchronous tumors than conventional studies, which has an impact on the therapeutic patient management and RT planning.

[Endoscopic treatment for the posterior impingement of the ankle]. / Tratamiento endoscópico del pinzamiento posterior del tobillo.

BACKGROUND: Chronic pain on the posterior portion of the ankle is often due to posterior impingement between bony or soft tissue structures. The presence of an os trigonum or a prominent posterior apophysis of the talus can produce this impingement. The purpose of this study was to assess the outcome of hindfoot endoscopy in patients with a diagnosis of posterior ankle impingement. MATERIAL AND METHODS: We studied 24 individuals who underwent a posterior ankle endoscopic procedure during the period between 2008 and 2012, with the diagnosis of posterior ankle impingement. We analyzed variables such as: sport, level of sports activity according to the CLAS classification, return to sport. All patients were classified in accordance to the AOFAS and SFMCP (Société Française de Médecine et Chirurgie du Pied) scores for ankle pathology. We measured patient satisfaction to the procedure with the Linkert scale. RESULTS: The average follow-up was 27.13 ± 5.26 months. The average age of our patients was 31.8 ± 5.26 years. We had 19 male (79.2%) and five female (20.8%) patients. The average preoperative Visual Analog Scale of pain (VAS) 5.75 and postoperative was 0.95. The average preoperative AOFAS scale of 76.22 ± 5.29 rose to 97.21 ± 1.96. The average preoperative SFCMP scale of 77.16 ± 3.53 became 98.54 ± 1.38. Our patients had their ankles immobilized for an average of 19.75 ± 2.48 days. They returned to their sports activities at an average of 4.6 (± 1.27) months. Our patients rated their personal satisfaction as very satisfied in 16 cases (66.7%), satisfied in seven cases (29.2%), regular satisfaction in one case (4.2%). One patient developed a complex regional pain syndrome that was resolved with physical therapy and another had a wound erythema. CONCLUSION: The posterior ankle impingement is a pathology which diagnosis is mainly clinical, it is greatly associated with an os trigonum or a large Stieda process. It has a strong repercussion in the sports activities of the patients. The arthroscopic treatment is an ideal option for this pathology as it presents a good postoperative recovery with a swift return to patients preoperative sports activities.

ANTECEDENTES: El dolor crónico de la región posterior del tobillo es generalmente debido a un conflicto entre estructuras capsuloligamentares y óseas. La presencia del os trigonum o una apófisis posterior del astrágalo pronunciada puede ocasionar por sí sola este pinzamiento. El propósito de este estudio es mostrar los resultados de la endoscopía del retropié por un pinzamiento posterior del tobillo. MATERIAL Y MÉTODOS: Veinticuatro pacientes con diagnóstico de síndrome de pinzamiento posterior del tobillo fueron operados mediante técnica artroscópica posterior en el período comprendido entre 2008 y 2012. Se analizaron como variables el tipo de deporte, nivel deportivo según clasificación CLAS y retorno a la actividad deportiva. Fueron valorados según la EVA del dolor y las escalas AOFAS, SFMCP (Société Française de Médecine et Chirurgie du Pied) para el tobillo, y se evaluó la satisfacción personal con escala de Likert. RESULTADOS: El seguimiento promedio fue de 27.13 ± 5.26 meses, con edad promedio de 31.8 ± 5.26 años; 19 fueron masculinos (79.2%) y cinco femeninos (20.8%). La valoración del dolor con EVA 5.75 pasó a 0.95; la valoración funcional mediante una escala AOFAS preoperatoria 76.22 ± 5.29 puntos aumentó a 97.21 ± 1.96 puntos y la escala SFMCP preoperatoria 77.16 ± 3.53 puntos subió a 98.54 ± 1.38 puntos. Se registró una inmovilización en promedio de 19.75 ± 2.48 días y un retorno a la actividad deportiva en promedio de 4.6 meses (± 1.27), con 66.7% (16 individuos) muy satisfechos, 29.2% (siete) satisfechos y 4.2% (uno) regularmente satisfecho. Se encontró un caso (4.2%) de distrofia simpático refleja como complicación y otro con eritema en el portal endoscópico. CONCLUSIÓN: El conflicto posterior del tobillo es una patología cuyo diagnóstico es clínico y está muy relacionado con la presencia de un os trigonum o un proceso de Stieda grande, lo cual repercute con la actividad deportiva. El tratamiento artroscópico es una opción ideal para dicha patología por la adecuada evolución clínica y estética, así como un pronto retorno a una actividad deportiva.

Claudin-6 enhances cell invasiveness through claudin-1 in AGS human adenocarcinoma gastric cancer cells.

