Fijación artroscópica sin metal del bloque óseo en la inestabilidad anterior del hombro. Resultados funcionales y radiológicos a corto plazo / Arthroscopic bone block metal-free fixation for anterior shoulder instability. Short-term functional and radiological outcomes

Introducción: Existen múltiples técnicas para la reconstrucción del defecto óseo glenoideo con bloque óseo en la inestabilidad glenohumeral anterior que reducen el riesgo de recidiva tras cirugía de partes blandas, la mayoría utilizando fijación metálica. El objetivo de este estudio es evaluar la seguridad quirúrgica y los resultados funcionales y radiológicos a corto plazo de los pacientes sometidos a una técnica artroscópica con bloque óseo y fijación sin metal. Material y métodos: Estudio retrospectivo de pacientes con inestabilidad y defecto óseo glenoideo>15% con 12 meses de seguimiento mínimo. Se sometieron a estudio radiográfico y tomografía axial computarizada. Se cumplimentaron escalas funcionales de manera pre y postoperatoria: el Western Ontario Shoulder Instability Index y la escala de Rowe. Resultados: Se incluyeron un total de 21 pacientes con una edad media de 30,6 (DE 7,1). Todos mostraron consolidación radiográfica a los 3 meses. El 90,4% de los injertos presentó osteólisis en las áreas más periféricas y el 95,2% presentó consolidación en las áreas de contacto con la glenoides. La media del área de superficie de la glenoides pasó del 79,3% preoperatoria al 98,4% a los 12 meses. Los resultados funcionales medios resultaron estadísticamente significativos (p<0,001) tanto para el Western Ontario Shoulder Instability Index (de 35,6 a 86,9) como para la escala de Rowe (de 25,2 a 96,4). No se presentaron complicaciones graves. Conclusión: La técnica de bloque óseo y fijación sin metal es un método de fijación seguro, sin componentes metálicos. Consigue una consolidación completa del injerto con buenos resultados funcionales y radiográficos a los 12 meses.(AU)

Introduction: Anterior glenohumeral bone loss reconstruction reduces failure rates after soft tissue surgery in patients with large glenoid bone defects. Multiple bone block techniques have been described, most with metal hardware fixation. The objective of this study is to evaluate the safety, as well as the short-term functional and radiological results of an arthroscopic bone block metal-free fixation or bone block cerclage. Material and methods: Retrospective study of patients with glenohumeral instability and>15% glenoid bone loss operated during 2019 with follow-up of at least 12 months. Radiography and computerized tomography studies were performed. Functional outcomes were evaluated before and after surgery with the Western Ontario Shoulder Instability Index and Rowe score. Results: A total of 21 patients with a median age of 30.6 (SD 7.1) were included. All showed radiographic consolidation at 3 months follow-up. A percentage of 90.4 of bone grafts presented osteolysis at peripherical areas and 95.2% revealed consolidation in the areas with contact to the glenoid. The median glenoid estimated surface went from 79.3% before surgery to 98.4% at 12 months. Functional scores were statically significant (P<.001) for Western Ontario Shoulder Instability Index (35.6-86.9) and Rowe score (25.2 to 96.4). No serious complications were reported. Conclusion: The bone block cerclage is a safe, metal-free technique that achieves total consolidation of the bone graft and favorable functional and radiological outcomes at 12 months follow-up.(AU)

Arthroscopic bone block metal-free fixation for anterior shoulder instability. Short-term functional and radiological outcomes / Fijación artroscópica sin metal del bloque óseo en la inestabilidad anterior del hombro. Resultados funcionales y radiológicos a corto plazo

