[Medium-term results of autologous osteochondral transplantation in patellar cartilage injuries]. / Resultados a mediano plazo del trasplante osteocondral autólogo en las lesiones del cartílago patelar.

INTRODUCTION: Patellar cartilage is subject to high mechanical requests and is a very frequent location of injuries. There is no consensus on their treatment. Autologous osteochondral transplantation may be an alternative to small to medium-sized condral defects with varying results in the literature. Our goal is to analyze the medium-term functional outcomes of patients with grade III-IV patellar cartilage injuries from the International Cartilage Repair Society (ICRS) treated at our facility. MATERIAL AND METHODS: Retrospective study in patients under 55 years of age, with a symptomatic patellar condral defect, diameter less than 2 cm, grade III-IV of ICRS treated by autologous osteochondral transplant between 2012 and 2018. The following variables are evaluated: age, sex, injury size, affected facet, number of transplanted cylinders, pre- and postoperative Kujala score, and pre- and postoperative analog visual pain scale (EVA). RESULTS: Eleven patients integrated into our study. The median age was 47 years. The median diameter of the condral defect 1.3 cm. Median follow-up 3.9 years (1.84-5.58 years). The median of the preoperative Kujala questionnaire is 33 and is 89 at the end of the follow-up (p = 0.003). The median of the preoperative EVA score is 9 and 2 at the end of the follow-up (p = 0.003). CONCLUSION: Autologous osteochondral transplantation generated a significant subjective improvement in function and pain.

INTRODUCCIÓN: El cartílago rotuliano está sometido a altas demandas mecánicas y es una localización muy frecuente de lesiones. No existe consenso en cuanto a su tratamiento. El trasplante osteocondral autólogo puede ser una alternativa para los defectos condrales de pequeño o mediano tamaño con resultados variables en la bibliografía. Nuestro objetivo es analizar los resultados funcionales a mediano plazo de los pacientes con lesiones del cartílago patelar grado III-IV de la International Cartilage Repair Society (ICRS) tratados en nuestro centro. MATERIAL Y MÉTODOS: Estudio retrospectivo con pacientes menores de 55 años, con un defecto condral patelar sintomático, diámetro menor de 2 cm, grado III-IV de la ICRS tratados mediante trasplante osteocondral autólogo entre los años 2012 y 2018. Se evalúan las siguientes variables: edad, sexo, tamaño de la lesión, faceta afectada, número de cilindros trasplantados, escala de Kujala pre y postoperatoria y escala visual analógica del dolor (EVA) pre y postoperatoria. RESULTADOS: Integramos en nuestro estudio 11 pacientes. La mediana de edad fue de 47 años. La mediana del diámetro del defecto condral 1.3 cm. La mediana de seguimiento 3.9 años (1.84-5.58 años). La mediana del cuestionario Kujala preoperatoria es 33 y asciende a 89 al final del seguimiento (p = 0.003). La mediana de la puntuación EVA preoperatoria es nueve y dos al final del seguimiento (p = 0.003). CONCLUSIÓN: El trasplante osteocondral autólogo generó una importante mejora subjetiva de la función y del dolor.

Resultados a mediano plazo del trasplante osteocondral autólogo en las lesiones del cartílago patelar / Medium-term results of autologous osteochondral transplantation in patellar cartilage injuries

