[Results of the treatment of irreparable rotator cuff ruptures with the use of the subacromial balloon]. / Resultados del tratamiento de roturas irreparables de manguito rotador con el uso del balón subacromial.

INTRODUCTION: arthroscopic surgical treatment of rotator cuff tendon injuries has replaced open surgery as the first treatment option. Different surgical techniques have been described for massive or irreparable ruptures, and recently, a new device that consists of a biodegradable subacromial spacer between the humeral head and the acromion has been used. The present study aims to analyse the results of this implant in our experience. MATERIAL AND METHODS: we conducted an observational and retrospective study of all patients undergoing subacromial spacer implantation at our centre from 2017 to 2019. Patients were assessed pre- and postoperatively using the Constant, DASH and VAS scales. RESULTS: a total of 43 patients met the inclusion criteria and the minimum follow-up of 24 months. The mean DASH scale score went from 53.6 at preoperative assessment to 27.9 at postoperative assessment (p = 0.026). There was also a significant improvement in the Constant scale from a mean of 37.9 to 61.8 (p = 0.037). In terms of pain assessment, the mean VAS went from a mean of 7.44 to 3.38 (p = 0.916). In 90% of patients no complications or need for further interventions were objectified. CONCLUSIONS: the subacromial balloon has shown favorable results in our series of patients, so it could be a valid treatment option in patients with non-repairable rotator cuff tears.

INTRODUCCIÓN: el tratamiento mediante cirugía artroscópica de las lesiones del manguito rotador ha desplazado a la cirugía abierta como primera opción de tratamiento. Existen diferentes técnicas quirúrgicas descritas para tratar las roturas masivas o no reparables. Desde hace unos años se viene utilizando un nuevo dispositivo que consiste en un balón subacromial biodegradable que actúa como espaciador entre la cabeza humeral y el acromion. Este trabajo pretende analizar los resultados de este implante. MATERIAL Y MÉTODOS: realizamos un estudio observacional y retrospectivo de todos los pacientes a los que se les implantó un balón subacromial en nuestro centro entre 2017 y 2019. Se evaluó a los pacientes pre y postoperatoriamente mediante las escalas de Constant, DASH y EVA. RESULTADOS: un total de 43 pacientes cumplieron los criterios de inclusión y el seguimiento mínimo de 24 meses. La puntuación media de la escala DASH pasó de 53.6 en la evaluación preoperatoria a 27.9 en la postoperatoria (p = 0.026). También se obtuvo una mejoría significativa en la escala de Constant, que pasó de una media de 37.9 a 61.8 (p = 0.037). En cuanto a la evaluación del dolor, la EVA media pasó de 7.44 a 3.38 (p = 0.916). En 90% de los pacientes no se objetivaron complicaciones ni necesidad de nuevas intervenciones. CONCLUSIONES: el balón subacromial ha mostrado resultados favorables en nuestra serie de pacientes, por lo que podría suponer una opción válida de tratamiento en pacientes con roturas no reparables del manguito rotador.

Cardiac hemodynamic profiles and pro-B-type natriuretic Peptide in cirrhotic patients undergoing liver transplantation.

BACKGROUND: The aim of our study was to determine concentrations of amino-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with cirrhosis, thereby describing the hemodynamic and cardiac profiles to verify the existence of cirrhotic cardiomyopathy. METHODS: Clinical data, NT-proBNP levels, echocardiography, and right heart hemodynamic measurements were performed on all patients undergoing liver transplantation for cirrhosis. RESULTS: Our patients showed a hyperdynamic circulation with elevated left-sided pressures despite high cardiac outputs. This observation suggested abnormalities in left ventricular diastolic compliance. We verified these results, because our cohort showed a significant left ventricular mass index and, consequently, diastolic dysfunction. Mean NT-proBNP levels were high. The great expansion of central volume may explain these results and the later development of left ventricular hypertrophy. CONCLUSION: We concluded that elevated concentrations of NT-proBNP indicated the presence of hyperdynamic syndrome and cardiac dysfunction.