Introduction: Anterior glenohumeral bone loss reconstruction reduces failure rates after soft tissue surgery in patients with large glenoid bone defects. Multiple bone block techniques have been described, most with metal hardware fixation. The objective of this study is to evaluate the safety, as well as the short-term functional and radiological results of an arthroscopic bone block metal-free fixation or bone block cerclage. Material and methods: Retrospective study of patients with glenohumeral instability and>15% glenoid bone loss operated during 2019 with follow-up of at least 12 months. Radiography and computerized tomography studies were performed. Functional outcomes were evaluated before and after surgery with the Western Ontario Shoulder Instability Index and Rowe score. Results: A total of 21 patients with a median age of 30.6 (SD 7.1) were included. All showed radiographic consolidation at 3 months follow-up. A percentage of 90.4 of bone grafts presented osteolysis at peripherical areas and 95.2% revealed consolidation in the areas with contact to the glenoid. The median glenoid estimated surface went from 79.3% before surgery to 98.4% at 12 months. Functional scores were statically significant (P<.001) for Western Ontario Shoulder Instability Index (35.6-86.9) and Rowe score (25.2 to 96.4). No serious complications were reported. Conclusion: The bone block cerclage is a safe, metal-free technique that achieves total consolidation of the bone graft and favorable functional and radiological outcomes at 12 months follow-up.(AU)

Introducción: Existen múltiples técnicas para la reconstrucción del defecto óseo glenoideo con bloque óseo en la inestabilidad glenohumeral anterior que reducen el riesgo de recidiva tras cirugía de partes blandas, la mayoría utilizando fijación metálica. El objetivo de este estudio es evaluar la seguridad quirúrgica y los resultados funcionales y radiológicos a corto plazo de los pacientes sometidos a una técnica artroscópica con bloque óseo y fijación sin metal. Material y métodos: Estudio retrospectivo de pacientes con inestabilidad y defecto óseo glenoideo>15% con 12 meses de seguimiento mínimo. Se sometieron a estudio radiográfico y tomografía axial computarizada. Se cumplimentaron escalas funcionales de manera pre y postoperatoria: el Western Ontario Shoulder Instability Index y la escala de Rowe. Resultados: Se incluyeron un total de 21 pacientes con una edad media de 30,6 (DE 7,1). Todos mostraron consolidación radiográfica a los 3 meses. El 90,4% de los injertos presentó osteólisis en las áreas más periféricas y el 95,2% presentó consolidación en las áreas de contacto con la glenoides. La media del área de superficie de la glenoides pasó del 79,3% preoperatoria al 98,4% a los 12 meses. Los resultados funcionales medios resultaron estadísticamente significativos (p<0,001) tanto para el Western Ontario Shoulder Instability Index (de 35,6 a 86,9) como para la escala de Rowe (de 25,2 a 96,4). No se presentaron complicaciones graves. Conclusión: La técnica de bloque óseo y fijación sin metal es un método de fijación seguro, sin componentes metálicos. Consigue una consolidación completa del injerto con buenos resultados funcionales y radiográficos a los 12 meses.(AU)

Arthroscopic bone block metal-free fixation for anterior shoulder instability. Short-term functional and radiological outcomes. / Fijación artroscópica sin metal del bloque óseo en la inestabilidad anterior del hombro. Resultados funcionales y radiológicos a corto plazo.

INTRODUCTION: Anterior glenohumeral bone loss reconstruction reduces failure rates after soft tissue surgery in patients with large glenoid bone defects. Multiple bone block techniques have been described, most with metal hardware fixation. The objective of this study is to evaluate the safety, as well as the short-term functional and radiological results of an arthroscopic bone block metal-free fixation or bone block cerclage. MATERIAL AND METHODS: Retrospective study of patients with glenohumeral instability and>15% glenoid bone loss operated during 2019 with follow-up of at least 12 months. Radiography and computerized tomography studies were performed. Functional outcomes were evaluated before and after surgery with the Western Ontario Shoulder Instability Index and Rowe score. RESULTS: A total of 21 patients with a median age of 30.6 (SD 7.1) were included. All showed radiographic consolidation at 3 months follow-up. A percentage of 90.4 of bone grafts presented osteolysis at peripherical areas and 95.2% revealed consolidation in the areas with contact to the glenoid. The median glenoid estimated surface went from 79.3% before surgery to 98.4% at 12 months. Functional scores were statically significant (P<.001) for Western Ontario Shoulder Instability Index (35.6-86.9) and Rowe score (25.2 to 96.4). No serious complications were reported. CONCLUSION: The bone block cerclage is a safe, metal-free technique that achieves total consolidation of the bone graft and favorable functional and radiological outcomes at 12 months follow-up.