Resumen: Introducción: El cartílago rotuliano está sometido a altas demandas mecánicas y es una localización muy frecuente de lesiones. No existe consenso en cuanto a su tratamiento. El trasplante osteocondral autólogo puede ser una alternativa para los defectos condrales de pequeño o mediano tamaño con resultados variables en la bibliografía. Nuestro objetivo es analizar los resultados funcionales a mediano plazo de los pacientes con lesiones del cartílago patelar grado III-IV de la International Cartilage Repair Society (ICRS) tratados en nuestro centro. Material y métodos: Estudio retrospectivo con pacientes menores de 55 años, con un defecto condral patelar sintomático, diámetro menor de 2 cm, grado III-IV de la ICRS tratados mediante trasplante osteocondral autólogo entre los años 2012 y 2018. Se evalúan las siguientes variables: edad, sexo, tamaño de la lesión, faceta afectada, número de cilindros trasplantados, escala de Kujala pre y postoperatoria y escala visual analógica del dolor (EVA) pre y postoperatoria. Resultados: Integramos en nuestro estudio 11 pacientes. La mediana de edad fue de 47 años. La mediana del diámetro del defecto condral 1.3 cm. La mediana de seguimiento 3.9 años (1.84-5.58 años). La mediana del cuestionario Kujala preoperatoria es 33 y asciende a 89 al final del seguimiento (p = 0.003). La mediana de la puntuación EVA preoperatoria es nueve y dos al final del seguimiento (p = 0.003). Conclusión: El trasplante osteocondral autólogo generó una importante mejora subjetiva de la función y del dolor.

Abstract: Introduction: Patellar cartilage is subject to high mechanical requests and is a very frequent location of injuries. There is no consensus on their treatment. Autologous osteochondral transplantation may be an alternative to small to medium-sized condral defects with varying results in the literature. Our goal is to analyze the medium-term functional outcomes of patients with grade III-IV patellar cartilage injuries from the International Cartilage Repair Society (ICRS) treated at our facility. Material and methods: Retrospective study in patients under 55 years of age, with a symptomatic patellar condral defect, diameter less than 2 cm, grade III-IV of ICRS treated by autologous osteochondral transplant between 2012 and 2018. The following variables are evaluated: age, sex, injury size, affected facet, number of transplanted cylinders, pre- and postoperative Kujala score, and pre- and postoperative analog visual pain scale (EVA). Results: Eleven patients integrated into our study. The median age was 47 years. The median diameter of the condral defect 1.3 cm. Median follow-up 3.9 years (1.84-5.58 years). The median of the preoperative Kujala questionnaire is 33 and is 89 at the end of the follow-up (p = 0.003). The median of the preoperative EVA score is 9 and 2 at the end of the follow-up (p = 0.003). Conclusion: Autologous osteochondral transplantation generated a significant subjective improvement in function and pain.

[Granulocytic sarcoma (chloroma) of small bowel: an unfrequent cause of intestinal obstruction]. / Sarcoma granulocítico (cloroma) del intestino delgado: una causa infrecuente de suboclusión intestinal.

Granulocytic sarcoma or chloroma is a malignant extra medullar tumor, based on inmature myeloid cells. It usually emerges as a secondary manifestation of acute myeloid leukemia. Chloromas are scarcely diagnosed in patiens without hematological malignances, either peripheral or medullar, and are thus frequently misdiagnosed for other tumors. In these patients, further development of acute leukemia seems to stand as a rule. Small bowel location of these tumors has hardly been reported. A case of granulocytic sarcoma in a non-leukemic at time of diagnosis patient is reported therein. Medical literature is briefly reviewed.

[Treatment with endoscopic endoprosthesis in choledocholithiasis]. / Tratamiento con endoprótesis endoscópica de la litiasis de la vía biliar principal.

The results of the placement of endoscopic endoprosthesis in 51 patients with choledocholithiasis from October 1991 to December 1995 are reviewed. In 13 cases the endoprosthesis was provisionally placed. Surgical or endoscopic treatment was electively completed in all the cases. Thirty-eight patients received the endoprosthesis on a permanent basis. During the follow up (mean 15.2 months) extraction was completed and the prosthesis removed in three cases, one by emigration. Six patients presented recurrent biliary obstruction and underwent surgery or replacement of another prosthesis. In the latter cases, another two underwent surgery due to repeated obstructions. The remaining patients remained asymptomatic until the end of follow up or until death (8 cases) due to unrelated causes. Only three mild episodes of cholangitis were observed as complications related to prosthesis placement. The authors conclude that endoscopic endoprosthesis is an effective provisional treatment to solve acute situations and is a permanent alternative for unextracted choledocholithiasis following sphincterotomy in patients who cannot undergo other techniques and who have a short life expectancy.