Claudins participate in tissue barrier function. The loss of this barrier is associated to metalloproteases-related extracellular matrix and basal membranes degradation. Claudin-1 is a pro-MMP-2 activator and claudin-6 transfected AGS (AGS-Cld6) cells are highly invasive. Our aim was to determine if claudin-6 was direct or indirectly associated with MMP-2 activation and cell invasiveness. Cytofluorometry, cell fractioning, immunoprecipitation, gelatin-zymography, cell migration and invasiveness assays were performed, claudin-2, -6, -7 and -9 transfected AGS cells, anti-MMP-2, -9 and -14, anti-claudins specific antibodies and claudin-1 small interfering RNA were used. The results showed a significant (p<0.001) overexpression of claudin-1 in AGS-Cld6 cell membranes. A strong MMP-2 activity was identified in culture supernatants of AGS-Cld6. Claudin-1 co-localized with MMP-2 and MMP-14; interestingly a significant increase in cell membrane and cytosol MMP-14 expression was detected in AGS-Cld6 cells (p<0.05). Silencing of claudin-1 in AGS-Cld6 cells showed a 60% MMP-2 activity decrease in culture supernatants and a significant decrease (p<0.05) in cell migration and invasiveness. Our results suggest that claudin-6 induces MMP-2 activation through claudin-1 membrane expression, which in turn promotes cell migration and invasiveness.

[Minimal invasive anterolateral ankle stabilization with a modified Hemi-Castaing technique]. / Estabilización anterolateral del tobillo por incisión mínima con técnica de Hemi-Castaing modificada.

BACKGROUND: The lesions to the lateral ligaments of the ankle are a common sports related injury. There are multiple surgical technics to address the problem all with a common goal: achieve a proper stability of the ankle. The improvements in the minimal invasive technics as well as those in the materials to fixate bone-tissue have also impacted the technics for lateral stabilization of the ankle. MATERIAL AND METHODS: We included all the patients with a diagnosis of lateral ankle instability which underwent surgery with a modify Hemi-Casting procedure with minimal invasive approach during the period between May 2004 and December 2007. We have an average follow-up of 30.3 months. RESULTS: Our patients presented a good outcome with an improvement in the Karlsson’s scale of 48.7 points (± 15.6) in the preoperative to 93.6 points (± 9.6) during follow-up. They returned to their sports activities after an average of 5.72 months (± 4.93). We used dynamic X-ray’s taken with the Telos system and achieved 81.9% of our patients presented an excellent and good personal satisfaction. CONCLUSIONS: The modifications to the Hemi-Castaing procedure to perform it with a minimal invasive technic are reproducible and provide us with another tool for the treatment of this pathology specially in the cases where there is no sufficient tissue to perform an anatomical repair.

ANTECEDENTES: Las lesiones de los ligamentos laterales del tobillo son comúnmente observadas en las actividades deportivas. Se encuentran descritas múltiples técnicas para su tratamiento, todas con un último fin: lograr una adecuada estabilidad del tobillo. Las técnicas de invasión mínima y los adelantos tecnológicos en los sistemas de fijación hueso-tendón han venido ganando adeptos en la última década y han impactado también las técnicas de estabilización del tobillo. MATERIAL Y MÉTODOS: Se incluyeron todos los pacientes con diagnóstico de inestabilidad lateral de tobillo que se intervinieron quirúrgicamente y se les realizó un procedimiento de Hemi-Castaing modificado con abordajes mínimos operados en el período de Mayo 2004 a Diciembre del 2007. Tenemos un seguimiento promedio de 30.3 meses. RESULTADOS: Nuestros pacientes presentaron una buena evolución, encontramos una mejoría importante en la escala de Karlsson de 48.7 puntos (± 15.6) a 93.6 puntos (± 9.6). Los pacientes regresaron a su actividad deportiva posterior a la cirugía a los 5.72 meses en promedio (± 4.93). Tenemos una adecuada estabilización corroborada con radiografías dinámicas con sistema Telos. Con una satisfacción personal excelente y buena en 81.9% de los pacientes. CONCLUSIONES: Las modificaciones a la técnica de Hemi-Castaing con el abordaje por incisión mínima, son seguras, reproducibles y nos dan una herramienta más para el tratamiento de esta patología y sobre todo en los casos en donde no se encuentre un adecuado tejido remanente para realizar una reparación anatómica.

[Evaluation of technical skills in surgical training]. / Evaluación objetiva de competencias técnicas en cirugía.