Treatment of oesophageal cancer with preoperative chemoradiotherapy may increase operative mortality.

AIMS: This phase II multicentric study evaluates a modified preoperative chemoradiotherapy schedule. METHODS: Patients <75 years with potentially resectable neoplasm were eligible. Treatment included an initial course of CDDP 100 mg/m2 (Day 1) and 5-FU CI 5000 mg/m2 (Days 1-5) followed by 45 Gy (Days 28-63) and 5-FU CI 5000 mg/m2 (Days 28-33), CDDP 75 mg/m2 (Day 56) and 5-FU CI 3750 mg/m2 (Days 56-61). Regional lymph nodes were irradiated. RESULTS: Nineteen patients were studied. Oesophagectomy was performed in 17. Clear margins were achieved in 16 of these. Eight patients showed a pathologic complete response (pCR). One patient died of infection during the preoperative treatment and four died due to acute surgical complications. The study was closed prematurely because of excessive mortality. Median follow-up was 19 months. Local and regional relapse occurred in one and three patients, respectively. Median time and actuarial 3-year of overall survival and progression free rates were 18.6 months and 28%, and 12.7 months and 10.4%, respectively. CONCLUSIONS: This schedule showed a high pCR, resectability and local control rate. Treatment-related mortality limits its clinical applicability, but further investigations are warranted.

Tratamiento quirúrgico de la acalasia: estudio comparativo entre la cirugía abierta y la laparoscópica / Surgical treatment of achalasia: comparison between open and laparoscopic surgery

Introducción. La miotomía quirúrgica es una eficaz alternativa al tratamiento médico o endoscópico de la acalasia, especialmente en pacientes jóvenes o ante la recidiva tras la dilatación. Las características técnicas de la miotomía extramucosa tipo Heller (intervención funcional, sobre una zona anatómica fácilmente accesible por laparoscopia) ha modificado el abordaje quirúrgico, proponiéndose como una buena indicación para el abordaje laparoscópico. Sin embargo, no existen estudios comparativos sobre la eficacia entre ambos tipos de abordaje. Objetivo. Comparar los resultados inmediatos y a medio plazo tras el tratamiento quirúrgico de la acalasia, bien mediante abordaje abierto o laparoscópico. Material y métodos. Se han revisado los resultados postoperatorios inmediatos y a medio plazo de una serie de 31 pacientes intervenidos entre 1999 y 2000 con el diagnóstico clínico, endoscópico y manométrico de acalasia. Se evaluó la sintomatología pre y poscirugía mediante una puntuación (DeMeester modificado: disfagia, pirosis, dolor y regurgitación [puntuación 0-3]), así como la tasa de conversión, la morbimortalidad inmediata y a medio plazo, la estancia y el grado de satisfacción de la intervención (puntuación 0-4).Resultados. Trece pacientes fueron intervenidos de forma abierta (grupo I) y 18 por laparoscopia (grupo II). En todos ellos se efectúo una miotomía tipo Heller, asociado a una hemiplicatura anterior tipo Dor en 29 o posterior tipo Toupet en 2. Un paciente se convirtió a cirugía abierta y en otro fue imposible crear el neumoperitoneo por adherencias por cirugía previa. Un paciente intervenido previamente por vía abierta fue reoperado por laparoscopia por recidiva de la acalasia.No existieron diferencias en la duración de la intervención (132 ñ 29 frente a 140 ñ 25 min; p: NS) ni en la morbilidad, aunque se observó una significativa reducción de la estancia postoperatoria (7,7 ñ 2 frente a 3,7 ñ 1 días; p < 0,0001) y de la reanudación de la actividad normal (45 ñ 20 frente a 20 ñ 13 días; p < 0,002). Ambas técnicas fueron efectivas de forma similar en la reducción de la sintomatología de la acalasia, aunque el abordaje laparoscópico se acompañó de una mayor satisfacción estética (2,2 ñ 1,1 frente a 3,4 ñ 0,7; < 0,005).Conclusión. El abordaje laparoscópico mantiene las características del tratamiento quirúrgico convencional añadiendo las ventajas de una técnica menos agresiva (AU)