N-terminal brain natriuretic peptide as a diagnostic test in cirrhotic patients with pulmonary arterial hypertension.

BACKGROUND: The aim of this study was to assessed the correlation of N-terminal natriuretic peptide type B (NT-proBNP) with echocardiographic and hemodynamic indexes of right ventricular (RV) function and to evaluate the sensitivity and specificity of Doppler echocardiography in the diagnosis of portopulmonary hypertension. METHODS: All patients underwent liver transplantation for cirrhosis. We obtained clinical data, NT-proBNP levels, echocardiography, and right heart hemodynamic measurements before transplantation. RESULTS: Patients with pulmonary hypertension displayed significantly higher levels of NT-proBNP. They also showed higher model for End-stage Liver Disease scores and higher indices of RV overload on cardiac hemodynamics. The negative predictive value of echocardiography to identify pulmonary hypertension was 83%. A correlation was not observed between systolic pulmonary artery pressures measured by the two methods; however, NTproBNP showed a trend toward a significant correlation with mean pulmonary pressure as determined by hemodynamics (r = .3; P < .01). CONCLUSION: We concluded that NT-proBNP values showed significant correlations with pulmonary hypertension that could assist in a noninvasive diagnoseis for this group of patients.

[Spinal cord compression by tumor with onset following epidural catheterization]. / Compresión medular neoplásica iniciada tras cateterización peridural.

We report the case of a 16-year-old boy with a pelvic tumor who developed signs of spinal cord compression following placement of a lumbar epidural catheter to obtain a percutaneous biopsy. The fact that a catheter had been inserted led us to suspect epidural hematoma as a complication, but surgery revealed that the pelvic tumor had spread to the lumbar epidural space and was causing motor blockade of both legs.

Compresión medular neoplásica iniciada tras cateterización peridural / Spinal cord compression by tumor with onset following epidural catheterization

Presentamos un caso clínico en el que un paciente de16 años portador de un tumor pélvico comienza a desarrollarclínica de compresión medular tras la colocaciónde un catéter epidural lumbar para la realización debiopsia percutánea diagnóstica. Este antecedente hizosospechar la producción de un hematoma epiduralcomo complicación de la introducción del catéter. Laintervención quirúrgica evidenció que el tumor pélvicose había extendido al espacio epidural lumbar siendo elcausante de la clínica de bloqueo motor de ambas extremidadesinferiores (AU)

We report the case of a 16-year-old boy with a pelvictumor who developed signs of spinal cord compressionfollowing placement of a lumbar epidural catheter toobtain a percutaneous biopsy. The fact that a catheterhad been inserted led us to suspect epidural hematomaas a complication, but surgery revealed that the pelvictumor had spread to the lumbar epidural space and wascausing motor blockade of both legs (AU)

De la Cartera de Servicios hacia la evaluación de la calidad asistencial en Atención Primaria / From a Catalogue of Services toward the evaluation of the quality of care in Primary Care

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No disponible

Efectos hemodinámicos de dos gases anestésicos distintos sobre las fases anhepática y de reperfusión del transplante hepático / Hemodynamic effects of two different anesthetic agents during anhepatic and reperfusion stages of liver transplantation

