Resultados clínicos y radiográficos de la luxación acromio-clavicular grado III de Rockwood tratados mediante cirugía mínimamente invasiva / Clinical and radiological results for grade III Rockwood acromio-clavicular dilocations treated by minimally invasive surgery

Objetivo: Presentar los resultados a corto y medio plazo de un grupo de pacientes intervenidos mediante una nueva técnica quirúrgica mínimamente invasiva. Material y método: Estudio prospectivo recogiendo los resultados postoperatorios de 24 pacientes con luxación aguda acromio-clavicular grado III, intervenidos entre octubre de 2009 y enero de 2012, con un seguimiento medio de 18 meses. Se evalúan parámetros radiográficos y funcionales. Resultados: Encontramos resultados estadísticamente significativos con el hombro contralateral en la anchura de la articulación acromio-clavicular y el desplazamiento vertical de la clavícula. Se obtuvo una puntuación media «excelente» en la valoración funcional mediante el test de Imatani. Conclusión: La cirugía mínimamente invasiva como técnica aislada en este grupo de pacientes ha arrojado unos resultados satisfactorios desde el punto de vista radiológico y funcional (AU)

Objective: To show the short and medium term results of a series of patients who underwent surgery with a new minimally invasive surgical procedure. Material and methods: A prospective study carried out with 24 patients from October 2009 to January 2012, with a mean follow-up of 18 months. Radiographic and functional parameters were assessed. Results: Statistically significant radiographic post-surgical results were obtained when compared with the contralateral shoulder for the width of the acromio-clavicular joint and the vertical displacement of the clavicle. An «excellent» mean score was obtained in the functional assessment using the Imatani test. Conclusion: Minimally invasive surgery, as an isolated technique in this group of patients, has yielded satisfactory results from a radiological and functional point of view (AU)

[Minimally invasive surgical treatment of acromioclavicular dislocations]. / Tratamiento quirúrgico de las luxaciones acromioclaviculares mediante cirugía mínimamente invasiva.

INTRODUCTION: Treatment of grade III Rockwood acromioclavicular lesions continues to be controversial. A new surgical technique for reduction using minimally invasive surgery provides good results. The purpose of this paper is to present the short and medium-term results of a series of patients with grade III acromioclavicular dislocations who underwent surgery. METHODS: Prospective assessment of a series of 14 patients with acromioclavicular dislocation who underwent surgery from May 2009 to June 2010 consisting of open reduction and synthesis with coracoclavicular fixation with a double anchor. Radiologic, functional and personal satisfaction parameters were assessed. RESULTS: Statistically significant radiologic results were obtained, which reflect a correct reduction. An "excellent" mean score was obtained in the functional assessment using the Imatani test. Patients reported subjective satisfaction during the interviews at the outpatient visits. CONCLUSIONS: There are only a few papers reporting postoperative results with this surgical technique. Without a control group it is not possible to make a comparison with orthopedic treatment, so comparisons were made with published series using classical techniques. The surgical technique provides similar results; it is simple, inexpensive and has not shown to have any postoperative complications during a mean follow-up of 13.7 months. Surgical treatment of grade III acromioclavicular lesions using this surgical technique has provided appropriate results in this group of patients.

Diagnóstico y terapia del cáncer mediante magnetosomas / Cancer therapy and diagnosis by magnetosomes

Los magnetosomas (magnetoliposomas) han permitido en los últimos años un gran avance en la terapia del cáncer, gracias a su capacidad para transportar de forma eficiente diferentes agentes quimioterápicos hasta la masa tumoral. Estos sistemas no sólo se usan en el transporte de fármacos sino que también presentan importantes posibilidades en el diagnóstico de esta severa enfermedad, en terapia génica (transfección magnética o magnetofección) y en hipertermia. Sin embargo, su destino biológico, una vez que son administrados, se encuentra fuertemente condicionado por su geometría y propiedades fisicoquímicas. El presente trabajo se centra en la investigación de los principales aspectos relacionados con el diseño y utilización clínica de los magnetosomas. En concreto, estrategias de formulación, biocompatibilidad, toxicidad y situación actual a nivel preclínico(AU)

During the last years, magnetosomes (magnetoliposomes) have contributed to a significant improvement in cancer therapy, thanks to their capability to transport very efficiently the antitumor drug dose to the malignant cells. Interestingly, these systems also offer very promising possibilities in cancer diagnosis, gene therapy (magnetic transfection or magnetofection), and hyperthermia. However, the biological fate of magnetosomes, upon administration, is markedly conditioned by their geometry and physicochemical properties. This work is focussed on the investigation of the main aspects related to the engineering and clinical use of liposomes. Concretely, formulation strategies, biocompatibility, toxicity, and current state of the art at the preclinical level(AU)

Impacto del diagnóstico de desnutrición y el soporte nutricional en los grupos relacionados con el diagnóstico. ¿Merece la pena? / Impact of the diagnosis of malnutrition and nutritional support in diagnosis-related groups. Is it worth it?