Evidencia de translocación bacteriana en un modelo experimental de politraumatismo / Fevidence of bacterial translocation in an experimental model of multiple trauma

Objetivo. Analizar la relación entre el politraumatismo y la translocación bacteriana en un modelo experimental. Material y métodos. Se ha utilizado 132 ratones Balb/c de 8 a 12 semanas de vida, siendo traumatizados mediante el Aparato Generador de Politraumatismo, con una mortalidad prevista del 20 por ciento. Se ha determinado la translocación bacteriana a las 0, 4, 8, 12, 24, 48 y 72 h tras la agresión. Se ha analizado mediante test exacto de Fisher. Resultados. La translocación global en el grupo control fue del 14,3 por ciento; la translocación en el grupo politraumatizado fue del 70 por ciento (p < 0,00001). Con un intervalo de confianza del 95 por ciento, el número de colonias por gramo de ganglio linfático fue de 1 a 3.6 en el grupo control y entre 20,7 y 127,7 en el grupo traumatizado. Las diferencias entre el grupo control y el traumatizado a los intervalos de tiempo descritos son significativas a las 8 h (p = 0,01), 12 h (p = 0,041), 24 h (p = 0,041) y a las 72 h (p = 0,041), según test exacto de Fisher. Conclusión. Existe una translocación bacteriana precoz tras un politraumatismo experimental. Creemos que esta translocación puede actuar como un importante activador del fallo multiorgánico tras el politraumatismo (AU)

Determinación intraoperatoria de la parathormona intacta en el hiperparatiroidismo primario. su utilidad cara a un abordaje quirúrgico selectivo / Intraoperative determination of intact parathyroid hormone in primary hyperparathyroidism. Its utility in a selective surgical approach

Se presenta una serie de 29 pacientes con hiperparatiroidismo primario (HPTP) por adenoma único, tratados quirúrgicamente de forma consecutiva. Siempre se realizó localización preoperatoria del tejido paratiroideo patológico mediante gammagrafía con 99Tc-sestamibi (g-MIBI), lo cual permitió el abordaje quirúrgico directo al adenoma. En ningún caso se practicó una disección cervical bilateral y en un paciente se accedió directamente al mediastino anterior. En todos los casos se determinó la parathormona intacta preoperatoriamente al inicio de la operación, en el momento de hallar el adenoma y 5 min después de su extirpación. Los resultados obtenidos indican un descenso de más del 50 por ciento de las concentraciones de parathormona entre el valor pre y postextirpación del adenoma en todos los pacientes operados, lo que se siguió de normalización de las concentraciones de calcio en todos los casos. El tiempo de anestesia media para cada paciente en esta serie ha sido de 97 min, con un tiempo quirúrgico medio de 81 min. El ahorro de tiempo quirúrgico obtenido nos ha permitido intervenir a 3 pacientes con HPTP por adenoma, en una sola sesión quirúrgica. La combinación de la localización preoperatoria del tejido paratiroideo hiperfuncionante mediante la g-MIBI y la determinación preoperatoria de la parathormona permiten disminuir el tiempo quirúrgico en el tratamiento del HPTP, manteniendo o incluso mejorando la eficacia terapéutica en términos de curación y de morbimortalidad (AU)

Efficacy of PdB in preventing intraoperative risk of infectious diseases.