OBJETIVOS: La enfermedad hepática crónica en fases terminales se caracteriza por un estado hiperdinámico. Hemos analizado los efectos hemodinámicos del sevoflurano y desflurano durante las fases anhepática y de reperfusión del trasplante hepático. PACIENTES Y METODO: Estudiamos 58 pacientes sometidos a trasplante a los cuales se les administró como anestésico de mantenimiento sevoflurano o desflurane. Las determinaciones hemodinámicas fueron: basal (postinducción) (A), 5 minutos antes de pinzas la porta (B), 10 minutos después de pinzar la cava (C1), 5 minutos antes de revascularizar (C), 5 minutos tras revascularizar el injerto (D1) y a los 30 minutos de despinzar (D2). Los parámetros hemodinámicos analizados fueron los siguientes: frecuencia cardíaca (FC), presión arterial media (PAM), presión venosa central (PVC), presión de la arteria pulmonar media (PAPM), presión capilar pulmonar (PCP), gasto cardíaco (GC), índice cardíaco (IC), índices de resistencias vasculares sistémicas y pulmonares (IRVS, IRVP), transporte de oxígeno (DO2), consumo de oxígeno (VO2) y saturación en sangre venosa mixta (SVO2). RESULTADOS: La FC, PAM; PVC, PAPM, PCP, DO2 y SVO2 las diferencias no fueron significativas desde el punto de vista estadístico entre ambos gases anestésicos. El GC y el IC presentaron valores más altos en todo momento con el desflurano que con el sevoflurano, siendo las diferencias estadísticamente significativas (p < 0,05) en B. C2; D1. Los IRVS siguieron una tendencia descendente desde el comienzo de la intervención. En todo momento el sevoflurano mantuvo unos valores más elevados que el desflurano, siendo las diferencias muy significativas (p < 0,01) en B y C2, en D2 significativas (p < 0,05). Con respecto a los IRVP, con el sevoflurano se mantuvieron más elevados. cuyas diferencias fueron significativas (p < 0,05) en B. En el grupo del desflurano, el V02 tras revascularizar el injerto, tendió a elevarse y sus diferencias fueron significativas (p < 0,05) a los 5 minutos de la fase neohepática. CONCLUSIONES: En nuestra experiencia, el desflurano mantiene un GC y un IC con valores más elevados que el sevoflurano, antes de la fase anhepática que permanecen tras la revascularización del injerto. Ello puede ser la consecuencia de que los IRVS son menores con el desflurano, produciendo, por tanto, mayor vasodilatación periférica en la fase anhepática. Sin embargo, no existen variaciones entre ambos anestésicos respecto a la SVO2 lo que nos hace sospechar que con un buen manejo anestésico no existirían muchas diferencias prácticas entre los dos grupos (AU)

Kin recognition and the 'armpit effect': evidence of self-referent phenotype matching.

In species with multiple paternity or maternity, animals may best assess their relatedness to unfamiliar conspecifics by comparing their own phenotype(s) with those of unidentified individuals. Yet whether animals can recognize kin through self-matching is controversial. Because golden hamsters (Mesocricetus auratus) mate multiply and can produce multiply sired litters, they were tested for their ability to use self-matching for kin recognition. Hamsters that were reared only with non-kin since birth responded differentially to odours of unfamiliar relatives and non-relatives. Postnatal association with kin was not necessary for this discrimination. Prenatal learning was unlikely because of delayed production and perception of social odours. To our knowledge, this is the first demonstration that a vertebrate can use its own phenotype for kin-recognition purposes without prior experience with kin. By using itself as a referent, rather than its siblings or parents, a golden hamster may be better able to direct nepotism towards the most appropriate individuals. Kin discrimination via self-inspection may be especially important in nepotistic contexts (to identify most closely related conspecifics), whereas inclusion of the phenotypes of close kin as referents may be favoured in mate-choice contexts (to identify all related individuals).

Innovative new concepts in augmentative breast surgery.

The female breast is seen as a badge of feminine beauty in our society. While it can vary over time and with fashions, the perfect breast will always be symmetrically balanced and proportionate to the rest of the body. To create an aesthetic and symmetrically balanced breast using implants to enhance them is not an easy task. Surgery must combine the concepts of an ideal breast with the desires of the patient in terms of size. The satisfactory breast should remain soft, well positioned, and mobile to respond to gravity and postural changes. In attempting to construct an "ideal breast," certain basic aesthetic anatomical proportions should be taken into account: natural positioning of the breast in the thorax; symmetry; the position of the nipple-areola complex as the focal point of the breast in the frontal view; a side profile of the breast with a natural soft fall; and, overall, the position of the new inframammary crease in the standing position, while lying down, and while moving.