INTRODUCTION: technical skills acquisition is considered to be of paramount importance in surgical training. Yet, formal assessment of technical skills is the weakest and less developed area. Currently available resources to evaluate technical skills are largely subjective, and lack of validity and reliability. Direct observation, one of the most frequently used methods, is largely biased by interpersonal subjectivity and personality traits. We propose the creation and use of a new procedure-specific tool for objective assessment of technical skills in surgery to evaluate validity and reliability. MATERIALS AND METHODS: laparoscopic cholecystectomy and Lichstenstein's inguinal hernia repair were the chosen procedures. Three groups of comparison were defined according to surgical expertise: initial, intermediate, and experts. Surgeries were videorecorded in real time without identification of the patient or the surgeon. Tapes without any posterior edition were assigned to two expert surgeons in a blind and randomized sequence. A newly proposed procedure-specific rating scale was used for evaluation, as well as Reznick's OSATS global scale. Kruskal-Wallis non-parametric test was used to assess validity. p < 0,05 was considered statistically significant. Chronbach's? values> 0.8 granted reliability. RESULTS: from April 2010 to December 2012 36 laparoscopic cholecystectomies and 31 inguinal hernia repairs were recorded. Significant difference was found among groups of comparison for every item (p<0.05). Crhonbach's ? was largely over 0,80 for both procedures. There was no significant difference between the assessments of the two raters. There was no significant difference between our newly proposed procedure-specific instrument and Reznick's OSTATS. DISCUSSION: the objective assessment of technical skills in surgery is feasible and useful. The tool we proposed showed construct validity and reliability. Video recording of surgical procedures grants durability over time to an ephemeral phenomenon. The objectivity is based on the explicit statements and quantification of every step to be evaluated, and the blind randomization and anonymous treatment of the sample. Sharing the same quality criteria between evaluators is of paramount importance to reach satisfactory results. The process of evaluation always implies a shortened view of the reality.

Introducción: La adquisición de habilidades quirúrgicas constituye un factor central en la formación de todo cirujano. Sin embargo, la evaluación de las habilidades técnicas es uno de los factores más débiles y menos desarrollados. En la actualidad los recursos para evaluar las competencias técnicas adolecen de subjetividad, falta de confiabilidad y validez. La observación directa, método de evaluación más frecuentemente utilizado en nuestro medio, presenta inconvenientes instrumentales y está fuertemente influenciada por las relaciones intersubjetivas y los rasgos de personalidad. El objetivo de esta investigación es proponer creación y el uso de un instrumento objetivo para evaluar el desempeño técnico y determinar su confiabilidad y validez.Material y método: se seleccionaron dos procedimientos: colecistectomía laparoscópica y hernioplastia inguinal (técnica de Lichtenstein). Se constituyeron tres grupos de comparación según la experiencia quirúrgica: inicial, intermedio, y expertos. Se filmaron las cirugías en tiempo real, sin identificación del paciente ni del cirujano. Las filmaciones sin edición fueron asignadas a dos cirujanos expertos en forma aleatoria por sorteo y con sobres sin identificación. Para la evaluación se propuso el uso de un instrumento objetivo (explicitación de pasos a evaluar y cuantificación mediante escala de Likert) y específico para cada procedimiento. Así mismo se utilizó la escala global OSATS (R. Reznick). Se aplicó análisis de varianza no paramétrico para determinar validez. Valores de p menores a 0.05 fueron considerados estadísticamente significativos. Valores superiores a 0,80 del Coeficiente alfa de Cronbach aseguraron confiabilidad. Resultados: Desde Abril del 2010 hasta Diciembre del 2012 se filmaron 36 colecistectomías videolaparoscópicas y 31 hernioplastias inguinales. Se encontraron diferencias significativas entre los grupos en todos los ítems evaluados p<0.05. El coeficiente ? de Crohnbach fue mayor a 0,80 para ambas técnicas. No hubo diferencias significativas entre las calificaciones de ambos evaluadores. No hubo diferencias entre nuestro instrumento específico y la escala global OSATS. Discusión: Es posible y útil aplicar un instrumento objetivo de evaluación del desempeño técnico en cirugía. La herramienta presentó validez de constructo y confiabilidad aceptables. La filmación confiere perdurabilidad a un evento efímero: la cirugía. La objetividad se basa en la enunciación y cuantificación explícita de cada paso, y en la aleatorización y anonimato de la muestra. La uniformidad de criterios entre los evaluadores es fundamental para obtener resultados satisfactorios. Evaluarsiempreimplicaráunrecorte de la realidad.

[Posterior tibial tenoscopy. Case report]. / Tenoscopía tibial posterior. Reporte de un caso.