La desnutrición hospitalaria constituye un grave problema por sus implicaciones en la morbilidad de los pacientes hospitalizados y el elevado consumo de recursos. Nuestra realidad social nos recuerda que éstos son limitados y que una buena gestión clínica debe conseguir un manejo nutricional eficiente. Los sistemas de información son una de las mejores herramientas de la gestión sanitaria y los clínicos somos los principales responsables de ellos. Términos como conjunto mínimo de base de datos, case mix, grupo relacionado con el diagnóstico y contabilidad analítica se hacen imprescindibles en nuestro vocabulario. La correcta codificación de la desnutrición hospitalaria, los procedimientos utilizados en su tratamiento y su comunicación en el informe de alta del paciente no sólo ayuda a mejorar los sistemas de información del centro hospitalario, sino que deja patente la repercusión que una actividad clínica como la nutrición puede tener en los resultados hospitalarios generales, medidos en efectividad, eficacia y calidad (AU)

Hospital malnutrition is a serious problem, increasing morbidity in hospitalized patients and leading to high resource consumption. Resources are limited and good clinical management should achieve efficient nutritional management. Information systems are among the best health management tools and the main persons responsible for these systems are clinicians. Terms such as the minimum data set, case mix, diagnosis-related group, and analytical accounting are essential in our vocabulary. Correct codification of hospital malnutrition, the procedures used in its treatment and its recording in the patient¿s discharge record not only help to improve the hospital¿s information systems but also make clear the effect that a clinical activity such as nutritional intervention can have on the hospital¿s general results, measured in terms of effectiveness, efficiency and quality (AU)

Clinical use of enteral nutrition.

Enteral Nutrition is among the most developed disciplines in modern Medicine. Technological advances, a better knowledge of malnutrition physiopathology and its involvement in the evolution of several clinical entities have made it possible to improve the nutritional attention paid to our patients. The use of EN has expanded as a first choice practice in patients with undernutrition or at risk of undernutrition that have a minimally functional intestine and are unable to cover their total calorie and protein requirements with natural or supplemented diets. Terms like "medical food" or "organ- or system-specific nutrition" or "pathology-specific nutrition" have revolutionized the EN field in the last 20 years with the emergence of specifically defined formulations. EN has been shown to be cost-effective in patients with malnutrition when the indication is established early. Home and Ambulatory Artificial Nutrition techniques are administratively regulated and, as they are widespread in our country, they allow some cost reductions in certain processes. Occasionally, the introduction, use or withdrawal of EN may constitute a situation of ethical dilema that should be avoided by making use of respect, companionship and shared information between the health team, patients and their substitutes.

Utilización clínica de la nutrición enteral / Clinical use of enteral nutrition

La Nutrición Enteral es una de las disciplinas más desarrolladas en la medicina moderna. Los avances tecnológicos, el mejor conocimiento de la fisiopatología de la desnutrición, y su participación en la evolución de diferentes entidades clínicas han hecho posible mejorar el cuidado nutricional de nuestros pacientes. La utilización de la NE se ha extendido como una práctica de primera elección en pacientes desnutridos o en riesgo de desnutrición que tienen un intestino minimamente funcionante y no son capaces de cubrir con la alimentación natural o suplementación, el total de sus requerimientos calórico-proteicos. Términos como "alimento-medicamento" o "nutrición órgano o sistema-específica o nutrición patología-específica" han revolucionado el campo de la NE en los últimos 20 años con la eclosión de fórmulas específicamente definidas .La NE ha demostrado ser coste-efectiva en los pacientes desnutridos cuando se establece la indicación con precocidad. La Nutrición Artificial Domiciliaria y Ambulatoria es una técnica regulada administrativamente muy extendida en nuestro país que permite reducir el coste de algunos procesos. En ocasiones la utilización o la retirada de la NE puede constituir una situación de conflicto ético que debe ser evitado desde el respeto, el acompañamiento y la información compartida entre el equipo sanitario, los pacientes y sus sustitutos (AU)

Enteral Nutrition is among the most developed disciplines in modern Medicine. Technological advances, a better knowledge of malnutrition physiopathology and its involvement in the evolution of several clinical entities have made it possible to improve the nutritional attention paid to our patients. The use of EN has expanded as a first choice practice in patients with undernutrition or at risk of undernutrition that have a minimally functional intestine and are unable to cover their total calorie and protein requirements with natural or supplemented diets. Terms like "medical food" or "organ- or system-specific nutrition" or "pathology-specific nutrition" have revolutionized the EN field in the last 20 years with the emergence of specifically defined formulations. EN has been shown to be cost-effective in patients with malnutrition when the indication is established early. Home and Ambulatory Artificial Nutrition techniques are administratively regulated and, as they are widespread in our country, they allow some cost reductions in certain processes. Occasionally, the introduction, use or withdrawal of EN may constitute a situation of ethical conflict that should be avoided by making use of respect, companionship and shared information between the health team, patients and their substitutes (AU)