Early auditory experience and the ontogeny of alarm-call discrimination in Belding's ground squirrels (Spermophilus beldingi).

Because young ground squirrels are vulnerable to predation, selection would favor the early ability to respond to alarm calls. This requires discrimination of classes of alarm calls from each other as well as from non-alarm calls. Pre-emergent auditory experience may influence the development of discrimination. As a means of determining when Belding's ground squirrels (Spermophilus beldingi) can discriminate among calls, cardiac responses to alarm calls and control stimuli were recorded from 2 rearing groups that differed in the frequency of alarm-call exposure. Results suggest that before natal emergence, young can discriminate between 2 classes of alarm calls but they may not discriminate these calls from control stimuli. No differences in responses were found between the rearing groups; thus experience with calls may not influence the onset of discrimination. Early discrimination may facilitate the rapid development of post-emergent behavioral alarm-call responses.

[Minor surgery in the family physician's office. Description of one year's experience]. / Cirugía menor en la consulta del médico de familia. Descripción de un año de experiencia.

OBJECTIVE: To describe the first results from minor surgery (MS) performed by the family doctor (FD) and to analyse the concordance between presurgical diagnosis and anatomical pathology. DESIGN: Prospective study. SETTING: Health centre and hospital anatomical pathology service. PARTICIPANTS: Interventions over a year by 4 FD and 8 third-year family medicine interns. MEASUREMENTS AND MAIN RESULTS: Descriptive variables for all the interventions were analysed. There were: age and gender; place, size and diagnosis of the lesion; reason for the MS; type of intervention; waiting time; and histological findings. The prior diagnosis was compared with the anatomical pathology for simple agreement. There were 243 interventions. Complete data were obtained for 229 (124 female and 105 male, aged between 4 and 79). The most common reason for MS was aesthetic, followed by fear of malignity and pain. The techniques used most often were: surgical exeresis (56.3%) and cryotherapy (36.2%). Most problems treated were naevi (72 cases), verrucas (83) and epidemic-sebaceous cysts (23). All the substances extracted (140) were sent to Pathology and there was 84.1% agreement between the Laboratory report and doctor's diagnosis. Average waiting time for the intervention was 15 days. CONCLUSIONS: Performing MS in primary care is feasible, as long as the FD is correctly trained. In our unit there is little waiting time and high histopathologic concordance.

Sexual maturation in male prairie voles: effects of the social environment.

The effects of various social contexts on sexual maturation in captive male prairie voles were investigated. Sexual maturity was assessed as the ability of a young male to produce urine capable of activating a diestrous adult female into estrus, as females remain anestrus until they ingest a male urinary chemosignal. In five experiments the postweaning social environments of developing males were manipulated (e.g., presence or absence of dam, sire, or junior litter, exposure to unfamiliar adult voles, social isolation) to determine if the age at which males begin to produce potent urine was sensitive to social effects. In general, there was no difference in the age of potent urine production as a function of social environment. Findings are discussed in the context of dispersal, inbreeding avoidance, and mate acquisition.

Estudo clínico multicêntrico sobre o efeito metabólico do contraceptivo mensal injetável contendo acetofenido de dihidroxiprogesterona 150 mg + enantato de estradiol 10 mg / A multicenter clinical trial on the metabolic effect of an injectable monthly contraceptive containing dihydroxyprogesterone acetophenide 150 mg + estradiol enanthate 10 mg