The objectives of this study were to (1) determine the number of punctures surgeons and assistants suffer during operations involving a laparotomy during the intraabdominal and closure phases; and (2) determine if the number of puncture injuries during wound closure can be reduced using a new surgical instrument (PdB) that protects the surgeon's hands and the patient's viscera against needlesticks. For the first objective, all laparotomies performed during 1 month (n = 52) were controlled, collecting the gloves used and determining the number of perforations. For the second objective, a randomized prospective controlled study, involving two series of 100 medial laparotomies, was carried out. The incidence of perforations was 29% during the intraabdominal phase and 16% during the wound closure phase. The glove perforation rate while closing medial laparotomies was 31.5% if the PdB was not used and 3% if the PdB was used (p < 0.0001). The glove perforation rate during laparotomy is significant, but with the use of the PdB this incidence can be significantly reduced.

Prepyloric antrectomy, truncal vagotomy, and front pylorotomy for the treatment of duodenal ulcer.

We have performed a suprapyloric antrectomy with anterior pylorotomy and truncal vagotomy in 106 patients with chronic duodenal ulcer between 1975 and 1990. Follow-up was carried out in 94 patients, during a mean time of 6 years. We have had no postoperative mortality and no long-term recurrence. The percentage of Visick I patients is similar to that after truncal vagotomy and antrectomy. We, therefore, believe that this procedure is safe and can be performed when an antrectomy is mandatory to avoid the operative morbidity and mortality of classic antrectomy.

Effects of pentagastrin and of the somatostatin analog (SMS 201-995) on growth of CT26 in vivo adenocarcinoma of the colon.

This study was done to investigate the effects of pentagastrin and of somatostatin analog (SMS 201-995) on growth of CT26 adenocarcinoma of the colon implanted in mice. Eighty Balb C mice were inoculated subcutaneously with 100,000 cells. Four groups of 20 mice each were treated with 0.1 milliliters of saline solution every eight hours; 250 micrograms per kilogram of pentagastrin every eight hours; 100 micrograms per kilogram of SMS 201-995 every 12 hours; 250 micrograms per kilogram of pentagastrin every eight hours, plus 100 micrograms per kilogram of SMS 201-995 every 12 hours. Tumoral weight, volume and deoxyribonucleic acid (DNA) content and mean survival rates were determined for each group. Control mice had tumors weighing 1,619 +/- 179 milligrams, of 1.47 +/- 0.2 milliliters to the third power and with 12.9 +/- 1.1 milligram of DNA, at 30 days after inoculation. The mean survival rate was 42.5 days. Pentagastrin administration increased the three parameters of tumoral growth by 40 percent and reduced survival time to 29.6 days (p < 0.01), while SMS 201-995 inhibited growth by 40 percent and prolonged survival time to 48.5 days (p < 0.01). Simultaneous administration of both peptides had no effects. These data suggest that pentagastrin has a trophic effect and SMS 201-995 an inhibitory effect on CT26 adenocarcinoma in mice.

Experimental study of the efficacy of the endoluminal prosthesis in colonic anastomoses.

Colorectal surgery is still associated with a significant morbidity and mortality rate, mostly related to suture failure. We have carried out a randomized experimental study in dogs on colonic anastomoses exposed to a number of anastomotic risk situations. A total of 42 dogs was used. They were divided into three study groups (control, occlusion and diverticulitis), with and without an endoluminal tube. The aim was to assess the efficacy of the endoluminal prosthesis using clinical and radiological assessment of anastomotic healing. Pre- and post-anastomotic intraluminal pressures were also measured to determine whether these might be a factor in suture failure. There were significant differences in suture failure in animals in which the endoluminal tube was used. Mean duration of placement was 10.5 days. In the colon healing study, no significant differences were found between the groups in the pathological examination or in the assay of hydroxyproline content. The presence of the endoluminal tube may increase the maximum pressure applied on the colon wall. No significant differences were found in the intracolonic pressure differentials between the different groups or after the inclusion of the endoluminal prosthesis. The results obtained establish the efficacy of the endoluminal prosthesis in protecting the colonic anastomosis, and could be a valuable technique in colonic anastomoses with a high risk of suture dehiscence.

