[Long-term analysis of minimally invasive surgery in knee arthroplasty]. / Análisis a largo plazo de la cirugía mínimamente invasiva en la artroplastía de rodilla.

BACKGROUND: Knee arthroplasty is the treatment of choice for gonarthrosis. The development of minimally invasive surgery (MIS) requires assessing results based on the classical approaches and this is the purpose of our study. METHODS: Randomized, prospective study comparing two groups; one underwent MIS (45 patients) and the second one a classical approach (51 patients); both groups were comparable. The following variables were assessed in the immediate postoperative period and at 4 and 8 years: blood loss, pain according to the VAS, flexion and extension and quality of life measured with the SF-36. RESULTS: In the immediate postoperative period we observed statistically significant differences (p < 0.05) in favor of the MIS approach in pain, hospital stay and blood loss. However, this was not observed at 4 and 8 years concerning pain, quality of life and range of motion. We observed an improvement in the functional scale and quality of life compared with the preoperative status, without any differences when both groups were compared. CONCLUSIONS: The MIS technique results in a better immediate postoperative period, but no differences were seen in the choice of the approach 4 and 8 years after surgery.

Novel mutations and defective protein kinase C activation of T-lymphocytes in ataxia telangiectasia.

Three ataxia telangiectasia (AT) patients have been characterized immunologically and molecularly. Patient 1 presents two nondescribed splicing mutations which affect exons 15 and 21 of the ATM gene. The maternal defect consists of a G > A transition in the first nucleotide of the intron 21 donor splicing site which results in a complete deletion of exon 21. The paternal mutation consists of an A > C transversion in the intron 14 acceptor splicing site which produces a partial skipping of exon 15. Two abnormal alternative transcripts were found, respectively, 17 and 41 nucleotides shorter. Patient 2 presents a homozygous genomic deletion of 28 nucleotides in the last exon of the gene. This deletion changes the normal reading frame after residue 3003 of the protein and introduces a premature stop codon at residue 3008 that could originate a truncated ATM protein. Patient 3, a compound heterozygote, presents a defect which consists of a G > A transition in the first nucleotide of intron 62 donor splicing site which results in a complete deletion of exon 62. The results obtained during a three year period in the proliferation assays show an impaired PMA (phorbol myristate acetate) activation in specific T lymphocyte activation pathways (CD69, CD26, CD28, CD3, PHA, PWM and Con A mediated) but not in others (CD2, ionomycin, and Ig surface receptor). The possible link among specific ATM mutations and abnormal immune responses is unknown.

[Obstructive uropathy secondary to retrovesical hydatid cyst]. / Uropatía obstructiva secundaria a quiste hidatídico retrovesical.

The genitourinary affectation by the hydatidosis, is the third in frequency after the hepatic and pulmonary affectation. The finding of an obstructive uropathy by a retrovesical hydatid cyst is uncommon, but it must be in account in high incidence zones. We present a case of this pathology, accomplishing a review of their etiopathogenic mechanisms, as well as of their arrival way, diagnostic approach and treatment.

[Spontaneous rupture of hydrocele: an unusual complication]. / Rotura espontánea de hidrocele: una complicación inusual.

Description of a case report of a male patient with a long standing pressure hydrocele that underwent spontaneous rupture while doing farm work although there was no previous trauma. The clinical signs were minimal scrotal discomfort, disappearance of turgescence and late ecchymosis and localized edema in penis and scrotum.