Posterior tibial tendinitis occurs commonly in patients involved in sports activities. It may result from either excessive use or sudden overload of the tendon. This tendinitis may also occur in patients with systemic inflammatory conditions and is classified as posterior tibial tendon dysfunction stage I. Initial treatment, which has produced good results, is based on immobilization and rehabilitation. In cases without clinical improvement or in which tendinitis is associated with partial tendon rupture, open techniques may be used to perform tenosynovectomy and tendon revisions to improve painful symptoms. With the advent of minimally invasive techniques broad tendon revisions may be done that cause minimal damage or they may be combined with traditional techniques in cases of partial rupture. This paper describes the clinical case of a 35 year-old female patient with posterior tibial pathology and chronic pain. She underwent posterior tibial tenoscopy and was followed-up postoperatively for 24 months. Endoscopic and/or tenoscopic treatment is a simple and reproducible technique. We obtained excellent functional and cosmetic results in this patient. We need larger case series of patients subjected to this treatment.

Evaluación objetiva de competencias técnicas en cirugía. / [Evaluation of technical skills in surgical training].

INTRODUCTION: technical skills acquisition is considered to be of paramount importance in surgical training. Yet, formal assessment of technical skills is the weakest and less developed area. Currently available resources to evaluate technical skills are largely subjective, and lack of validity and reliability. Direct observation, one of the most frequently used methods, is largely biased by interpersonal subjectivity and personality traits. We propose the creation and use of a new procedure-specific tool for objective assessment of technical skills in surgery to evaluate validity and reliability. MATERIALS AND METHODS: laparoscopic cholecystectomy and Lichstensteins inguinal hernia repair were the chosen procedures. Three groups of comparison were defined according to surgical expertise: initial, intermediate, and experts. Surgeries were videorecorded in real time without identification of the patient or the surgeon. Tapes without any posterior edition were assigned to two expert surgeons in a blind and randomized sequence. A newly proposed procedure-specific rating scale was used for evaluation, as well as Reznicks OSATS global scale. Kruskal-Wallis non-parametric test was used to assess validity. p < 0,05 was considered statistically significant. Chronbachs? values> 0.8 granted reliability. RESULTS: from April 2010 to December 2012 36 laparoscopic cholecystectomies and 31 inguinal hernia repairs were recorded. Significant difference was found among groups of comparison for every item (p<0.05). Crhonbachs ? was largely over 0,80 for both procedures. There was no significant difference between the assessments of the two raters. There was no significant difference between our newly proposed procedure-specific instrument and Reznicks OSTATS. DISCUSSION: the objective assessment of technical skills in surgery is feasible and useful. The tool we proposed showed construct validity and reliability. Video recording of surgical procedures grants durability over time to an ephemeral phenomenon. The objectivity is based on the explicit statements and quantification of every step to be evaluated, and the blind randomization and anonymous treatment of the sample. Sharing the same quality criteria between evaluators is of paramount importance to reach satisfactory results. The process of evaluation always implies a shortened view of the reality.

Evaluación objetiva de competencias técnicas en cirugía / [Evaluation of technical skills in surgical training].

INTRODUCTION: technical skills acquisition is considered to be of paramount importance in surgical training. Yet, formal assessment of technical skills is the weakest and less developed area. Currently available resources to evaluate technical skills are largely subjective, and lack of validity and reliability. Direct observation, one of the most frequently used methods, is largely biased by interpersonal subjectivity and personality traits. We propose the creation and use of a new procedure-specific tool for objective assessment of technical skills in surgery to evaluate validity and reliability. MATERIALS AND METHODS: laparoscopic cholecystectomy and Lichstenstein’s inguinal hernia repair were the chosen procedures. Three groups of comparison were defined according to surgical expertise: initial, intermediate, and experts. Surgeries were videorecorded in real time without identification of the patient or the surgeon. Tapes without any posterior edition were assigned to two expert surgeons in a blind and randomized sequence. A newly proposed procedure-specific rating scale was used for evaluation, as well as Reznick’s OSATS global scale. Kruskal-Wallis non-parametric test was used to assess validity. p 0.8 granted reliability. RESULTS: from April 2010 to December 2012 36 laparoscopic cholecystectomies and 31 inguinal hernia repairs were recorded. Significant difference was found among groups of comparison for every item (p<0.05). Crhonbach’s ? was largely over 0,80 for both procedures. There was no significant difference between the assessments of the two raters. There was no significant difference between our newly proposed procedure-specific instrument and Reznick’s OSTATS. DISCUSSION: the objective assessment of technical skills in surgery is feasible and useful. The tool we proposed showed construct validity and reliability. Video recording of surgical procedures grants durability over time to an ephemeral phenomenon. The objectivity is based on the explicit statements and quantification of every step to be evaluated, and the blind randomization and anonymous treatment of the sample. Sharing the same quality criteria between evaluators is of paramount importance to reach satisfactory results. The process of evaluation always implies a shortened view of the reality.