[Effect of somatostatin analog SMS 201-995 on the growth in vitro and in vivo of colonic adenocarcinoma CT 26 in mice]. / Effet de l'analogue de la somatostatine SMS 201-995 sur la croissance in vitro et in vivo de l'adénocarcinome du côlon de souris CT 26.

The purpose of this study was to assess the effects of a somatostatin analog (SMS 201-995), in vitro and in vivo on mice colonic adenocarcinoma cells CT 26. To perform the in vitro study 50,000 neoplasic cells were grown in RPMI 1640 culture medium with different concentrations of SMS and DNA synthesis determination was made. For the in vivo study, 100,000 cells in balb C mice were implanted. Several doses of SMS (200 micrograms/kg/12 h and 100 micrograms/kg/12 h) were given. The weight, size and DNA content of the tumors was determined. No in vitro effect of SMS was demonstrated. Nevertheless, an in vivo inhibition was found for all the parameters studied. A confirmation of these results in other cell lines could point towards possible hormonal manipulation in the treatment of colonic cancer.

[Gastric villous adenoma. 2 new cases]. / Adénome villeux gastrique. Deux nouvelles observations.

Villous adenomas are extremely rare in the stomach. This type of lesion is characterized by its high capacity of malignant degeneration, as well as by its association with other tumors of the gastrointestinal tract. In this regard, we present two cases of villous adenoma of the stomach observed in our hospital, as well as a review of the characteristics of these tumors and of the treatment required.

[Primary abscess of the psoas. 2 new cases]. / Abcès primaire du psoas. Deux nouvelles observations.

Since the antibiotherapy for tuberculosis, psoas abscess is an infrequent disease. The psoas abscess can be divided in primary and secondary, being the primary the most infrequent. We present two other cases of primary psoas abscess treated in our hospital. We review also the symptoms, the diagnosis and the therapy of this disease.

Perineal necrotizing infection.

Perineal necrotizing infection is a severe disease that ever since its first description by Fournier in 1883 has been referred to by many names prompted by its protean nature in terms of location and suspected etiology. We treated nine patients with PNI. The infection began as a perineal abscess of long evolution (7 days +/- 2 SD) in eight patients. The ninth patient had had an inguinal herniorrhaphy 3 days before. The cultures of the exudates and tissues always yielded aerobic and anaerobic mixed flora of colorectal origin, except in one instance, in which S. aureus and hemolytic streptococcus A were identified. The treatment was medical support and wide surgical debridement of the infected tissues. In six patients a left transverse colostomy was performed. Only one patient died, of septic shock. On the basis of the results in our series and on a review of the literature, it is our opinion that PNI is a mixed bacterial infection that despite its origin, clinical appearance and microbiologic findings, is highly uniform in terms of clinical course and treatment. Therapy is based on radical surgical debridement with excision of all necrotic tissue. The current plethora of terms seems impractical and confusing. We propose a rather comprehensive term perineal necrotizing infection for the sake of clarity.

The influence of age on early surgical treatment of acute cholecystitis.

This study was undertaken to assess the influence of age on the early surgical treatment of acute cholecystitis. One hundred consecutive patients who had early operations for acute cholecystitis were divided into two groups according to age. Group 1 consisted of 41 patients who were younger than 60 years of age, and group 2 was made up of 59 patients who were more than 60 years of age. Shock, leukocytosis, hyperglycemia and uremia were more common in those patients in group 2 (p less than 0.05). The over-all diagnostic effectiveness was 94 per cent. The mortality rate was 4.1 per cent (n = 4). There were no significant differences in morbidity and mortality between both groups. In conclusion, advanced age is not a contraindication for early surgical treatment of acute cholecystitis.