O efeito metabólico do contraceptivo mensal injetável contendo acetofenido de dihidroxiprogesterona (DHPA) 150 mg + enantato de estradiol (Een) 10 mg foi comparado ao de outros métodos anticoncepcionais comumente utilizados (pílulas contendo: etinilestradiol (EEn) 0,050 mg + levonogestrel (LNG) 0,250 mg, EE 0,030 + LNG 0,150 mg; e EE 0,030/0,040/0,030mmg + LNG 0,050/0,075/0,0125 mg; enantato de noretisterona (NEE) 200 mg via i.m.; e métodos nao-hormonais. Foram determinados os triglicerídeos séricos, colesterol HDL/LDL, cobre, ceruloplasmina, cortisol total e livre, CBG e testosterona total e livre e SHBG de usu rios crônicas. Este estudo contou com a participaçäo do total de 237 mulheres. As usuárias de métodos nao-hormonais utilizadas como controle apresentaram níveis mais altos de triglicerídeos. Os níveis de testosterona total e livre foram mais baixos em mulheres que utilizavam DHPA 150 mg + Een 10 mg e nas que tomavam pílulas anticoncepcionais (p<0,05 - 0,01). Tais alteraçöes foram levemente menores no grupo que utilizou o injetável. Os efeitos do DHPA 150 mg + EEn 10 mg sobre o colesterol HDL/LDL, cobre, ceruloplasmina, CBG, cortisol total e livre e SHBG foram raros ou inexistentes. Entretanto, com as pílulas anticoncepcionais (mesmo as de formulaçäo de baixa dosagem) ocorreram alteraçöes em todas essas vari eis, que foram altamente significativas na comparaçäo com o método injetável (p< 0,01) e com os métodos nao-hormonais (p<0,01); näo houve diferenças entre estes dois últimos métodos. Os resultados sugerem que o efeito metabólico da injeçäo mensal i.m. de DHPA 150 mg + Een 10 mg näo é superior aos dos anticoncepcionais orais comumente utilizados. Estes resultados também nao sugerem que a dose contida nesse injetável seja excessiva. Nao há qualquer evidência de que ele produza efeito cumulativo no organismo. Esses achados devem ser levados em consideraçäo com relaçäo à segurança do uso a longo prazo desse injetável.

Multicentred clinical study of the metabolic effect of the monthly injectable contraceptive containing dihydroxyprogesterone acetophenide 150 mg + estradiol enanthate 10 mg.

The metabolic effect of the monthly injectable contraceptive containing dihydroxyprogesterone acetophenide (DHPA) 150 mg + estradiol enanthate (EEn) 10 mg was compared to that of other regularly used contraceptive methods (pills containing: ethinylestradiol (EE) 0.050 mg + levonorgestrel (LNG) 0.250 mg, EE 0.030 mg + LNG 0.150 mg; EE 0.030/0.040/0.030 mg + LNG 0.050/0.075/0.0125 mg; norethisterone enanthate (NEE) 200 mg i.m.; non-hormonal methods). Serum triglycerides, HDL/LDL-cholesterol, copper, ceruloplasmin, total and free cortisol, CBG, total and free testosterone and SHBG in chronic users were determined. A total of 237 women took part in this study. Taking users of non-hormonal methods as control, triglyceride levels were higher, and total and free testosterone levels were lower in women using DHPA 150 mg + EEn 10 mg and in those taking contraceptive pills (p less than 0.05 - 0.01). Such modifications were slightly less in the group using the injectable. The effects of DHPA 150 mg + EEn 10 mg on HDL/LDL-cholesterol copper, ceruloplasmin, CBG, total and free cortisol and SHBG were rare or non-existent. Nevertheless, the contraceptive pills (even the low-dose formulations) correlate with modifications of all those variables, which were highly significant in comparison with the injectable (p less than 0.01) and with non-hormonal methods (p less than 0.01); there were no differences between the last two methods. The results suggest that the metabolic effect of DHPA 150 mg + EEn 10 mg is not higher than that of the commonly used oral contraceptives. On the other hand, they do not suggest that the dose contained in this injectable is exaggerated. There is no evidence that it produces accumulation of effects in the organism. These findings should be taken into account when referring to the long-term safety of this injectable.